Thursday, September 10, 2009

Improved Health Insurance Reform Flowchart

Several commenters have helped me find more accurate statistics on the number of Americans with employer-provided insurance, as well as on the income of those who have individual insurance. Below is an updated flowchart that illustrates how many of the currently uninsured will end up with Medicaid, subsidized individual insurance, or unsubsidized individual insurance; how many people will end up using the Public Option; and what exactly those "new consumer protections" will accomplish. Update: to clarify, this covers something like the Rockefeller bill or the Baucus Bill. Something like HR 3200 or the Senate HELP Bill, both of which which provide subsidies up to 400% of poverty and Medicaid up to 150 or 167% of poverty, would make those portions of the chart bigger and the unsubsidized portion smaller. This is not a sign that I hate HR 3200; it is just much easier to find statistics on the insurance coverage of those making 300% of the poverty line than it is for 400% of the poverty line.

Click the image for a larger version:



I made this flowchart to drive two points home:
  • A tremendous amount of the shouting has tried to convince people that this is "too complicated" and so we should throw up our hands and give up. But for most Americans, figuring out "what does health insurance reform mean for me" requires answer three questions -- "do I currently have government-provided health care?", "do I currently have employer-provided health insurance?", and "how much money does my family earn". That's it! Three questions! That's easier than ordering dinner at T.G.I.Friday's ("What would you like to drink?" "What would you like to eat?" "How would you like it cooked?" "Would you like fries, chips, cole slaw, or a side salad?" See! Four questions!). So the next time Betsy McCaughey shows up with a one-thousand page binder, remember that nine hundred ninety-nine of those pages happen behind the scenes. People who are not employed by health care providers or insurance companies only have to worry about one page.
  • The other point I wanted to drive home is that the Public Option will only affect a small number of people. It's not even available if you have employer-provided insurance. Making regulations 10% more consumer-friendly for 177 million with employer-provided insurance has more overall impact than doubling the size of Public Option enrollment from 12 million to 24 million. Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.
To give folks some context, this is Chris Hayes at Netroots Nation, giving the spiel that kicked off this whole thing:



Finally, i the interests of balance, here is a Republican flowchart from their budget proposal submitted earlier in 2009:


63 comments:

Bruce.McFarling said...
This comment has been removed by the author.
BruceMcF said...

The first point is that there is the problem of political legitimacy. Mandatory entry into a Captive Market without a publicly administered choice is the functional equivalent of Taxation without Representation ... you have neither a choice to opt out nor a say in the running of the system.

The second is that you are assuming a static outcome, rather than a dynamic one. If we establish an individual mandate with government subsidized health insurance premiums restricted to for-profit corporations, those corporations have a strong incentive to get all the people qualifying for the subsidy into the system.

So we are establishing a system where there is a strong mutual self-interest of insurance companies to ramp up the numbers of people who receive the government subsidy to use to choose between available premiums, as well as the strong mutual self-interest in undermining the regulation of policies in those markets.

Provide a publicly administered choice in the exchanges, and the elasticity of demand for corporate health insurance as a whole rises dramatically, and while the interest in gaining increased subsidies remains, the commercial benefit of undermining regulation in the markets is substantially reduced, because policies perceived as junky policies will not sell as well when there is the alternative of a not-as-junky policy seen to be available.

The health insurance companies know this ... that is why they are investing so much in demonizing public choice in the markets that will cover so few, and investing so little in fighting regulatory reforms. Given the right market structures, the experience of the last thirty years is that regulations can be undermined and eventually eliminated over time.

eRobin said...

It's not even available if you have employer-provided insurance.

Does it matter to the chart that small businesses (10 and fewer employees then 25 and fewer employees) are allowed into the exchange?

Mike said...

Nice flowchart! One suggestion:

People scan instead of reading, and when I look at "Employer provided Insurance: yes--->" the first thing I see is scary, bolded words like "Ban, Ban, Cap, Require", so my immediate reaction is not positive.

Instead of explaining what the government is going to do to the insurance companies, you could try rewriting it in terms of how it benefits me. For example:

- Your pre-existing conditions will now be covered
- Your benefits won't have lifetime caps
- Your annual out-of-pocket expenses will be capped
- The insurance company won't be able to cancel your insurance if you get sick (a practice called rescission)
- Men and women will pay the same rates
- Preventive care will be free
- Adult children can stay on their parents' plan
- You decide to when to cancel your insurance plan, not the insurance company

Also it's not clear what the bold labels under the bubbles mean. 64 million what?

Chris Newham said...

I think your chart is a great way to show what's going on with respect to insurance according to the number of people served. My guess is that the next series of objections to "the plan" will be around how it is financed, so a chart that enables us to follow the money wold be a great addition.

Nicholas Beaudrot said...

"Does it matter to the chart that small businesses (10 and fewer employees then 25 and fewer employees) are allowed into the exchange?"

I can't tell from the Kaiser study whether or not "employer-sponsored" is just large employers or it includes small employers. But in general it turns out even most small employers that currently offer insurance are likely to keep it ... it's a good way to attract employees, etc.

anna said...

Those employees who are particularly purpose-driven generally will not be satisfied with pushing the company agenda. They can, however, be motivated by what the company does for the greater good. Choose a charity or three that are meaningful to you and your staff and brainstorm ways to support them. Select your most purpose-driven staff member to head up and organize those drives. Not only will your employees be more motivated to see your business succeed, but you will also make a name for your company as a concerned, responsible citizen in the marketplace.

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r4 card said...

I wish them good luck with this but it seems the GOP scare about the deficit is penetrating so why not this scare tactics. I wish people would educate themselves instead of believing every piece of rhetoric that is repeated many times.

tv vanavond said...

