Aetna Slowly Bailing out of ACA Public Health Insurance Exchange

[mommytobees]

Actually, if he is a biological child of an AD service member, I don't believe he can be dropped before age 21.  When I married an AD servicemember (prior to Tricare being around), they actually backdated my two kids (from a previous marriage) to the date my husband joined the military.  In DEERS STILL, my kids show eligibility date from the date he joined, my date shows from our date of marriage.  

 

Not sure how it works once he's 21 (if he can be dropped) if he's in full time school (normally covered to age 23 if in full time).  Once he isn't in school full time, whether at 21 or 23, he can be part of Tricare Young Adult, WITHOUT the servicemember's permission.  Premium for my son in Colorado a year ago was about $165/mo for TYA.

 

The problem is that his father can remove him from DEERS at any time after graduation. This isn't that the military/Tricare will remove him, this is that his father has been a jerk. The insurance is fantastic; the parent providing it is not.

 

Kris

[TechWife]

 

BUT, you're right.  Those with significant conditions require a bit more.  I think we all should chip into those.  I think once someone has passed, say, $500,000 of needs for an incident, they ought to get gov't paid medical care removing them (for that incident) from their program and seeing to it that no program goes bankrupt, but folks still get the care they need.  This would require less overhead for the gov't to worry about making it easier to run.  Taxes need to cover those.  Those are something I'd want my taxes paying for.

 

And for those who can't afford the basics?  I'd still keep Chip and similar helps for them - very much like WIC.  There are ways we can provide for all - if we (as a country) wanted to.

 

 

 

Why is it preferable to you to pay higher taxes and have the government take care of the large expenses rather than pay a higher share in your Samaritan membership and take care of the large expenses through Samaritan? 

[TechWife]

We had Samaritan for about seven years. I grew increasingly uncomfortable with the extreme theology they pushed in their newsletters. What really made me lose respect for them was when they published a Special Prayer Need (an opportunity for members to support medical care not covered under the plan) for anorexia. It said treatment for anorexia wasn't covered because it was considered psychiatric and all psych care is excluded. I already knew psych care was excluded, but not covering anorexia really bothered me.

 

Yet, their "foundational principles" state:

 

"We must live according to Biblical ethics in all aspects of health care."

 

 

I have no idea how excluding mental health care is upholding that principle. 

[TechWife]

 

 

Sorry if that boggles your mind.  Looking at things "outside the box" of what is expected (when expected doesn't work the greatest) is part of what I like to do.  I'm fully aware of how difficult it is to get others to see anything outside the lines drawn.  Perhaps that's why I like working with teens the best.  They aren't yet confined by lines...

 

It boggles my mind because it is inconsistent with Samaritans' own philosophy. They clearly state that a family should take care of their own (I agree) and then if they can't, they should go to the church (again, I agree). Noticeably absent is the mention of going to the government for aid. I know a couple of families that use Samaritan and they believe that government aid is unbiblical, that not only are Christians supposed to take care of each other, but Christians shouldn't use government aid programs.

 

I don't disagree with your comments, suggestions and observations, but in light of what I know about Samaritan and the families I've met, your viewpoints are surprising to me, that's all. 

 

Are all Christian organizations supposed to go bankrupt because they want to help the whole world, but can't?  Or just health shares?

 

ETA:  Can I also presume you're not doing well financially since there are so many worthy causes we need to be sending ALL our money to?  (Or perhaps you're not Christian, so are exempt.  I honestly don't pay attention to who is and who isn't on this board.  If not, then are only Christians supposed to spend themselves into the poorhouse due to all the worthy causes our planet has?)

 

 

Um, actually, I never said anything approaching this. I have no idea how you got to this conclusion. 

 

We strive to spend our money according to Biblical principles, but what we do with it is absolutely none of your business.

[creekland]

Why is it preferable to you to pay higher taxes and have the government take care of the large expenses rather than pay a higher share in your Samaritan membership and take care of the large expenses through Samaritan? 

