stop it James.
you can't say Gerrymandering to get seats was "cheating" then say the ppl got what they want.
the majority of ppl want the Dems in....
but I'll let you guys keep playing these games to feel like you are getting what you want.
Peace.
Senate Healthcare Bill Thread - UPDATE: 9/26 Graham-Cassidy Bill is Offically DEAD! Free Daps/Reps!
- Thread starter Black Panther
- Start date
you can't say Gerrymandering to get seats was "cheating" then say the ppl got what they want.
the majority of ppl want the Dems in....
but I'll let you guys keep playing these games to feel like you are getting what you want.
Peace.
my bad, I may have mistakenly quoted the wrong alias.........James?
my point still stands.
my bad, I may have mistakenly quoted the wrong alias......
my point still stands.
What point?
What exactly are you expecting Dems to do to "get their s#it together"?
Heard mcconnel hint of going back to funding risk corridors that Marco Rubio bytch ass silently pushed to stop doing in order to break ACA.
That is a good move. But pre existing, Essential Health Protections, and Medicaid expansion still need to stay
That is a good move. But pre existing, Essential Health Protections, and Medicaid expansion still need to stay
they need to focus on building their party back.
they are weak, fractured and completely defeated.
I mean, I completely agree with that, don't get me wrong...
But in regards to the healthcare bill--you know, the topic of the thread--what more are you expecting them to do? Their voting in Congress has been fairly solid where it counts.
I think they need to focus on more long term goals(as in long term health care plan). They also need to come out as a party to one solution and then all advocate for that.
they should ALL be supporting the same thing single payer/UHC. have everyone on the same page so they can be pushing that out to their local supporters.
they need to (kind of) accept that what the republicans are doing is going to happen, so what is their next step?
Bleed The Freak
Superstar
Like we ain't even know this shyt....nikkas was ready to be opposing it for another 4 years and had no idea on how to replace it.
:Snapmjlol:...James?
BaileyPark31
Love, Peace, Health, and Wealth
Bleed The Freak
Superstar
Mitch folding like a cheap turtle
Not sure why people are surprised
.....Obama took the conservative plan and implemented it. They're fukked.
To my colleagues in Congress: I have MS. Don’t make my insurance unaffordable.
By Donna F. Edwards July 7 at 7:54 PM
Donna F. Edwards, a Democrat from Maryland, was a member of the U.S. House of Representatives from 2008 to 2017. She is currently a senior fellow at the Brennan Center for Justice.
Dear colleagues in Congress,
All my life, I’ve mostly been active and healthy (save for the occasional sports injury). While in Congress, I rode my bicycle regularly to clear my head. I played on our congressional women’s softball team and on our football team. Each January, I jumped in the ice-cold Potomac River to call attention to climate change. In 2015, I ran a handful of 5K and 10K races. I thought I was in great health. I was not.
After my loss in the April 2016 Senate primary, I wasn’t just disappointed, I was exhausted. During the recess that May, I decided to spend a week relaxing in the Outer Banks of North Carolina. The beach was beautiful, but it did not cure my exhaustion. One day, on an early-morning run, my legs felt like spaghetti. Assuming I had a pinched nerve or stretched tendon, I decided to see my doctor on my return. Still, I went to work and kept up my schedule; after all, we had votes in the House on Monday.
The doctor found nothing out of the ordinary, though I was still tired. Because all the tests were normal, I decided to go for a 10-mile bike ride the following weekend, thinking the exercise would make me feel better. Trying to avoid some runners and children on the bike path, I upended on my bike and flipped into the brush. I was scratched and bruised, and my ankle was pretty badly sprained, but I survived. I was fortunate, though, because the accident prompted some additional delving into my symptoms.
As a member of Congress, I had pretty decent health care. After the passage of the Affordable Care Act — Obamacare — we were required to leave the Federal Employees Health Benefit Plan and go into the D.C. Health Exchange. I chose a gold-tier Blue Cross-Blue Shield plan with a $400-a-month premium (plus deductibles and copays) that enabled me to see all the specialists I needed. I finally got my diagnosis after nearly two months of tests and analysis. It came June 22, 2016 — the day of the House sit-in in support of gun-control legislation.
That morning, I went to the House floor to join the sit-in. But hours into our protest, the House attending physician called me to his office to tell me I had multiple sclerosis, an autoimmune disease that attacks the central nervous system. At first, I couldn’t process what he was saying. I thought I had a pinched nerve; I didn’t know anything about MS. Devastated, I blinked away my tears and went back to the chamber, where I stayed for the remainder of the evening.
