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 Post subject: This will never happen at the fed level
PostPosted: 05 Apr 2010, 09:29 
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Short-term customers boosting health costs
Thousands of consumers are gaming Massachusetts’ 2006 health insurance law by buying insurance when they need to cover pricey medical care, such as fertility treatments and knee surgery, and then swiftly dropping coverage, a practice that insurance executives say is driving up costs for other people and small businesses.

In 2009 alone, 936 people signed up for coverage with Blue Cross and Blue Shield of Massachusetts for three months or less and ran up claims of more than $1,000 per month while in the plan. Their medical spending while insured was more than four times the average for consumers who buy coverage on their own and retain it in a normal fashion, according to data the state’s largest private insurer provided the Globe.

The typical monthly premium for these short-term members was $400, but their average claims exceeded $2,200 per month. The previous year, the company’s data show it had even more high-spending, short-term members. Over those two years, the figures suggest the price tag ran into the millions.

Other insurers could not produce such detailed information for short-term customers but said they have witnessed a similar pattern. And, they said, the phenomenon is likely to be repeated on a grander scale when the new national health care law begins requiring most people to have insurance in 2014, unless federal regulators craft regulations to avoid the pitfall.

“These consumers come in and get their service, and then they leave because current regulations allow them to do it,’’ said Todd Bailey, vice president of underwriting at Fallon Community Health Plan, the state’s fourth-largest insurer.

The problem is, it is less expensive for consumers — especially young and healthy people — to pay the monthly penalty of as much as $93 imposed under the state law for not having insurance, than to buy the coverage year-round. This is also the case under the federal health care overhaul legislation signed by the president, insurers say.

Governor Deval Patrick recently filed legislation that state regulators believe will help fix the problem, by restricting insurance enrollment to twice a year for people who buy on the open market and allowing waiting periods before coverage kicks in. But insurers say stronger action is needed. Consumer advocates caution, however, that many people who sign up for short-term coverage may merely be between jobs.

When state lawmakers overhauled the health care system in 2006, they combined into a single insurance pool consumers who buy coverage on their own with those who get insurance through their jobs at small businesses that employ 50 or fewer people. The aim was to make insurance more affordable for the individuals buying coverage on their own, who tended to be sicker and therefore had been paying very high premiums. And the hope was that having small businesses and their workers absorb some of the cost of covering this group would raise their premiums only modestly.

But insurers now say that it didn’t work as planned, and that consumers who work for small businesses have ended up shouldering a much larger burden. Part of the reason, they say, are the short-termers.

Insurers want rules that would restrict enrollment for individuals buying on the open market to a designated month each year, unless they have had a major life change, such as a divorce — similar to the practice used by most employers. They say this would curb the practice of buying coverage just before an expensive elective procedure that can be planned ahead, such as knee or hip replacements or fertility treatments. Imposing waiting periods for coverage on this group, which was effectively disallowed by the 2006 law, would also deter this practice, insurers say.

“I raised these concerns with the Patrick administration, but I didn’t make much progress. And I even sent them my data,’’ said Charles D. Baker, a Republican candidate for governor and former chief executive of the state’s second largest insurer, Harvard Pilgrim Health Care. He blogged about these issues last June, when he was still at the company.

Baker’s data showed that about 40 percent of the consumers who purchased insurance from Harvard Pilgrim on the open market kept the insurance fewer than five months, and they incurred, on average, $2,400 a month in medical expenses — about six times higher than the monthly spending of other consumers.

“They said to me, ‘This is interesting, we’ll get back to you,’ ’’ Baker said in an interview last week referring to conversations he had with state regulators.

Patrick administration officials said they are taking the short-term coverage issue seriously, noting that they requested data on the problem from all insurers last year and expect to release their findings this month.

“This is an issue we have been concerned about, and carriers have not been shy about bringing this to our attention,’’ said Barbara Anthony, undersecretary of the Office of Consumer Affairs and Business Regulation, which oversees insurance.

“Even though our report isn’t concluded, the proposal by the governor to limit open enrollment to two times a year seems like an obvious way to get a handle on the problem,’’ Anthony said.

In February, Patrick filed legislation that would give his administration sweeping authority to cap rates charged by insurers and medical providers. The bill included a provision that would restrict enrollment for consumers who are buying insurance on their own to two annual periods — in June and December — but includes exceptions for people facing life changes, such as loss of workplace insurance or the birth of a child.

It would also bring back the rule allowing insurers to exclude coverage for preexisting conditions for six months, or impose a similar waiting period under certain conditions for people buying coverage on their own. However, the new national legislation prohibits insurers from denying coverage based on preexisting conditions as of 2014, and will allow only a three-month waiting period.

