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You are here: Home / Anderson On Health Insurance / Preference Sensitive surgeries and ACA uncertainty

Preference Sensitive surgeries and ACA uncertainty

by David Anderson|  February 1, 201711:00 am| 5 Comments

This post is in: Anderson On Health Insurance

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Traditionally, the end of the benefit year will see a significant shift in the composition of surgeries. The shift is in who is getting the surgery done and what type of work is being done. More people who have already maxed out their deductible will attempt to have surgery to take care of a problem that they could deal with and have dealt with for years before the deductible and out of pocket limits reset at the start of the new benefit year. This makes sense. Once the out of pocket maximum is reached, the marginal out of pocket cost to an individual for a narrow window of time is zero instead of thousands of dollars if they wait a month or two later.

This is why trying to get an appointment for elective care in December is so tough if you’re calling in November.

Let’s use this logic to riff on what Charles Gaba is pointing out:

Yup. Related: If people load up on pricey treatments/procedures *this* year, further hurts risk pool for rate determination *next* year. https://t.co/QpBgJiMEnZ

— ☪️Charles Gaba ☪️ (@charles_gaba) February 1, 2017

Teasing out the nuance here, Charles is working towards a model where people who have issues this year that they’ve been able to deal with for a while decide that due to uncertainty about the future, they’ll decide that they’ll schedule everything as early as possible in case the market blows up due to Republican sabotage.

If there is no sabotage, then there will be a rate bump as utilization would be higher than the actuaries projected last May. If there is sabotage and intentionally caused death spiraling, people will have gotten the care that they needed.

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Reader Interactions

5Comments

  1. 1.

    MomSense

    February 1, 2017 at 11:10 am

    Everyone I know who is an ACA insurance holder is talking about doing all the things (not necessarily surgery) and trying to get as healthy as possible now while they still have coverage.

  2. 2.

    seejanerun

    February 1, 2017 at 12:43 pm

    I’m on Medicare plus employer insurance. Had my annual physical on Monday and my doc encouraged me to get going on anything I want done, because we don’t know what’s going to happen.

  3. 3.

    martian

    February 1, 2017 at 12:58 pm

    The way he says “load up on pricey treatments/procedures” really rankles. Like it’s frivolous somehow as opposed to people getting needed healthcare.

    And I freely admit I might be a little thin skinned about this since I spent the end of last year frantically trying to make sure my child got in to see all of her specialists and am now figuring out how to get my own deferred problems handled by my specialists before healthpocalypse hits. There’s so much fear, and need, and so many hard choices packed up in those little words “load up”. It makes it sound like so many people are trying to belly up to the buffet before it closes that the restaurant is losing money and will soon be forced to charge for soda refills. Eh, I’m sure he meant it harmlessly, and it’s the limits of twitting. Obviously, it’s an important issue to discuss.

    Depressing to think of an unexpectedly high rate bump as being the best likely outcome we can hope for. We’re swamped already. Fingers crossed!

  4. 4.

    ruckus

    February 1, 2017 at 1:18 pm

    @martian:
    You and I read this the same way. Maybe David could clarify if he knows which way the wind blows.

  5. 5.

    martian

    February 1, 2017 at 1:47 pm

    @ruckus: Glad it’s not just me! I feel so hair trigger lately, I have to question myself.

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