"Affordable" Care Act vent

[QueenCat]

DH recently switched jobs just because of the insurance.  At the previous company we could not afford the premium and opted out (no insurance for over a year) at the new company the premium is less then a third of the cost.  When he told me I cried, we could finally go to the doctor again.  ACA costs almost the same with less coverage as the old company.  I am a big supporter of many of the ACA changes; no denial for pre-existing conditions, older children could stay on parents policy, no cap for lifetime benefits, and a well visit yearly.  But it is crazy how much they charge and how little they cover.  Maybe DH had always in the past worked for companies that had good coverage for decent premiums ($1500 deductible, $20 co-pay, $300 premium for example), but I am shocked at the rates/deductibles and lack of coverage most companies offer now.

 

Please remember that ACA is not insurance. There are federal and state exchanges that sell ACA compliant policies. These are all PRIVATE insurance companies selling their policies. There are standards but what is covered and how much you will pay varies based on the insurance company, the level of coverage you choose, where you live, etc.

[Wildiris]

Our family does not qualify for subsidies, and premiums are too high for us to afford health insurance for 5. We only insure our kids. I seldom go to the Dr. I wish health care was more affordable. 

[texasmama]

And health insurance does not equate to health care.  I often think that the US spends its healthcare dollars too much on insurance and not enough on actual medical/health/preventive care.

 

Our family has had many years when we spent many thousands of dollars on health insurance but went without needed health care because, due to high deductibles, we still could not afford actual health care.  That is all kinds of messed up. 

 

Also, regarding Medicare, I had great difficulty getting a good PCP for my dad a few years back because doctors were not accepting NEW Medicare patients.  I begged and called in a favor and got a neighbor who is a PCP whom I trusted with my dad's care to accept him as a patient.  It was embarrassing, but I was desperate for help for my dad.  The only reason he accepted my dad as a patient was because of our personal relationship. 

[Lanny]

We do not live in the states so we are exempt from ACA in the I.R.S. regulations. I read all of the posts that were in this thread up to when I began writing this.

 

Post #103 mentioned something that is critical to this issue. The U.S. Supreme Court will decide, by June 2015, if it is legal in the 36 states that do not operate their own Exchanges to have their residents eligible for subsidies. That seems to be contrary to the wording in ACA and to the belief of the MIT professor who was instrumental in the design of ACA.

 

If the Supreme Court decides that only residents of the 14 states with exchanges can receive subsidies, I suspect during July 2015 ACA will begin to unravel.

 

For approximately 25 years, I had an Individual Major Medical policy that I paid for myself. Every few years, I had them increase the Deductible, trying to keep the premiums I paid affordable.

 

With regard to the Canadian system that is far from perfect and I've read about many Canadians who go to the USA for medical treatment, because of rationing and long wait lists.

 

Probably some of the issues discussed in this thread are why so many people travel to Colombia and other countries, for medical treatment. They call that “Medical Tourismâ€.

 

I follow ACA, wondering what would happen to us if we moved to the USA and if DD attends university there, what medical insurance, if any, she will be able to afford.

[Momof3littles]

We have rationing of healthcare, limited access to the right specialists depending on insurance, etc. right now under our system.  FWIW, my career was in healthcare.

[creekland]

This thread is highly political. It's also futile. People refuse to be educated.

 

???  Are we reading the same thread?  I'm not seeing any of that.

 

I've yet to see anything political in the way that politics is not allowed on this board.

 

Maybe it's futile in that a bunch of homeschool parents aren't likely to be able to change the system for better, but it is a "vent" thread and there's a fair bit of info being shared.  Venting is never futile.  It helps people get some stress off their minds - or at least - that's how it works for me when I use it.

 

Whether people are getting educated or not depends upon them I suppose.  I have no desire to change off health share, so I'm reading mostly out of curiosity, but I've also shared what has worked well for us in case it's a decent consideration for others.  I do hope those reading realize they are playing with financial fire if they don't have some sort of coverage because life happens, but it's up to them if they act upon that or not.

[Guest]

This thread is highly political. It's also futile. People refuse to be educated.

Well, all vent threads are futile, I suppose.

 

Refuse to be educated? Please, enlighten me how I can pay for health insurance and still send my kids to college???

 

Political? I don't see it. We're talking about the crappy American health insurance system. I suppose if one party wants to identify with the system, this thread is political.

[Pawz4me]

We do not live in the states so we are exempt from ACA in the I.R.S. regulations. I read all of the posts that were in this thread up to when I began writing this.