Blue Cross-Blue Shield executives said the governor’s proposal is a step in the right direction, but the insurer favors a plan that would allow only one annual enrollment period, and that would also bar consumers from buying on the open market if they have access to coverage through work or a spouse. Larry Croes, a Blue Cross-Blue Shield vice president for small group sales, said this would stop consumers from buying insurance for procedures not covered by their employer — typically fertility treatments — then dropping the plan after treatment.

Senate President Therese Murray said in an e-mailed statement that the issue needs to be tackled.

“I support the governor’s proposal . . . and could see us going even further, with reasonable exceptions, to a single annual enrollment for individuals,’’ Murray said. “The Senate continues to work on payment reform legislation that targets this issue and others to reduce waste and inefficiency in the delivery and administration of health care.’’

Consumer advocates said they aren’t convinced that a lot of people are gaming the system, and they said that many of the individuals buying on the open market are likely those who are between jobs, new to the state, or have some other legitimate reason to buy coverage for a short period. They said that before the state makes it harder for consumers to buy coverage, there should be reliable data showing the extent of the problem.

“We would need to understand the severity of the issues,’’ said Brian Rosman, research director at Health Care for All, a Boston-based consumer group, “and whether the governor’s proposed changes would address the problem.’’


TLDR: Young people find it cheaper to pay the penalty for not carrying insurance than to carry it. Then suddenly they buy it right before a procedure, get their procedure, and then drop it when the hospital bill is paid.

Mass state law requires insurance companies to give anyone insurance at any time and pay for "pre-existing conditions" regardless of the fact that they are obviously playing the system. Governor proposes bill allowing insurance companies to not pay for "pre-existing conditions" and only allow people to sign up for health insurance during 2 windows per year.

This will never happen at the federal level, right?.....right?

So the insurance companies say the way to fix this is to have a limit on benefits for some length of time ... hmmm that sounds a whole lot like "pre-existing condition" doesn't it? So what is the solution? Maybe we should have just left the health care system alone.

Face it, O'Negro and Peloser have just made it mandatory for everyone to either pay the insurance companies or pay the government, and the welfare losers will still milk the system and honest people will get screwed even harder than they are now.

Hope and Change indeed.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 05 Apr 2010, 09:58 
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I love that you post articles obviously written by the insurance lobby. Christ man can you not see the propaganda or is it just what you want to see?

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 Post subject: Re: This will never happen at the fed level
PostPosted: 05 Apr 2010, 10:32 
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Dude that was the Boston Globe. Yankee Liberal newspaper.

http://www.boston.com/news/local/massachusetts/articles/2010/04/04/short_term_customers_boosting_health_costs/?page=1

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 Post subject: Re: This will never happen at the fed level
PostPosted: 05 Apr 2010, 10:38 
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mzziqztixl wrote:
I love that you post articles obviously written by the insurance lobby. Christ man can you not see the propaganda or is it just what you want to see?

Can you not see the abuse? Do you assume that all people are honest? Are you really THAT naive?

I know several people who waited for their unemployment benefits to end before really looking for a job, I know LOTS of people that will tell you that they don't want to get a job because they make more money on welfare/food stamps/HUDD. They can make a better living doing nothing than getting a real job.

Really, humans are as worthless as you LET them be. If you give them everything they will work for nothing. This is not a racist or cultural thing, it is species wide. Everyone will try to "Get one over on the man" this is basic human nature, there are almost no exceptions to this rule.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 05 Apr 2010, 11:22 
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Fuck that noise. I've never taken one penny from the federal government whether it be aid, student loans, unemployment, or whatever. (I think I have probably smoked weed that was bought with unemployment money but that would be the only scenario I can think of). And it's not like I'm a fucking saint in any way - but I have more faith in humanity - the common man is not a lazy piece of shit who will do the least to get by.

And I do see the abuse. Guess what I see it tempered with? The fact that my state BLOWS EVERYONE ELSE TO FUCKING KANSAS IN EVERY SINGLE HEALTH CARE CATEGORY.

936 scammers averaged $2200 for 3 months (or less but I'll use 3 just to pad your numbers.) A little over $6.1 million less than $90k in penalties they had to pay so let's call it a $6 million dollar problem.

Versus

The 2 million people who now have health insurance in Massachusetts alone who didn't before. It's actually higher I think than that.


My numbers > your numbers. $6 million vs 2 million human lives that have been enriched who will each have to pay 3 more dollars a year to cover the abuse.

Stop it.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 05 Apr 2010, 12:16 
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One of my favorite quotes: Any man who is younger than 30 who is conservative doesn't have a heart. Any man who is over 30 who is liberal doesn't have a brain.

