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ACA Exchange Premiums Going Up; Shoppers and South Dakotans Can Save

As the federal health insurance exchange launches its open enrollment period, the New York Times reports that the private insurers participating in the exchange may be jacking up their rates by as much as 20%. Policyholders wanting to keep their premiums down will have spend their valuable time shopping around, comparing deductibles, benefits, and provider networks. And this differs from the pre-Affordable Care Act system how?

NYT's Upshot finds one important difference—lower premium increases than pre-ACA averages:

That competitive pressure appears to be working in most markets, andparticularly in large cities. Over all, we found that if you compared the cheapest plan in the most popular category from 2014 with the cheapest plan in that same category for 2015, the price rose modestly, by 3.4 percent.For comparison, price increases in the individual market before the Affordable Care Act were in the neighborhood of 10 percent a year, and premiums for employer plans grew by 3 percent last year.

But people who just stay in the plan that was cheapest — and most popular — in 2014 are looking at much bigger increases. The average rate increase for those plans across the country is 9.7 percent [Margot Sanger-Katz and Amanda Cox, "Why Shopping Is So Important in Health Enrollment," New York Times: The Upshot, 2014.11.14].

You shop, you save. You cruise, you lose.

Competition matters: NYT finds the premium hikes are sharpest in places with fewer insurers participating in the exchange. Ah, competition—how much nicer it would be if the federal government would add some competition to the program by implementing the public option of Medicare for Everyone. Yes, Medicare, solid, reliable insurance with the least overhead and coverage pretty much everywhere—why aren't we enhancing the competition we already see working under the ACA?

Gallup finds another important difference between policies on the exchange and other insurance. In a survey conducted over the last three weeks, Gallup finds that folks who bought policies through the exchanges are about as satisfied with their insurance as folks who get coverage elsewhere, but exchange participants are more satisfied with the cost of their policies. I assume Gallup will survey that satisfaction again after this open enrollment period.

Premiums aren't going up everywhere. Most South Dakota counties will see cheaper plans on the exchange. According to this NYT interactive map, the cheapest silver plans out in West River will cost $46 less per month, a 15.2% drop. A slaunchwise tier of East River counties from Sully to Yankton will see a $31 decrease, down 10.9%. The rest of East River sees the lowest premium stay about the same or creep up a two to five bucks. South Dakota has the same three providers this year: Avera, Sanford, and Dakotacare.


  1. John Hess 2014.11.15

    There are better prices now on the exchange. My Wellpoint BCBS policy (not on the exchange) is going up. They said last year and again in July they would put their policies on the exchange (which is necessary to get the subsidy) but for a second year decided not to for SD and IA. They said they wanted to make sure all the bugs were out of the system but CoOportunity who offers insurance in IA isn't buying that: "Now that the website has been totally fixed and no one is having trouble signing up ... that is not why they are doing this," Gold said. "They have denied consistently that what they are trying to do is push bad risk into the exchanges, but that rings pretty hollow right now."

  2. jerry 2014.11.15

    What is going to happen to BCBS is that the market will dictate what direction they will take. They have high prices, then the market will direct the policy holders in other directions. BCBS has pooped in their nests before and looks like it is gonna get pretty stinky for their arrogance and manipulation. Savvy policy holders will and should look to alternatives.

  3. Jenny 2014.11.15

    Anyway you want to work it Cory, we all know that cost controls should have been the number one priority with the ACA.
    Having said that, I do like a lot of things in the ACA in spite of big business winning again. The CEOs will continue to get their grossly overpaid salaries and bonuses. The GOP certainly wouldn't have reined in greed and costs much either. Business as usual.

  4. John Hess 2014.11.15

    Hopefully you're right Jerry unless their competitors are forced out of the market by excessive risk. Why does the government force use of the exchange to get the subsidy? I suspect they are protecting their own little nibble.

  5. caheidelberger Post author | 2014.11.15

    John, if I may ask, is your BCBS policy still offering you better coverage than the policies than the exchange participants?

    Jenny, I agree we have much work left to do. I won't be satisfied until we go full Canada. All of our moving around this year has convinced me that we need a national system so that folks can move around and not go through insurance rigamarole. Weiland's Medicare-as-public-option plan is a great step in that direction.

