Affordable Care Act -- NOT Affordable

[Penny_P]

I work part-time for insurance.  DH's work doesn't offer insurance.  Our rate will go up from $800-something to $1100-something a month.  I'm trying to be grateful that they still cover part-time employees, but I pretty much won't be bringing home a paycheck starting in January.

[Mrs Mungo]

The IRS website offers a lot of information on the tax credit and things like that.

 

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

[NicksMama-Zack's Mama Too]

Didn't the president grant delays and waivers to the law --- all without congressional approval?  I have been watching the healthcare.gov news and it looks like a delay would be welcome about now.  

 

 

[Mrs Mungo]

Didn't the president grant delays and waivers to the law --- all without congressional approval?  I have been watching the healthcare.gov news and it looks like a delay would be welcome about now.  

 

I refer you back to this post:

http://forums.welltrainedmind.com/topic/489993-to-those-who-are-affected-by-the-govt-shutdown/?p=5234426

 

And people have until the end of March to sign up. I'm sure a lot of questions will be answered and kinks worked out between now and then.

[Trish]

With high premiums plus high deductibles, I wonder how many of the newly insured will STILL have to use the emergency room to access health care?

[smudge]

That there is the kicker. The ACA did nothing to make health care affordable. Having insurance does NOT guarantee having health care. Very uncertain times for A LOT of folks. :(

[Pawz4me]

With high premiums plus high deductibles, I wonder how many of the newly insured will STILL have to use the emergency room to access health care?

 

I'm confused -- How would it financially benefit an insured person to use an ER for health care in lieu of a regular doctor?  Wouldn't the ER co-pay and final bill be much higher than going to a doctor?  And the deductible would still apply.  Or at least that's how our insurance works.

[ktgrok]

The Virginia link does not provide a details (deductibles, copays, out-of-pocket) about the plans.  It's funny, although my best friend's income is 25% higher than mine, she gets a subsidy and I don't!

It could be you were supposed to be covered with the medicaid expansion. The subsidies don't cover people below a certain income, because those people are supposed to get medicaid under the expansion plan. 

[Pawz4me]

They can get in the door and get treated at the ER without paying any cash up front.

Not so at the Dr's office...they want the copay and many times the co-insurance up front.

 

But that ER bill will come in a few weeks.  So yeah, you can get treated but eventually you're going to very likely pay many more times what you would have if you'd gone to a doctor's office.

 

Is that a case of people who aren't financially savvy not understanding how things work, to their long-term detriment?  'Cause I am well and truly confused by this line of thinking.

[Pawz4me]

They don't intend to pay.  The bill is more than they can afford or are wiilling to budget in, no matter where they are treated.

 

Since the law requires that the ER give a certain amt of care without demanding cash up front, they go there. The hospital writes the bill off and gets enough profit off of those who do pay to cover the freeloaders.

 

I understand how hospital write-offs work for people without insurance.  But I don't understand how it would work for people with insurance (which is the whole premise for this discussion).  Can people with insurance get away w/o paying for ER visits?  If you're going to do that, then why would pay for insurance?  Unless I'm missing something, it makes no sense at all.

[NicksMama-Zack's Mama Too]

But that ER bill will come in a few weeks.  So yeah, you can get treated but eventually you're going to very likely pay many more times what you would have if you'd gone to a doctor's office.

 

Is that a case of people who aren't financially savvy not understanding how things work, to their long-term detriment?  'Cause I am well and truly confused by this line of thinking.

 

 

You are assuming that they are going to pay the bill.  Do you think any of these newly-insured are going to have money set aside for the 40% portion of the bill (the Bronze Plan)?  

 

This reminds me of the housing bubble.  Uniformed people signed up for ARMs to buy houses and then as their rates increased and property taxes came due, they defaulted.  They were not educated about what they were purchasing.  I think the same scenario is going to be played out here.

[Pawz4me]

You are assuming that they are going to pay the bill.  Do you think any of these newly-insured are going to have money set aside for the 40% portion of the bill (the Bronze Plan)?  

 

But this is exactly what I'm trying to figure out -- why would you buy insurance you can't afford to use?  Why not just pay the fine instead?

[Lisbeth]

With high premiums plus high deductibles, I wonder how many of the newly insured will STILL have to use the emergency room to access health care?

ERs should /should be permitted to screen in the waiting room. Non-ER visits should be told to see a family doctor within a few days and be sent packing. Hospitals should NOT pad other patients' bills to pay for them.

[Jane in NC]

I am one of the lucky ones in this big mess.  My (large) employer will continue to offer 3 different types of plans (HMO, PPO, CDHP) for which they pay part of the premiums.  My employer also offered a Wellness program this past year, and if you participated in it and earned a certain amount of points, you earned a 15% discount on 2014 premiums.  Kicker is that the premiums did go up by 13% -- so the work that I put into earning the points, netted me a 2% discount.  I will actually pay $10 less per month for medical in 2014 than 2013.  Co-pay and coverage stayed the same, thank God again.  With 2 ppl in the house that have chronic illness issues, I am so very, very thankful for what I have.