 

Because in my (ideal world) system, the gov't would chip in to cover all with super high needs.  This way no group would have to worry about anything (single incident) in excess of 500K and would make the stats more stable.  The person would still be a member of their group for most things and all group policies would apply (pick your own doctor, etc).

 

Over the past decade I've seen SM cover organ transplants, oodles of cancers, cardiac issues, accidents, premature babies, and all sorts of things that end up being costly.  These systems (with enough members) can handle those, but as a pp mentioned earlier, there is a small risk that if a group ended up on the edge of the high cost bell curve statistically, there could be a problem.  This would eliminate that risk.  Some of the lower cost could be diverted to taxes to cover those meaning no net loss to members.

 

The key to lower health care costs (the way I see it) is to drop the "for profit" part and reduce paperwork, but I also like the good things health share offers - the ability to cover (or not) what one wants covered (say, abortions) and no networks or preapproval, etc, needed.  Most of the practices I've seen appreciate not having to do the paperwork for insurance too.

 

It boggles my mind because it is inconsistent with Samaritans' own philosophy. They clearly state that a family should take care of their own (I agree) and then if they can't, they should go to the church (again, I agree). Noticeably absent is the mention of going to the government for aid. I know a couple of families that use Samaritan and they believe that government aid is unbiblical, that not only are Christians supposed to take care of each other, but Christians shouldn't use government aid programs.

 

I don't disagree with your comments, suggestions and observations, but in light of what I know about Samaritan and the families I've met, your viewpoints are surprising to me, that's all. 

 

 

 

Um, actually, I never said anything approaching this. I have no idea how you got to this conclusion. 

 

We strive to spend our money according to Biblical principles, but what we do with it is absolutely none of your business.

 

Absent doesn't mean the same thing as condemning.  Perhaps all Christians and/or all Samaritan members don't fall into the same mold as those you've seen?  We (personally) use gov't aid programs for other things - like college student aid.  So do most Christian colleges.  I tend to think most Christians don't view the gov't as 100% evil, yet it's still nice when we can band together to attempt to make a better health care coverage system.  There's no reason everyone has to follow the crowd if someone comes up with a decent working idea.

 

The fact that these systems work well is why they were/are allowed with ACA.  They weren't forgotten.  Congressmen looked into them.  I suspect insurance lobbyists had a say into why no others are allowed to form.

 

And on the latter... you seemed to be saying that Health Shares should cover absolutely everything that would match the Christian ideal.  The fact that they don't bothered you - even though it was pointed out that doing so would bankrupt them.  

 

If one extrapolates that same thought to churches or food banks or families, it seems we should all go bankrupt because there are so many (truly) needy causes out there.  How can we, as Christians (or humanitarians), not help them?  

 

There's nothing magical about health share families.  I doubt any of us have unlimited wealth (and even the wealth of the Gates Foundation hasn't fixed all ills in the world even though they try).  Heath shares, like families, have to live in the Real World, not the Ideal World.  If one condemns Health Shares for having to live in the real world, it seems only logical that they should do that for all groups rather than single this one (type) out - unless their logic is skewed for some reason or another.

[Bluegoat]

Yet, their "foundational principles" state:

 

"We must live according to Biblical ethics in all aspects of health care."

 

 

I have no idea how excluding mental health care is upholding that principle. 

 

I wouldn't say that excluding mental health care is ideal, but I don't see how there is a requirement that one product do everything.  Someone can set up a product that covers medical but not dental care, or doesn't include drugs, or whatever.  It means people who choose that will need to have some other way to manage those needs.  It might make it a poor product, but an immoral one seems a stretch even when the product is there to serve a moral need. 

 

My parish church runs a soup kitchen, but not a shelter.  Many of the people who use the soup kitchen also need shelters, but we just don't really have the capacity for that, financially or in infrastructure terms.  Either someone else needs to provide it or, sadly, people go without.

 

Mental health is important, but also expensive, and it may well be that they could not include it while maintaining a cost that worked for their users, or they did not have the administrative capability of managing it.  So, the cover what they can make work, and people need to make other arrangements for mental health care.  Individuals of course might well feel obliged, in terms of their ethics, to help with such expenses if they can, but the program can't manage that.