  6. leslie 2014.11.15

    yep, we lost big this election. i guess we have to just sit back, tighten our seatbelts and let the repubs entertain with brilliant idiocy. my current fav- "not my circus, not my monkey"

  7. John Hess 2014.11.15

    Comparisons are not exactly apples to apples, but no. The Avera policy is much cheaper, like $50 a month, and that's before the subsidy. The thing is BCBS allows use of their contracted provider network all across the country. That's a big benny. A person should be able to get back on a BCBS plan later unless the Republicans get their way. Once again they are scaring people and their health care.

  8. Anne Beal 2014.11.15

    Avera was the cheapest but only has facilities in the eastern half of the state, hence west river residents were really pushing the physician choice measure. When I saw the ad of the d woman in Hot Springs complaining how she had to drive to Sioux Falls for medical care I figured out that's what happened: she signed up for Avera insurance without checking to see where they were located. Passage of IM 17 may well drive up Avera's cost, so the increase may well be coming.
    Also, the ACA very deliberately restricted subsidies to the state-run exchanges only, it was not an oversight or mistake. It the SCOTUS does their job they will rule that the law, as written, passed, and signed, says what it says and any revision will have to go back through the proper legislative process, Where it will die in a Republican-controlled Congress. So, while passage of IM 17 means west river residents will be able to use their Avera insurance close to home, nothing stops Avera from raising their rates. And the SCOTUS will likely eliminate any subsidies.

  9. John Hess 2014.11.15

    That would be a nightmare.

    From the Atlantic: Would Roberts, the court's swing vote in its first landmark ruling on Obamacare, join a decision gutting it just two-and-a-half years later? It's hard to see, but there's enough of a chance to worry supporters of the law. Nicholas Bagley, a professor at the University of Michigan Law School writing at the healthcare blog, the Incidental Economist, argued on Friday that the court's decision to hear the case was an ominous sign for Obamacare. The move, he wrote, "substantially increases the odds that the government will lose this case."

    Sounded to me like the subsidy could affect the mandate.

  10. bearcreekbat 2014.11.15

    "And the SCOTUS will likely eliminate any subsidies."

    If you are right Ms. Beal, that SCOTUS decision would only adversely affect the people living in brilliant red states like SD that refused to establish a state exchange. In such a case, South Dakotans who would otherwise be eligible for a subsidy (along with the 40,000 people who would have had coverage through the Medicaid expansion in SD) need to thank our state conservative leaders for eliminating those financial benefits.

  11. John Hess 2014.11.15

    The Daily Caller, so consider the source, said insurance companies are concerned enough about the ruling so they are writing their new policies so they can be terminated if the subsidies are terminated.

    The uncertainty is not a good thing.

  12. mike from iowa 2014.11.15

    The wingnuts did everything they could contrive to get Clinton to commit a crime so they could impeach him. Wingnuts have tried everything they could contrive to destroy the ACA to deny the Black guy in the White House his rightful legacy. Wingnuts will do everything they can contrive to keep Obama's legacy brief.

  13. Jana 2014.11.15

    John, the GOP is creating uncertainty that is hurting business and the economy...that should bother them.

  14. leslie 2014.11.15

    gee ann beal any more roses you'd like to spread? is that fox talking? I have heard your position is a fairly strained legal analysis that shouldn't have a real chance. call the purchaser stupid too for choosing one of two alternative SD providers in Medicaid free expansion SD, cause its cheaper and likely not able to afford anything, or just catastrophic care. who provides yours?

  15. John Hess 2014.11.15

    It took 4 supreme court justices to agree to review the case which they say may indicate they think an error was made by the lower court. With the numerous reckless things Gruber has said and been publicized it would now be politically easier for Roberts to decide against the law. Yes, Ann expresses the conservative take, but from different sources I've read the outcome is pretty darn iffy. No ruling expected till June.

  16. leslie 2014.11.15

    mfi-couldn't agree more. the entire GOP strategy. idiots

  17. jerry 2014.11.15

    @John Hess, "Why does the government force use of the exchange to get the subsidy?"