 

My heart is breaking for all of you!  Really it saddens me so much to hear all that is going on with this hot mess!!  I pray and pray that things actually start to change and look better in the future.

 

~coffee~

 

My husband's company also offers a Wellness program incentive.

 

We don't have our 2014 plan costs yet but it is worth noting that while our insurance costs have gone up a bit in the last few years, we have not had co-pays on preventative care (part of AHA)--which covers most of our medical appointments.  I formerly had a co-pay with my mammogram or would have had to pay a percentage of a colonoscopy. My husband had the latter earlier in the year with no out of pocket cost to us.

 

I have not run the numbers to see how the increase has been off set by the lack of co-pays.

[TeenagerMom]

ERs should /should be permitted to screen in the waiting room. Non-ER visits should be told to see a family doctor within a few days and be sent packing. Hospitals should NOT pad other patients' bills to pay for them.

 

That is what they do here.  All 3 of our local ERs triage the patients as they come in.  Something that is truly an emergency (compound fracture, chest pain, stroke symptoms, 104+ temps) goes to the ER.  All others are routed through Minor Medical where you must pay a deposit to be seen. Last I heard the fees were a minimum deposit of 50% of fees at 1 ER and a fee of $100-$150 at the other ER to be seen.

 

The local clinics charge $120 cash for individuals who aren't insured and bill you after the insurance pays if you don't have a co-pay.  There is also an income based clinic for the working poor where you can be seen for a max fee of $25.  So basically here, it's cheaper to go to the Dr than the ER, even if you have to pay fees up front.

[Murphy101]

That's weird.  A friend of mine lives in Alexandria, VA and was able to talk with someone yesterday - she got quotes (not good ones, apparently).  Here's her Facebook post about it.

 

"Just for fun, i called a healthcare.gov representative to get some pricing on insurance. My family will be losing their healthcare coverage soon. After asking a few questions i receive outrageous pricing on a plan that doesn't even come close to what i have now. I told the representative i can't afford that and will have to go without insurance. She said "i'm so sorry. Have i answered all your questions today?"[/size]

 

 

Why are people receiving different information?

 

Because that's the norm in red tape and insurance and they have been combined in this not so wonderful thing called ACA. Color me not even slightly surprised.

 

That there is the kicker. The ACA did nothing to make health care affordable. Having insurance does NOT guarantee having health care. Very uncertain times for A LOT of folks. :(

 

 

Yep. Having insurance does not mean having healthcare. Never has.

 

 

I'm confused -- How would it financially benefit an insured person to use an ER for health care in lieu of a regular doctor? 

It's not a financial benefit. There is not any financial benefit.

 

You presume that:

They can get into a regular dr. It's nightmare of time and frustration to get into the doctor for many people. Can they get off work during his hours? Can they afford the office copay/deductible and rx, even if they do have insurance? Can they find a dr that will accept their insurance?

 

The answer to every one of those questions is No for huge numbers of our population.

 

 

These workers all had good health insurance...a simple co-pay and everything else was covered 100%.  My conclusion is that a fraction of our population wants a SugarDaddy to take care of everything rather than pay even a dollar out of their own pocket.

 

They were likely paying a bloody fortune out if their own pocket for the insurance and not having anything left over for a simple copay. It's not at all uncommon. Just because it came directly out of their paycheck, doesn't mean they didn't pay it out of their own pocket or were looking for a sugar daddy.

 

(Which is not to say I condone fraudulently claiming workers comp either.)

 

But this is exactly what I'm trying to figure out -- why would you buy insurance you can't afford to use?  Why not just pay the fine instead?

The examples given are preACA. And many didn't have a choice. My dh's previous employers would not let employees not enroll in the health plan unless they could prove they were covered elsewhere. It was a huge chunk of his paycheck and we often saw little to no benefit from it whatsoever.

 

As for the ACA..

 

I have not heard many who are buying in based on the plans the estimated calculators are projecting. A few very well off are going to because they are terrified of not having insurance. Everyone else is coming to accept they will be without and just pay the fine. We are currently on expanded Medicaid, but we only use it for rx, because we can't find drs who accept it and are taking patients. So we scrap the money together, sometimes with debt, to see drs. If we can't scrape the money together, we do without. And we have been doing this for many years now whether we had insurance or not. 9/10 times out insurance either didn't pay or we couldn't afford the 20%+ portion anyways. I've been seeing growing numbers of people in the lower middle class or lower economic range starting to do the same thing.

