"Affordable" Care Act vent

[creekland]

And what do you imagine happened to the left over veg back then?  It all ends up in the bin.  whether it touches the kid's trays or not.

 

Actually, for veggies, far less was cooked/prepared back then as the cafeteria workers were quite good at estimating how much was needed.

 

There is far, far more waste now.  They aren't even on the same scale.

[horsellian]

You are missing the part where the insurance company would drop you, or not renew, after a catastrophic illness. Not to mention that since most people had insurance through their work, losing their job meant that they would very often havea gap in coverage (COBRA is expensive!) and then couldn't get insurance privately do to preexisting issues. My father lived in terror that he would lose his job, and not be able to get insurance again for my mom, because of her cancer diagnosis. They paid all their lives, and yet something out of his control, a lay off, could cause her to lose insurance, and possibly her life. 

 

This is the way travel insurance works in the UK.  My FIL can't change travel insurance company because he had kidney cancer nearly 25 years ago.  The only company that will cover him is the one he was covered by at the time - no-one else will take him on now even though it's been decades.  That means he's definitely paying over the odds, but my ILs like to travel.

 

Of course, if he couldn't get travel insurance, he has the choice not to travel, but I just can't understand how you can have a system apply similar rules to healthcare.

[Trish]

ACA works best for people eligible with subsidies.

 

Without a subsidy it gets a lot less affordable for people, especially when you factor in the rather large deductibles.

[SKL]

Yes, but if you want to have a free market, then you have to let people choose not to get insurance.  Also, what you describe is inherently redistributive, and reminds me of the way a single-payer system is redistributive.

 

But it's a sharing of risk, which is the whole contractual intent of all the parties.  That is completely different from a redistribution of wealth.

[SKL]

You are missing the part where the insurance company would drop you, or not renew, after a catastrophic illness. Not to mention that since most people had insurance through their work, losing their job meant that they would very often havea gap in coverage (COBRA is expensive!) and then couldn't get insurance privately do to preexisting issues. My father lived in terror that he would lose his job, and not be able to get insurance again for my mom, because of her cancer diagnosis. They paid all their lives, and yet something out of his control, a lay off, could cause her to lose insurance, and possibly her life. 

 

Thankfully she is not old enough for medicare, and he no longer has that fear hanging over him. 

 

Employer-provided health insurance doesn't solve every one of society's problems.  It isn't supposed to.  We have always needed and will always need other programs to fill the gaps.  However, the fact is that employer-provided insurance has been very effective for most people for a long time.  There is / was no need to throw out the baby with the bathwater.

 

[Carrie12345]

ACA works best for people eligible with subsidies.

 

Without a subsidy it gets a lot less affordable for people, especially when you factor in the rather large deductibles.

 

But a lot less affordable compared to what? Compared to what they paid through an employer, or compared to the entire cost they and their employer paid before?

 

I don't like paying so much for my health insurance.  But I don't think telling businesses to pay it on my behalf is the "right" answer, and I definitely don't think it' a "fair" trade off to give businesses the power to chose my coverage to a certain extent.

 

What I would really like to see is how today's HC dot gov costs compare to former private policy costs.  I've never purchased my own policy before the exchange, so I truly don't know.  If anyone has links, I'd happily read them.

[texasmama]

But a lot less affordable compared to what? Compared to what they paid through an employer, or compared to the entire cost they and their employer paid before?

 

I don't like paying so much for my health insurance.  But I don't think telling businesses to pay it on my behalf is the "right" answer, and I definitely don't think it' a "fair" trade off to give businesses the power to chose my coverage to a certain extent.

 

What I would really like to see is how today's HC dot gov costs compare to former private policy costs.  I've never purchased my own policy before the exchange, so I truly don't know.  If anyone has links, I'd happily read them.

 

I have no links.  I'm sure everyone's experience is a bit different.  My family purchased a private plan (high deductible) for 8 years and was not covered under any employer plan.  Before the change to an ACA compatible policy, we paid $580 a month for our family of five.  The same plan was going to cost about $1200 due to becoming ACA compatible.  I searched on the healthcare dot com marketplace, and in order to keep our current (high deductible coverage), we would pay about $1200 per month.  We (oddly, IMO, because we are solidly middle class) qualified for subsidies.  However, my dh owns a small business and his income is quite variable within the same year.  If we chose to accept subsidies for our high deductible, low coverage, overpriced health insurance, we would run the risk of having to pay those back if dh's business picked up.  And we would not know this until tax filing time.  So we didn't really know what our cost would be.   We could have chosen to opt out of the subsidies and pay $1200 a month for something that would not be terribly helpful to our family but would cause us financial hardship to pay for on a monthly basis. 

 

No thanks.  That is when we went with Samaritan Ministries, and I am very grateful that there was a good option for us. 

