Some of the issue with the ACA falls on CMS not the issuers. Early years of the ACA, CMS failed to provide the subsidies issuers were promised. Disparity between claims vs premiums were greater than what CMS reimbursed. This put a lot of the small state plans out of business eliminating competition. - ThreadSky

janep1907.bsky.social • 62 days ago

Some of the issue with the ACA falls on CMS not the issuers. Early years of the ACA, CMS failed to provide the subsidies issuers were promised. Disparity between claims vs premiums were greater than what CMS reimbursed. This put a lot of the small state plans out of business eliminating competition.

Comments

janep1907.bsky.social•62 days ago

This left the largest most established issuers like UHC and the Blues to run it. Those were the companies that got us to institute the ACA and extend benefits to millions. Of course, those bigger issuers to advantage of the market and got more of the subsidies.

conservativedem5.bsky.social•62 days ago

The subsidies were given to "patients" who could not afford the insurance. There were hundreds of Insurance companies across the US that offered discounted premiums to ACA applicants. The government administers the program not the insurance companies.

janep1907.bsky.social•62 days ago

Partially correct. Patients were given subsidies on premiums, but there is a component for premiums setting by issuers too. Year one, small startup ACAs didn’t have claim experience to properly set rates. They were promised support by CMS to reimburse issuers that fell short at the end of the year.

janep1907.bsky.social•62 days ago

Those startup ACAs didn’t survive for long and competition for established payers in the market survived. One startup survived that’s CommonGround in WI.

conservativedem5.bsky.social•62 days ago

ACA(Affordable Care Act) is only a place to shop for insurance while getting a group rate instead of higher individual rates as agreed upon in the ACA bill passed. Ins companies chose to participate. You seem to be demonizing it and painting it as something it is not.

janep1907.bsky.social•62 days ago

That’s my point. Those ACA plans are administered by the big payers that were already big players prior to ACA. I have a Medicaid ACA plan administered by BCBS. Now, providers accept BCBS private plans, but not ACA plans. It’s different payment models.

conservativedem5.bsky.social•62 days ago

The insurance companies only increased their profit margin by gaining thousands of newly covered customers/patients and by denial of care in some situations. The program is solid and it works. The end that needs working on is the price of providing medical care and prices of meds.

janep1907.bsky.social•62 days ago

I agree. The plans like the Blues had established provider networks with deep discounts. The startup ACAs had trouble negotiating provider networks because they had a smaller membership base.

conservativedem5.bsky.social•62 days ago

The premiums for the patients are very high there.Nobody was getting deep discounts, & the ins companies were making big money because people flocked to the ACA website to buy coverage that was only somewhat cheaper & thanks to Obama & the Affordable Care Act there was no more pre-existing clauses.

Comments

Posting Rules

Reply