I’ve learned a lot about MS since that day. It’s likely that I have had the disease for the past decade, undiagnosed. I’ve learned that more than 400,000 Americans have MS, that it’s not fatal and that it affects different people in different ways. Once I received my diagnosis, I was determined to find a great neurologist, which I did. I read up on the latest treatments and research studies. I wanted to take control of my treatment. I also knew that I was fortunate to be diagnosed relatively early and to have great health-care coverage, which enabled me to take care of my medical needs without worrying.
A year later, I am no longer in Congress, and my future health care is uncertain. I am not employed, and I pay $800 a month for my COBRA coverage, which ends in June 2018. I’m not sure what I’ll do then. My medication, which has thankfully halted the progression of my MS, costs roughly $73,000 a year. I’ve had three sets of MRI scans and will require one each year to check my progress; that’s roughly $7,000 each. I admit, I do not completely understand all of the bills. It’s very confusing.
Unlike some of you, I am not wealthy. When I was younger, I had the experience of not having health insurance, and I almost lost my home after landing in the emergency room. One reason I ran for Congress was to help make sure no one would have to go through that, and I was proud to be one of the presiding officers when the Affordable Care Act passed. I did not think the law was perfect; I believed it was a good start. I never thought I could have to go back to a time when I would not have health-care coverage.
And yet, with the health-care bills you are now advancing, here I am. If we return to a time when people with preexisting conditions can be charged more than healthy people, it will surely result in my never being able to afford insurance again. If we return to a time of lifetime caps, I will no longer have health insurance.
In January, I set out in a 25-foot motor home and logged 12,000 miles through 27 states over three months. I talked to a lot of people in Alabama and Mississippi, Arizona and Texas, Kansas and Indiana. We talked about our dreams and aspirations — about jobs, education and health care, about children and grandchildren. I heard people’s stories about losing jobs, working in retirement, not having health care and family members dying. They told me about their cancer, diabetes and heart disease. I told them about my MS — all strangers.
Most of the people I met in RV parks across the country were Republicans. They had no idea that I once was privileged to serve in Congress as a Democrat. And this story, my diagnosis of MS, is not about me; it’s about them — millions of Americans who are trusting you to help, not harm. Like them, I’m scared. Like them, I’m scared of being sick and not being able to afford to go to my doctor or purchase the medicine that is saving my life; like them, I’m worried that one day I will have to sell my home or spend my retirement savings on my health care. I don’t know what I will do next or whether I will run for public office again. I do know that my MS will not stop me. But not having health-care coverage because of my MS could stop me permanently.
I’m doing fine. I’ve adjusted to my new body and different capacity. But I pray that as you finish doing whatever it is that you are doing with health care, you remember that I was one of your colleagues, that I worked hard and that I don’t have a preexisting condition because I was a bad person who led an unhealthy life. I have a preexisting condition simply because I do; and I, like millions of other Americans in the same situation, deserve quality, affordable health care.
Warmest regards,
Donna
Insurers in the Affordable Care Act marketplaces earned an average of nearly $300 per member in the first quarter of 2017, more than double what they earned in a similar period in the marketplaces’ previous three years, according to new analysis by the Kaiser Family Foundation.
That figure puts insurers on track to make a profit in the marketplaces after years of losses, according to Cynthia Cox, a researcher at the Kaiser Family Foundation who worked on the analysis.
Total profits in 2017 will probably be lower than the first-quarter numbers suggest. First-quarter earnings are typically higher than subsequent quarters, since many people are still paying off their deductibles. Additionally, the gross earnings measure does not include administrative costs, which further eat away at profit margins. Still, the bountiful first quarter suggests the marketplaces are becoming a more profitable environment for the private companies selling insurance plans on the public exchanges.
That figure puts insurers on track to make a profit in the marketplaces after years of losses, according to Cynthia Cox, a researcher at the Kaiser Family Foundation who worked on the analysis.
Total profits in 2017 will probably be lower than the first-quarter numbers suggest. First-quarter earnings are typically higher than subsequent quarters, since many people are still paying off their deductibles. Additionally, the gross earnings measure does not include administrative costs, which further eat away at profit margins. Still, the bountiful first quarter suggests the marketplaces are becoming a more profitable environment for the private companies selling insurance plans on the public exchanges.
Obamacare marketplaces just had their most profitable first quarter ever
That figure puts insurers on track to make a profit in the marketplaces after years of losses, according to Cynthia Cox, a researcher at the Kaiser Family Foundation who worked on the analysis.