 

ETA:  In the year prior to the marketplace plans being offered, due to the ACA legislation, we were rated up $100 a month for my dd's fully corrected congenital birth defect of bilateral clubfoot, even though she needed no treatment.  After a long process of letter writing from her doctor, this was what the insurance company agreed to in order to cover her at all.  It had been a $400 per month upcharge.  All of this for a high deductible plan that if she ever needed surgery would likely not cover much of it.  In the past, we had gladly chosen to have dd's clubfoot condition uncovered.  Due to the legislation, this choice was taken from us, and we were forced to pay for coverage we didn't need and didn't want due to the legislation.  So that is the downside to the "no preexisting conditions" coverage.  We paid more, and our choice was taken from us. 

[shinyhappypeople]

ACA ticks me off. We are at 150% of FPL.  We (the family) do NOT qualify for a subsidy, because my DH's employer pays for his coverage, so because his coverage is less that 9% of his income, we are told that WE (me, kids) have access to affordable coverage.  The powers that be call this a "drafting error."  Except, if it was an error (doubtful), they've made no effort to correct it.  This would actually be an excellent use of executive order:  use the order to correct the error (yeah, right) so the law may be implemented as intended. (It was hard writing that with a straight face.  I do not believe it was an error, I believe that ACA is already mind-bogglingly unaffordable for our nation, so to add in the costs of subsidies for millions(?) more families would set it over the tipping point)

 

Meanwhile, I'll likely be fined about $350 for not having coverage on myself.  The cost under "Covered California" (the health insurance exchange) is a little below 8% so the powers that be have deemed it "affordable."  Who the heck is the government to tell me what is and what isn't affordable for my family???    Especially since the cheapest exchange plan had HUGE deductibles (like $5,000 or more).  If I'm already paying over $200/mo for crappy insurance, how am I supposed to save up for a deductible?  Not feasible.

 

My hope:  ACA will be repealed and individual states will implement more extensive safety net programs to make sure that its residents have access to the essential medical services they need.  Or maybe some states will choose a "universal healthcare" model.  Whatever.  Individual states can figure out the best (or at least better) plan to meet the needs of their unique demographic.  None of this "one size fits all"  what's good for New York, must be good for Iowa, must be good for Texas bull.

 

[Scarlett]

ACA ticks me off. We are at 150% of FPL. We (the family) do NOT qualify for a subsidy, because my DH's employer pays for his coverage, so because his coverage is less that 9% of his income, we are told that WE (me, kids) have access to affordable coverage. The powers that be call this a "drafting error." Except, if it was an error (doubtful), they've made no effort to correct it. This would actually be an excellent use of executive order: use the order to correct the error (yeah, right) so the law may be implemented as intended. (It was hard writing that with a straight face. I do not believe it was an error, I believe that ACA is already mind-bogglingly unaffordable for our nation, so to add in the costs of subsidies for millions(?) more families would set it over the tipping point)

 

Meanwhile, I'll likely be fined about $350 for not having coverage on myself. The cost under "Covered California" (the health insurance exchange) is a little below 8% so the powers that be have deemed it "affordable." Who the heck is the government to tell me what is and what isn't affordable for my family??? Especially since the cheapest exchange plan had HUGE deductibles (like $5,000 or more). If I'm already paying over $200/mo for crappy insurance, how am I supposed to save up for a deductible? Not feasible.

 

My hope: ACA will be repealed and individual states will implement more extensive safety net programs to make sure that its residents have access to the essential medical services they need. Or maybe some states will choose a "universal healthcare" model. Whatever. Individual states can figure out the best (or at least better) plan to meet the needs of their unique demographic. None of this "one size fits all" what's good for New York, must be good for Iowa, must be good for Texas bull.

Did you try this?

 

jeninok, on 24 Nov 2014 - 11:38 AM, said:

Could you expand on this please, we are in the same situation and while my son and husband are now insured, I am not but would very much like to be.

 

Scarlett replied. They had me apply alone. I still had to declare my Dh's income, but he wasn't applying for coverage on the application...just I was. Somehow it made a difference and I was allowed to show the cost of insurance for ME through my dhs employerer which was very expensive.

[Sdel]

You are missing the part where the insurance company would drop you, or not renew, after a catastrophic illness. Not to mention that since most people had insurance through their work, losing their job meant that they would very often havea gap in coverage (COBRA is expensive!) and then couldn't get insurance privately do to preexisting issues. My father lived in terror that he would lose his job, and not be able to get insurance again for my mom, because of her cancer diagnosis. They paid all their lives, and yet something out of his control, a lay off, could cause her to lose insurance, and possibly her life. 

 

Thankfully she is not old enough for medicare, and he no longer has that fear hanging over him. 

 

Which is why health insurance tied to jobs is probably not the best plan?  Employer based insurance came about when wages were being controlled in WWII as a way for companies to attract, retain, or compensate employees when they could not do so via wages.

 

This works fine in a culture of employee loyalty, where everyone involved has the cultural expectation that generally employees will work for the same company for their entire careers.  Not so much in a culture where there is no such expectation and the workforce is highly mobile.

 

And anyway, what we have now is just flat out *not* completely insurance, it is something else.  Insurance is catastrophic in nature. 

