• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓
  • ←
  • →

Balloon Juice

Come for the politics, stay for the snark.

Come on, man.

The press swings at every pitch, we don’t have to.

Republicans choose power over democracy, every day.

Anne Laurie is a fucking hero in so many ways. ~ Betty Cracker

You come for women, you’re gonna get your ass kicked.

The willow is too close to the house.

Whatever happens next week, the fight doesn’t end.

One of our two political parties is a cult whose leader admires Vladimir Putin.

Not all heroes wear capes.

Bark louder, little dog.

Their freedom requires your slavery.

🎶 Those boots were made for mockin’ 🎵

Perhaps you mistook them for somebody who gives a damn.

If you don’t believe freedom is for everybody, then the thing you love isn’t freedom, it is privilege.

When you’re a Republican, they let you do it.

Books are my comfort food!

Many life forms that would benefit from greater intelligence, sadly, do not have it.

Fuck these fucking interesting times.

Let me eat cake. The rest of you could stand to lose some weight, frankly.

Tick tock motherfuckers!

Compromise? There is no middle ground between a firefighter and an arsonist.

Oh FFS you might as well trust a 6-year-old with a flamethrower.

Trump should be leading, not lying.

The cruelty is the point; the law be damned.

Mobile Menu

  • Seattle Meet-up Post
  • 2025 Activism
  • Targeted Political Fundraising
  • Donate with Venmo, Zelle & PayPal
  • Site Feedback
  • War in Ukraine
  • Submit Photos to On the Road
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • COVID-19
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • 2025 Activism
  • Garden Chats
  • On The Road
  • Targeted Fundraising!
You are here: Home / Anderson On Health Insurance / EHB and cost spreading

EHB and cost spreading

by David Anderson|  March 21, 20176:12 am| 11 Comments

This post is in: Anderson On Health Insurance

FacebookTweetEmail

Milliman has a good paper on the actuarial impacts of Essential Health Benefits(EHB) with actual pricing attached to some of the benefits. Every health plan in 2017 that is offered on Healthcare.gov pays at least 89% of their claims dollars for EHB. The overwhelming majority pay more than 99% of their claims dollars to EHB.

First, here is a good illustration of the relative importance of each category of benefit:

New @millimanhealth paper: “Are essential health benefits here to stay?” https://t.co/KRjuEbZGUx pic.twitter.com/9tOKRQKLVW

— Paul Houchens (@PaulHouchens) March 20, 2017

As you can see, doctor visits (ambulatory patient services), hospitals, presriptions, labs and phyical rehab make up the overwhelming majority of the spending on EHBs. There is not a lot of fat in there unless we allow people to buy “not cancer” policies with specific, high cost disease exclusions. Now let’s look at one of the vulnerable EHB, maternity care:

Rolling maternity benefits up into the standard benefit package raises everyone’s rates by the price of a single entree at Olive Garden every month. Splitting the benefit out as an optional benefit makes men better off and concentrates all of the pain on women either through higher premiums and or higher out of pocket limits. The reasonable second order effect is that Medicaid will take on a lot more births that it covers.

There is only money in the EHB’s and the main EHB’s are fairly well protected in my opinion. So the EHB’s that are not well protected (maternity, mental health, child dental/vision) just don’t have a lot of money attached to them.

FacebookTweetEmail
Previous Post: « Tuesday Morning Open Thread: You Repubs Think You’re Sick of This Crap?
Next Post: Still not understanding Oscar’s business model »

Reader Interactions

11Comments

  1. 1.

    rikyrah

    March 21, 2017 at 7:28 am

    Maternity, MENTAL HEALTH, child dental/vision…

    Sigh….

    Thanks for the info Mayhew.

    PS- are you going to do a post on the proposed changes to Trumpcare?

  2. 2.

    WereBear

    March 21, 2017 at 7:53 am

    Just look at the YOOOOOGE chunk that is prescription medicines. What a ripoff; when you consider that most of the research is done at taxpayer expense.

  3. 3.

    Mike J

    March 21, 2017 at 8:45 am

    @rikyrah: I’ve only skimmed, biggest thing I saw was drug testing poor people. Almost certainly the result will be millions spent to discover 20 or 30 people from whom they can strip healthcare.

    Oh, they moved the tax cuts for the rich up too, so they take effect sooner. Probably more in there, but I’ll wait for the people who have to read it to do so and save my beautiful mind.

  4. 4.

    gvg

    March 21, 2017 at 8:50 am

    I fail to see how splitting maternity out benefits all men. It only benefits single men who never intend to reproduce, possibly gay men. Dads have to pay for births too, willingly or unwillingly (lawsuits and garnished wages). It’s actually a complaint if a dad discovers “his” child’s birth costs aren’t covered. Many men consider insurance coverage when choosing employers if they can, and care deeply when it has poor coverage. Once they are married, they look at family coverage, not just themselves. some families get their coverage through a wife’s policy, and a spouse is still going to consider it poor insurance if it doesn’t cover maternity. If they have to pay out of pocket, men consider themselves hurt. In other words, more insurance than not is for a whole family. Next the republicans “thinkers” will try to eliminate coverage of childhood shots because “men” don’t need them, ignoring a whole bunch of similar issues. Most of the lawmakers are married. How can they not know this? It’s like they think being petty to women is exciting to their voters which currently does seem to be the case for reasons I don’t get. and of course they just don’t understand how insurance works or even what it is.