[ktgrok]

I've already said I'd vote for a single payer system over what the US has currently (or in the past).  My musings have just been for a better way for all.  My step-mom is Canadian (NS).  My mom and dad (and aunts/uncles) have medicare.  My uncle is a veteran.  Our exchange student was/is German.  I've seen all the above (pros/cons) IRL and consider health share (with modifications to cover all as already mentioned) to be superior to any of those, but any of those are superior to the cruddy "system" we have now.

 

Yes, but again, the reason healthshare seems superior is probably that it is a relatively small group limited to lower risk people. Any system that covers everyone will be less ideal, due to the financial realities of covering people with much higher risk factors. So unless we are saying that there should be two tiers of care, one for lower risk people who get better/cheaper care and one for everyone else, which strikes me as implicitly unfair and likely to create problems with funding by taxes, etc, a system that works for everyone will never be as nice as one that just covers relatively small groups of low risk people.

[Bluegoat]

There are very good heath systems worldwide that are a combination of something like a healthshare and public coverage as well.  They are actually rated among some of the most effective.  So I don't see why that would be impossible though of course the devil is in the details.

[creekland]

Yes, but again, the reason healthshare seems superior is probably that it is a relatively small group limited to lower risk people. Any system that covers everyone will be less ideal, due to the financial realities of covering people with much higher risk factors. So unless we are saying that there should be two tiers of care, one for lower risk people who get better/cheaper care and one for everyone else, which strikes me as implicitly unfair and likely to create problems with funding by taxes, etc, a system that works for everyone will never be as nice as one that just covers relatively small groups of low risk people.

 

There are two situations we're talking about here.

 

1)  Now.  Americans ought to have something covering them now.  If folks reading think Health Share programs might work for them, they are worth checking into to see the details and their situation.  If they work, the savings are significant and IME the "coverage" is better.  That will not be the case for everyone, so comparison to what is available as insurance is a wise idea.  We did that back when we were contemplating what our health coverage future would be.

 

2)  The future - our ponderings as to what could happen to make things better for all.  It is my belief that if the gov't took over payment for the very needy health issues (and we all pay for it via taxes) while still letting health share groups (of all sorts - something to fit everyone) cover the majority we'd have the best of both worlds.  Individuals could pick what they wanted covered (or not) and align accordingly.  Our (collective) nation is diverse enough to have oodles of different options.  What would remain the same is all would be non-profit and networks would disappear.  Doctors/patients would make decisions - no preapproval needed from the non-medically trained purse string holders.

 

The gov't would have to keep Chip and other low income options, but more would be covered with health shares because they are lower cost and more affordable to many.

 

If someone still opted for nothing - even with appropriate cost and oodles of options, then they would have to be on their own.  It's what they chose.  Or I guess a penalty paid could be assessed with the $$ going into a collective bin for all the "non-joiners" so they'd have their own group of sorts.  Anyone not paying their bills regularly (on time) would also be tossed into this group.  I know for short term issues (job change, etc) Samaritan's assists its members, so I would suspect most groups could do similarly.

 

To make the transition the gov't would have to cover all of those with pre-existing major things, but that would phase out in a few decades at longest.  It would be needed to begin with to assure the groups didn't go under at the beginning.  Otherwise, costs in = costs out - and statistically - that stays pretty constant with increases needed only to account for inflation and things.

 

And it will all never happen because we'd need to toss the for-profit insurance industry - that many members of congress and oodles of others have in their retirement portfolios - benefiting from illnesses, etc.  It's a group far larger than insurance itself - and they hold the votes.  (sigh)  It crosses both parties.  But one can dream.

 

And then we have to admit we live in the real world now, so letting people know various options exist (even if they have drawbacks) is important so they can look into them if desired.  We do that with different insurance options.  Legally, health share is an option too.  Nothing works for everyone, so all have to see what is best for them.