 

Stefanie

[SKL]

Which is why health insurance tied to jobs is probably not the best plan?  Employer based insurance came about when wages were being controlled in WWII as a way for companies to attract, retain, or compensate employees when they could not do so via wages.

 

This works fine in a culture of employee loyalty, where everyone involved has the cultural expectation that generally employees will work for the same company for their entire careers.  Not so much in a culture where there is no such expectation and the workforce is highly mobile.

 

And anyway, what we have now is just flat out *not* completely insurance, it is something else.  Insurance is catastrophic in nature. 

 

Stefanie

 

True, but it still worked well for most people.  Not perfect, but pretty well.  Most Americans who are not on Medicare are employed, and I don't know the % today, but I believe it's a pretty high % that is employed by an employer who offers some halfway decent insurance.  Before ACA the quoted figure was that 90% of Americans had health insurance.  I never did understand why we didn't just target the solutions at the 10% who didn't have it.

 

The loyalty thing is completely beside the point.  People switch health insurance when they switch jobs.  I've done it 4 times so far, and I'm not a job hopper.  I've also had employers change insurance companies while I worked there.  No biggie.

 

[shinyhappypeople]

Did you try this?

 

jeninok, on 24 Nov 2014 - 11:38 AM, said:

Could you expand on this please, we are in the same situation and while my son and husband are now insured, I am not but would very much like to be.

 

Scarlett replied. They had me apply alone. I still had to declare my Dh's income, but he wasn't applying for coverage on the application...just I was. Somehow it made a difference and I was allowed to show the cost of insurance for ME through my dhs employerer which was very expensive.

 

I don't trust the government not to come back and say, "Hey!  Turns out you had "affordable" coverage through your husband's job, so pay us back the subsidy."   That would put us in a much, much worse situation.

[CAmomof4]

DH makes all the insurance decisions for our company, which covers our family and the other employees.  We have a deductible plan with HSAs.  This year, after several years of 20+% increases per year, we have two choices.  Stay on our current plan, $4500/$9000 deductible, for a 6% price increase, or move to our ACA-compliant plan a year early: either a $4500/$9000 ded. for a 33% increase, or step down to the lowest ACA plan for a $5000/$125000 deductible for an 11% increase.  Kicker is, either ACA plan - although it costs more - comes with a subsidy which will cover almost half the cost to the company.  Then over the next couple years they gradually wean you off the subsidy.

 

I don't get it - they take a plan that has been working for us, tell us it's not good enough, that we need to move to a plan that has a higher deductible yet somehow costs more - then they offer us someone else's money to pay the higher price.  Huh???  I'm not as smart as Gruber, obviously, but...something doesn't add up there.

 

Our ins. company is Kaiser by the way, a non-profit.

[NicksMama-Zack's Mama Too]

I don't get it - they take a plan that has been working for us, tell us it's not good enough, that we need to move to a plan that has a higher deductible yet somehow costs more - then they offer us someone else's money to pay the higher price.  Huh???  I'm not as smart as Gruber, obviously, but...something doesn't add up there.

 

Our ins. company is Kaiser by the way, a non-profit.

No need to wonder why the insurance companies love ACA.

 

http://www.nytimes.com/2014/11/18/us/politics/health-law-turns-obama-and-insurers-into-allies.html?_r=0

[Momof3littles]

No need to wonder why the insurance companies love ACA.

 

http://www.nytimes.com/2014/11/18/us/politics/health-law-turns-obama-and-insurers-into-allies.html?_r=0

 

This is one reason among many I'd prefer a single payer system.

[SKL]

DH makes all the insurance decisions for our company, which covers our family and the other employees.  We have a deductible plan with HSAs.  This year, after several years of 20+% increases per year, we have two choices.  Stay on our current plan, $4500/$9000 deductible, for a 6% price increase, or move to our ACA-compliant plan a year early: either a $4500/$9000 ded. for a 33% increase, or step down to the lowest ACA plan for a $5000/$125000 deductible for an 11% increase.  Kicker is, either ACA plan - although it costs more - comes with a subsidy which will cover almost half the cost to the company.  Then over the next couple years they gradually wean you off the subsidy.

 

I don't get it - they take a plan that has been working for us, tell us it's not good enough, that we need to move to a plan that has a higher deductible yet somehow costs more - then they offer us someone else's money to pay the higher price.  Huh???  I'm not as smart as Gruber, obviously, but...something doesn't add up there.

 

Our ins. company is Kaiser by the way, a non-profit.

 

Oh, I totally get it.  The ultimate goal is single-payor nationwide.  Knowing the majority of voters don't want that, they are hoping to do this incrementally, and the above is a step in the process.

[Scarlett]

I don't trust the government not to come back and say, "Hey! Turns out you had "affordable" coverage through your husband's job, so pay us back the subsidy." That would put us in a much, much worse situation.

 

.? I filled out the forms just like they told me.

[Bootsie]

Which is why health insurance tied to jobs is probably not the best plan?  Employer based insurance came about when wages were being controlled in WWII as a way for companies to attract, retain, or compensate employees when they could not do so via wages.