Total profits in 2017 will probably be lower than the first-quarter numbers suggest. First-quarter earnings are typically higher than subsequent quarters, since many people are still paying off their deductibles. Additionally, the gross earnings measure does not include administrative costs, which further eat away at profit margins. Still, the bountiful first quarter suggests the marketplaces are becoming a more profitable environment for the private companies selling insurance plans on the public exchanges.
That figure puts insurers on track to make a profit in the marketplaces after years of losses, according to Cynthia Cox, a researcher at the Kaiser Family Foundation who worked on the analysis.
Total profits in 2017 will probably be lower than the first-quarter numbers suggest. First-quarter earnings are typically higher than subsequent quarters, since many people are still paying off their deductibles. Additionally, the gross earnings measure does not include administrative costs, which further eat away at profit margins. Still, the bountiful first quarter suggests the marketplaces are becoming a more profitable environment for the private companies selling insurance plans on the public exchanges.
Obamacare marketplaces just had their most profitable first quarter ever
Individual Insurance Market Performance in Early 2017
Concerns about the stability of the individual insurance market under the Affordable Care Act (ACA) have been raised in the past year following exits of several insurers from the exchange markets, and again with renewed intensity in recent months as debate over repeal of the health law has picked up. Our earlier analysis of premium and claims data from 2011 – 2016 found that insurer financial performance indeed worsened in 2014 and 2015 with the opening of the exchange markets, but showed signs of improving in 2016. A similar analysis by S&P looking at a subset of Blue Cross Blue Shield plans found a comparable pattern.
In this brief, we look at recently-released first quarter financial data from 2017 to examine whether recent premium increases were sufficient to bring insurer performance back to pre-ACA levels. These new data offer more evidence that the individual market has been stabilizing and insurers are regaining profitability.
We use financial data reported by insurance companies to the National Association of Insurance Commissioners and compiled by Mark Farrah Associates to look at the average premiums, claims, medical loss ratios, gross margins, and enrollee utilization from first quarter 2011 through first quarter 2017 in the individual insurance market.1 These figures include coverage purchased through the ACA’s exchange marketplaces and ACA-compliant plans purchased directly from insurers outside the marketplaces (which are part of the same risk pool), as well as individual plans originally purchased before the ACA went into effect.
Medical Loss Ratios
As we found in our previous analysis, insurer financial performance as measured by loss ratios (the share of health premiums paid out as claims) worsened in the earliest years of the Affordable Care Act, but began in improve more recently. This is to be expected, as the market had just undergone significant regulatory changes in 2014 and insurers had very little information to work with in setting their premiums, even going into the second year of the exchange markets.
Loss ratios began to decline in 2016, suggesting improved financial performance. In 2017, following relatively large premium increases, individual market insurers saw significant improvement in loss ratios, averaging 75% in the first quarter. First quarter loss ratios tend to follow the same pattern as annual loss ratios, but in recent years have been 10 to 15 percentage points lower than annual loss ratios.2 Though 2017 annual loss ratios are therefore likely to end up higher than 75%, this is nevertheless a sign that individual market insurers on average are on a path toward regaining profitability in 2017.
Figure 1: Average First Quarter Individual Market Medical Loss Ratios, 2011 – 2017
Margins
Another way to look at individual market financial performance is to examine average gross margins per member per month, or the average amount by which premium income exceeds claims costs per enrollee in a given month. Gross margins are an indicator of performance, but positive margins do not necessarily translate into profitability since they do not account for administrative expenses. As with medical loss ratios, first quarter margins tend to follow a similar pattern to annual margins, but generally look more favorable as enrollees are still paying toward their deductibles in the early part of the year, lowering claims costs for insurers.
Figure 2: Average First Quarter Individual Market Gross Margins Per Member Per Month, 2011 – 2017
Looking at gross margins, we see a similar pattern as we did looking at loss ratios, where insurer financial performance improved dramatically in the first quarter of 2017 (increasing to $99 per enrollee, from a recent first quarter low of $36 in 2015). Again, first quarter data tend to indicate the general direction of the annual trend, and while annual 2017 margins are unlikely to end as high as they are in the first quarter, these data suggest that insurers in this market are on track to reach pre-ACA individual market performance levels.
Underlying Trends
Driving recent improvements in individual market insurer financial performance are the premium increases in 2017 and simultaneous slow growth in claims for medical expenses. On average, premiums per enrollee grew 20% from first quarter 2016 to first quarter 2017, while per person claims grew only 5%.
