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. - ThreadSky

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.

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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

Note that not all BCBS plans on the Affordable Care Act website are Medicaid plans. They offer high premium plans with high deductibles to those who think they are getting a "reliable" company.

janep1907.bsky.social•62 days ago

Correct. There is still privatized plans with their own PPO/HMO network negotiations. There are many facets to the system we have now. And I agree that the privatization component needs to go and single payer would be better. Greed exists with both issuers and providers.

conservativedem5.bsky.social•62 days ago

Indeed

conservativedem5.bsky.social•62 days ago

Yes, they are different for Medicaid plans. That is a whole other ball game.

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.

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