 

 

Yes, employer based health insurance is a result of the market finding away around government regulation.  Free markets do that.  So, now we regulate employer based insurance, and the market works to find a way around that---these solutions are generally less efficient than if a free market determined the outcome.  

[Ausmumof3]

Late to the thread, but there was discussion earlier about preventing non emergency visits to emergency. One initiative we have here is a free health direct line. If you are unsure whether to go in or not you can ring up and they will give advice. There is also a good government website for health advice that is useful in assessing when to go to the dr.

 

Pharmaceuticals like pain killer are charged for in emergency anyway, so there would be no benefit in going there for that. Various things are subsidised but you get the same subsidy from the pharmacy as long as you have a prescription.

 

I don't know too many people that go the dr for fun. Some are quicker to seek medical help than others as is the case under all systems.

 

Also if you are over a certain income you are required to have private health cover or pay a levy. Our private health costs around $2000 a year.

 

There are maximum costs set by Medicare for certain things. Some Drs only charge that cost. Other drs choose to charge more. If you go to a more expensive one you pay the difference.

[Jane in NC]

Yes, employer based health insurance is a result of the market finding away around government regulation.  Free markets do that.  So, now we regulate employer based insurance, and the market works to find a way around that---these solutions are generally less efficient than if a free market determined the outcome.  

 

Generally less efficient?  It appears that other countries with regulated single payer systems do a far better job both in terms of reach and cost effectiveness.

 

Could you please give me an example of a free market medical system that you would like the US to emulate?

 

Thank you.

[Bootsie]

Generally less efficient?  It appears that other countries with regulated single payer systems do a far better job both in terms of reach and cost effectiveness.

 

Could you please give me an example of a free market medical system that you would like the US to emulate?

 

Thank you.

First, I was not comparing the efficiency of the US system with any single payer system.  I was comparing a free market system with a system that regulates the market, which then reacts to that regulation, that then is further regulated, etc.  This is generally different than a single payer system. 

 

Second, I didn't say that there was a free market medical system that I would like the US to emulate.  I never even said that my preference was a free market medical system.  I was speaking, as an economist, of the impact of regulation.  

 

My preference would be for health care and health insurance to be totally separated from employment situations.  There is no more logical reason for my health insurance to be tied to my employment than for my car insurance to be.  The fact that health insurance and employment is tied together at all is the result of wage regulation.

[Jane in NC]

First, I was not comparing the efficiency of the US system with any single payer system.  I was comparing a free market system with a system that regulates the market, which then reacts to that regulation, that then is further regulated, etc.  This is generally different than a single payer system. 

 

Second, I didn't say that there was a free market medical system that I would like the US to emulate.  I never even said that my preference was a free market medical system.  I was speaking, as an economist, of the impact of regulation.  

 

My preference would be for health care and health insurance to be totally separated from employment situations.  There is no more logical reason for my health insurance to be tied to my employment than for my car insurance to be.  The fact that health insurance and employment is tied together at all is the result of wage regulation.

 

Sorry--since this is an ACA thread I thought that was the issue you were addressing. 

 

Do you consider the power that insurers have to limit medical choices to be a good thing from a market perspective? 

[texasmama]

Part of the issue for my family is that neither my dh nor I have an employer.  He is a small business owner, and I have been primarily a stay at home mom or a part-time employee for the past 14 years. So we have no employer health insurance offered, and this has always been a hardship.  After ACA, it is more of a hardship than ever.  I actually had hope that the legislation would help my family, but this was not the case at all.  Quite the opposite.

[Bootsie]

Sorry--since this is an ACA thread I thought that was the issue you were addressing. 

 

Do you consider the power that insurers have to limit medical choices to be a good thing from a market perspective? 

A free, competitive market would allow for me to enter into a contract with insurers that was mutually agreeable.  I would then be able to make medical choices, or really have the insurer pay for those medical choices, based upon that contract.  I would not see that as the insurer limiting medical choices; I would see that as the insurer paying for items as agreed upon the in the contract.  I do not think a system in which I buy insurance and then I can choose whatever medical treatment I want at any point in time and the insurer has to pay for it would be a sustainable system.  What type of medical choice limits are you asking about?

[Jane in NC]

A free, competitive market would allow for me to enter into a contract with insurers that was mutually agreeable. I would then be able to make medical choices, or really have the insurer pay for those medical choices, based upon that contract. I would not see that as the insurer limiting medical choices; I would see that as the insurer paying for items as agreed upon the in the contract. I do not think a system in which I buy insurance and then I can choose whatever medical treatment I want at any point in time and the insurer has to pay for it would be a sustainable system. What type of medical choice limits are you asking about?

Doctors have told me that insurers impose limits on treatment options, days of hospitalization, types of medication that can be used.

[cjzimmer1]

Late to the thread, but there was discussion earlier about preventing non emergency visits to emergency. One initiative we have here is a free health direct line. If you are unsure whether to go in or not you can ring up and they will give advice. There is also a good government website for health advice that is useful in assessing when to go to the dr.

