Obamacare

Yet Another Health Insurer Scales Back Its Participation in Obamacare

BCBS Tennessee pulls out of the state's largest markets.

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Whitehouse.gov

At the end of last month, Tennessee Insurance Commissioner Julie McPeak—the state's top insurance regulator—warned that the state's Obamacare exchange was "very near collapse."

At the beginning of the summer, two of the insurance carriers operating in the state exchanges, Cigna and Humana, had filed for rate increases of 23 and 29 percent, respectively. But after those requests were put in, both companies returned to the state and asked to re-file for even higher rates—with Cigna requesting a 46 percent bump, and Humana requesting a 44 percent increase. Those revised requests were eventually granted, with McPeak saying that she feared that the two insurers would pull out of the exchange system set up under the health law.

At the time, the state had only one insurer operating throughout the state: BlueCross BlueShield of Tennessee (BCBST), which had requested and won a 62 percent rate hike.

But even that, apparently, was not enough: This week, Blue Cross Blue Shield of Tennessee announced that it will exit the state's largest markets: For 2017, the insurer will no longer offer exchange coverage for Nashville, Knoxville, and Memphis.

The move means that about 130,000 people in the state will lose their current insurance plans. Although every county will still have at least one insurance option through the exchange system, the move means that instead of 57 counties with just one exchange-based insurer, 72 counties of the state's 95 counties will be served by just one carrier, the Tennessean reports.

BCBST isn't the first insurer to back away from the health law's exchanges. BlueCross BlueShield insurers have scaled back participation in Minnesota, Arizona, and Nebraska. Aetna said last month that it would cease selling on the exchanges in 11 of the 15 states in which it had been operating. UnitedHealth also announced this year that it would be pulling out of exchanges in 26 states, including Tennessee, where it had sold in every county.

In every case, the reason continues to be the same: The insurers are losing money on the exchange business. BCBST, for example, said it was facing a projected $500 million loss. That's just not sustainable.

Obamacare was supposed to create a marketplace where insurers would want to compete for business. But in a lot of states and counties, it turns out there won't be any competition, and lots of insurers won't be doing any business at all.

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  1. The move means that about 130,000 people in the state will lose their current insurance plans

    Must mean they don’t like their plans.

    1. They were too stupid to understand they were happy with shitty plans.

    2. Medicaid is waiting with open arms.

  2. *whistles a tune about Cassandra Maximus, whilst polishing the Iron Laws*

      1. Pics or GTFO

      2. Nope. I predicted this stuff with remarkable accuracy (and still maintain it is all by design), back when joke-handles were much, much easier, and “Cassandra Maximus” was the handle I used while authoring said prediction. In fact, it was in response to J sub D, who oft asked, “By what metric will Obamacare be measured as a success?” and he had a list of metrics to which I responded to each and every one. It may have been Memory Holed.

        It was a few months before he died, and I still can’t find that post.

        1. Doc, I hope you are a better surgeon than a googler.

          Here it is.

          By what metric will the Obama adminstration judge the success or failure of Obamacare?

          a) Insurance costs?
          b) Number of people on the health insurance dole?
          c) Medical costs?
          d) Deficit reduction?
          e) Life expectancy?
          f) Who cares? We passed it.

          And

          g) 100% ownership of the medical field

          a) I predict something along the lines of a per capita rating very similar to how many people have car insurance. Enforced by the IRS and HHS. Any physician that accepts CMS will be (is) a de facto agent of the state, as will be any hospital. Freestanding surgicenters, private urgent cares, and clinics, AFAIK are exempt (for now, as these are not required to be accessible 24 hrs or maintain an ER).

          b) Also tracked by the aformentioned agencies and states. Bolstering state Medicaid payments from the Fed (Unspent stimulus anyone? Remember that?) will aid in “enrollment” and enforcement as well and will be made easier as all medical records will go electronic eventually. Again, when this system implodes, entitlement will be even worse now and the public will be screaming bloody murder for true single payer. Investment in torch and pitchfork companies would be wise. Dmitiri Molotov will demand residuals from the grave. Metric will be scored against a).