 

Post #103 mentioned something that is critical to this issue. The U.S. Supreme Court will decide, by June 2015, if it is legal in the 36 states that do not operate their own Exchanges to have their residents eligible for subsidies. That seems to be contrary to the wording in ACA and to the belief of the MIT professor who was instrumental in the design of ACA.

 

If the Supreme Court decides that only residents of the 14 states with exchanges can receive subsidies, I suspect during July 2015 ACA will begin to unravel.

 

For approximately 25 years, I had an Individual Major Medical policy that I paid for myself. Every few years, I had them increase the Deductible, trying to keep the premiums I paid affordable.

 

With regard to the Canadian system that is far from perfect and I've read about many Canadians who go to the USA for medical treatment, because of rationing and long wait lists.

 

Probably some of the issues discussed in this thread are why so many people travel to Colombia and other countries, for medical treatment. They call that “Medical Tourismâ€.

 

I follow ACA, wondering what would happen to us if we moved to the USA and if DD attends university there, what medical insurance, if any, she will be able to afford.

 

Most larger universities (and I would assume many, if not most, of the smaller universities and colleges) offer affordable insurance coverage for their students.  DS didn't need it (we have very good insurance through DH's work) but it was something we investigated at each school he considered, just in case.

[Bootsie]

Not the person you were asking but maybe this will help answer your question --

 

In 1993, I had a plan that cost $28 a month and covered everything at 100% after a $1500 deductible. We had a child that year so I still had the info with the baby things. That also included prescription coverage. In today's dollars it would be $32.86 a month. Fo those accountants out there - it was twice a month, not biweekly.

I am not understanding these numbers.  If something cost $28 a month in 1993 cost $32.86 in today's dollars, that would be assuming an average annual inflation rate of only 0.765%,

[plansrme]

I am an employee benefits attorney and work with ACA, especially the employer mandate component, and am going to add my two cents as to why the ACA is making health insurance more expensive.  This is all I am going to say on this subject, but I do think it is important to address the argument that the spike in premiums would have happened anyway.

 

1.  The requirement that a compliant policy cover every single dollar of preventive care makes coverage vastly more expensive, and that increase is most assuredly not balanced out by all of the "free" coverage we're all supposedly receiving.  It is a fact of human nature that we're all going to use more of something when it costs us nothing.  Yes, the argument is that preventive care saves "us" money in the long run.  There is little, if any, reliable evidence to that effect.  It is like arguing that getting everyone to stop smoking saves "us" (collective "us") money; it really doesn't--smoking saves the collective "us" money in that smokers die earlier, before incurring expensive end-of-life care.   Have you ever looked at the list of what is considered preventive care?  It is incredibly long and covers a lot of expensive treatments.  BRCA testing, anyone?

 

2.  ACA got rid of annual and lifetime maximums that, for all of their faults, did keep costs in check.  I recently answered a question from an employer whose premiums are going up a significant amount because one employee is on a drug that costs $75,000 a month.  That is nearly $1 million a year.  Employers and insurance companies can no longer insulate themselves from those sorts of costs.  Argue all you want about whether limits are worth the cost, but eliminating them definitely comes at a cost.

 

3.  The ACA affordability requirement does not apply to spousal coverage.  That's right; employer-provided coverage for the employee and dependents has to be within the affordability guidelines, but employers are free to jack up the cost of spousal coverage (or to drop it entirely) to make up for reductions in employee contributions for their own and the children's coverage.

 

4.  The ACA eviscerated even the limited pre-existing condition ("PEC") exclusions that were available before.  There is a reason for PEC exclusions--they keep healthy people in the system.  Before the ACA, a PEC could not be applied if you had continuous coverage from some source without a break of more than a couple of months.  This covered short gaps in care that resulted from job transitions and the like but did mostly keep people from going without coverage until they were diagnosed with cancer or diabetes or something else that is expensive to treat.

 

 

[Artichoke]

I am not understanding these numbers. If something cost $28 a month in 1993 cost $32.86 in today's dollars, that would be assuming an average annual inflation rate of only 0.765%,

Hmmm. I used the calculator posted earlier in the thread. Maybe I did something wrong.

Okay, just tried it again and now have the number of $46.01. Does that sound more accurate?

[Sdel]

Gosh, it sounds like y'all might need universal health care.

 

No thank you.

 

Stefanie

[Bootsie]

.  It is like arguing that getting everyone to stop smoking saves "us" (collective "us") money; it really doesn't--smoking saves the collective "us" money in that smokers die earlier, before incurring expensive end-of-life care.   

 

This is interesting.  I have never seen statistics on this.  Do, smokers really die without incurring expensive end-of-life care?  Or do they just incur expensive end-of-life care at an earlier age?  