  5. 5.

    dr. bloor

    March 21, 2017 at 9:05 am

    Rolling maternity benefits up into the standard benefit package raises everyone’s rates by the price of a single entree at Olive Garden every month.

    This needs to be re-worked. If you tell those assholes that some brown woman’s maternity benefits are costing them a trip to Cholesterol Garden, they’ll freak. Maybe something like “…by the price of a coastal elite’s Cosmopolitan at the Union Square Cafe.”

  6. 6.

    Barbara

    March 21, 2017 at 9:57 am

    I am still scratching my head at the notion that men have nothing to do with women becoming pregnant and are completely indifferent to the health of their own offspring. Rather than this being binary to women and men, in reality, it is binary to all people over a certain age — let’s say 50 — who are done with procreating. Yet those people depend on younger people with reproductive potential to keep their own vastly higher costs of utilization down (through risk sharing). But of course, in the world where people are competing to see who they can get away with throwing overboard, women and children are usually the first ones in the water. It’s virtually tribal.

  7. 7.

    MomSense

    March 21, 2017 at 10:12 am

    @Barbara:

    Isn’t there a value to society to have healthy women and babies? I just can’t wrap my head around the level of selfishness these Repubs have that they resent maternal/fetal health. I bet a bunch of these greedy pigs are opposed to reproductive health and choice, too.

    Selfishness and greed are not good governing principles.

Comments are closed.

Trackbacks

  1. Eliminating essential health insurance benefits is a lousy idea that won't save money. Here's why. | The LAX Report says:
    March 22, 2017 at 3:49 pm

    […] David Anderson of Duke points us to a recent… […]

  2. Eliminating essential health insurance benefits is a stupid idea that won’t save money. Here’s why. – Today's Headline says:
    March 22, 2017 at 11:27 pm

    […] David Anderson of Duke points us to a recent paper by Milliman, the preeminent cost-analysis firm in healthcare, about how much these essential benefits actually add to the cost of health insurance and the consequences of removing the mandates. The paper finds that eliminating the most vulnerable mandates, such as maternity care, will reduce average premiums somewhat but drive costs for people who need those services sky-high and transfer much of the cost to other public programs. The net gain for society is almost invisible. To put it another way, the savings are an illusion. In fact, eliminating the mandates might even cost the federal government more money. […]

  3. Eliminating essential health insurance benefits is a stupid idea that won't save money. Here's why. | The LAX Report says:
    March 23, 2017 at 10:47 am

    […] David Anderson of Duke points us to a recent paper… […]

  4. Eliminating essential health insurance benefits is a stupid idea that won’t save money. Here’s why. – Live List says:
    March 23, 2017 at 12:09 pm

    […] David Anderson of Duke points us to a recent… […]

Primary Sidebar

Image by HinTN (5/22/25)

Recent Comments

  • Gloria DryGarden on Thursday Evening Open Thread (May 23, 2025 @ 1:06am)
  • Melancholy Jaques on Thursday Evening Open Thread (May 23, 2025 @ 1:06am)
  • Gloria DryGarden on War for Ukraine Day 1,183: A Quick Thursday Night Update (May 23, 2025 @ 1:03am)
  • prostratedragon on Thursday Evening Open Thread (May 23, 2025 @ 12:54am)
  • wjca on War for Ukraine Day 1,183: A Quick Thursday Night Update (May 23, 2025 @ 12:46am)

PA Supreme Court At Risk

Donate

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year
View by Past Author

Featuring

Medium Cool
Artists in Our Midst
Authors in Our Midst
War in Ukraine
Donate to Razom for Ukraine

🎈Keep Balloon Juice Ad Free

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal

Meetups

Upcoming Ohio Meetup May 17
5/11 Post about the May 17 Ohio Meetup

Calling All Jackals

Site Feedback
Nominate a Rotating Tag
Submit Photos to On the Road
Balloon Juice Anniversary (All Links)
Balloon Juice Anniversary (All Posts)
Fix Nyms with Apostrophes

Hands Off! – Denver, San Diego & Austin

Social Media

Balloon Juice
WaterGirl
TaMara
John Cole
DougJ (aka NYT Pitchbot)
Betty Cracker
Tom Levenson
David Anderson
Major Major Major Major
DougJ NYT Pitchbot
mistermix

Keeping Track

Legal Challenges (Lawfare)
Republicans Fleeing Town Halls (TPM)
21 Letters (to Borrow or Steal)
Search Donations from a Brand

PA Supreme Court At Risk

Donate

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • YouTube
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2025 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc

Share this ArticleLike this article? Email it to a friend!

Email sent!