 

 Every insurance I've ever had here has this as well so I would guess that the majority of people with insurance would have this option as well.  THe problem is that no matter what you call for they will tell you to bring the person in.  Seriously, I have never been told that the situation didn't need treatment or even been told to wait.  I've heard others complain the same thing - they always tell you to come in.  I think it's one of those cover their backsides issues.  I no longer bother to call the help line because I already know what they are going to say.  So at least around here that option does nothing to decrease costs.

[QueenCat]

 Every insurance I've ever had here has this as well so I would guess that the majority of people with insurance would have this option as well.  THe problem is that no matter what you call for they will tell you to bring the person in.  Seriously, I have never been told that the situation didn't need treatment or even been told to wait.  I've heard others complain the same thing - they always tell you to come in.  I think it's one of those cover their backsides issues.  I no longer bother to call the help line because I already know what they are going to say.  So at least around here that option does nothing to decrease costs.

 

With ours, if we call in for a non-emergency and they tell us to go in, we don't get penalized later if it turns out it could have waited. If we go without calling, to the ER, and it's not an emergency, then we pay a higher out of pocket. I should note that they do not expect us to call for obvious emergencies. Additionally, this is definitely not new. Like  you, it's been similar to this for us for 20+ years.

[Murphy101]

Except that most Americans have been paying in all along. And those of us who have been paying in all along are the ones getting bigger and bigger bills.

 

We paid in until nearly 5 years ago. And furious most of the time too bc the insurance bickered over every. Dang. Thing. Insurance was an infuriating large chunk of dh's paycheck that was wasted bc we could never afford to use it or they gave us the run around on paying out or we couldn't find a dr that took it or... But we kept getting it taken out of his checks bc we were scared of being without it.

 

Go figure being without insurance for 5 years has been pretty much just like being on insurance we can't afford to use, only now we can spend that premium to see actually see a dr sometimes and to order insulin from Canada.

 

I don't care where the insurance is coming from, employer or mandated purchase, I think it's a scam screwing over citizens and we should work hard to get rid of it as a primary source of providing medical care for general citizenry.

[Frances]

A free, competitive market would allow for me to enter into a contract with insurers that was mutually agreeable.  I would then be able to make medical choices, or really have the insurer pay for those medical choices, based upon that contract.  I would not see that as the insurer limiting medical choices; I would see that as the insurer paying for items as agreed upon the in the contract.  I do not think a system in which I buy insurance and then I can choose whatever medical treatment I want at any point in time and the insurer has to pay for it would be a sustainable system.  What type of medical choice limits are you asking about?

 

While I certainly agree that having insurance tied to your employer is not really a good thing, I don't see how a free market system with no government regulation would work for those with potentially expensive pre-existing conditions. What incentive would the insurance companies have to insure them? This is one of the main things the ACA was trying to address. If you've paid for private insurance for many years and then get cancer, why wouldn't the insurance company drop you when your policy comes up for renewal? Or if you were born with a life long health problem, how will you ever get insurance in a free market system?

 

Also, given the complexity of most health insurance policies, I think some people might find they don't really have what they think they purchased when they need it most. I've certainly heard in the past of people being burned when buying private insurance. And while the free market does help to some extent to weed out the bad players, there are always those who will try to take advantage of others in the name of greed.

[Frances]

The same is true of many nurses, physical therapists, physician assistants, etc. across the healthcare system.  I have articulated my desires in this realm to my DH, as having a proxy clear on your desires is IMO more important than a "living will" in most cases.  I agree regarding CPR, and am open to palliative care, hospice, etc. as I age.  If I am close to death, I do not want a feeding tube, for example.  I had the privilege of taking a course when I was in school co-taught by an oncologist and his wife, who served as a chaplain and hospice nurse for 35 years.  That really shaped my beliefs about end of life care and intervention, in combination with my own personal and professional experience.

 

It doesn't mean that everyone has to arrive at those decisions, but many, many people do not realize how poor the outcomes are with things like CPR under certain circumstances, do not realize that withholding feeding at the end of life can actually be more comfortable for the patient, etc.  I think it would be beneficial for people to be given this information, as I think that we still aren't there.  And doctors should be explaining to patients how to articulate their wishes to their family, how to select a proxy, etc so that individuals can have the best chance possible to have their desires honored. 

 

 

For a fascinating podcast on a city in Wisconsin where almost everyone has made end of life plans, listen to this: http://www.npr.org/blogs/money/2014/02/28/283444163/episode-521-the-town-that-loves-death.

[TranquilMind]

Theoretically, if the majority of policies were sought by individuals there could be affordable mental health (like vision or dental insurance) rider or bundled plans that individuals chose in addition to whatever level of catastrophic coverage they wanted.  I believe this is how those few self purchase plans work, they are just such a minority of purchasers they don't have good collective bargaining power over price.  This type of model works very well for every other type of insurance, why is it so unacceptable for health insurance?  What you are describing is one of the negatives to single payer and employer based health insurance where you are not the insurance company's primary consumer. 