    The insurance companies that wanted to be in the Marketplace had to give notice to the government on what their price structure would be and what plans they would be offering. The three that were in it last year were Avera, Dakotacare and Sanford with a total of some 40 different plans to choose from. In some cases Avera was less and some Sanford was so that was where the choices came from. In order for the subsidy to be administrated, whatever plan that the customer choose, the subsidy was automatically configured and the premium was displayed. That was really the only way to do it with both the subscriber and the insurance company's input.

    " I suspect they are protecting their own little nibble." All insurance companies that operate in the State of South Dakota have a buffer that they operate on that are called fees that are embedded in each of the offerings, both the Marketplace as well as companies like Wellmark. What those fees and assessments do is to offset any kind of unsustainable loss occurrence that any of the insurance companies may have due to the fact that there is no underwriting on subscribers both in and out of the Marketplace. What existing policy holders need to do is their due diligence on what will work for them this year. If they want, they can do nothing and stay where they are. As this is now called the Marketplace, shoppers need to check out the products being offered for their best deal. This is not free, so they should be aware of what is out there.

  18. jerry 2014.11.15

    Also, Gruber was really just a guy that worked on Romneycare for Mitt, of which this ACA is based. He can say what he wishes but as far as being the go to guy on this, that is a stretch. If anyone thinks that this was going to be paid for by fairy dust instead of subsidies, they should stop what they are doing and immediately grab their shoulders and pull down. That pop you hear will clear yourself from your nether region and you can catch your breath and think clearly.

  19. jerry 2014.11.15

    Anne Beal, bless your heart girl, you are really really out there. How the Marketplace works for those involved, Avera, Dakotacare and Sanford, is that they must submit their working relationships with providers not only in West River but also in East River with a set of providers that will encompass both areas to pass the requirements of the Marketplace. Now, with two of the companies, Avera and Sanford, they have agreements with Rapid City Regional hospital and also have their own hospitals for enrolles. Dakotacare is an HMO that is doctor/hospital affiliated so that is not an issue either. All three insist as much as possible that you have your goods and services done in state to help control costs. It is not a matter of going to Sioux Falls to get your toe looked at, it is a matter of going to Sioux Falls for a kidney transplant or something like that. They have every right to try to control costs by utilizing those in their network as that makes perfect business sense.

    The new Imitated 17 will be about as effective as what we are presently doing. In other words, it will really do nothing if the willing providers cannot reach a contract agreement with the insurance companies.

  20. caheidelberger Post author | 2014.11.15

    Anne, what complete fantasy. Halbig is GOP postmodernist lying at its best. The ACA was predicated on the idea that all citizens could access the premium subsidies, regardless of the status of the exchange with which they were dealing. The Halbig reading of the ACA is absurd, and would logically lead to rejecting the existence of any tax credits or special rates for capital gains.

    Come join the Democratic Party, Anne. We don't require you to leave your honesty at the door.

  21. jerry 2014.11.15

    Avera is a hospital system that was started with the Presentation Sisters and the Benedictine Sisters. The bottom line will have zero effect on Avera and its future.

  22. John Hess 2014.11.15

    I think you missed my question Jerry. Last year the on line brokers were telling customers the ACA would allow them to sell the ACA compliant policies directly rather than just through the exchanges. They were saying they would be able to provide the proof of coverage or whatever it would take to get the subsidy but it hasn't worked out that way.

    I would not dismiss the possibility this part of the law could be tossed out. Mainstream sources reflect a lot of uncertainty on the outcome. Gruber played a role in the ACA which they will extort for maximum benefit. He didn't say anything that doesn't happen all the time but was so stupid to do so.

  23. jerry 2014.11.15

    Wellmark Blue Cross and Blue Shield can be sold through on line brokers and those plans are ACA compliant, but they do not qualify for a subsidy.

    All new plans, all of the major medical plans from all of the insurance companies, are ACA compliant. The only ones that you can get a subsidy on are through the Marketplace.

    What exactly could get thrown out in your mind that would not change the whole dynamics of the ACA in the all regards?

  24. John Hess 2014.11.15

    If a person buys an ACA compliant policy they only get the subsidy if they bought it at the Marketplace. Why?