You are young and idealistic. I applaud you for your faith in humanity, When I was your age I felt the same way. I believed that all men were created equal, I believed that the world could be saved from itself. I believed that helping those less "fortunate" than myself was altruistic. At some point in my life I looked around and realized that all men are NOT created equal, that saving the world was an exercise in futility, and that those less "fortunate" than myself were really just less motivated.

When you get old enough to see the world as it really is, as opposed to the world as you think it should be, then you will understand. Come talk to me in 10 years about your ideals.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 05 Apr 2010, 19:15 
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5 years actually. Then I'll be 30.

On the subject of Churchill's quote there: What are you if you believe in either when you are 30 exactly? That always bothered me about his quote. Are you just assumed to be retarded when you hit 30 and you get a mulligan at 31?

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 Post subject: Re: This will never happen at the fed level
PostPosted: 06 Apr 2010, 07:45 
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Obviously it is not exactly 30, but I can tell you that at somewhere around 30 I ...changed... my views became more conservative, things I had always taken for granted I started questioning, I found myself actually glad to see a cop roll by my house because it meant that my possessions were safer rather than I became paranoid that he was after me, little things. I am not sure why, biological, physiological, maturity, hormonal? I don't know, but it does happen.

Don't get me wrong, I still hate all authority, I still think the government is corrupt and self serving (regardless of political party) and I still want to "stick it to the man", but I no longer feel as if it is my personal responsibility to save the world, in fact I would be rather happy if the rest of the world would just bugger off and leave me and mine alone.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 06 Apr 2010, 08:58 
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dageaux wrote:
Don't get me wrong, I still hate all authority, I still think the government is corrupt and self serving (regardless of political party) and I still want to "stick it to the man", but I no longer feel as if it is my personal responsibility to save the world, in fact I would be rather happy if the rest of the world would just bugger off and leave me and mine alone.


have you considered that its this mass-apathy that allows corruption that everyone acknowledges to persist, and is in fact the cause of lack of change (for better or worse) in the status-quo?

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 Post subject: Re: This will never happen at the fed level
PostPosted: 06 Apr 2010, 09:32 
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j'adore roro

lol

we can still save it.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 06 Apr 2010, 10:03 
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rogallia wrote:
have you considered that its this mass-apathy that allows corruption that everyone acknowledges to persist, and is in fact the cause of lack of change (for better or worse) in the status-quo?

Have you considered that banging your head against a wall at some point loses it's attraction? The wall is harder than your head, and you are only hurting yourself. The wall is not going to change because you bang your head against it. The only way to effect a wall is with dynamite, and personally I am not an explosive expert.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 06 Apr 2010, 19:45 
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dageaux wrote:
...but I can tell you that at somewhere around 30 I ...changed... my views became more conservative, things I had always taken for granted I started questioning...

Unfortunately, sharing this wisdom is just pissing up a rope. It's painful to watch, but a neccessary rite of passage that speaks volumes about their intellect. Read as a compliment, not a slam.
Old hippies don't drive unreliable, spray painted, fun VW camper vans...they drive safe, boring, conservative Volvos.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 06 Apr 2010, 21:36 
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So break the mold.

I own a business and by rights should be a Republican so that I keep my taxes low and my profits high...but fuck that noise. They consistently showed me that morality was a guise to hide the actual message : fear-mongering.

The Democrats are just as bad but at least the message is right. No one left behind, not in this country. It's just not necessary.

Equality and compassion for all. If we all did it, there would be no problems.

Left foot first, now the right....

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 Post subject: Re: This will never happen at the fed level
PostPosted: 08 Apr 2010, 15:06 
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mzziqztixl wrote:
No one left behind, not in this country. It's just not necessary
I counter with survival of the fittest, leaving the stragglers behind = evolution. No one left behind --> stagnation of the species

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 Post subject: Re: This will never happen at the fed level
PostPosted: 08 Apr 2010, 16:35 
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You may actually have me there.

Shit, foiled by own hatred for pathetic scamming pieces of garbage...

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 Post subject: Re: This will never happen at the fed level
PostPosted: 08 Apr 2010, 17:05 
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i counter with pre-war japan lets-kill-any-slightly-different-babies and post-war japan lets-ostracize-anyone-whos-different.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 08 Apr 2010, 17:25 
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Well yea ok, but everyone knows Japanese people are fucked up.

I am talking social responsibility not genocide.

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 Post subject: Re: This will never happen at the fed level
PostPosted: 08 Apr 2010, 19:15 
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What you mean these wonderful chaps

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