 

Stefanie

Right.  Why can't there be riders for coverage if you need it?   Why does everyone have to pay for it?   Why do we have to pay for birth control for everyone;  we are past child-bearing age, and never even bought birth control for ourselves (except rarely,and at the drugstore out of our own pocket)? 

 

I don't get this shifting of costs onto everyone, if everyone isn't likely to use it.  Hospital coverage - yes - all are potentially liable to use it.  Special coverages for mental health care and birth control and prostate care, etc.  no. 

 

 

[Ausmumof3]

Mental health issues have the potential to affect everyone if they aren't adequately dealt with.

[Laura Corin]

Right.  Why can't there be riders for coverage if you need it?   Why does everyone have to pay for it?   Why do we have to pay for birth control for everyone;  we are past child-bearing age, and never even bought birth control for ourselves (except rarely,and at the drugstore out of our own pocket)? 

 

I don't get this shifting of costs onto everyone, if everyone isn't likely to use it.  Hospital coverage - yes - all are potentially liable to use it.  Special coverages for mental health care and birth control and prostate care, etc.  no. 

 

 

 

FWIW, mental illness affects a very large proportion of people at some point in their lives, so I would be glad of that coverage, myself.  Mental health issues can have a severe effect on earning capacity, so they are difficult to self finance.  Birth control?  I would prefer that a larger proportion of the babies born come into homes where they are truly welcome - it improves the life chances of the individual child, as well as reducing the potential burden on society.  

 

I'm happy to have wide coverage: I will also probably have medical problems in the future that others would prefer not to pay for, but that's the nature of mutual support and the spreading of risk.

 

L

[TranquilMind]

FWIW, mental illness affects a very large proportion of people at some point in their lives, so I would be glad of that coverage, myself.  Mental health issues can have a severe effect on earning capacity, so they are difficult to self finance.  Birth control?  I would prefer that a larger proportion of the babies born come into homes where they are truly welcome - it improves the life chances of the individual child, as well as reducing the potential burden on society.  

 

I'm happy to have wide coverage: I will also probably have medical problems in the future that others would prefer not to pay for, but that's the nature of mutual support and the spreading of risk.

 

L

I just don't see it that way. I guess I come from a long line of very stable people who have never needed or obtained mental health care, so it is not coverage that I would ever need.   No unwanted babies in my entire family line, but we didn't assume it was everyone else's responsibility to ensure that result. 

You won't have "wide" coverage under the ACA. You have the new narrow coverage.  You pay for everything under the sun that could potentially happen to anyone, even if it is unlikely or impossible (prostate) that you need it yourself, but you get the choice of a couple of places to go for that care.  Do a google search on narrow coverage, the hallmark of this legislation. 

Let's spread the reasonable risk of hospitalization and disease in general (and that could include severe things like psychosis, but I don't think everyone should pay for every antidepressant out there) - not every single thing, though you are free to opt in if you like. 

[Guest]

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

 

Yes, well... It's great. It's better, in fact, than most of the private hospital/private care system here. Just like our public univcersities are so much better than private that the private ones have mainly failed. ...and like our education system, it's being undermined and gutted. It's being routinely underfunded in what is effectively a handout and subsidy of private health insurance.

 

As a dual national, who left the US for Australia many years back, I'm really glad we have universal health care. It's something we need to fight for, and keep going.

 

It's not very expensive, actually, and if we increased the health levy (a part of our tax), there wouldn't be such pressure on it.

 

Dede

[Guest]

I just don't see it that way. I guess I come from a long line of very stable people who have never needed or obtained mental health care, so it is not coverage that I would ever need.   No unwanted babies in my entire family line, but we didn't assume it was everyone else's responsibility to ensure that result. 

You won't have "wide" coverage under the ACA. You have the new narrow coverage.  You pay for everything under the sun that could potentially happen to anyone, even if it is unlikely or impossible (prostate) that you need it yourself, but you get the choice of a couple of places to go for that care.  Do a google search on narrow coverage, the hallmark of this legislation. 

Let's spread the reasonable risk of hospitalization and disease in general (and that could include severe things like psychosis, but I don't think everyone should pay for every antidepressant out there) - not every single thing, though you are free to opt in if you like. 

 

Birth control is a preventative issue. It saves society all sorts of problems. The problem is, even if it is avaiable, not everyone has the wisdom to use it, especially those who should.

[TranquilMind]

Birth control is a preventative issue. It saves society all sorts of problems. The problem is, even if it is avaiable, not everyone has the wisdom to use it, especially those who should.

So...what?  We need to tell people to use birth control and pay for it for them?  I just don't think Big Brother needs to manage society to that degree. 

[Sdel]

Birth control?  I would prefer that a larger proportion of the babies born come into homes where they are truly welcome - it improves the life chances of the individual child, as well as reducing the potential burden on society.  

 

I'm happy to have wide coverage: I will also probably have medical problems in the future that others would prefer not to pay for, but that's the nature of mutual support and the spreading of risk.