[Jane in NC]

 

The examples given are preACA. And many didn't have a choice. My dh's previous employers would not let employees not enroll in the health plan unless they could prove they were covered elsewhere. It was a huge chunk of his paycheck and we often saw little to no benefit from it whatsoever.

 

 

Interesting.  Has there ever been a hue and cry raised over corporate mandates to require insurance?

[Murphy101]

So basically here, it's cheaper to go to the Dr than the ER, even if you have to pay fees up front.

It isn't about cheaper. I'd bet most of the folks just go home because they can't afford either.

 

I've seen it plenty and we've heard people mention it here before too. Even if the ER sees them, god forbid the ER write a RX because they can't afford to get it filled. And the ER usually says they should follow up with their primary dr, but most never do bc that is also yet another cost and time off work (usually without pay). It's very common.

 

Our citizens will never get genuine healthcare until people wake up and realize that the majority of the poor and the sick do work and contribute to society and are not stupid or mooches looking for sugar daddies.

[Murphy101]

Interesting. Has there ever been a hue and cry raised over corporate mandates to require insurance?

I have no idea, but I mentioned here those problems several years ago when we were so frustrated we wanted to drop it and just use the money as needed elsewhere and they wouldn't let him... Someone more savvy than I am would have to try to find that thread. I did call the insurance commissioner and he said it wasn't illegal.

 

And many people don't complain because they don't want to lose their job by creating problems for their employer and they are scared of losing insurance, which is often promoted as just this side of the messiah if you ever get a "serious illness."

[Trish]

But this is exactly what I'm trying to figure out -- why would you buy insurance you can't afford to use?  Why not just pay the fine instead?

 

I think this is the crux of the matter. Many will NOT buy the insurance, will pay the fine instead, because the sheer amount of monthly premium PLUS deductible will likely dwarf what they are currently paying out of pocket. (and there is always the emergency room, a bill that may or may not get paid depending on the situation)  If you are living paycheck to paycheck and are barely managing to cover everything, including the monthly health care bill, will you have money left over for a co-pay? Or to pay everything out of pocket if your deductible is not met? (some insurance plans pay for well care or preventive care before you meet your deductible. Some don't) Thiis could easily be the situation for many people. I'm not criticizing or passing judgment on that scenario. If you have a sick child and no means to pay for a doctor visit upfront, and you're very worried, of course you would go to the ER! I would.

 

Anecdotal aside, my brother is a firefighter in a big city, and also drives an ambulance on some of his days off. He says it is common for inner city people to not only use the ER as a doctor's office, but to CALL THE AMBULANCE TO GET THERE, because they cannot or will not get a cab, or a ride, or take mass transit. Most often if they aren't busy, the ambulance will comply. (the public ends up paying for that) If they're busy of course they do the important cases. I suppose I'm being a little bit critical in this case (what, they're too lazy to get a ride to the ER?), but part of me thinks there are people who truly have no means to get to the ER, and so again I don't want to judge their situation. It seems wasteful (ambulance rides aren't cheap, and they're part of the reason everyone's health care insurance is so high), but people do need access. So there it is.

 

But, I think a lot of people will pay the fine in lieu of health care.

[mommaduck]

Honestly, it IS cheaper to pay out of pocket.

[Pawz4me]

I think this is the crux of the matter. Many will NOT buy the insurance, will pay the fine instead

 

But earlier you said --

 

With high premiums plus high deductibles, I wonder how many of the newly insured will STILL have to use the emergency room to access health care?

 

Which is what prompted my question of why someone would pay for insurance if they knew they couldn't afford to use it instead of just paying the (presumably cheaper) fine.

[MrsBasil]

But earlier you said --

 

 

Which is what prompted my question of why someone would pay for insurance if they knew they couldn't afford to use it instead of just paying the (presumably cheaper) fine.

 

The ER is often easier to get into, open all the time, you can't be turned away if you have an outstanding balance,and, IME, it's easier to work out payment plans with lower monthly amounts at the ER -even with insurance.  So if you have a deductible and haven't met it, going to the ER might allow you to work out a payment plan for whatever your costs are with a lower monthly payment than what your Dr's office might want to set up.  That is not a universal experience, but it has been mine.

[Trish]

But earlier you said --

 

 

Which is what prompted my question of why someone would pay for insurance if they knew they couldn't afford to use it instead of just paying the (presumably cheaper) fine.

 

I would think a lot of people who have high deductibles are hoping that their health care costs are not high enough to have their insurance kick in.  Some people have insurance for just that, INSURANCE, against a major hospitalization or illness.

 

Meanwhile, if they're having a hard time making ends meet month to month, the emergency room beckons.

 

Don't get me wrong, I'm GLAD that resource is there for the public. But I don't think Obamacare is going to "solve" the problem of people utilizing the emergency room for less than emergency reasons, and maybe (or maybe not) paying the bill.

[MomtoCandJ]

There needs to be more free/low cost clinics and have those open on weekends and later than 5 pm. Also more walkin clinics with the same hours.