          1. c) Nanny statism as its finest. There is truth to the maxim “you get out of your body what you put into it.” This is where state Depts. of Health, state medical boards and medical schools will be apparatchiks to this. “Encouragement” for healthier lifestyles as individuals and states have not implemented this at a fast enough rate to decrease demand related to this cause of disease. Expect to hate the phrase, “In the interest public health…” with every bit of passion as “It’s for the children,” as a justification of mandatory preventative care. Risk, via this legislation has been collectivized. Metric here will be mortality and morbidity scored against actuaries. See also: Dr. Ezekiel Emmanuel, rationing.

            d) Won’t happen till the bank breaks or rationing has taken place, something Dr. Ezekiel Emmanuel fully endorses (and a loathsome man. I would take a shit the size of Vermithrax Pejorative on his grave or in his mouth if I could, whichever happens first). Attrition of the most expensive patients will be encouraged here and to supplement c) as a metric.

            1. e) Draw your own conclusion from the above. Lack of TORT reform anywhere in this bill will make it very difficult to sue your provider (governments, like insurance companies hate to lose money). Since recission will be verboten, costs will have to be balanced somewhere. Metric will be decreased suits, but not in the positive way (better care). See: NHS.

              f) See profane rant.

              g) Nothing is 100%, but owning the means of practicing medicine (surgical equipment, diganostic equipment, syringes, ambu bags, J tubes, etc., and other means of delivering care) via even higher taxes on this biomedical stuff will ensure de facto ownership. Metric will be government oversight and amount of procedures done. Expect more procedures to be deemed “elective” to lower costs as well. We will see John Edwards’ “Two Americas”: one that will pay cash for private providers and shitty care for the rest.

              1. The fact that all this was in one post is proof that you photoshopped it.

                1. The fact that all this was in one post is proof that you photoshopped it.

                  Only one layer, Paul. Only one layer. In fact, I stil have the .PSD file. *SCOFFS*

                  Blame Reason’s “reasoned” response to White Indian and its Tribe for our current posting woes, such as character counts, link, and font restrictions. To say nothing of a lack of the fleeting, legendary /Blink Tag…

                  1. And the bane of P Brooks: Threading.

        2. Groovus,

          My wife works for a med school in the research section. She was talking to a couple of the researchers there, one of whom is an MD PHD and the other a PHD and their SWAG regarding Hillary’s health is that she has a very progressive disease called vascular progressive supranuclear palsy.

          Thoughts?

          1. [T]heir SWAG regarding Hillary’s health is that she has a very progressive disease called vascular progressive supranuclear palsy.

            Ah! Dudley Moore Disease. Exceptionally rare and novel disease…. and its S/SX spread does, overall, fit what she has been publicly exhibiting in addition to what her Dr. has released, though this is excluding what happened to her blood clot (which still has not been explained).

            I wouldn’t rule it out, but it is such a rare disease process, I would want to double, nay, even triple check that one. Oddly enough, the disease process really seems to gravitate to celebs and other people of notoriety.

            1. I had never heard of it. These guys have never examined her. So, they would not stake their reputations on it. But they both agreed that was the only thing that really fit all of her publically known symptoms. Interestingly, they estimate given when she first had symptoms that she likely has no more than a year to 18 months to live.

              1. That would be the worst case scenario. It’d give her enough time to get in office, then let her much less hated VP unite the nation.

                1. You misspelled “untie the nation”.

          2. HTML FAIL quoting John!

            At least I didn’t break the comments….

            1. John needs a self-posting computer.

          3. Tim Kaine will be POTUS

          4. she has a very progressive disease called vascular progressive supra nuclear palsy

            Not the first time I’ve heard that.

            1. wait…isn’t ‘progressive’ always a positive?

  3. Obamacare proves that no matter how much damage government does to a market, they can always fuck it up even worse.

    -jcr

  4. I really don’t understand how the insurance companies can refuse to offer plans in certain counties when they operate within a given state, especially considering they have to get the states permission to operate in the first place.

    Can someone explain this to me?

    1. They haven’t been nationalized yet so they are still senselessly allowed to make voluntary decisions which place profits above people.

      1. that was brilliant and should win a HnR Satire (short form) Award.

    2. I don’t know the answer, but that brings up another question – are they pooling people based on geographic location, down to the city/county level??? That seems absurd. Or maybe the costs in those areas are exceptionally high.

      1. Insurance is nothing but discrimination, which is a good thing. The problem is, insurance companies aren’t allowed to discriminate based on a great many things which forces them to find suitable analogs to discriminate upon. The results are often retarded.

        1. It’s a good thing in moderation, but if you get too much actuarial accuracy, you aren’t really dealing in insurance anymore and you face a supply-side death spiral.