 

L

 

Birth control doesn't really have that much impact on life chances of individual children.  Many crappy parents truly welcome babies and those babies go on to be "burdens on society" and many surprise babies have parents that completely step up to the plate of raising children and go on to not being burdens.  Life outcome has more to do with the individuals involved than the circumstances of conception.  Also, birth control is very far removed from developing some medical problem.  The actions that necessitate birth control to prevent babies are (with one notable exception) completely driven by an individual's choices which are 100% in their control.  That is not the case with most chronic and debilitating diseases. 

 

Stefanie

[Slartibartfast]

Birth control doesn't really have that much impact on life chances of individual children.  Many crappy parents truly welcome babies and those babies go on to be "burdens on society" and many surprise babies have parents that completely step up to the plate of raising children and go on to not being burdens.  Life outcome has more to do with the individuals involved than the circumstances of conception.  Also, birth control is very far removed from developing some medical problem.  The actions that necessitate birth control to prevent babies are (with one notable exception) completely driven by an individual's choices which are 100% in their control.  That is not the case with most chronic and debilitating diseases. 

 

Stefanie

That's awkward.

[Sdel]

That's awkward.

 

I don't see how it is.  Most BC isn't about yes/no to kids......its about when most people want them to arrive or not and whom they want them with or not.   I don't have issues with people using BC, I have issues with being expected to pay for another person's intimate personal decisions.  There just really is no way around that fact that a primary biological purpose of sex is to get pregnant and have babies. 

 

Stefanie

[kewb]

A lot of people go on the pill for medical reasons. It is used for more than birth control.

[Sdel]

If you are on BC for a medical reason, then you are on BC for a medical reason.  There is a distinction and medical reasons would have validity in being covered.  Trust me, it really isn't an overly onerous burden for the vast majority of people to pay OOP for BC.  I've done it my entire adult life.

 

Stefanie

[Χά�ων]

I still cannot afford it. I am timing my return to the workforce for when my son is no longer a minor because right now, if I return to work I risk having to pay out the wazoo for insurance AND still pay for what he needs. Heck, I have him on medicaid and still pay out of pocket for additional therapy that he needs.

[StephanieZ]

I just don't see it that way. I guess I come from a long line of very stable people who have never needed or obtained mental health care, so it is not coverage that I would ever need.   No unwanted babies in my entire family line, but we didn't assume it was everyone else's responsibility to ensure that result. 

You won't have "wide" coverage under the ACA. You have the new narrow coverage.  You pay for everything under the sun that could potentially happen to anyone, even if it is unlikely or impossible (prostate) that you need it yourself, but you get the choice of a couple of places to go for that care.  Do a google search on narrow coverage, the hallmark of this legislation. 

Let's spread the reasonable risk of hospitalization and disease in general (and that could include severe things like psychosis, but I don't think everyone should pay for every antidepressant out there) - not every single thing, though you are free to opt in if you like. 

 

That is not true of ACA policies in my state. I have a PPO that covers both in network (which, so far as I can tell, covers every single doctor in my region) OR out of network. My OUT OF NETWORK OOP MAX is under 6k (family), and they cover 90% of everything in or out of network until I get to that max. In fact, it is the exact same network but BETTER coverage than I had previously, and I was the person who chose the previous policy for our company, and it is with the best insurer in our region with the best coverage. 

 

So, the ACA network/choice factor is definitely not a hallmark of ACA in general. There are low-choice HMO style plans, or more expensive PPO style plans. Your choice. 

[TechWife]

I just don't see it that way. I guess I come from a long line of very stable people who have never needed or obtained mental health care, so it is not coverage that I would ever need.   

...

Let's spread the reasonable risk of hospitalization and disease in general (and that could include severe things like psychosis, but I don't think everyone should pay for every antidepressant out there) - not every single thing, though you are free to opt in if you like. 

 

That's a lot like saying "No one in my family has ever had a heart attack, so I won't have one either." You never know what the future hold for yourself or your dependents. 

 

Additionally, I think perhaps you have some misconceptions about antidepressants and how they are used. I'm not going to take the time to correct them, but suffice it to say that depression strikes a large number of people, research is sadly lacking and sometimes finding the right medications requires a lot of trial and error. It isn't a matter of covering a lot of anti-depressants, it's a matter of making sure that a wide range of anti-depressants are available in the hopes that, should you need it, there will be one that works for you. When you find that medication, it needs to be affordable, or many patients will not be medication compliant, which then has the potential to drive the cost of mental health care up further through hospitalizations, more frequent office visits, etc.. 

[Elisabet1]

Birth control doesn't really have that much impact on life chances of individual children.  Many crappy parents truly welcome babies and those babies go on to be "burdens on society" and many surprise babies have parents that completely step up to the plate of raising children and go on to not being burdens.  Life outcome has more to do with the individuals involved than the circumstances of conception.  Also, birth control is very far removed from developing some medical problem.  The actions that necessitate birth control to prevent babies are (with one notable exception) completely driven by an individual's choices which are 100% in their control.  That is not the case with most chronic and debilitating diseases. 