I have no issues paying for services but a lot of times when I took dd to the ER, a walk in/ urgent care place would have been more appropriate or even a regular doctor but the hours that the issues happened required us to go to the ER because nothing else was open.

[LizzyBee]

Honestly, it IS cheaper to pay out of pocket.

 

Until something catastrophic happens. And you find out that you will have to be on medicine for the rest of your life that costs nearly $10,000 for a 28 day supply.  :eek:  

 

[Trish]

Until something catastrophic happens. And you find out that you will have to be on medicine for the rest of your life that costs nearly $10,000 for a 28 day supply.  :eek:  

 

 

But the way Obamacare is set up, I'm under the impression people can just pay the fines yearly until they get into a situation where they need coverage, and then they can buy in. Maybe only at certain times of the year, though.

[Mommy22alyns]

It isn't about cheaper. I'd bet most of the folks just go home because they can't afford either.

 

I've seen it plenty and we've heard people mention it here before too. Even if the ER sees them, god forbid the ER write a RX because they can't afford to get it filled. And the ER usually says they should follow up with their primary dr, but most never do bc that is also yet another cost and time off work (usually without pay). It's very common.

 

Our citizens will never get genuine healthcare until people wake up and realize that the majority of the poor and the sick do work and contribute to society and are not stupid or mooches looking for sugar daddies.

 

 

Thank you so much for this, and it bears repeating.  So many people seem to think that if you are low income, it's all your fault and you're just a lazy leech.  That's not true.

[LizzyBee]

But the way Obamacare is set up, I'm under the impression people can just pay the fines yearly until they get into a situation where they need coverage, and then they can buy in. Maybe only at certain times of the year, though.

 

Yes, although open enrollment won't last six months after this year.  I'm not sure how long it will normally last.  I read one article that said a lot of young people are going to pay the penalties rather than buy health insurance.  BUT... ACA is not sustainable without lots of young, healthy people buying in.

 

[LizzyBee]

Thank you so much for this, and it bears repeating.  So many people seem to think that if you are low income, it's all your fault and you're just a lazy leech.  That's not true.

 

I know people with master's degrees working at low income, no-benefit jobs because that's all they can find in this economy. I am so tired of people saying that if people want better salaries and health insurance, they should get an education and a good job.  It's a kick in the teeth to people who are doing the best they can.

 

I am so thankful for my job and insurance, and yes, I worked hard to get where I am, but a lot of people work hard and can't seem to catch a break.

 

[Murphy101]

Yes, although open enrollment won't last six months after this year. I'm not sure how long it will normally last. I read one article that said a lot of young people are going to pay the penalties rather than buy health insurance. BUT... ACA is not sustainable without lots of young, healthy people buying in.

 

I can't think of any reason a healthy young person would voluntarily buy in to screwing themselves out of money.

 

Nevermind the issue that until age 26 they can just "mooch" off mom and dad and have them pay for it instead. Way to screw over people already trying to deal with elder care too.

 

(And nope, my 18 year isn't signing up and we aren't signing up, so nope, none of us signing up.)

[PinkyandtheBrains.]

Until something catastrophic happens. And you find out that you will have to be on medicine for the rest of your life that costs nearly $10,000 for a 28 day supply.  :eek:  

 

 

Yes or your child needs $30,000 + in medical care over the summer...

 

 

I am grateful for insurance for this reason. It may seem expensive the rest of the time. But this year we made good use of it.

[Jane in NC]

I can't think of any reason a healthy young person would voluntarily buy in to screwing themselves out of money.

 

Nevermind the issue that until age 26 they can just "mooch" off mom and dad and have them pay for it instead. Way to screw over people already trying to deal with elder care too.

 

(And nope, my 18 year isn't signing up and we aren't signing up, so nope, none of us signing up.)

 

It has occurred to me as I read this thread that some people are more risk tolerant than others.  I could not tolerate the risk of not having health insurance--although we have minimal health issues so we rarely use it.  Yes, we pay a lot of money into the system but obviously we choose to do this so that we are not walloped by huge medical bills should something happen.

 

I suspect that Health Savings Accounts and a catastrophic plan would be a good option for people who are generally healthy. 

 

If your eighteen year is going to enroll in college, he or she may be required to buy insurance in order to attend.

[Reflections]

I understand how hospital write-offs work for people without insurance.  But I don't understand how it would work for people with insurance (which is the whole premise for this discussion).  Can people with insurance get away w/o paying for ER visits?  If you're going to do that, then why would pay for insurance?  Unless I'm missing something, it makes no sense at all.

 

You could potentially find yourself owing a lot of money for one ER visits because of high deductibles.  An ER visit where the insurance company will pay 80% after one has met the $1,000 deductible and then they will pay 100% after one meets the $3000 co-insurance deductible for each person could leave you with a $4000 bill for one person.  