Edited August 25, 2016 by creekland

[ktgrok]

But wouldn't that still result in two tiers of care? People who can't afford Health Shares, or can afford them but can't afford preventative care that isn't covered by them, and then those that can? Do we think two tiers of care is appropriate? Do we think that people that can afford insurance/healthcare deserve better care (you are saying you find health share to be better than government programs) than those that can't? To me, that is not ideal. And if only the poor mainly get government run care, there will be very little incentive to make that care the best it can be, because the people with money and influence would be using the health share model. 

 

 

[Bluegoat]

But wouldn't that still result in two tiers of care? People who can't afford Health Shares, or can afford them but can't afford preventative care that isn't covered by them, and then those that can? Do we think two tiers of care is appropriate? Do we think that people that can afford insurance/healthcare deserve better care (you are saying you find health share to be better than government programs) than those that can't? To me, that is not ideal. And if only the poor mainly get government run care, there will be very little incentive to make that care the best it can be, because the people with money and influence would be using the health share model. 

 

That doesn't seem to be a significant problem in places where they have that type of system, so I assume there are factors that prevent or minimize it.

 

For example, Australia has both a public and private healthcare system, but the public one is considered quite good and in fact people often use it over the private system by choice, and it doesn't seem to mean that the people in the public system get shafted.

 

I think it could be a bit like public vs private education in some countries that really put quite a lot into public education as a matter of principle.  They have high standards they meet, and as a result few people tend to use private education, especially without a particular reason for doing so.

[ChocolateReignRemix]

There are very good heath systems worldwide that are a combination of something like a healthshare and public coverage as well.  They are actually rated among some of the most effective.  So I don't see why that would be impossible though of course the devil is in the details.

 

Which ones?

[ktgrok]

 

For example, Australia has both a public and private healthcare system, but the public one is considered quite good and in fact people often use it over the private system by choice, and it doesn't seem to mean that the people in the public system get shafted.

 

 

 

But is the public system only for the poor and the very sick? Or does everyone have access, then top off, or??? Genuinely curious. 

[Bluegoat]

But is the public system only for the poor and the very sick? Or does everyone have access, then top off, or??? Genuinely curious. 

 

No, anyone can use the public system there, and from what I understand most people do.  A bit like the UK in that though I think it might be administered rather differently.

[Bluegoat]

Which ones?

 

 

Off the top of my head, mixed systems that include publicly funded and also significant private elements (as in private insurance or hospitals and other facilities) are France, Germany, the UK, the Netherlands, Australia, Switzerland, japan, Singapore, and I am sure others as well.

 

Some of them have elements similar to a group cost share though I am afraid I can't remember which. 

 

We have universal care and a pretty limited private element, and that seems most natural to me, but given that these countries with mixed systems seem to have outcomes as good or in some cases better, I can't see that kind of mixing as an inevitable barrier.

[ktgrok]

No, anyone can use the public system there, and from what I understand most people do.  A bit like the UK in that though I think it might be administered rather differently.

 

Ok, so that's not really at all like what Creekland was suggesting, where the very poor, or the very sick would use a public system, but everyone else would have a health share type system. 

[ChocolateReignRemix]

Off the top of my head, mixed systems that include publicly funded and also significant private elements (as in private insurance or hospitals and other facilities) are France, Germany, the UK, the Netherlands, Australia, Switzerland, japan, Singapore, and I am sure others as well.

 

Some of them have elements similar to a group cost share though I am afraid I can't remember which. 

 

We have universal care and a pretty limited private element, and that seems most natural to me, but given that these countries with mixed systems seem to have outcomes as good or in some cases better, I can't see that kind of mixing as an inevitable barrier.

 

I was specifically asking about health share systems.  I don't recall any of the nations you listed having something like Samaritan Ministries.  Private insurance is not the same as a health share.

Edited August 25, 2016 by ChocolateReignRemix

[Catalytic]

The problem is that his father can remove him from DEERS at any time after graduation. This isn't that the military/Tricare will remove him, this is that his father has been a jerk. The insurance is fantastic; the parent providing it is not.