    3. Amazing what shoveling a few dollars towards the insurance commissioner’s re-election campaign can do, isn’t it?

      Seriously, I think that the choice the insurance commissioner has is a) allow insurer to only provide service in select counties or b) have insurer exit the state entirely. When insurers are running for the doors because of Obamacare, the commissioner has very little leverage. If the regulatory burden was significantly lower and insurers could compete across state lines, the commissioner would have more leverage since one provider leaving wouldn’t leave the state high and dry. Something about supply and demand.

    4. Some states require insurance companies to register their products in specific counties. It’s a way of increasing the ‘value’ of the filings with the DOI.

    5. how the insurance companies can refuse to offer plans in certain counties

      Nobody but nobody does state-wide risk ratings and premiums. Costs and utilization vary widely by locale. Attempting to set premiums at a single level statewide would be suicidal. Attempting to force an insurance company to do so would drive many insurers out of that state.

      The insurers have, on occasion, called the bluff of an uppity insurance commish and exited a state. They generally return when the commish backs down.

  5. Obamacare means that the government fines people for not having insurance that they cannot afford and in many cases isn’t even available to buy even if they could afford it.

    The Top Men really outdid themselves on this one.

    1. “Kafka was a piker.”
      – Nancy Pelosi

  6. The Obamacare people still refuse to acknowledge that my son, born in the United States, is a US citizen because his mother is an immigrant. A birth certificate alone isn’t good enough to prove citizenship. They require that I also show my one year old’s military ID, driver’s license, utility bill, high school diploma, library card, or credit card statement. Never mind that none of those things can possibly be attained by a one year old, none of those things can even remotely prove citizenship either. These are the people that Democrats want to be in sole control of our healthcare system.

    1. Try telling the Hillary campaign that your son will vote for her.

      1. Or better yet kick a few million into the Foundation.

    2. Just wait until President Trump deports YOUR ass along with your anchor baby.

      1. I’m more of a jus sanguin guy myself, but I’ve got that base covered too.

    3. It took those assholes 5 months and two copies of the bc and shot records from the pediatrician before they would acknowledge that our almost six month old was an American citizen. And both her parents are citizens who already had insurance through the “marketplace” when she was born.

      1. Talking to them on the phone had me thinking that their call center must be staffed by people deemed too stupid to work for the TSA. If you type up a complaint letter, or a letter offering proof or any kind of information, they literally throw it in the garbage without reading it, they told me this point blank. If you send it certified mail to verify that they got it, they won’t sign for it and they have the postal service send it back. The only way to send a letter to those fucks is to hand-write the damn thing, but every time I did that, they pretended that they never received it and since I couldn’t send it certified, I couldn’t call them liar to any affect. The job of those people is to not do their job, it’s designed precisely in that way.

    4. “library card”

      Might not be too hard to find a really lax library or sympathetic librarian…

      1. And then comes the swat team to raid the library to put a stop to the library card black market. 3 children, a dog and an 80 year librarian who was one day from retirement killed in the raid. All police officers returned home safely with a confiscated copies of the Harry Potter series for their children.

        1. At least everyone got home safely.

          1. Every story needs a happy ending.

    5. The Obamacare people still refuse to acknowledge that my son, born in the United States, is a US citizen because his mother is an immigrant.

      So have we achieved peak irony yet?

      1. Peak Kafka. The whole “if you’re born here, you’re a citizen” concept is the most easily grasped piece of law in the land, by far, and literally every person I’ve ever talked to at their call center says that’s not true, even after I recited the applicable clause of the Constitution.

        1. Your wife is not:

          1) From South of the Border in the Western Hemisphere; nor

          2) In any way shape or form Muslim, by country of origin or personal declaration.

          The reason I say this is my own children, though eligible to apply for USA Citizenship (my first calls upon each of my children’s births was to the US Consulate so they would be recognised as having an American father), are UKR citizens since UKR, except in very specific circumstances (and only UKR’s President can confer Instant, Temoprary, or Dual UKR citizenship), will not recognise Dual-Citizenship.

          I asked my Expy Atty (who is British and specialises in International Expatriations and Law) what it would take for my wife (and subsequently my children) to be recognised as USA citizens since wifey isn’t and kiddos sired by one, and she said, quite blandly and seriously, either aforementioned condition 1), or 2) would get them on the list pronto, and would make them jump queue very quickly.