[scrapbookbuzz]

What I don't understand is why the government is REQUIRING everyone to get medical insurance? For the most part, I've found that physicians actually prefer

out-of-pocket payments, even if on a low monthly payment plan, because it's just  less hassle. If we prefer to pay for our medical needs that way, why are we being 

forced to do something else?

[VeganCupcake]

I can't think of any reason a healthy young person would voluntarily buy in to screwing themselves out of money.

 

Nevermind the issue that until age 26 they can just "mooch" off mom and dad and have them pay for it instead. Way to screw over people already trying to deal with elder care too.

 

(And nope, my 18 year isn't signing up and we aren't signing up, so nope, none of us signing up.)

 

 

It has occurred to me as I read this thread that some people are more risk tolerant than others.  I could not tolerate the risk of not having health insurance--although we have minimal health issues so we rarely use it.  Yes, we pay a lot of money into the system but obviously we choose to do this so that we are not walloped by huge medical bills should something happen.

 

Absolutely true. Perhaps my no-insurance risk aversion is because I grew up in Canada. When I moved to the U.S., it was unthinkable, even as a young, healthy person, to go without insurance. I was not willing to take that risk. I used it very rarely, but it was worth it to me. I was fortunate that for a young, healthy, single person, premiums were not that high, and I had a decent-paying job.

[QueenCat]

I can't think of any reason a healthy young person would voluntarily buy in to screwing themselves out of money.

 

Nevermind the issue that until age 26 they can just "mooch" off mom and dad and have them pay for it instead. Way to screw over people already trying to deal with elder care too.

 

(And nope, my 18 year isn't signing up and we aren't signing up, so nope, none of us signing up.)

 

We don't pay any more for having our young adult on our policy. Our cost would be exactly the same without him on it. And he is NOT mooching as we told him we WANT him on it rather than being uninsured.

[LMV]

I'm confused -- How would it financially benefit an insured person to use an ER for health care in lieu of a regular doctor?  Wouldn't the ER co-pay and final bill be much higher than going to a doctor?  And the deductible would still apply.  Or at least that's how our insurance works.

It may not be that it is cheaper to go to the ED (because in general it isn't) but if your plan comes with a several thousand dollar deductible and you don't have that available you may avoid seeking care until things have deteriorated to a point where you probably are best served in an ED. 

 

We aren't eligible to use the exchange because my employer provides health care (in a small network PPO plan which for most of what we need is fine, we also have an additional family plan through my husband's law firm and this comes in handy for some out of network providers and anything which might be an out of area true emergency) but if we were using the exchange we would be paying slightly more than twenty five thousand a year in premiums along with another potential ten thousand out of pocket with deductibles and coinsurance costs.  I'm not complaining because we're fortunate to be getting a slightly better deal through the private market and even if we had to go with this we could afford to do so.  However, if we hadn't been insured in the past, I can see how it might be hard to suddenly budget an extra three thousand monthly for health expenses.  

[Pawz4me]

You could potentially find yourself owing a lot of money for one ER visits because of high deductibles.  An ER visit where the insurance company will pay 80% after one has met the $1,000 deductible and then they will pay 100% after one meets the $3000 co-insurance deductible for each person could leave you with a $4000 bill for one person.  

 

Yes, our insurance is similar.  Which is exactly why we avoid ERs except for true emergencies.  It's *much* cheaper to pay the office visit co-pay and head things off before they become emergencies.

[LizzyBee]

We don't pay any more for having our young adult on our policy. Our cost would be exactly the same without him on it. And he is NOT mooching as we told him we WANT him on it rather than being uninsured.

 

I agree - a family policy costs the same regardless of the number of children, so until the youngest reaches adulthood, there is no extra cost to have an adult child on the policy. 

 

My oldest child's college adds a health insurance premium to her bill each semester which is removed when she provides proof of other insurance.  Every student is required to be insured.

 

A lot of young people can't find a job with benefits even after graduating from college.  In that situation, I would rather keep my adult child on my policy unless she can find cheaper insurance with an individual policy.  I am one of those risk-averse people who doesn't want to be without insurance unless their is no other option.  Cost of insurance is killing us financially, but it's a high priority.  My kids have all three have asthma, and one ER visit is a couple thousand $$, so it makes more sense to keep them insured if possible.  Even with healthy people, you never know when that can change overnight.

[Kari C in SC]

Yes or your child needs $30,000 + in medical care over the summer...

 

 

I am grateful for insurance for this reason. It may seem expensive the rest of the time. But this year we made good use of it.

Or one 9 year olds crushed ankle on a trampoline. Two surgeries, 4 days in the hospital, 16 weeks of care, a $26,000 bill.

[Reflections]

Yes, our insurance is similar.  Which is exactly why we avoid ERs except for true emergencies.  It's *much* cheaper to pay the office visit co-pay and head things off before they become emergencies.