 

Stefanie

This is very true.

 

My mother was very well educated. She grew up in a great family. She was very career oriented and was well respected in her career-a normally male dominated field even now. No one had a clue what she was like. But when I was born, which she got pregnant with me on purpose, she moved far from family "for career reasons." Then she tossed me to foster care because she hated me (she told me this many many times) and was a very abusive parent. She never told my grandparents or other relatives. Everyone else just thought she was living this great life. Back then (the 70's), the courts did not charge her child support for this. But, in the 80's, they did. So she took me back and was horrible and nasty to me, horribly abusive. I still have nightmares from the abuse sometimes. I doubt anyone who knows her (not closely like I do) would have a clue. As far as everyone else was concerned, she was just this brilliant, wonderful, career person.  Her income was 6 figures in 1980. She was capable of preventing pregnancy. She went to a top school (Rice University). 

 

 

Personally, birth control should have been the last of the concerns of Obamacare, or anything mandated. Anyone who is capable of having sex is capable of getting a job to pay for the birth control. On the other hand, 90 yr olds cannot get the medical care they need anymore. My grandmother is having to pay cash for a lot of things that used to be covered. Fortunately, she can, but many people her age cannot and have to go without and will no doubt die younger or suffer from it. 

[Joker]

I just don't see it that way. I guess I come from a long line of very stable people who have never needed or obtained mental health care, so it is not coverage that I would ever need.   No unwanted babies in my entire family line, but we didn't assume it was everyone else's responsibility to ensure that result. 

You won't have "wide" coverage under the ACA. You have the new narrow coverage.  You pay for everything under the sun that could potentially happen to anyone, even if it is unlikely or impossible (prostate) that you need it yourself, but you get the choice of a couple of places to go for that care.  Do a google search on narrow coverage, the hallmark of this legislation. 

Let's spread the reasonable risk of hospitalization and disease in general (and that could include severe things like psychosis, but I don't think everyone should pay for every antidepressant out there) - not every single thing, though you are free to opt in if you like. 

 

Yeah, I came from a long line of "stable people" too - until I didn't. Needing mental health care isn't a weakness.

[TranquilMind]

That is not true of ACA policies in my state. I have a PPO that covers both in network (which, so far as I can tell, covers every single doctor in my region) OR out of network. My OUT OF NETWORK OOP MAX is under 6k (family), and they cover 90% of everything in or out of network until I get to that max. In fact, it is the exact same network but BETTER coverage than I had previously, and I was the person who chose the previous policy for our company, and it is with the best insurer in our region with the best coverage. 

 

So, the ACA network/choice factor is definitely not a hallmark of ACA in general. There are low-choice HMO style plans, or more expensive PPO style plans. Your choice. 

That is just so not true nationally.

 

There are hundreds of articles about this:  Here is just one from (liberal) CNN:  http://www.cnn.com/2013/10/29/health/obamacare-doctors-limited/

 

Another:  http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

 

 

I think we were told we can't post articles or snippets from them, but if I could, it would not be difficult to refute your position.  You are a rarity. 

[TranquilMind]

Yeah, I came from a long line of "stable people" too - until I didn't. Needing mental health care isn't a weakness.

I did not say it was a weakness.  I do not think everyone needs to pay for that coverage however, as they do hospital coverage or general medical care, or even specialists.  If you need it, buy it.  

[TranquilMind]

This is very true.

 

My mother was very well educated. She grew up in a great family. She was very career oriented and was well respected in her career-a normally male dominated field even now. No one had a clue what she was like. But when I was born, which she got pregnant with me on purpose, she moved far from family "for career reasons." Then she tossed me to foster care because she hated me (she told me this many many times) and was a very abusive parent. She never told my grandparents or other relatives. Everyone else just thought she was living this great life. Back then (the 70's), the courts did not charge her child support for this. But, in the 80's, they did. So she took me back and was horrible and nasty to me, horribly abusive. I still have nightmares from the abuse sometimes. I doubt anyone who knows her (not closely like I do) would have a clue. As far as everyone else was concerned, she was just this brilliant, wonderful, career person.  Her income was 6 figures in 1980. She was capable of preventing pregnancy. She went to a top school (Rice University). 

 

 

Personally, birth control should have been the last of the concerns of Obamacare, or anything mandated. Anyone who is capable of having sex is capable of getting a job to pay for the birth control. On the other hand, 90 yr olds cannot get the medical care they need anymore. My grandmother is having to pay cash for a lot of things that used to be covered. Fortunately, she can, but many people her age cannot and have to go without and will no doubt die younger or suffer from it. 

THIS!   This is so upsetting as the waves of boomers enter their older years.  My Mom had a couple of years of health issues in the end of her life, and a couple of hospitalizations.  They tried a couple of different antibiotics to get rid of the c. diff infection, courtesy of the hospital.  ALL covered for her, just a few years ago.  I think I ended up paying a grand out of pocket, if that.

 

Yet now, it is a totally different story.