[JumpyTheFrog]

Whatever we do, we need to get medical costs under control. Why should a PP be charged $500 or more per pint of blood? People donate it and screening and storing it can't be nearly that expensive.

[Bootsie]

Hmmm. I used the calculator posted earlier in the thread. Maybe I did something wrong.

Okay, just tried it again and now have the number of $46.01. Does that sound more accurate?

That would be an inflation rate of 2.4% a year which looks more reasonable (there isn't one precise measure of inflation)

[Laura Corin]

No thank you.

 

Stefanie

 

Just for reference: it's not often understood, but in the UK many people have top-up insurance on top of the universal system.  The universal system is paid for through taxes and, per capita, is cheap.  Many people also have top up insurance that allows for queue-jumping.  I just checked, and for someone of my age, this would cost between USD 70 and USD 160 per month as a private applicant.  I get it 'free' as part of my employment package.

 

L

[StephanieZ]

This is interesting.  I have never seen statistics on this.  Do, smokers really die without incurring expensive end-of-life care?  Or do they just incur expensive end-of-life care at an earlier age?  

 

They die younger, so they don't collect as much of the social security and medicare benefits. If everyone retires at 65, and smokers die at 72 instead of 80 . . . Then, even assuming each person would have equally expensive final 12 months of life (when the vast majority of lifetime dollars on health care are spent), then, still the smoker would have collected social security retirement benefits and medicare benefits -- both very expensive, for half as long. . .  Add to that the many other gov't subsidies and benefits for retired people (reduced property taxes, etc.), and it is pretty clear that smokers are on average cheaper for gov't than nonsmokers.

 

My dad, a smoker who died at age 60 for reasons not directly, but indirectly, related to his smoking . . . and who paid in to soc. security at top rates and would have been eligible for maximum monthly social security a few years later for many many years . . . saved the system millions by dying so young. A minimum of 40k/yr in social security and medicare costs for decades  . . . He also made that very argument to me in the years preceding his death when all the states were suing and settling with the tobacco industry for financial costs of smoking. We guessed that the tobacco companies weren't using that defense since it is predicated on the fact that smoking is deadly. . .  Seemed like a bad PR move, lol. If you google, you will find some economists arguments along these lines. Pretty depressing.

[happypamama]

 

3. The ACA affordability requirement does not apply to spousal coverage. That's right; employer-provided coverage for the employee and dependents has to be within the affordability guidelines, but employers are free to jack up the cost of spousal coverage (or to drop it entirely) to make up for reductions in employee contributions for their own and the children's coverage.

 

.

And if your DH's employer offers coverage, with his share for himself being "affordable" according to the ACA (under 8% of income or whatever it is), then you are totally out of luck for getting the subsidies for wife and kids, right, even if you would have qualified for them if your DH's employer didn't even offer insurance? Or am I wrong about that? Can subsidies be used to get employer-sponsored coverage? Anyone know more about that?

[creekland]

They die younger, so they don't collect as much of the social security and medicare benefits.

 

I remember a comedian connecting this to the federal budget and musing if the gov't were sending out the wrong message to children with the latest eat healthy and be fit campaign rather than an eat at Burger King campaign (since their foods traditionally have the worst health numbers).

 

As a joke it was quite funny.  IRL, not so much.

[TechWife]

I am an employee benefits attorney and work with ACA, especially the employer mandate component

 

Your user name makes so much sense! 

[creekland]

National health care folks - an off topic question for you.

 

When someone is diagnosed with a disease that takes a while to treat, is there compensation for their lost income?  This came up around the lunch table Friday as we were discussing a case where the person has decent insurance to cover med bills, but can't take the time off he should because he needs to support his family.  We were wondering if other countries did it differently.

[Sdel]

Just for reference: it's not often understood, but in the UK many people have top-up insurance on top of the universal system.  They universal system is paid for through taxes and, per capita, is cheap.  Many people also have top up insurance that allows for queue-jumping.  I just checked, and for someone of my age, this would cost between USD 70 and USD 160 per month as a private applicant.  I get it 'free' as part of my employment package.

 

L

 

I don't particularly care.  I don't care for universal systems for the same reason I don't particularly like the current system.

 

Stefanie

[SemiSweet]

I'm in a family of numerous doctors. They are happy with Medicare (granted no insurance company is fabulous, but Medicare is fine). Approval is generally easy, they pay well (many insurance companies base reimbursement on Medicare to some degree), there are usually no major issues. Because so many people are covered by them, the office staff and physicians know exactly what they will cover...where the problems may be, etc. The electronic/direct deposit of payments works well. It is definitely no worse than "normal" insurance companies for approval or reimbursement.

