Hacker News Reader

Comment by Bsharp | Hacker News Reader

> "The first month of the new health law’s rollout reveals an unexpected pattern in several states: a crush of people applying for an expansion of Medicaid and a trickle of sign-ups for private insurance. This early imbalance — in some places nine out of 10 enrollees are in Medicaid — has taken some experts by surprise. The Affordable Care Act, which expanded Medicaid to cover millions of the poorest Americans who couldn’t otherwise afford coverage, envisions a more even split with an expanded, robust private market..."

So you're telling me that more people who are getting free benefits showed up to the party than people who have to pay significant annual premiums? Shocking. I think they need new "experts".

View on HN

I think what they are referring to is the impact of the individual mandate. Sure you'd expect people to rush into the free option, but everyone who is uninsured and doesn't qualify for Medicaid will have have to pay a penalty if they don't buy insurance.

Sure, but what's the hurry? If you don't really want to buy insurance but are doing it to avoid the penalty, you might as well wait until the deadline is closer.

Definitely. However the concern here is that people ignore the individual mandate's penalty. Precisely nobody wants that, and the hope was that the ease of signing up and looking for insurance via exchanges would provide a carrot or at least a smooth road to go along with the stick of the penalty. Whoopfail.

The carrot isn't really in play either, yet, since there's no advantage to signing up before December. Coverage starts at the same date either way, so why bother now?

Pay 1.0-2.5% tax penalty for not having Insurance

Pay 10-15% of your pre-tax income for a plan under Obamacare

I don't think it's going to work out that great.

It depends on your expected medical costs. If you're relatively young and healthy, saving that 9-12.5% of your income is worth it. If you're sick/old/etc., then it's absolutely worth buying coverage. Note that in this system the healthy don't join the risk pool.

This, my friend, is called adverse selection.

The goalposts have already been moved to March 31st, 2014 and could be delayed further. What's the rush?

Adverse selection death spiral (https://www.google.com/search?q=obamacare+Adverse+selection+...), and moving the goalposts too far forward means insurance companies, which have to submit 2015 plans in the January through March (as I recall; maybe April) period will have very poor data to do that with, very possibly resulting in higher than needed costs.

And while I don't think you were addressing this, millions will lose their now outlawed plans on January 1.

And while I don't think you were addressing this, millions will lose their now outlawed plans on January 1.

I see this as a huge impending disaster that could turn public sentiment against ACA to the point that it does get repealed. If people get their old plans cancelled and it is very difficult to use healthcare.gov to sign up for a new plan, a lot of people are going to be left in the lurch.

Unfortunately the horse is already out of the barn and into the next county. Maybe by a stroke of luck healthcare.gov will be functioning smoothly at the end of November like Obama and company have said it would. But I'd be willing to bet this will not be the case, given all the problems that project has to deal with.

Even if a massive effort were put underway to stand up call centers so people could navigate the healthcare exchanges over the phone, it would still need to be administered via a computer system, there's little chance a wide-scale paper process could be put in place quickly at this point.

Shock and awe, anyone?

On the one hand it's around 5% of the population, and unless you need subsidies, you can get policies directly from the insurers, and there are private comparison shopping sites.

On the other hand, most will have to pay more money, often a LOT more, often for worse coverage in ways they most care about, and this small fraction of the population includes some of the most influential. Maybe ... the rules of that seem to be changing, this could in fact be a good test of the recent Angelo Codevilla et. al. modern US ruling and country classes thesis.

Of course people will enroll eventually, but the first ones will be the ones with the most to gain. It isn't guaranteed that individuals won't eat the penalty and enroll when they need it, but you can guarantee that people who benefit with little or no cost to them will be want their benefits ASAP.

My point was mostly that if their "experts" can't think critically about the incentive system the program creates, what else will they be surprised about? Adverse selection? Insurer bankruptcy and industry consolidation?

Reply on news.ycombinator.com