          My wife’s profession does nothing to help her at all (dual specialty in Urology and OBGYN), even if she has a hospital sponsoring her residency in the USA (and Dr. Groobvy still knows all the right people).

          1. Your wife is not:

            1) From South of the Border in the Western Hemisphere; nor

            2) In any way shape or form Muslim, by country of origin or personal declaration.

            I suspected that’s where I ran afoul. Interestingly enough, one day I told a call center employee that I consider it anti-immigrant discrimination to treat us this way and the CSR seemed genuinely rattled. Her supervisor called us up an hour later and told us they’d fast track everything through, then called the next day and told me that it was done and my son was listed on the policy. The following month’s statement came out, and I found out that he was not in fact listed at all, and that supervisor either lied to me, or the changes he made got reverted back.

            With an immigration policy that seems to be implicitly geared against European immigrants and in favor of third world ones, one has to wonder what the fuck the intention of US immigration policy is at present, I can’t think of anything other than to “displace the dominant ethnic group”.

            1. Displace the dominant ethnic group with one that has a much rosier view of crony socialism and banana republicanism.

        2. Jeebus, do I really have to explain the joke that Obamacare is being all strict about the citizenship paper of people born in this country to a citizen and a non-citizen?

          1. Jeebus, do I really have to explain the joke that Obamacare is being all strict about the citizenship paper of people born in this country to a citizen and a non-citizen?

            Not at all Counselor. *grins* I got it immediately. I was just explaining my situation to Free Society, since it mirrors his. The only real difference is my wife would rather flee to Estonia or Italy as opposed to the USA, should we need to relocate.

            It should also be noted, if one remembers Kafka’s The Metamorphosis, how dismal Gregor’s medical care was (non-existent), ended up a literal broken shell of a carapace, whilst his father got a government job and both his parents viewed his sister as the next source of sustenance (as metaphorically shown as her shedding her innocence like a chrysalis as her figuratively spider-like parents observed), as Gregor was previously the only breadwinner.

          2. NO! I got it the whole time, I swear.

            1. *squints suspiciously at Free Society*

    6. These are the people that Democrats want to be in sole control of our healthcare system.

      No, FS, these are the people that ARE in sole control of our healthcare system.

  7. What a spectacular clusterfuck….

  8. I blame congressional Republicans.

    1. That is right. Had it not been for them, we could have had single payer. And something had to be done.

      This is what they actually believe.

      1. And now the bastards refuse to help fix it!

        1. But in California, the hospitals “willingly” pay a Medi-Cal fee.

          Although, I’m not sure why I’m required to vote on it if hospitals willingly pay it already. Seems like Prop 52 is unnecessary . . .. hmmmmm

      2. It’s entirely their fault John!

        It was originally proposed by the Heritage Foundation, so Republicans ahd a duty to support it. The big meanies were so racist that they wouldn’t even support their own idea when the Democrats out of bipartisanship altruistically implemented their idea!*

        *Actual argument Tony made back in c. 2011

        1. http://www.lawyersgunsmoneyblo…..chart-form

          I like the first chart, it made me laugh.

          1. I would have opposed the Heritage plan too, but it has some positives to it.

            Like ending the employment insurance connection.

      3. The public argument was a little more subtle:

        Republicans*: we won’t vote for this because it won’t work.

        Media: Republicans oppose Obamacare for partisan reasons.

        Republicans: as we predicted, Obamacare is failing.

        Media: why won’t you help fix Obamacare?

        Republicans: it’s a fucking mess, it can’t be fixed.

        Media: Republicans refuse to fix Obamacare for partisan reasons.

        *Stipulates that this does not include all Republicans.

        1. Never you mind that most people have health insurance through their employer – and is part of unionized employees CBA – we MUST have single payer to solve this problem!

  9. This statist crap of banning and hobbling markets, then trying to recreate them with laws, is bunkum, is known to be bunkum, has shown itself to be bunkum, yet continues and continues.

    I fully expect the decentralization trend since Gutenberg to continue and for coercive government to eventually wither away and rid of us such bunkum, but that is my long term optimism. In the short run, I am a cynic of the first water.

    1. I fully expect the decentralization trend since Gutenberg to continue

      You’re kidding, right?

      1. No I am not. For instance, there’s a lot more arbitration nowadays, which is one way of bypassing the State judiciary. California especially hates this and its courts go to extreme lengths to think up excuses why the federal laws allowing arbitration do not apply, and they regularly get slapped down by federal courts.