 

Completely agree with this, I was a medical biller for quite awhile and Medicare is by far one of the easiest insurance companies to deal with, by far. The payments were fast and more likely to be correct than any other company, even big ones like BCBS. The rhetoric that the government is unable to do anything right does not work in this instance.

[SKL]

About smoking and costs - it would be an interesting analysis for sure, but I'd want to use real numbers, not assumptions.

 

One thing to consider is that we tend to go all out to try to save the life of someone who isn't old enough to die of "old age."  So a smoker having a heart attack at 60 is likely to receive expensive life-saving treatment, while a non-smoker having one at 90 isn't.  (I realize there is not a 30 year difference in average life span but just for the sake of discussion.)

 

Long-term meds (e.g., blood pressure meds) that do keep people alive are more likely to be taken by smokers, I think.  So that is a cost.

 

Also, although the %s may not be high, there are people who drop out of the workforce earlier because of health issues related to smoking.  So they are not paying in as much FICA and may receive more SS payments earlier.  So that would mitigate the "nonsmokers cost more in SS" situation.

 

One of my grandmas was a smoker and the other was not.  The smoker had a massive heart attack at 65, but was saved at a world-renowned hospital in her city.  A couple of years later she had another (smaller) heart attack, again saved and sent home.  She then was diagnosed with cancer, went through surgery and chemo, got more cancer, and died in the hospital at age 70.  The non-smoker almost never went to the doctor and she died at home in her sleep at 87.  Obviously anecdotal, but I am pretty sure the government spent more on my smoker grandma than on the other one.

 

Then there is the question of who is really paying for the cigarettes in the first place ... and who benefits from the cigarette taxes ... but let's not open those cans of worms .... 

 

If I were a college student with no work or parenting duties, I might find it very interesting to run that comprehensive cost analysis.

 

Not that I think the value of a life is quantifiable.

[Bootsie]

National health care folks - an off topic question for you.

 

When someone is diagnosed with a disease that takes a while to treat, is there compensation for their lost income?  This came up around the lunch table Friday as we were discussing a case where the person has decent insurance to cover med bills, but can't take the time off he should because he needs to support his family.  We were wondering if other countries did it differently.

In the US, this is why it is important to have disability insurance in addition to health insurance

[SKL]

Oh, and another thing about the costs of smoking.  You have to include the effects smoking has on gestating babies, and on kids growing up around smokers.  Such kids have a higher likelihood of having asthma, for example.  Low birth rate, premie births (IIRC) ... these can be very expensive.

[Laura Corin]

National health care folks - an off topic question for you.

 

When someone is diagnosed with a disease that takes a while to treat, is there compensation for their lost income?  This came up around the lunch table Friday as we were discussing a case where the person has decent insurance to cover med bills, but can't take the time off he should because he needs to support his family.  We were wondering if other countries did it differently.

 

In the UK here's statutory sick pay for up to 28 weeks.  There's also personal independence allowance - my brother has lived on that when he was not well over a longer period.  Neither would come close to full income level for many middle class people, but it's something.

 

L

[goldberry]

As a person in favor of universal healthcare, the ACA is a joke.  It did help a few people.  The health insurance industry is a mess of inter-related problems, and ACA tried to address just one small area without addressing any of the others.  People say it was set up to lead to government takeover of healthcare, I think instead it was set up to fail.  We will then go back to the previous system of outrageous medical costs, denial of coverage, care-rationing/doctor interference by *private, for profit insurance companies* and everyone will be *so grateful*.  Because as long as it's not the government, all those behaviors are ok apparently.

 

I say this because I have yet to hear anyone in with authority who wants ACA to go away that actually has any real ideas about fixing the *still broken* system.  On both sides it's all about political posturing.  This whole situation disgusts me.  *vent over*

 

 

[Sdel]

Why not ?

 

Instead of someone - let's call her me - having to pay extraordinary amounts for health insurance, go bankrupt or sell everything I own to stay alive - I just rock up at the hospital when required where they treat me - quite successfully and skilfully - with no charge to me.

 

Of course, there's a charge to the taxpayer. But what better thing to spend taxes on, than keeping a population healthy and productive ?

 

Because I don't think insurance/gov't health care does much but drive up costs. I think our routine care could/should be affordable enough to actually pay it all out of pocket leaving people to pay for plans that generally just cover catastrophic or chronic issues.  I don't think health insurance should be provided through any 3rd party; employers or government.  When you look at how health insurance developed in the states, you can understand a lot of the problems we have today with it.  But that is the way I think it should work, not necessarily what I think is possible to achieve after the long years of health care decline.  So, in my mind, universal health care is so much more of a step in the wrong direction.