 

Yup! :)  

[Murphy101]

It has occurred to me as I read this thread that some people are more risk tolerant than others.  I could not tolerate the risk of not having health insurance--although we have minimal health issues so we rarely use it.  Yes, we pay a lot of money into the system but obviously we choose to do this so that we are not walloped by huge medical bills should something happen.

 

I suspect that Health Savings Accounts and a catastrophic plan would be a good option for people who are generally healthy. 

 

If your eighteen year is going to enroll in college, he or she may be required to buy insurance in order to attend.

For many people, including young people, it is not about risk per se as basic mathematics. When you make nothing or not enough to live on your own or are barely making it by paycheck to paycheck, how the heck are they expected to risk the rent for insurance that they often can't afford to use?

 

So I'm 22, let's say, I make minimum wage or slightly above. I live in my own and am in relative good health.

 

I can pay for insurance I likely can't use. As in, yes I have insurance, but I don't have the money to pay the copays, deductibles, and my 20%+ portion. And or it's a PITA to find a dr in network even if I scrape the funds for the visit.

 

Or I can do the math and think if I am not spending a couple hundred or more every month, that's money I can use for my medical expenses.

 

My dh and I lived that with many children for years before he was layed off his job of 14 years and we were without insurance entirely. We were genuinely frustrated and scared of illness even though we had insurance and figured it'd be nightmare worse without it. No. In fact, paying cash without insurance as gotten me better care, faster care, and less expensive care the vast majority of the time. (The exception is my dh's endocrinologist. He is one of the best in town and takes months to get into. However he works in a cooperative office, and the medical group he is under doesn't work with anyone as far as I can tell. However, our portion AFTER insurance was always right at about $350 every 3-4 months. Without insurance we are paying closer to $400 and we turn down some things insurance wanted, but we felt were unnecessary.)

 

Now I know many people are thinking what about cancer, heart attacks, car wrecks?!

 

Well you know what?

 

If I can't afford to pay $20,000+ for my portion AFTER insurance, it doesn't really matter if the bill is $200,000 without it. Either way I wouldn't be able to pay it. I suppose there might be a win for the staff because they'd at least get the benefit of my premiums, but it likely won't change a thing about me needing to file bankruptcy for medical bills. (Medical bills are the number one cause of bankruptcy and most of them had insurance.)

 

From the young person perspective doing that math, it would seem a zero sum deal for them. If anything they are being told to risk their already precarious finances now for a gamble they will have some awful tragedy and it *might* help them.

 

As for medications, I wish medications had nothing to do with insurance or were separate insurance.

 

But again, insurance often doesn't help with outrageously priced meds. 20% of a med that costs several grand or more is just not going to happen for many people.

 

I've yet to see how they are making care more affordable. Insurance doesn't do that. It just doesn't. The problem with meds that cost hundreds and thousands every month is not that people don't have insurance to pay 60-80% of it. The problem with meds that cost hundreds and thousands every month IS that they cost hundreds and thousands every month.

[Truscifi]

For many people, including young people, it is not about risk per se as basic mathematics. When you make nothing or not enough to live on your own or are barely making it by paycheck to paycheck, how the heck are they expected to risk the rent for insurance that they often can't afford to use?

 

So I'm 22, let's say, I make minimum wage or slightly above. I live in my own and am in relative good health.

 

I can pay for insurance I likely can't use. As in, yes I have insurance, but I don't have the money to pay the copays, deductibles, and my 20%+ portion. And or it's a PITA to find a dr in network even if I scrape the funds for the visit.

 

Or I can do the math and think if I am not spending a couple hundred or more every month, that's money I can use for my medical expenses.

 

My dh and I lived that with many children for years before he was layed off his job of 14 years and we were without insurance entirely. We were genuinely frustrated and scared of illness even though we had insurance and figured it'd be nightmare worse without it. No. In fact, paying cash without insurance as gotten me better care, faster care, and less expensive care the vast majority of the time. (The exception is my dh's endocrinologist. He is one of the best in town and takes months to get into. However he works in a cooperative office, and the medical group he is under doesn't work with anyone as far as I can tell. However, our portion AFTER insurance was always right at about $350 every 3-4 months. Without insurance we are paying closer to $400 and we turn down some things insurance wanted, but we felt were unnecessary.)

 

Now I know many people are thinking what about cancer, heart attacks, car wrecks?!

 

Well you know what?

 

If I can't afford to pay $20,000+ for my portion AFTER insurance, it doesn't really matter if the bill is $200,000 without it. Either way I wouldn't be able to pay it. I suppose there might be a win for the staff because they'd at least get the benefit of my premiums, but it likely won't change a thing about me needing to file bankruptcy for medical bills. (Medical bills are the number one cause of bankruptcy and most of them had insurance.)