        Or consider Bitcoin, eBay, Uber, and all the other new ways of bypassing governments.

        Or back to Gutenberg. Before the printing press, information was extremely scarce. Martin Luther could not have split the church without the printing press. Then came railroads, the telegraph, telephone, radio, TV, and the internet. Before UHF channels, there were just three networks, all hogtied by the federal government, especially using the FCC hammer. UHF put a crimp in that parade, cable destroyed it, and the internet is destroying what replaced networks. The government can no longer control the new cycle.

        Railroads provided an unheard of mobility, cars increased it. The government used to have great control over mobility, now it doesn’t.

        It’s a long term trend which government will lose.

        1. It may take several hundred years, the US may go full retard and collapse or turn into a dictatorship, but society as a whole is becoming less and less dependent on coercive government. I don’t mean government is retreating, but that what it does is less and less effective, more and more bluster. 3D printed guns are a fine example. The DarkNet is a fine example. Drugs are cheaper and better than ever. Trump thinks he can find and deport 11M people. Kickstarter and GoFundMe bypass SEC security regs. Governments are cranking out regulations faster and faster, but they are more and more out of date. Obamacare is huge, a real drag on the economy, but people started gaming it right from the start, and it can only survive by sucking up so much money that it bankrupts the government; they will have to slim it way down or go into hyperinflation mode if they want to keep it.

          1. Stop I can only get so erect.

            1. Wha?!? Go tell SugarFree!

          2. I have more and more friends whose income is unknown to the government, all in perfectly respectable jobs. Their clients probably suspect why cash is preferred, and don’t care, or, liek me, laugh and encourage it.

            And then there’s all the pot farmers around here, nothing like the old criminals, all part timers with legit jobs, all growing in their backyards, all little worried about crackdowns because their plots are so small, the feds are in retreat on such small scale operations, and the local cops know how much it contributes to the economy. It’s prohibition all over again.

            Drones are making drug delivery easier and less dangerous. Governments would love to crack down on burner phones but can’t manage even that.

            My expectation is that the government will continue tightening the noose around its own neck with more and more regulations on the old stale parts of society, and just like black markets everywhere, the incentives will drive people to abandon the government-controlled areas and find new unregulated areas. The bigger government gets, the less agile and hidebound it becomes, and the trend will accelerate. The government economy will shrink, government will have less and less money to regulate with, and the shadow economy will gradually become the only economy most people care about. Government enforcement will have to shrink as they run out of money.

            1. The end game will be a government so isolated and cornered that no one will give a shit about what it does. Only a few people will participate in elections, and it will just hang on like the appendix. Its final disappearance will be a trivia answer even less well known than when the Articles of Confederation ceased to have effect.

              But like I said, I am a short term cynic, and don’t expect the interval til then to be fun and games.

              1. And that’s not to mention science! I expect within 50 years that everyone will have some system in their house which monitors their health and dispenses daily medicine for incipient cancers, colds, all known diseases, and probably a lot of unknown diseases. Whether it monitors toilets or checks your blood with some non-invasive gizmo doesn’t matter. Computers, mesh nets, 3D printing, they all take the government out of the loop. Once you have the raw ingredients which can make anything, government control goes out the window, just as it does with the internet (0 and 1s). They already can’t keep up with designer recreational drugs.

                Solar power and batteries are going to be so good that there will be no grid for most people. Maybe people will get their water by condensing water vapor. It’s all going in the same direction, away from everything susceptible to mass control.

                What will they do when people can 3D print their own cars? What happens when battery tech is so good that crude energy sources like oil turn into backups for solar and other renewable energy, and people 3D print their own flying cars, and roads no longer provide such a handy excuse for regulating cars and drivers and transportation? Look at how many people are ignoring the FAA drone regulations, and this is just the early stages.

                Government is a crude one-rule-fits-all mechanism which is obsolete but will take a long time to die.

        2. Yet, since Gutenberg, governments consume more and more of society’s resources, and in the last 100 years have exerted more and more direct control over people’s lives.

          1. I blame democracy and worship of the demos for that.

          2. No, they have exerted less and less control over people’s lives. Consider how much power governments had over dissemination of news just 100 years ago. Now they have almost none.

            Yes they pass more and more regs, but they are over areas that didn’t exist 100 years ago. As a percentage of daily life, government has less to say than it did 100 years ago.