 

But the bolded isn't quite true now is it....you may not be paying directly at point of service, but you ARE paying in the form of much increased taxes.  And every year those "costs" go up due to many different factors.  And a vicious cycle begins when people are not generally held responsible for their personal choices and are removed from the consequence of their choices.  It is generally accepted that it is generally a bad thing when a parent shields their children from consequence, I don't see most of life all that differently.  In this case, the choice has been removing the public from their role in making their own insurance choices (employers and gov't make those choices) and the bad thing that has happened is that health care costs have bloomed out of control.

 

Stefanie

[SKL]

I really just want to be able to buy what I want, from whom I choose to buy it from.

 

My ideal is to have stop-loss insurance and try to take the best care of my family's health as I can.  I would like to be able to go to the doctor of my choice and pay a reasonable fee for a reasonable service.  What is so radical about that, I do not know.

 

I agree that it looks as though nobody "in charge" ever really wanted ACA to succeed.  It was an item to check off the list.  Not sure the cost of it was much of a consideration.

[Scarlett]

We have, but I thank you. The coverage is a good plan, it is just very pricey to add on our family. His work plan meets all of the legalities for affordability for employees because it would be deemed affordable for DH, since his premium would be fully covered. The affordability standard isn't the same for non employee family members. DH is well compensated, but it still hurts to pay upwards of 10K for health insurance, plus of course deductibles, etc. Others certainly have it worse, however. And I said upthread, my brother has greatly benefited, with a major reduction in his rates thanks to a subsidy.

 

edited to add link that addresses the ruling stating employer sponsored coverage for the family (vs the employee) doesn't have to meet the affordability standard. Even if affordability applied, Dh's compensation is such that it would still be deemed "affordable" according to his income. But it is a moot point since we wouldn't pay >9.5% of his income toward *his* premium, since DH's employer would pick up his premium at 100% if we didn't have a private family policy.

http://www.dol.gov/ebsa/pdf/flsawithplans.pdf

I had this same problem last year but someone at the marketplace told me how to apply to get around that. It worked.

[Sdel]

I really just want to be able to buy what I want, from whom I choose to buy it from.

 

My ideal is to have stop-loss insurance and try to take the best care of my family's health as I can.  I would like to be able to go to the doctor of my choice and pay a reasonable fee for a reasonable service.  What is so radical about that, I do not know.

 

I agree that it looks as though nobody "in charge" ever really wanted ACA to succeed.  It was an item to check off the list.  Not sure the cost of it was much of a consideration.

 

Amen.  I said it up thread....I really think health insurance should be kind of like car insurance.  Can you imagine what car insurance would cost you if they paid on a similar structure for gas, inspection, repairs, etc.  Can you imagine what would happen to the costs of gas, inspections, repairs if it worked like health care.

 

Stefanie

[goldberry]

  I would like to be able to go to the doctor of my choice and pay a reasonable fee for a reasonable service.  What is so radical about that, I do not know.

 

 

 

I have an appointment on Monday for a prescription renewal for DD.  No exam, just maybe 5-10 minutes of "everything still working ok?  Here's your renewal."  I will pay $100 for this.  (No insurance coverage that actually applies to anything....)

 

I live in a rural area where there are not too many choices.  I could drive farther to get a cheaper doctor, but would probably make up the difference in gas. 

 

So yes, I too would like to pay a reasonable fee for a reasonable service.....

[SKL]

I keep hoping that someone in the health care field with a true entrepreneurial spirit will figure out a way to give people what they really want.

[Sdel]

I keep hoping that someone in the health care field with a true entrepreneurial spirit will figure out a way to give people what they really want.

 

They can't.....it's too wrapped up in red tape.

 

Stefanie

[regentrude]

National health care folks - an off topic question for you.

 

When someone is diagnosed with a disease that takes a while to treat, is there compensation for their lost income?  This came up around the lunch table Friday as we were discussing a case where the person has decent insurance to cover med bills, but can't take the time off he should because he needs to support his family.  We were wondering if other countries did it differently.

 

In Germany, yes there is.

The employer is required to continue to pay wages/salary for six weeks if the employee is sick and unable to work; after that, the person receives compensation from the health insurance company of 70% of his gross income.

An employer can also not fire a sick worker.

 

[TechWife]

Whatever we do, we need to get medical costs under control. Why should a PP be charged $500 or more per pint of blood? People donate it and screening and storing it can't be nearly that expensive.