 

From the young person perspective doing that math, it would seem a zero sum deal for them. If anything they are being told to risk their already precarious finances now for a gamble they will have some awful tragedy and it *might* help them.

 

As for medications, I wish medications had nothing to do with insurance or were separate insurance.

 

But again, insurance often doesn't help with outrageously priced meds. 20% of a med that costs several grand or more is just not going to happen for many people.

 

I've yet to see how they are making care more affordable. Insurance doesn't do that. It just doesn't. The problem with meds that cost hundreds and thousands every month is not that people don't have insurance to pay 60-80% of it. The problem with meds that cost hundreds and thousands every month IS that they cost hundreds and thousands every month.

 

The person in your example would possibly qualify for free health care through Medicaid, and would certainly qualify for subsidies.  Also, people keep talking about the super high deductibles and huge coinsurance. I know it varies from state to state but what we were quoted through the exchange was $503 a month for no coinsurance and a lower deductible than we have now for a family of 4. We still get a better deal through dh's employer (for now at least, his franchise was bought by another company and we don't know what will happen).

 

[Jane in NC]

For many people, including young people, it is not about risk per se as basic mathematics. When you make nothing or not enough to live on your own or are barely making it by paycheck to paycheck, how the heck are they expected to risk the rent for insurance that they often can't afford to use?

 

So I'm 22, let's say, I make minimum wage or slightly above. I live in my own and am in relative good health.

 

I can pay for insurance I likely can't use. As in, yes I have insurance, but I don't have the money to pay the copays, deductibles, and my 20%+ portion. And or it's a PITA to find a dr in network even if I scrape the funds for the visit.

 

Or I can do the math and think if I am not spending a couple hundred or more every month, that's money I can use for my medical expenses.

 

My dh and I lived that with many children for years before he was layed off his job of 14 years and we were without insurance entirely. We were genuinely frustrated and scared of illness even though we had insurance and figured it'd be nightmare worse without it. No. In fact, paying cash without insurance as gotten me better care, faster care, and less expensive care the vast majority of the time. (The exception is my dh's endocrinologist. He is one of the best in town and takes months to get into. However he works in a cooperative office, and the medical group he is under doesn't work with anyone as far as I can tell. However, our portion AFTER insurance was always right at about $350 every 3-4 months. Without insurance we are paying closer to $400 and we turn down some things insurance wanted, but we felt were unnecessary.)

 

Now I know many people are thinking what about cancer, heart attacks, car wrecks?!

 

Well you know what?

 

If I can't afford to pay $20,000+ for my portion AFTER insurance, it doesn't really matter if the bill is $200,000 without it. Either way I wouldn't be able to pay it. I suppose there might be a win for the staff because they'd at least get the benefit of my premiums, but it likely won't change a thing about me needing to file bankruptcy for medical bills. (Medical bills are the number one cause of bankruptcy and most of them had insurance.)

 

From the young person perspective doing that math, it would seem a zero sum deal for them. If anything they are being told to risk their already precarious finances now for a gamble they will have some awful tragedy and it *might* help them.

 

As for medications, I wish medications had nothing to do with insurance or were separate insurance.

 

But again, insurance often doesn't help with outrageously priced meds. 20% of a med that costs several grand or more is just not going to happen for many people.

 

I've yet to see how they are making care more affordable. Insurance doesn't do that. It just doesn't. The problem with meds that cost hundreds and thousands every month is not that people don't have insurance to pay 60-80% of it. The problem with meds that cost hundreds and thousands every month IS that they cost hundreds and thousands every month.

 

You raise some valid points.  Part of the reason that I don't want to be without insurance is because of an experience that I had as a young and healthy uninsured adult.  When I was a grad student, I was living a hand to mouth existence off my stipend.  Because I had grown up in a home with parents who had a fear of debt (and were parsimonious scrimpers as a result), I did not want to borrow money for grad school.  Well I became quite ill--a situation that required a five day hospitalization and numerous follow up tests.  I was lucky.  The student infirmary rates were much below the standard hospital so I was not faced with a staggering medical bill but one that was certainly beyond my paycheck.  To pay it off I had to take out a student loan, the thing that I had initially tried to avoid.

 

In retrospect, it would have been cheaper for me to have borrowed money in the student loan program to pay for insurance. But of course I did not know that I would become ill--or that I would have a well paid job out of grad school.  Life is a risk. 

 

But having been there, I choose not to take the risk now.  Yes, we have the financial resources that enable me to make that decision.  The medical bill from my grad school days was mine without insurance--as it would have been with insurance.  I am not sure I see the logic in your statement "I can pay for insurance I likely can't use." If one has a life-threatening illness (or a less severe one that requires medical care), one will have to pay for hospitals, doctors, etc. anyway. 