    Why are we being forced to go to the Markeplace to get the subsidy even though an ACA compliant policy can be purchased elsewhere. It doesn't make sense.

  25. jerry 2014.11.15

    Here is why Mr. Hess. The IRS dictates what your subsidy shall be as you are declaring what your income is to qualify for the subsidy. The IRS verifies that it is consistent with your last years earnings and this is how it is determined what your subsidy shall be and also, if you get a subsidy at all.

  26. Les 2014.11.15

    """"Here is why Mr. Hess. The IRS dictates what your subsidy shall be as you are declaring what your income is to qualify for the subsidy. The IRS verifies that it is consistent with your last years earnings and this is how it is determined what your subsidy shall be and also, if you get a subsidy at all."""". That is a crock. If true, it is even a bigger crock. A social on any applicant can determine eligibility with or without a marketplace.

  27. jerry 2014.11.15

    How ya coming Les?

  28. caheidelberger Post author | 2014.11.15

    Les, Jerry has explained the mechanism.

    I will agree that we could use an "Any Willing Insurer" provision. If an insurer is offering a plan that meets the basic terms of the ACA, a person buying that plan should be able to get the premium tax subsidy, whether or not the buyer uses the exchange. Every insurer could issue a proof of insurance and premium just as easily as every employer issues a W-2.

    But the trick might be issuing the subsidy as prepayment directly to the insurer without the involvement of the marketplace. I suspect that's how pretty much everyone on the exchange has done it. Is that the main reason we need to the exchange, to coordinate the proper transfer of federal dollars to private insurers?

  29. caheidelberger Post author | 2014.11.15

    Remember, we could simplify all of this by putting everyone on Medicare.

  30. jerry 2014.11.15

    You are correct Cory. The mechanism to pay the insurance company has to be done in such a way that it does all it can to protect the taxpayer's whose money goes to pay the subsidy.

    In essence, this is really not to different than Medicare and how the bottom line is for that. What surprises me to this day is why business owners are not beating the drum for Medicare for all. Think of the lost time they have to go through each and every year enrolling their employees into a very expensive outlay of capital, not to mention HR departments that continue to shuffle the papers long after the enrollments to get ready for the next years.

  31. Les 2014.11.16

    """""The mechanism to pay the insurance company has to be done in such a way that it does all it can to protect the taxpayer's whose money goes to pay the subsidy."""""""ha ha ha ha, of course, Jer. Protect me. It feels soooo good.

  32. John Hess 2014.11.16

    I am not buying it either Les. Taking the subsidy upfront is optional. They could have developed a system to work with existing private salespeople but they took it over.

  33. John Hess 2014.11.16

    If an individual has bought an ACA compliant policy they have complied with the law and should get their subsidy. No excuses. The aspects of the law are acceptable but not forcing people to buy from the government "Marketplace" which is nothing but a misnomer in this case.

  34. jerry 2014.11.16

    Well Les, I am glad you agree! This is probably one of the few ways in which government actually tries to protect the taxpayer in what they contribute to make this country great! It is always good to see such exuberance on a Sunday Morning, I am sure your pastor or rabbi or imam or priest or hoochie coochie giver will be ecstatic with your happiness and think it is a divine intervention.

  35. jerry 2014.11.16

    Mr. Hess, you said "to work with existing private salespeople" That is exactly what it does. It works with private insurance agents (Fisher/Rounds) along with other private entities that bring the information to the masses of uninsured or poorly insured that have not been able to afford the insurance in the past. Not only did the Democrats hear you Mr. Hess, they and they alone put this forward. There were many involved with building this project and the mandate is really the only thing that makes it run, kind of like your mandatory car insurance.

  36. jerry 2014.11.16

    Mr. Hess, no one is forcing you to buy through the Marketplace. You can call the insurance agents of your dreams and they will trot over to your camp and sell that policy that fits your needs. As I do not know the financial condition of your homestead, I cannot say if you would qualify for a subsidy or not, that is where the Marketplace comes in. You can access it yourself if you would like and navigate it at will with your household information. The freedom to choose if you will. If you do not qualify for a subsidy then your household is doing well enough that you should be able to afford what the Wellmark Blue Cross and Blue Shield is offering or Avera, or Dakotacare or Sanford without a subsidy.

