@Avram in MD
Reb Avram-
Thanks for taking the time to read and comprehend my rant- If I would have known that I had an audience I would have posted it earlier.
It doesn’t favor large companies at the expense of smaller companies per se- it encourages the greedy companies to continue their behavior at the expense of the companies that are trying to do what’s morally correct.
Another issue I saw in the ACA that I haven’t seen mentioned too much is the CSR debacle.
CSR (Cost Share Reduction) would pay part of the premium for people who earned a living but not enough to pay their full premium (it was a function based on their income and the poverty level). So, what people would do is sign up for coverage, have the ACA pay for a percentage of their premiums (say 50% or so) and never pay a premium on their own. So, CMS would pay for 50% of their premiums which would get them through half the year, they’d cram in as many appointments and fill as many prescriptions as they could (and trust me, it’s not cheap for people who haven’t taken care of their health in years). When those premiums ran out the policies lapsed and then CMS would claim that those policies never should have been active as the insured never made a single payment and demanded back the premiums that they fronted. So, these companies had to return millions of Dollars in premiums to CMS, paid out millions of Dollars in claims to providers for people who were never even members (technically they could have demanded the funds back from the providers as they shouldn’t have been made in the first place- but good luck with that) and had to absorb the loss themselves. (Keep in mind that with 80% to 85% of premiums taken in being paid out to legitimate claims or the policy holder is issued a rebate, 20+% is going to Risk Adjustment payments- that’s already over 100% of all the premiums collected for the year- and that doesn’t include payments for real estate, employee compensation, millions in claims paid for people who aren’t members plus all the regulatory filings…)
(To be fully transparent though- some larger companies may have anticipated this and built a feature into the process that ensured the insured was making the required premium payments before paying claims.)
I respectfully disagree with you on your staircase example, humans are humans and humans have human nature which tries to get away with as much as possible- until stopped. So, until people are gently reminded not to stop and schmooze on the staircase it’s going to continue. Would you say that highways should have speed bumps every 100 feet to make sure no one speeds? Or would you say that there should be speed traps to gently remind people not to speed?
From your screen name (and the public-school incomes you provided for your state) it seems like you’re in Maryland. There was a story in the news a year or two ago where a Baltimore mother was shocked to hear that her son wasn’t going to graduate as his GPA was less than .15 or something (yet he still ranked around the 50th percentile in the grade). So while $58,000 may not sound like a high salary- they should only be paid the rate of a babysitter (if they insured that the kids were there and stayed out of trouble under their watch- which I don’t recall was the case).
In short- if they get paid $58,000 and have nothing to show for it- it’s a huge salary.
““THIS MAY NOT SOUND LIKE A BIG DEAL TO YOU”
Actually, it does.”
I actually didn’t realize the future implications it could have until later on- when I switched doctors, I didn’t have my record transferred.