A tremendous amount of the shouting has tried to convince people that this is "too complicated" and so we should throw up our hands and give up.

r4 card said...

I think your chart is a great way to show what's going on with respect to insurance according to the number of people served.

r4 card said...

Those employees who are particularly purpose-driven generally will not be satisfied with pushing the company agenda.

r4 card said...

If we establish an individual mandate with government subsidized health insurance premiums restricted to for-profit corporations, those corporations have a strong incentive to get all the people qualifying for the subsidy into the system.

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I can't tell from the Kaiser study whether or not "employer-sponsored" is just large employers or it includes small employers. B

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If we establish an individual mandate with government subsidized health insurance premiums restricted to for-profit corporations, those corporations have a strong incentive to get all the people qualifying for the subsidy into the system.

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People scan instead of reading, and when I look at "Employer provided Insurance: yes--->" the first thing I see is scary, bolded words like "Ban, Ban, Cap, Require", so my immediate reaction is not positive.

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It is more economical and gives higher coverage for each member of the family. In addition it provides the flexibility that any member can use any proportion of the floater. This is helpful because in most cases one individual gets seriously ill, rather than the entire family.

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They can, however, be motivated by what the company does for the greater good. Choose a charity or three that are meaningful to you and your staff and brainstorm ways to support them.

property rental management said...

The health insurance companies know this ... that is why they are investing so much in demonizing public choice in the markets that will cover so few, and investing so little in fighting regulatory reforms.

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Those employees who are particularly purpose-driven generally will not be satisfied with pushing the company agenda.

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The second is that you are assuming a static outcome, rather than a dynamic one.

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If we establish an individual mandate with government subsidized health insurance premiums restricted to for-profit corporations, those corporations have a strong incentive to get all the people qualifying for the subsidy into the system.

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People scan instead of reading, and when I look at "Employer provided Insurance: yes--->" the first thing I see is scary, bolded words like "Ban, Ban, Cap, Require", so my immediate reaction is not positive.

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Provide a publicly administered choice in the exchanges, and the elasticity of demand for corporate health insurance as a whole rises dramatically.

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So we are establishing a system where there is a strong mutual self-interest of insurance companies to ramp up the numbers of people who receive the government subsidy to use to choose between available premiums, as well as the strong mutual self-interest in undermining the regulation of policies in those markets.

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Several commenters have helped me find more accurate statistics on the number of Americans with employer-provided insurance, as well as on the income of those who have individual insurance.

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Given the right market structures, the experience of the last thirty years is that regulations can be undermined and eventually eliminated over time.

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After Mr. Walberg was announced (by a Chelsea businessman and Beatles tribute band member ["Paul"]), a surreal moment occurred when he suggested the group say the Pledge of Allegiance but then realized there were no flags in the empty building.

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The other point I wanted to drive home is that the Public Option will only affect a small number of people. It's not even available if you have employer-provided insurance.

property management firms said...

So we are establishing a system where there is a strong mutual self-interest of insurance companies to ramp up the numbers of people who receive the government subsidy to use to choose between available premiums, as well as the strong mutual self-interest in undermining the regulation of policies in those markets.

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Given the right market structures, the experience of the last thirty years is that regulations can be undermined and eventually eliminated over time.

seo company india said...

One of the first things that experienced insurance agents look for in a health insurance brochure is the summary or list of "exclusions." Often found in smaller print, "exclusions" are not covered under the plan. Sometimes, what's NOT covered can be just as important as what IS covered.

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Given the right market structures, the experience of the last thirty years is that regulations can be undermined and eventually eliminated over time.

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Mandatory entry into a Captive Market without a publicly administered choice is the functional equivalent of Taxation without Representation.

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People scan instead of reading, and when I look at "Employer provided Insurance: yes--->" the first thing I see is scary, bolded words like "Ban, Ban, Cap, Require", so my immediate reaction is not positive.

Anonymous said...

Several commenters have helped me find more accurate statistics on the number of Americans with employer-provided insurance, as well as on the income of those who have individual insurance.

property management las vegas said...

I think your chart is a great way to show what's going on with respect to insurance according to the number of people served.

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So we are establishing a system where there is a strong mutual self-interest of insurance companies to ramp up the numbers of people who receive the government subsidy to use to choose between available premiums, as well as the strong mutual self-interest in undermining the regulation of policies in those markets.

homeowners association said...

A tremendous amount of the shouting has tried to convince people that this is "too complicated" and so we should throw up our hands and give up.
ryt

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So we are establishing a system where there is a strong mutual self-interest of insurance companies to ramp up the numbers of people who receive the government subsidy to use to choose between available premiums, as well as the strong mutual self-interest in undermining the regulation of policies in those markets.

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The other point I wanted to drive home is that the Public Option will only affect a small number of people. It's not even available if you have employer-provided insurance.

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They can, however, be motivated by what the company does for the greater good. Choose a charity or three that are meaningful to you and your staff and brainstorm ways to support them.

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Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.

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If we establish an individual mandate with government subsidized health insurance premiums restricted to for-profit corporations, those corporations have a strong incentive to get all the people qualifying for the subsidy into the system.

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Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.

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People who are not employed by health care providers or insurance companies only have to worry about one page.

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People scan instead of reading, and when I look at "Employer provided Insurance: yes--->" the first thing I see is scary, bolded words like "Ban, Ban, Cap, Require", so my immediate reaction is not positive.

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Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.

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Instead of explaining what the government is going to do to the insurance companies, you could try rewriting it in terms of how it benefits me.

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Not only will your employees be more motivated to see your business succeed, but you will also make a name for your company as a concerned, responsible citizen in the marketplace.

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Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.

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