    This ACA was never designed to help the well off pay for their insurance. It was designed to help all find a way to truly protect themselves from catastrophic health costs that can ruin your family for life. If an insurance company leaves the state (many have before the ACA when Janklow was governor) and you are a sick person or your child is sick, you could not get insurance and you lost it all. The ACA put an end to that. By the same token, if you or a family member had something like cancer or high blood pressure, then you could not get insurance because they called it a pre existing condition, the ACA fixed that. Every Republican and Democratic president has worked to get healthcare reform since 1900, this is nothing new.

  37. John Hess 2014.11.16

    I'm well versed on the positives Jerry and would in fact have preferred single payer, but since the law was intended to keep private enterprise then the exchanges, oh I mean Marketplace, have no business selling policies. They could have been a place to review all ACA compliant options but purchases be directed to existing enterprise. That's the overreach and there's no excuse for not giving a subsidy if someone buys a compliant policy. That's forcing use of the exchange. And if the CEO from IA is right that BC has opted out to push high risk policies to competitors, then the system is being played.

  38. jerry 2014.11.16

    Medicare for all is the best and frankly the least expensive way to insure us. The Marketplace does not sell policies. There is no difference between what Sanford provides in the Marketplace and what it provides anyplace else. The plans are identical.

    If you qualify for a subsidy then the only reason you would buy outside of the Marketplace would be your choice. Maybe you do not like Avera, Dakotacare or Sanford whatever the case may be, it is your choice.

    The subsidy is provided through the taxpayer. The taxpayer deserves to know that the money being allocated for the subsidy is not being used in a manner that may not have any kind of repercussion if Bubba buys a new bass boat at Cabella's so that is where the IRS comes into the picture as that safety valve and that is why the need to go through the Marketplace if you want a subsidy.

    I have no idea about why Blue Cross did not get involved in the Marketplace, but I can tell you this. There are no pre existing conditions, so you get what applies, be that sick or soon to be sick. I think the insurance companies are no more to be blamed than are the medical providers if you think the system is played. Remember, the hospitals and providers submit a bill to the insurance companies to honor the contract they signed. If the bill is a hundred grand, the insurance company is obligated to pay it. I also think the healthcare reform should have included doctors and hospitals.

  39. John Hess 2014.11.16

    If a person can go to the exchange, select and enroll in a plan, that's a sale and in direct competition to brokers. The exchange has an edge because if someone goes there you're pulled in to use it. The system asks for a NPR or some such number of your private sales person. Who would know that? So while you're at the exchange most people are likely to use it. And you said the exchange collects fees, or why not call it a commission. Oh, that wouldn't sound right. It wouldn't have taken use of the exchanges to have checks and balances on the subsidies. If the Democrats did write the law to force the states to create their own exchanges or forgo subsidies then that political maneuvering could very well be coming back to bite them and all of us who have been left with lingering uncertainties. You only give Dem speak on all of it which is a shame since you can't do a Gruber if we don't know your last name anyway.

  40. Les 2014.11.16

    """""If you qualify for a subsidy then the only reason you would buy outside of the Marketplace would be your choice. """". Complete and unadulterated BS. Choice of being insured to the degree you have always hoped you would be after years of paying many thousands annually OR choice to accept much less..
    what was it I read? Don't join the ACA or buy insurance and you get a fine and pay all you med costs out of pocket?
    You've got every answer in the book on affordable health Jer, why are there only a few million signed up? Why Is health care still manipulating high costs onto the shoulders of the insured. How many of those first roughly 8 million are even paid up and still on the rolls?
    You really expect anyone to believe, govement is serious about protecting my money? Open your windows and let some light in for a day.

  41. leslie 2014.11.16

    as we debate this 30-70 people annually in sd are or have died because daugaard refuses to expand Medicaid. I don't blame Obama.

  42. jerry 2014.11.16

    By the same token Mr. Hess, a customer can go to Wellmark BC and purchase a policy on line by themselves, with no agent involvement, where is your complaint on that? I guess my advise to anyone who goes on line whether it be with Wellmark or the Marketplace, you should know that you will not get a professional insurance broker to give you advise nor to be there in the event of an issue, so it would be better to have an insurance agent, but you can certainly do it on your own as well.