 

It's a lot more than that, actually.  The supplies needed to draw the blood must be paid for, the people who staff donation centers and process the blood are paid, there are transportation costs, the blood is tested and processed (separated into it's different components to be used by different people) and extensive records on all of this are maintained.  

 

In the way of a public service announcement, donated blood has a limited shelf life - five days for platelets and just over forty days for red blood cells. Holidays are a particularly tough time as blood donations are down, yet people still become critically ill.  Blood given this week will expire before Christmas. When you donate blood, you really do give the gift of life. 

[horsellian]

I don't particularly care.  I don't care for universal systems for the same reason I don't particularly like the current system.

 

I don't really understand what system you do want then?  Everyone pays for healthcare themselves and stuff those that can't afford it?

 

Because I don't think insurance/gov't health care does much but drive up costs. I think our routine care could/should be affordable enough to actually pay it all out of pocket leaving people to pay for plans that generally just cover catastrophic or chronic issues.  I don't think health insurance should be provided through any 3rd party; employers or government.  When you look at how health insurance developed in the states, you can understand a lot of the problems we have today with it.  But that is the way I think it should work, not necessarily what I think is possible to achieve after the long years of health care decline.  So, in my mind, universal health care is so much more of a step in the wrong direction.

 

I really don't see how government healthcare drives up costs.  I think the statistics are that per capita the US and the UK spend similar amounts of government money on healthcare, but in the US that only pays for a minority of the population (Medicaid & Medicare) while in the UK it pays for everyone. 

 

Due to the volumes involved if you have a universal system governments get a very good deal with providers: wouldn't you want your company to provide (for example) nearly all the joint replacements in the UK?  And drug manufacturers will often reduce prices if the alternative is that their drug won't be prescribed at all because it is considered too expensive.

 

Plus,  as others have said, you can pay for private insurance or out-of-pocket for private treatment if you don't want what the NHS offers you.

[Momof3littles]

I had this same problem last year but someone at the marketplace told me how to apply to get around that. It worked.

 

Maybe I'm  missing something.  Our income is too high for a subsidy of any type, and our private plan (that we've had for 4.5 years now) has a lower deductible and lower cost per month.  As a result, I don't think the marketplace is a great option for us either way. 

My husband is offered his insurance paid at 100% (fwiw, they have had to start adding surcharges for smokers, etc. this year to contain costs.  DH works for a larger small business of about 50 employees.  This doesn't apply to DH, fortunately).  It would be 12K to add on our family, so we don't, and go use our private plan.  His company kicks back some money into an account since he doesn't take the work insurance, so that buffers things a bit for us.  DH's work insurance (if he took it) would not exceed 9.5% of his income, as his premium would be fully paid by the employer. 

 

I don't know any work around, and the marketplace in our case is still pricier for even a bronze plan than (with a deductible of 10K) than what we pay for our private plan with a 3500 per family deductible.  For a higher tier plan, we might as well just pay the premium and be added onto DH's work plan.

 

DH's employer is awesome in every other way, so we deal (for now).

[kewb]

I have yet to speak with a single person who is happy with the ACA. I'm not sure where these happy people are that I hear about on these boards and on the news. Our coverage has plummeted and our premiums and deductibles have skyrocketed over the last 2 years. Before that, prices for us were holding steady. I hear the same story from everyone I talk to. Our plan for this year was to get cheap, catastrophic insurance coverage, then save a good chunk monthly for prescriptions, doctor visits, etc. Then I find out that catastrophic coverage no longer exists because those plans aren't good enough under the ACA. We can't afford health insurance today, but we also can't afford the fine if we choose to go uncovered. It's a lose/lose where our right to choose has been stolen by the powers that be.

I am extremely happy with aca. Without it we would be uninsured. It is costing us less then what we had before and with adequate coverage.

My issues with insurance predate aca by more than 20 years.

[SKL]

Sadie, you trust your country's government to be reasonably fair & efficient, but that doesn't mean every government can be trusted in the same ways.

 

The US has long spent far more than other countries, per capita, on education of kids.  Do the comparative results reflect this?  No.  Our government is not designed to take care of everyone's social and individual needs.  It just isn't.  Shifting money to our government isn't going to get the job done better.

 

If I was one of the people getting a lot more than I paid for, I might see it differently.  But that isn't really a fair way to look at it.  To ignore the fact that the incremental cost is a serious hardship for many families is just ... unhelpful at best.

[Carrie12345]

How much money would a family need to make for $2k/month to be affordable??? Freaking health insurance.

 

My understanding is that the act considers 9.something% of household income "affordable".

Dh's small company option would cost us over $2,000/mo, which is why we purchased our own through the exchange.  Our household income doesn't qualify us for a subsidy, but we're able to buy a platinum plan with all the bells and whistles for almost half of the employer option.