Figure 3: Average First Quarter Individual Market Monthly Premiums and Claims Per Person, 2011 – 2017
One concern about rising premiums in the individual market was whether healthy enrollees would drop out of the market in large numbers rather than pay higher rates. While the vast majority of exchange enrollees are subsidized and sheltered from paying premium increases, those enrolling off-exchange would have to pay the full increase. As average claims costs grew very slowly in the first quarter of 2017, it does not appear that the enrollees today are noticeably sicker than it was last year.
On average, the number of days individual market enrollees spent in a hospital in first quarter of 2017 was similar to first quarter inpatient days in the previous two years. (The first quarter of 2014 is not necessarily representative of the full year because open enrollment was longer that year and a number of exchange enrollees did not begin their coverage until mid-year 2014).
Figure 4: Average First Quarter Individual Market Monthly Hospital Patient Days Per 1,000 Enrollees, 2011 – 2017
Taken together, these data on claims and utilization suggest that the individual market risk pool is relatively stable, though sicker on average than the pre-ACA market, which is to be expected since people with pre-existing conditions have guaranteed access to coverage under the ACA.
Discussion
Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse. First quarter premium and claims data from 2017 support the notion that 2017 premium increases were necessary as a one-time market correction to adjust for a sicker-than-expected risk pool. Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017. Some insurers have exited the market in recent years, but others have been successful and expanded their footprints, as would be expected in a competitive marketplace.
While the market on average is stabilizing, there remain some areas of the country that are more fragile. In addition, policy uncertainty has the potential to destabilize the individual market generally. Mixed signals from the Administration and Congress as to whether cost sharing subsidy payments will continue or whether the individual mandate will be enforced have led to some insurers to leave the market or request larger premium increases than they would otherwise. A few parts of the country may now be at risk of having no insurer on exchange, though new entrants or expanding insurers have moved in to cover most areas previously thought to be at risk of being bare.
Methods
We analyzed insurer-reported financial data from Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the National Association of Insurance Commissioners. The dataset analyzed in this report does not include NAIC plans licensed as life insurance or California HMOs regulated by California’s Department of Managed Health Care; in total, the plans in this dataset represent at least 75% of the individual market. All figures in this data note are for the individual health insurance market as a whole, which includes major medical insurance plans sold both on and off exchange. We excluded some UnitedHealth plans that filed negative enrollment in 2017 and corrected for a Centene plan that did not file “member months” in first quarter 2016 but did file first quarter membership.
To calculate the weighted average loss ratio across the individual market, we divided the market-wide sum of total incurred claims by the sum of all health premiums earned. Medical loss ratios in this analysis are simple loss ratios and do not adjust for quality improvement expenses, taxes, or risk program payments. Gross margins were calculated by subtracting the sum of total incurred claims from the sum of health premiums earned and dividing by the total number of member months (average monthly enrollment) in the individual insurance market.
Individual Insurance Market Performance in Early 2017
Concerns about the stability of the individual insurance market under the Affordable Care Act (ACA) have been raised in the past year following exits of several insurers from the exchange markets, and again with renewed intensity in recent months as debate over repeal of the health law has picked up. Our earlier analysis of premium and claims data from 2011 – 2016 found that insurer financial performance indeed worsened in 2014 and 2015 with the opening of the exchange markets, but showed signs of improving in 2016. A similar analysis by S&P looking at a subset of Blue Cross Blue Shield plans found a comparable pattern.
In this brief, we look at recently-released first quarter financial data from 2017 to examine whether recent premium increases were sufficient to bring insurer performance back to pre-ACA levels. These new data offer more evidence that the individual market has been stabilizing and insurers are regaining profitability.
We use financial data reported by insurance companies to the National Association of Insurance Commissioners and compiled by Mark Farrah Associates to look at the average premiums, claims, medical loss ratios, gross margins, and enrollee utilization from first quarter 2011 through first quarter 2017 in the individual insurance market.1 These figures include coverage purchased through the ACA’s exchange marketplaces and ACA-compliant plans purchased directly from insurers outside the marketplaces (which are part of the same risk pool), as well as individual plans originally purchased before the ACA went into effect.
Medical Loss Ratios
As we found in our previous analysis, insurer financial performance as measured by loss ratios (the share of health premiums paid out as claims) worsened in the earliest years of the Affordable Care Act, but began in improve more recently. This is to be expected, as the market had just undergone significant regulatory changes in 2014 and insurers had very little information to work with in setting their premiums, even going into the second year of the exchange markets.