    The Marketplace does not collect fees Mr. Hess, the insurance companies do, inside the Marketplace or outside the Marketplace. Wellmark collects fees with every policy they sell for an example.

    My name is irrelevant. I choose to use this name. By the power of this blog, I can change it to just about anything, kind of like Prince has done. I am just a feller of the prairie, kind of like a cocklebur under the saddle of some that I make uncomfortable. I have always found this healthcare reform to be interesting and have researched it on my own. I started to read on this in 2002 when Bush was putting the mandatory purchase of drug plans for Medicare recipients. After seeing how that would work and why a mandatory involvement made sense to me as a business model, it followed that it would make sense in the larger scope as well.

    Here is Gruber though as I know you would like to hear from him and his sidekick.

  43. Les 2014.11.16

    I do not blame Obama, rather I blame my party for not being involved and creating something along the lines of single payer, leslie. I blame my party for obfuscating the issues. I blame the Dems for willingly selling their souls to get what Obama wanted, no matter the cost.
    I blame those who have convinced us and continue to convince us how different we are from each other, rather than how similar most of our desires and needs are.

  44. jerry 2014.11.16

    Gosh Les, what happened to that ray of sunshine that had on his happy feet a few short breaths ago? You seem Republican.

    Okay then. bullet point "what was it I read? Don't join the ACA or buy insurance and you get a fine and pay all you med costs out of pocket?"

    If health insurance is affordable, (you can access to check that out), then you must purchase some plan from someone or get a penalty. If it is not affordable or if you fall into the Medicaid Expansion hole, then you will not get a fine and you will just suffer and die perhaps (hence, the death panels).

    Bullet "You've got every answer in the book on affordable health Jer, why are there only a few million signed up?" 1. Several million signed up last year and this year, it is expected some 17 million more will enroll.

    "Why Is health care still manipulating high costs onto the shoulders of the insured." 2. Healthcare costs are driven by what doctors and hospitals charge the insurance companies for services rendered. Keep in mind that 80% of premiums paid to the insurance companies, must go to settle claims incurred.

    "How many of those first roughly 8 million are even paid up and still on the rolls?"3. I do not know the exact number Les, but I have read someplace that it is like 97% of those who have received a subsidy have paid their portion of the premiums. If they do not pay their share, then the insurance company disenrolls them from their coverage and notices the Marketplace. At this point, that subscriber may be assessed a penalty.

    Les, I am an American that actually believes in government. I believed in it so much that I served in her military and left blood in the battlefields of Vietnam. I believe in her so much that I still trust my very life in the good hands of those dedicated doctors, nurses and all who take care of me. I am also keenly aware of what my government has brought to the state of South Dakota in the cold clean water I drink to the singing wires that light my house and provide me with communication. So yeah, Les, I am a believer. Come on over from the dark side and you to can breath the life of a freedom from Fox Cable news. Turn off rush and turn on to your surroundings, be grateful not hateful.

  45. John Hess 2014.11.16

    Besides not being one to complain Wellmark is facilitating its own sale rather than the government handling the transaction. And if that's being done at no cost then it's a further subsidy to support this sales effort that could have been done privately. My concerns remain but the basic aspects of the law are beneficial. Very much so but that's no reason to be blind to the facts.

  46. jerry 2014.11.16

    Mr. Hess, I am not following the logic of this being a cost to the insurance company. I am sure you are aware of the standards that were set by the Janlow administration that are a continuation of the ACA with regards to claims versus premiums paid and that is 80% of premiums collected must go to satisfy claims presented by providers.

    Any private insurance agent can sell in the Marketplace if they have received the training required and if they are appointed by the insurance companies within the Marketplace, they then will be compensated by that insurance company for all sales they make. There are also Navigators that will assist as they have assisted people in the past long before the ACA. As a taxpayer, you have every right to be concerned on how your tax dollars are being used. You are right in this being beneficial and we can all hope that business leaders and others will come to the business and practical decision of making Medicare for all the change we can go much further with at less cost.