            Go back 200 years, and a lot of people still lived under kings who could pretty much do what they wanted.

            Go back 300 years and almost all of humanity was under the control of despots.

            1. Go back 200 years, and a lot of people still lived under kings who could pretty much do what they wanted.

              I fear not. Tax rates prior to the “republican era” seldom rose above 3% and prior to the Ancien Regime, Kings could not simply decree new laws. Law was viewed as an ancient and largely unchanging thing and early in the medieval period it was administered by private jurists where it concerned non-state matters. Kings were viewed as monopolists and without being dressed up in the “will of the people” like democratically elected rulers, kings often had to wage their wars from rents from their own demesne and couldn’t simply raise taxes or print money. If the king had raised taxes too high, he was liable to lose his head because the naked injustice of statism under a king is not masked under the fineries of democratic trappings to make the tax increase appear voluntary or “for the greater good”.

          3. As for consuming society’s resources, that is a laugh and obviously false. In Gutenberg’s time, the only real resources were what could be farmed and mined, and governments took what they wanted. Nowadays? Not nearly so much. Don’t confuse a zillion regulations with reality. In fact, they are an indication of how much less control governments have. Back then, they just did what they wanted, maybe throw out a few royal decrees, but mostly just grab. Now they have to pass regulations and go through courts and legislation for a cover, and a not very good one at that. It only seems like more because there is so much more to society than there was.

  10. Q: Who always loses at the annual Polish Fathers and Sons Touch Football Game?

    A: Blue Cross

    1. This is a joke I can appreciate.

  11. I volunteer as a Certified Application Councilor every year to help people in my community navigate the health exchanges. I don’t do it because I like the law, I do it because I feel like I’m well equipped to understand and explain the law, the exchange and the health insurance plans to my community. I’m prohibited from giving any specific details, but out of the roughly 30 individuals/families I assist each year, most have medical conditions of a serious nature. Many have made financial mistakes that could have easily been avoided (people that have $500/mo. car payments so they can’t shell out $200/mo. on insurance premiums).

    Out of all the people I help each year, roughly 1 or 2 are under 30 years old. Most are at least 40, and the majority were people pushing 55. The simple fact is that young people are not signing up and would rather pay the fee. Friends my age (millennials) aren’t even thinking about health insurance. Most are more worried about trying to find a good-paying job (there aren’t any for most of them). While they continue their job search or additional education, their parents are filing their taxes, and, I assume, paying their health insurance fines (for friends over 26).

    (1/2)

    1. When I run the numbers for most people, the old folks with lots of dependents get more federal subsidies than the younger (and comparatively poorer and less equipped to find a high-paying job) are stiffed by low subsidies and huge premiums (think $400/mo. for one healthy individual in their mid 20s).

      Of course I do have distorted view, since I imagine most young people wouldn’t come to their public library for assistance, and probably navigate the online stuff by themselves.

      (2/2)

      1. Interesting perspective. Good to hear some firsthand reports of how it’s actually being used. Thanks!

      2. Friends my age (millennials) aren’t even thinking about health insurance.

        Looks like Pajama Boy has more work to do.

    2. Maybe they or their parents will think about it when the penalty hits $600+ this filing year.

      1. They should price the penalty to be at exact parity with the price of the citizenship-renunciation form.

      2. You should see the look on people’s faces when I discuss the uninsured penalty-tax with them. They’re usually blind-sided. They usually ask “why?” first. Then when I tell them that this is the law that the federal government passed, they respond with anger towards me, then usually apologize followed by anger towards the government and the president.

        I’ve had a several people cry on me.

        Young people get exceptionally angry.

        1. And that’s why the penaltax can never get high enough to be effective. It would create a backlash like the pols have never seen, same as if all speeding tickets were issued by cameras for even 1 mph over.

          1. We will see, I think I recall that it will climb upwards of $1.3k eventually (I have to check where its at each year). With the exchanges collapsing, how can you enforce such a law?

            1. You should explain to people that the only enforcement mechanism that the IRS has to make anyone pay the penalty is to withhold it from any tax refunds due to the taxpayer.

              All that anyone has to do is adjust their withholding allowances and/or estimated tax payments so that they are never due a tax refund on their federal income taxes and the IRS cannot make them pay the penalty.

    3. d (people that have $500/mo. car payments so they can’t shell out $200/mo. on insurance premiums).

      +1 Escalade with 27″ dubs in parking lot of run-down apartment complex.