Loss ratios began to decline in 2016, suggesting improved financial performance. In 2017, following relatively large premium increases, individual market insurers saw significant improvement in loss ratios, averaging 75% in the first quarter. First quarter loss ratios tend to follow the same pattern as annual loss ratios, but in recent years have been 10 to 15 percentage points lower than annual loss ratios.2 Though 2017 annual loss ratios are therefore likely to end up higher than 75%, this is nevertheless a sign that individual market insurers on average are on a path toward regaining profitability in 2017.
Figure 1: Average First Quarter Individual Market Medical Loss Ratios, 2011 – 2017
Margins
Another way to look at individual market financial performance is to examine average gross margins per member per month, or the average amount by which premium income exceeds claims costs per enrollee in a given month. Gross margins are an indicator of performance, but positive margins do not necessarily translate into profitability since they do not account for administrative expenses. As with medical loss ratios, first quarter margins tend to follow a similar pattern to annual margins, but generally look more favorable as enrollees are still paying toward their deductibles in the early part of the year, lowering claims costs for insurers.
Figure 2: Average First Quarter Individual Market Gross Margins Per Member Per Month, 2011 – 2017
Looking at gross margins, we see a similar pattern as we did looking at loss ratios, where insurer financial performance improved dramatically in the first quarter of 2017 (increasing to $99 per enrollee, from a recent first quarter low of $36 in 2015). Again, first quarter data tend to indicate the general direction of the annual trend, and while annual 2017 margins are unlikely to end as high as they are in the first quarter, these data suggest that insurers in this market are on track to reach pre-ACA individual market performance levels.
Underlying Trends
Driving recent improvements in individual market insurer financial performance are the premium increases in 2017 and simultaneous slow growth in claims for medical expenses. On average, premiums per enrollee grew 20% from first quarter 2016 to first quarter 2017, while per person claims grew only 5%.
Figure 3: Average First Quarter Individual Market Monthly Premiums and Claims Per Person, 2011 – 2017
One concern about rising premiums in the individual market was whether healthy enrollees would drop out of the market in large numbers rather than pay higher rates. While the vast majority of exchange enrollees are subsidized and sheltered from paying premium increases, those enrolling off-exchange would have to pay the full increase. As average claims costs grew very slowly in the first quarter of 2017, it does not appear that the enrollees today are noticeably sicker than it was last year.
On average, the number of days individual market enrollees spent in a hospital in first quarter of 2017 was similar to first quarter inpatient days in the previous two years. (The first quarter of 2014 is not necessarily representative of the full year because open enrollment was longer that year and a number of exchange enrollees did not begin their coverage until mid-year 2014).
Figure 4: Average First Quarter Individual Market Monthly Hospital Patient Days Per 1,000 Enrollees, 2011 – 2017
Taken together, these data on claims and utilization suggest that the individual market risk pool is relatively stable, though sicker on average than the pre-ACA market, which is to be expected since people with pre-existing conditions have guaranteed access to coverage under the ACA.
Discussion
Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse. First quarter premium and claims data from 2017 support the notion that 2017 premium increases were necessary as a one-time market correction to adjust for a sicker-than-expected risk pool. Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017. Some insurers have exited the market in recent years, but others have been successful and expanded their footprints, as would be expected in a competitive marketplace.
While the market on average is stabilizing, there remain some areas of the country that are more fragile. In addition, policy uncertainty has the potential to destabilize the individual market generally. Mixed signals from the Administration and Congress as to whether cost sharing subsidy payments will continue or whether the individual mandate will be enforced have led to some insurers to leave the market or request larger premium increases than they would otherwise. A few parts of the country may now be at risk of having no insurer on exchange, though new entrants or expanding insurers have moved in to cover most areas previously thought to be at risk of being bare.
Methods
We analyzed insurer-reported financial data from Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the National Association of Insurance Commissioners. The dataset analyzed in this report does not include NAIC plans licensed as life insurance or California HMOs regulated by California’s Department of Managed Health Care; in total, the plans in this dataset represent at least 75% of the individual market. All figures in this data note are for the individual health insurance market as a whole, which includes major medical insurance plans sold both on and off exchange. We excluded some UnitedHealth plans that filed negative enrollment in 2017 and corrected for a Centene plan that did not file “member months” in first quarter 2016 but did file first quarter membership.
To calculate the weighted average loss ratio across the individual market, we divided the market-wide sum of total incurred claims by the sum of all health premiums earned. Medical loss ratios in this analysis are simple loss ratios and do not adjust for quality improvement expenses, taxes, or risk program payments. Gross margins were calculated by subtracting the sum of total incurred claims from the sum of health premiums earned and dividing by the total number of member months (average monthly enrollment) in the individual insurance market.
Individual Insurance Market Performance in Early 2017