 

Kris

 

Have you spoken to JAG or IG about that?  (Not sure what the Navy calls them)  I'm definitely not saying it's impossible, but it wouldn't make sense for the military to allow GIs to willy nilly remove dependents.  (I realize ex-spouses are removed, but with the 20-20-20 rules, ex-spouses retain their medical and I can totally see a vindictive ex-spouse trying to remove them from DEERS.)  Anyway, not at all saying you're incorrect, it's just something I've not heard of happening, and it seems odd that it would be allowed by DEERS, so I would encourage you to get JAG/IG input if you haven't already.

[creekland]

But wouldn't that still result in two tiers of care? People who can't afford Health Shares, or can afford them but can't afford preventative care that isn't covered by them, and then those that can? Do we think two tiers of care is appropriate? Do we think that people that can afford insurance/healthcare deserve better care (you are saying you find health share to be better than government programs) than those that can't? To me, that is not ideal. And if only the poor mainly get government run care, there will be very little incentive to make that care the best it can be, because the people with money and influence would be using the health share model. 

 

You mean like already happens in Germany when the wealthy (like our exchange student's family) can afford private insurance so they get better care than just their system allows?

 

Or in Canada when my step mom comes to the US for quicker and more up to date care than she would have gotten in Canada - available to her because of my Dad's finances?

 

This already happens in places that are considered "good."

 

Ok, so that's not really at all like what Creekland was suggesting, where the very poor, or the very sick would use a public system, but everyone else would have a health share type system. 

 

Ok, you're misunderstanding me.  Only the paying entity is different.  All doctors and hospitals (and availability of them) is the same.  There would be no difference in care.  A doctor bill sent to Chip would be the same as one going to a health share - same cost for all.

 

The college analogy doesn't fit because there the colleges are different even though public/private can both be good/bad.

[creekland]

FWIW... NCAA has also decided (this year) that Health Shares are an option for college students in their system.  They are a legal and decent option if they fit.  The gov't should really consider allowing more to form (with their own identities) IMO.

 

My youngest son's college has allowed us to drop his insurance now since he's on health share.  That saves us about $1300.  He had one claim that they paid about $600 on (leaving us with an additional $40 to pay - so far - it's not done yet).  Health share would have covered it at 100% for no additional cost to us.  I'm thankful we can drop his insurance.

[TranquilMind]

Yet, their "foundational principles" state:

 

"We must live according to Biblical ethics in all aspects of health care."

 

 

I have no idea how excluding mental health care is upholding that principle. 

 

I have no idea about mental health care, but maybe covering other stuff at a low rate leaves you with more money to cover this, if necessary?  Maybe that is the idea.  Someone said she saved $15,000 by using health share.  That's a lot of money and a lot of mental health care, I would imagine. 

 

[TranquilMind]

FWIW... NCAA has also decided (this year) that Health Shares are an option for college students in their system.  They are a legal and decent option if they fit.  The gov't should really consider allowing more to form (with their own identities) IMO.

 

My youngest son's college has allowed us to drop his insurance now since he's on health share.  That saves us about $1300.  He had one claim that they paid about $600 on (leaving us with an additional $40 to pay - so far - it's not done yet).  Health share would have covered it at 100% for no additional cost to us.  I'm thankful we can drop his insurance.

 

That sounds awesome, actually. 

[TranquilMind]

You mean like already happens in Germany when the wealthy (like our exchange student's family) can afford private insurance so they get better care than just their system allows?

 

Or in Canada when my step mom comes to the US for quicker and more up to date care than she would have gotten in Canada - available to her because of my Dad's finances?

 

This already happens in places that are considered "good."

 

 

Ok, you're misunderstanding me.  Only the paying entity is different.  All doctors and hospitals (and availability of them) is the same.  There would be no difference in care.  A doctor bill sent to Chip would be the same as one going to a health share - same cost for all.

 

The college analogy doesn't fit because there the colleges are different even though public/private can both be good/bad.

 

This is true.  Tiered care exists everywhere that there are already public health options.    If you can or will pay more, you can get things done quicker. 

 

It won't change here either, if we implement single payer. 

 

[creekland]

This is true.  Tiered care exists everywhere that there are already public health options.    If you can or will pay more, you can get things done quicker. 

 

It won't change here either, if we implement single payer. 