      1. You would not be surprised. In the depressed areas near where I live, the extravagant cars in the parking lots astound me.

        1. and yet, the left laughs at the notion of the welfare queen in the Cadillac. I know that’s a date reference but it’s only a reference at all because it’s true. Can’t recall how many times the car had greater value than the home.

        2. You should see what people drive when they come to the hospital, and later claim they can’t afford to pay their share of the bill.

          My response “Why is it you can always come up with $500 to fix your care, but not a penny to fix yourself?”

          1. I really wish I could say something like that, but I’d get kicked out. I usually suggest that they look into selling the car if they want health insurance. I wonder if any of them take my advice…

          2. Considering how wildly warped medical care pricing care has become, it wouldn’t necessarily surprise me if he couldn’t afford it. Or at least that he was reluctant to pay such a ridiculous price for some aspirin and an uncomfortable bed.

            Earlier this year, my wife had pneumonia and the doctors recommended she stay overnight for observation. They proscribed some antibiotics (which we paid for out of pocket) and sent us on our way. The following month we got bill for over $8,000. They literally did nothing but proscribe pills that we paid for on the spot and we owe eight fucking grand. I don’t care how nice my car is, the only way I’m going to pay that bill is slowly and with as much aggravation to the hospital as possible.

            1. Let’s not start talking about surprises.

              1. That’s a surprising sentiment.

            2. The first thing they teach you in CAC training is to tell people to never, ever go the hospital. We literally had checklists that we had to complete with every person, most of which revolved around when to use the hospital and how to avoid using the hospital whenever possible. Most of the immigrants I assist are very confused because the hospital is the place to go in their home country. I have to explain to them that they will get poor service, huge bills and no cross-reference with their medical records to treat multiple illnesses while staying in the hospital.

              Use your doctor or an urgent care facility, they will send you to the hospital if they deem it necessary.

              1. I did bedside collections in a non-profit Hospital, and we would literally cut the bill in half if you were a self pay patient. Sadly, with everything the government has done, health care can only conglomerate into Hospitals or group practices. Your individual private practice is dying at an exponential rate. The government is almost entirely to blame for the process, but no one seems to care. The idea that the government can do anything to control costs while expanding care is the Big Lie.

              2. That’s generally my philosophy. I avoid hospitals like the plague.

            3. Considering how wildly warped medical care pricing care has become, it wouldn’t necessarily surprise me if he couldn’t afford it.

              Assuming they aren’t on Medicaid (in which case they don’t owe a fucking nickel of their own money), a typical ED visit generates a bill of between $500 and, at the high end if we do advanced radiology, $1500.

              They roll up in their $45,000 cars, rocking a new $600 phone with a $100/month data plan, and tell us they cain’t afford no hospital bill.

              I actually researched and proposed a plan to put a lien on their vehicles in Texas. Sure, it would have been underwater, but we could have forced the sale of their vehicle. My plan was rejected.

              1. Yeah, I don’t think your plan would work anywhere R.C. but I definitely understand the sentiment. There really isn’t anything you can do but harass them for life to pay their bill or sell the debt.

              2. I actually researched and proposed a plan to put a lien on their vehicles in Texas. Sure, it would have been underwater, but we could have forced the sale of their vehicle. My plan was rejected.

                Why would you go to that trouble of Obamacare will cover it?

        3. Why would I be surprised? I made the comment because I see it daily.

          1. I said “you would not be surprised”.

            1. Look, let’s not mince words here.

    4. I volunteer

      I stopped right there. Get the fuck off of this website, you Commie pussy.

      1. Trust me, as someone who works in finance, its important to volunteer for optics alone. It benefits me in intangible ways, and makes for great conversation with pretty women.

        1. I respect that it is all a ruse and helps you crush box.

          1. There’s a place here called The Crisis Clinic which is kind of a hot-shot local non-profit that everyone who’s anyone in the social work field has worked or volunteered for. It’s apparently an open secret “in the biz” that a large number of volunteers do so because they want to get laid.

            1. What can I say? Its extremely effective. The women that call themselves progressives would probably flip out if I followed up my conversation about volunteering with my thoughts on the minimum wage or affirmative action.

      2. That was so alpha.

    5. Epstein’s article suggests it’s worse than it was even predicted by those who believe incentives matter, and the web makes it that way:
      The parents of young people with serious diseases tend to belong to affinity groups on the web. Once Johnny signs up for insurance for his X, why mom jumps into the discussion on the X-Sufferers web site and mentions how and where you can sign up your kid, regardless, of course, whether you can afford the treatment already.