[Momof3littles]

My understanding is that the act considers 9.something% of household income "affordable".

Dh's small company option would cost us over $2,000/mo, which is why we purchased our own through the exchange.  Our household income doesn't qualify us for a subsidy, but we're able to buy a platinum plan with all the bells and whistles for almost half of the employer option.

 

And to be clear, it is deemed "affordable" if the *employee's* health insurance is offered at a price that doesn't exceed 9.5% of income.  Adding on your family is not included in that "affordability" standard at all, so yes, it can be deemed affordable even if it is *well* over 9.5% to insure your family, provided the *employee's* premium is under that 9.5% number.  Insuring a family on an employer's policy can add up very quickly, while still meeting the standard for affordability.

[plansrme]

Sadie, you trust your country's government to be reasonably fair & efficient, but that doesn't mean every government can be trusted in the same ways.

 

The US has long spent far more than other countries, per capita, on education of kids.  Do the comparative results reflect this?  No.  Our government is not designed to take care of everyone's social and individual needs.  It just isn't.  Shifting money to our government isn't going to get the job done better.

 

If I was one of the people getting a lot more than I paid for, I might see it differently.  But that isn't really a fair way to look at it.  To ignore the fact that the incremental cost is a serious hardship for many families is just ... unhelpful at best.

 

I swore I wasn't going to post on this other than my list of some of the ways the ACA is increasing the cost of health care, but I can't resist this one--SKL is absolutely correct that the income redistributive effects of the ACA should not be ignored.  There has been at least one significant study on this that is mentioned here, though there are many articles floating around that address the same study.  

[Zinnia]

We had babies in 2006, 08, 10, and 12, as well as an inpatient stay in 09.  All of those were covered by employer sponsored health insurance, not ACA.  The difference in the six years was LARGE.  In 2006, our total cost for prenatal/delivery/postnatal/hospital....$100.  Premiums were something like $50/month.

 

In 2012, premiums had risen to $400/month (still affordable, but 8x as much), and our out of pocket cost was $10,000.

 

This coming year, premiums are $500, deductible is $5250, and our oop is $12,000.  We are not eligible for a HSA, because the federal government does not define our plan as a high deductible (high ded. is $12,500 for a family).  This is our only option as employer-sponsored.  We do not qualify for subsidies though ACA.  We're considering one of those health share programs, because of costs. 

[Sdel]

 

You think I somehow should have had a magic mirror in which I could see I would have a non-lifestyle acquired life threatening chronic disease in 20 years time, and planned to meet my lifetime costs through taking out some prohibitively expensive cover-the-whole-damn-lot insurance while still a young adult ?

 

 

 

 

You are reading in too much.  Its just very well known that generally across the board, people don't take as good care of the things don't have financial stakes in.  Health care is no exception.  When you remove the individual from the costs of their health care....the vast majority get lax.  It doesn't have anything to do with being able to look into a crystal ball and seeing what your health is going to look like in 20 year.   It is about making better choices on the whole.  Some may make better choices about their lifestyles, but I really mean more responsible, non-lifestyle, choices as a whole, across the board. 

 

To go fall back on the extreme stereotype (which is actually fairly common), the person on "gov't insurance" who waited 8 hours in the ER because they wanted the "free healthcare" to give their kid the Tylenol so they didn't have to go buy it.  You really have to ask yourself, if there had been some cost to the the person for the ER visit, would they have just gone and gotten the Tylenol from the store?  Some, no, many more others, yes.  Yes, extreme example, but I see this behavior and type of thinking to some extent infiltrating everywhere.  I just think it cultivates a "something for nothing" attitude; with the lovely bonus of skyrocketing costs.

 

Stefanie

[Jane in NC]

Not sure that I even dare wade into this thread, but here goes.

 

How many of us think of the true cost of health care?  Many people seem to think of health care costs in terms of co-pays, deductibles and their personal contribution to an employer based insurance plan.  I know I did.

 

Last year, my husband's Fortune 500 employer began the big nudge to high deductible/HSA plans. At first I was appalled but I spoke to my friend who is a retired benefits guy.  We ran the numbers.  For us, the high deductible plan offers huge savings--but boy was I appalled when I had to pay $600 for one of my scripts. Even so, if I add up the cost of the "employee plus family" premium for the high deductible plan, add in a visit to my dermatologist ( other doctors' visits, lab work and tests are covered at 100% because they are preventative as is a prescription my husband takes), that over priced prescription, we are way ahead.  Knock on wood. Disaster may strike but in addition to what we have in the HSA, we have other savings.

