- Tax credits are pegged to income, so that people pay only a certain percentage of their income for their premiums, while the federal government pays the rest. That means people who benefit from cost-sharing reductions today will get bigger federal tax credits to pay for their monthly insurance costs, once those subsidies end.
“We think the federal government might end up paying more,” said Chet Burrell, president of CareFirst BlueCross BlueShield. “We’re already getting word from other analyses that this could increase federal outflows.”
The nonpartisan Congressional Budget Office forecast that ending cost-sharing reductions would increase the federal deficit by $194 billion over a decade, because the tax credit amounts would increase and because more people would receive them. The Kaiser Family Foundation found that premium tax credits would cost an additional $12.3 billion if cost-sharing reductions end next year.
What's that? You want to hear an awesome insurance story? So my wife's birth center takes medicaid. It's also contracted with more than a dozen different insurance companies that aren't medicaid. Which is adminstered by private insurance companies - the only difference between "single payer" and "that which you understand" is that the seven or so other companies that are under contract with medicaid have prices that are negotiated by the state, rather than "who run Bartertown" insurance companies. So the price we get for the facility with the Medicaid companies is like $1300. The price we get from the other insurance companies is anywhere between $650 and $2800. Like, I know, right? And obviously, we can't say "yeah, we know you have insurance but it sucks so we're not going to accept it." Except we can. Funny story. Company A pays out at $2800. Company B pays out at $650. And a little bird told us that Company B has a reciprocity agreement with Company A whereby providers that were not contracted by Company B but were contracted out by Company A would be reimbursed by Company B under Company A's plan. More simply: If we decide to take A but not B, and you have B, you get to come see us. A pays us. B pays A the difference. So it doesn't matter that B "negotiated" a rate of $650. All we have to do is tell B to piss up a rope. All of B's customers are still able to use their insurance to come see us. At A's rate. Since B and A have a fare-sharing arrangement to improve their collective bargaining, B and A are basically inviting every provider they have to figure out which one of them pays out better and then drop the other. B and A, in an effort to improve their profitability, have effectively increased the facility fee by 250% to us, but only if we're as cut-throat and evil as they are. I don't know how much you interact with insurance companies. I think it's fair to say that they employ dispirited morons that can't find a better living. Once you get up to the top, things are different - those guys are making real money. But the battlefield claims adjusters and benefits managers? They're fucking stupid. And mean. And stupid and mean. And their stupid meanness is expensive. Single payer means that the smart people get to collude, not the stupid ones. And they know it.
Everybody who works fighting insurance companies, who stops and looks at what a single payer system is, wants to work in a single payer system. Insurance companies are death panels that try to suck every last drop of blood out of the corpse while the heart still beats. You forgot evil. Stupid, mean and evil. They may not start vile and terrible people, but after a few months they all end up in the same place. But the battlefield claims adjusters and benefits managers? They're fucking stupid. And mean. And stupid and mean. And their stupid meanness is expensive.
We recently discovered that we've lost our Waste Management rep. He was friendly, knowledgeable and accommodating. He has since been replaced by a kid who called my wife up in fear of losing his job because he didn't know he wasn't supposed to give her an OSHA training manual. He was supposed to charge her $40 a month to look at it. I surmised that the friendly, knowledgeable and accommodating rep took a look around himself one day and said "self, you are the only friendly, knowledgeable and accommodating person in your entire chain of command" and fucked off somewhere he wasn't alone. I surmise this because it was my experience in working with government employees - enjoy the clever, friendly ones while you can because they will eventually determine that it's no fun being alone. The ones that don't leave? They acclimatize to the prevailing environment and if they weren't stupid, mean and evil to begin with, peer pressure transforms them over time. An insurance company is an organization whose success depends on monetizing that which our society believes should be freely available to everyone. They are figuratively in the position of renting life preservers to drowning swimmers. I sincerely believe that anyone self-aware, anyone empathetic or anyone with altruistic tendencies self-selects out of that industry over time... either that, or loses their humanity.
I surmised that the friendly, knowledgeable and accommodating rep took a look around himself one day and said "self, you are the only friendly, knowledgeable and accommodating person in your entire chain of command" and fucked off somewhere he wasn't alone.
this encapsulates why the private sector is soooo much better at doing most things. As someone that has interfaced with govt in the past on a business level, I was appalled at their lack of knowledge, willingness to care about things like.... revenue and profitability. The old adage people that can, do. People that can't teach. Should be, people that can, do. People that can't... work pushing paper in govt jobs
I think based on what you know about me, how much I've dealt with insurance companies should be apparent. Not like you have but still. Here's a funny insurance story. So Georgia has a community mental health infrastructure which is pretty goddamn surprising since the Republicans have controlled the state for like 30 years and they're allergic to helping the less fortunate. Anyway. I went to one of these places for a long time and I like it because it's a one-stop for therapy, psychiatry and medicine. So when I got insurance I decided to go back and assumed they'd like to have me since presumably they'd now be paid for their efforts. So I'm about done with the intake assessment with a counselor who I know when the financial lady comes in and says that they're out of network so if I finish the assessment I owe them $350. Because I have insurance. If I was uninsured it'd be free. I have a very deep loathing for insurance and even hospitals.
I've mentioned before that there are four or five companies we contract with that literally pay worse than medicaid. B, for example. And yeah - people come in and ask what it's going to cost, and we have to do the calc and tell them. Georgia probably pays what it pays because everybody who takes Medicaid in Georgia banded together and said "so... here's what facilities like ours make in Alabama, Mississippi, Florida, South Carolina, Louisiana, Virginia, Tennessee and Kentucky. If you'd like us to keep taking Medicaid, fuckin' hop to, squire." Meanwhile, your insurance offered a contract to that hospital that said "we'll pay you back 30% of what it costs on some stuff and 110% on other stuff and the rest of it fuck off, take it or leave it." But even that doesn't effect what you pay. What you pay is fuck you because fuck you. And by the way, fuck you.
It all sounds so grossly parasitic and rentier-prone. But the grooves of the system are so well-worn that a more efficient or sensible system is all but unimaginable.