 

 

I agree, but I also still say that single payer is better than what the US has now - which has to be the cruddiest system (overall) out there.  I just think even that could be improved based upon what I've seen with single payer.  Maybe I'm wrong.  Who knows?  At this point it's all theory.

[Bluegoat]

I was specifically asking about health share systems.  I don't recall any of the nations you listed having something like Samaritan Ministries.  Private insurance is not the same as a health share.

 

There is at least one that has something similar, though it isn't a religiously based thing - I want to say Germany for some reason but I think tha is wrong. (This is in the context of kgrok's question about whether it makes sense to have a group covering only less expensive/usual things and the government covering the poor or more serious things, so the health share aspect didn't seem to be the most important factor.). It is kind of like a co-op approach, I think, though it may be insurance rather than just cost sharing. 

[Bluegoat]

This is true.  Tiered care exists everywhere that there are already public health options.    If you can or will pay more, you can get things done quicker. 

 

It won't change here either, if we implement single payer. 

 

 

Yeah, I wouldn't really say that is true.  The very few people that can leave the country to get private care elsewhere is so small as to not really be a factor, it's like counting in those few people who could afford to pay for any health care issue out of pocket.

[creekland]

Yeah, I wouldn't really say that is true.  The very few people that can leave the country to get private care elsewhere is so small as to not really be a factor, it's like counting in those few people who could afford to pay for any health care issue out of pocket.

 

Not so true when one lives along the border.  There are quite a few Canadians who come across where I grew up.  It's definitely tougher when one lives farther away and has to factor in major travel expenses.

 

But then again... it's a wealthier section of Canada next to the border where I grew up (St Lawrence River area), so sort of true I suppose.

[mommytobees]

Have you spoken to JAG or IG about that?  (Not sure what the Navy calls them)  I'm definitely not saying it's impossible, but it wouldn't make sense for the military to allow GIs to willy nilly remove dependents.  (I realize ex-spouses are removed, but with the 20-20-20 rules, ex-spouses retain their medical and I can totally see a vindictive ex-spouse trying to remove them from DEERS.)  Anyway, not at all saying you're incorrect, it's just something I've not heard of happening, and it seems odd that it would be allowed by DEERS, so I would encourage you to get JAG/IG input if you haven't already.

 

Oddly enough, I've received mixed answers. JAG doesn't know. I've contacted DEERS office, but since I'm not the member, they won't talk to me. Go figure!! The Personnel office at the local AFB was a bit more help, but again, one says yes and the other says no.

 

We are waiting to see what happens. I pray that the idea of his parents getting PO'ed at him is enough to prevent it. 

 

Kris

[Bluegoat]

Not so true when one lives along the border.  There are quite a few Canadians who come across where I grew up.  It's definitely tougher when one lives farther away and has to factor in major travel expenses.

 

But then again... it's a wealthier section of Canada next to the border where I grew up (St Lawrence River area), so sort of true I suppose.

 

Well, people are more likely to go if it's easier, but the total numbers of Canadians that get care in the US are really very low, and the vast majority of them are people getting emergency care when they are visiting for some other reason. 

 

And we also get Americans coming here for care, so it balances out to a large degree.  And in both instances, sometimes it has nothing to do with wait times, or cost, but the person is going to a place with special expertise.

[Pam in CT]

For those interested in what various health care solutions look like in across nations, a few years ago TR Reid wrote a really terrific not-at-all-polemic book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care  that compares systems across France, the UK, Germany, Japan and several others.  It definitely includes hybrid models with "top-off" private insurance above a baseline level of coverage for all, though I don't recall anything quite like what I understand "cost-sharing" to be.

 

Another interesting health care read is President Obama's recent article about ACA in JAMA, in which he takes a (to my mind at least) pretty sober look at what it's accomplished, what problems with it have emerged (including exactly the issue that since has arisen with BCBS), and what are the challenges ahead (including his belief that over time, some evolution of some "public option" along the lines of opt-in to Medicare is warranted).

[Lanny]

Big rate increases for 2017, in TN, IL, KY and GA.