 

The corporate world seems to be embracing these high deductible plans--I don't think that can be blamed on ACA.

 

By the way, our health insurance is going up one dollar this year. We have a higher prescription deductible. 

 

[Sdel]

I don't really understand what system you do want then?  Everyone pays for healthcare themselves and stuff those that can't afford it?

 

 

I really don't see how government healthcare drives up costs.  I think the statistics are that per capita the US and the UK spend similar amounts of government money on healthcare, but in the US that only pays for a minority of the population (Medicaid & Medicare) while in the UK it pays for everyone. 

 

Due to the volumes involved if you have a universal system governments get a very good deal with providers: wouldn't you want your company to provide (for example) nearly all the joint replacements in the UK?  And drug manufacturers will often reduce prices if the alternative is that their drug won't be prescribed at all because it is considered too expensive.

 

Plus,  as others have said, you can pay for private insurance or out-of-pocket for private treatment if you don't want what the NHS offers you.

 

Everyone pays for their own *routine* care and then if the gov't would get out of the way some, the market can be quite inventive for a wide variety of plans.  Really, I can get a check up, the same x-rays, ultrasounds,  labs, and meds for my dog from the vet as I can for myself from my doc; and pay a ton less.  No, I'm not comparing people to animals; I'm comparing costs for the EXACT same services.  There is nothing intrinsically different.....so why is the cost so much greater for us?   For the record, my husband has been using our deceased dog's prednisone for years to fight off lingering sinus infections, it cost us $36.  But again, this is my ideal, not what I think is necessarily do-able based on how out of control costs currently are.

 

As for how gov't/insurance driving up costs....it's because neither actually pays the full costs.  Medicare/Medicaid pay by schedules.  The way medicare pays hospitals is by admitting diagnosis.  So, if you go in for pneumonia and Medicare has decided that pneumonia is a 4 day stay, they will pay for 4 days, and ONLY 4 days.  If you leave after 3, great the hospital made money on you.  If for some reason you don't respond well to treatment and you stay 5 or 6 days....well, too bad, hospital lost out on money and they'll have to eat the cost of your extra days stay.  Very much a simplified example, but what generally happens.  It is generally well understood that businesses "pay taxes"....they pass them on to the customer via price.  Same thing. The hospital doesn't just eat it, they try to get it back by increasing the costs of care. 

 

Same thing happens with insurance.  The contracts the doctors have with the different insurance carriers have agreements to "write off' portions of the bills, once again leaving those costs uncovered and to be made up elsewhere. 

 

It really isn't about paying for private insurance or private treatment.  Both are a bit unrealistic to your average person right now because of the constraints of the system and realistically has been for decades.  I would 100% do both if it were a viable option.  But bottom line, your generally 100% elective surgery options (Lasix/boob implants) are so much more affordable in the grand scheme of health care costs because they know they have to appeal directly to the consumer.

 

Stefanie

[Bootsie]

I don't really understand what system you do want then?  Everyone pays for healthcare themselves and stuff those that can't afford it?

 

 

I really don't see how government healthcare drives up costs.  I think the statistics are that per capita the US and the UK spend similar amounts of government money on healthcare, but in the US that only pays for a minority of the population (Medicaid & Medicare) while in the UK it pays for everyone. 

 

Due to the volumes involved if you have a universal system governments get a very good deal with providers: wouldn't you want your company to provide (for example) nearly all the joint replacements in the UK?  And drug manufacturers will often reduce prices if the alternative is that their drug won't be prescribed at all because it is considered too expensive.

 

Plus,  as others have said, you can pay for private insurance or out-of-pocket for private treatment if you don't want what the NHS offers you.I

I have used the medical system when on extended stays in Europe and have several friends who are doctors in Europe.  The differences in the medical systems go far beyond the payment mechanism.  I do not think moving to a single-payer, universal health care system in the US would result int he same outcome as European countries without some other major changes.  When doctors go to medical school almost for free, when doctors and hospitals are not concerned about expensive lawsuits, when doctors do not have to pay astronomical malpractice insurance, when there is a bias toward less invasive treatments and less use of expensive diagnostic and testing, etc. the outcome is much different.

[Bootsie]

 

 

Due to the volumes involved if you have a universal system governments get a very good deal with providers: wouldn't you want your company to provide (for example) nearly all the joint replacements in the UK?  And drug manufacturers will often reduce prices if the alternative is that their drug won't be prescribed at all because it is considered too expensive.

 

 

Unfortunately, we haven't seen these type of cost savings in the US when large contracts are granted to a few companies to provide services to the government.