  12. I question whether a system where all pricing changes must be approved by the government can even be called “competition” jokingly.

    I guess in the same way that WWE involves competition. Some people who used to really compete getting paid by the boss to act out a scripted imitation of battling one another to push the boss’ preferred narrative.

    1. And when the government controls prices, the prices are inevitably set to low because no government wants to raise prices and there are shortages. Who could have seen that coming?

      1. Raising prices is racist, where letting the system collapse is not.

      2. The USPS?

  13. UNEXPECTEDLY ALTERED PLANS

  14. You can tell the death spiral has begun in earnest from all the increased chatter about the ‘benefits’ of single payer. There was even an paid advertisement masquerading as a news report on our local online fishwrapper.

  15. Where is our modern day Nixon?

    I don’t know why the lefties haven’t fully embraced him as one of their own. Wage and price controls would get this economy humming toot sweet.

  16. Kulaks! Hoarders! Wreckers! To the gulag with them all!

    1. It won’t be too long now. The left is getting more and more irrational and vocal. People I actually liked on FB from law school are ready to start pushing the gov to get rid of all those who they disagree with.

  17. I heard a report on NPR last night where they closed a story with a postscript “some insurers” have left the ACA.

    Sounds like the ACA has the same structural problems as Venezuela: Low oil prices.

  18. Serious question, by letting Democrats have their way with Obamacare, was that effectively the Republicans executing a successful repeal?

    1. Giving someone enough rope is racist.

    2. Since the Democrats passed a bill that made no sense and could not be implemented as written and was doomed to fail no matter what, in a way yes it was. The thing is that Obamacare has in many ways already been repealed because it was never really implemented. The thing was so badly written that the Obama administration basically had to ignore it and rewrite it in so many ways that what we have now can fairly be called something different from what was passed. Now of course the entire thing is collapsing.

      This isn’t going to be something that will just linger on as the public adjusts to a new incredibly sucky normal. The fine for not having insurance goes up every year. And as more and more of these exchanges collapse more and more people will not only be unable to buy insurance but also will be being fined heavily for not doing so. That can’t and wont’ go on very long.

      And despite their dreams to the contrary, there is no money for single payer and it is not happening. That leaves one choice, repeal the coverage mandates, stop forcing insurance companies to cover pre-existing conditions, kill community rating, and kill the individual mandate. That is the only way to make so people can afford insurance again.

      1. Medical insurance will never be right until we start treating it like insurance.

        1. Insurance has been a scam since the beginning. It came into existence because it was a way for companies to attract better talent back when the government had wage caps in place, which prohibited companies from paying more for better talent. (and we think we have it bad today. Yikes.)

          Hence, the birth of employer sponsored health insurance. I know that no one actually gives a fuck that government essentially warped the market from the very start, or that they essentially created the incentives to create the market in the first place, but thinking the government can fix what is purely a creation of government regulation in the first place is the height of lunacy and misunderstands how and why insurance came into being. I’m not saying that it’s purely the fault of the government, but it’s undeniable that there would have been zero incentive to create such a monster if not for them.

  19. Hey, according to the SF Chron, this sort of minor difficulty was expected! It is a big and complex issue, so details like not being able to get insurance at a cost less than your mortgage is just a trifle that will be fixed by that guy with the pen and the phone.
    Honest! He promises!

  20. RE: Yet Another Health Insurer Scales Back Its Participation in Obamacare
    BCBS Tennessee pulls out of the state’s largest markets.

    These people are fools, I tell.
    Absolute fools!
    Don’t these people realize that Saint Lenin correctly stated that the best way to control the unwashed masses is through healthcare? Don’t these people recognize the potential for control? Just imagine The State limiting medication, treatment and hospitalization for the doubters, the counter-revolutionaries and the politically unconnected? They would all wither from the vine of our socialist slave tree and die, and that’s what’s it’s all about in our beloved workers paradise…getting rid of the freedom loving neanderthals and replacing them with willing, naive and eager fools and tools for socialism. Healthcare is the best way of doing just that, and I cannot honestly understand why these morons from Hell in Tennessee can’t understand that.

  21. The move means that about 130,000 people in the state will lose their current insurance plans

    but they can keep their doctors, uh, DOGS!

  22. King Obama does not like this!!!

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