  47. 90 schilling 2014.11.16

    Thanks, Jer. You took my place in the Nam and I appreciate it. I was 1A on my way when the lotto came out. My birthdate was drawn at 326 and the guilt for not serving never matched my relief for the lotto win.
    Understand, brushing all the details aside, we both want affordable healthcare for all.

  48. jerry 2014.11.16

    Good link from Larry Kurtz that shows the outlines of who may be eligible and who may not be according to household income.

  49. Les 2014.11.16

    I also believe in America as the greatest country to be alive in Jer. We are not far apart on that regardless how our differences separate us at times.

  50. jerry 2014.11.16

    90 Schilling, there should be no guilt in not serving. Veterans do not see others as anything but fellow citizens. As citizens all, we must pull together to make things even better than what we have seen regarding this life saving program. Les is correct about non involvement from his party, that makes no sense when it is a blueprint of their desires. The absolute ugliness of where we are right now is pure poison to make things work. Any fool can refuse to act in good faith, but for those who choose to see over the hill, that is where the progress will be made. Why we have the political wing of the black robes making more decisions on the law itself, is anarchy that only serves to weaken the fabric of democracy. Is the ACA the answer to all of our woes regarding our healthcare? Absolutely not. It is simply a start that people of good character will better as we go down the road.

  51. Les 2014.11.16

    My anger towards the ACA comes from the fact I now spend about $18k before I get much help beyond co pay and a few meds. It was not long ago that number was under $10k. Complicity at every stop against those of us paying our own way is how I feel.

  52. jerry 2014.11.16

    Les, direct your anger towards the South Dakota department of Insurance. The insurance companies submit requests to defend rate hikes so that is where you should start. Ask yourself what the ACA provides that was not provided before, then you will see what is really going on as there is really only the fact that they cannot drop you and there are no pre-existing conditions. I will tell you this, if my business model depended on not accepting the bitter with the sweet, I would be embarrassed of how I manipulated the system for profit. I would hope that you shop around to see if there is something better for you as that seems quite high. I took at look at what is offered in the Marketplace and those insurances there for my age (older than dirt) are considerably less than what you are saying. Now, if you are older than 65 you should look to Medicare.

  53. Les 2014.11.16

    No doubt. The players, working on commissions based upon premium costs, lobby the legis to continually allow or create increases based on deceit. It is rampant.

  54. jerry 2014.11.16

    The players, in this case, would be the lobbyists for the insurance companies. I am told that agents no longer receive commissions on the amount of the sale, but a simple across the board payment of the signing the customer. So then, if you are paying 18 thousand, I still don't know how that can be Les, and I am paying 1 thousand, the payment to the agent would be the same. As I understand it, they would have no reason whatsoever to direct you into a more expensive health plan.

  55. Les 2014.11.16

    I pay 10k annual for a BCBS with a 7500 deduct for each of us. If both of us meet the deduct, we will have invested 25k for that year. Interesting concept on retired folks making it to Medicare.

  56. larry kurtz 2014.11.16

    feel it slipping away, les? got that rv in texas yet, dipshit?

  57. Les 2014.11.16

    My ability to pay for my needs and desires while spending all this quality time with you is off the charts, Lar. No RV and normal slippage.

  58. jerry 2014.11.16

    A couple of things you may consider. Go to and plug in you and your brides information to see what plans come up. I am thinking you will find Dakotacare will fit your concerns if you are 64 or younger. Pay close attention to what your actual out of pocket maximum will be for you and for your family. It cannot rise past $12,500.00 for your family totally, thanks to the ACA. So you have cost containment there that you do not have with your old Wellmark plan that is not ACA compliant. Something else to consider as well, wellness benefits are covered at no cost to you. So if you need to go in to get something major like a colonoscopy as an example, it will not cost you anything if it is for a wellness exam. Preventive care is a smart thing to do. Check it out.

  59. Les 2014.11.16

    I was there in Feb. I'll let you know know what I find.

  60. jerry 2014.11.17

    Outstanding for Montana! Of course Bullock is a Democrat that knows the only way to address social issues to to meet them head on. What foresight and what courage.

  61. jerry 2014.11.17

    Good for Montana yet again. Here in our state, we have three, so maybe Montana might come to help us.

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