 

Does your community have a free clinic?  I have a relative who works at one.  She doesn't work for free though even if patients pay little or nothing.  Some people have insurance and choose to go to the doctors there.  Some governmental money is provided outside of Medicaid/Medicare which means that the larger community is helping those who need a hand.  I have no problem with that. 

 

The thing that concerns me though is when someone doesn't do the small steps to greater health because they are impoverished and cannot afford basic medical care or meds.  I would rather subsidize someone's high blood pressure meds than care for stroke recovery. 

[nmoira]

Where are all these young people who'd rather default on medical bills and ruin their credit ratings? Do we have statistics? And why, if they're making minimum wage are we assuming they don't qualify for premium assistance or Medicaid? And what about the OOP maximums? It's something like $6500 for an individual... so where do we get $20,000 or $200,000 from?  

 

ETA: OK... seems you're talking about foregoing insurance, even catastrophic. I'm pulling up numbers in the range of $85 a month after subsidies for a single person in their early 20's (making $20,000 a year) on a silver plan though. This doesn't jibe with saving a couple hundred a month.

[HRAAB]

I know people with master's degrees working at low income, no-benefit jobs because that's all they can find in this economy. I am so tired of people saying that if people want better salaries and health insurance, they should get an education and a good job.  It's a kick in the teeth to people who are doing the best they can.

 

I am so thankful for my job and insurance, and yes, I worked hard to get where I am, but a lot of people work hard and can't seem to catch a break.

 

You are my hero. Thank you for saying that. 

 

My oldest child's college adds a health insurance premium to her bill each semester which is removed when she provides proof of other insurance.  Every student is required to be insured.

Same for my dd. The premium for the insurance the school offered was $1100. per semester. Ouch. She has enough loans as it is. She's on my policy.

[HRAAB]

Where are all these young people who'd rather default on medical bills and ruin their credit ratings? Do we have statistics? And why, if they're making minimum wage are we assuming they don't qualify for premium assistance or Medicaid? And what about the OOP maximums? It's something like $6500 for an individual... so where do we get $20,000 or $200,000 from?  

 

ETA: OK... seems you're talking about foregoing insurance, even catastrophic. I'm pulling up numbers in the range of $85 a month after subsidies for a single person in their early 20's (making $20,000 a year) on a silver plan though. This doesn't jibe with saving a couple hundred a month.

First off, I haven't been able to see any actual numbers. Where are you finding these quotes?

 

Second, friends of my dds are making the same statements - that they'll forgo insurance and pay the penalty. They are, for the most part, young people she works with. They aren't making $20,000; more like $12,000 or so. (Don't ask me how they live? Share an apt w/several others) Anyway, what I'm hearing is that their income is low enough that they won't get a subsidy and instead need to apply for Medicaid. However, my state did not expand Medicaid coverage, so basically you need to be a pregnant female to qualify for it. If what I'm hearing from them is correct, they are falling through the cracks, and yes, the penalty this year would be far, far cheaper.

 

I don't know for sure about any of this. In fact, I don't even know what it would cost me to get ins. on the exchange for the girls and me because I can't get past the damned application. Grrrr......

[poppy]

What I don't understand is why the government is REQUIRING everyone to get medical insurance? For the most part, I've found that physicians actually prefer

out-of-pocket payments, even if on a low monthly payment plan, because it's just  less hassle. If we prefer to pay for our medical needs that way, why are we being 

forced to do something else?

 

I agree that many doctors would prefer that method, but I don't think that matters. Insurance covers the patient, not the service provider.

 

Do you also object to states requiring auto insurance?

[nmoira]

First off, I haven't been able to see any actual numbers. Where are you finding these quotes?

 

Here are the calculators I used:

 

http://laborcenter.berkeley.edu/healthpolicy/calculator/

http://kff.org/interactive/subsidy-calculator/

http://www.gohealthinsurance.com/subsidy

 

Second, friends of my dds are making the same statements - that they'll forgo insurance and pay the penalty. They are, for the most part, young people she works with. They aren't making $20,000; more like $12,000 or so. (Don't ask me how they live? Share an apt w/several others) Anyway, what I'm hearing is that their income is low enough that they won't get a subsidy and instead need to apply for Medicaid. However, my state did not expand Medicaid coverage, so basically you need to be a pregnant female to qualify for it. If what I'm hearing from them is correct, they are falling through the cracks, and yes, the penalty this year would be far, far cheaper.

 

I don't know for sure about any of this. In fact, I don't even know what it would cost me to get ins. on the exchange for the girls and me because I can't get past the damned application. Grrrr......

 

We're fortunate to live in state that is going ahead with Medicare expansion (ETA: We don't need it, but this is our home. KWIM?). That any state wouldn't is insane to me... I'm not making this as a political statement one way or the other: I'm Canadian and grew up in a very different system and outlook (both political and public) from what I'm experiencing in the US.