Aetna Slowly Bailing out of ACA Public Health Insurance Exchange

[ChocolateReignRemix]

So we should just disregard rate hike data because market share changes? Sure, since Aetna, is dropping out of exchanges their market share will most likely go down. That basically leaves those people moving to BCBS or Humana (as those three companies are currently ~90% of the marketshare). If they're lucky, they'll be able to go to BCBS which isn't going super crazy (roughly the same increase as Aetna). If they're unlucky, Humana is the other option in their area and they will see a gigantic increase. Most likely, average rate increase will actually be higher than that 27% weighted average in the article just because of how high the Humana rate increase is due to shifts from Aetna to other carriers. 

 

 

Also, no single state is going to be representative of the country. That doesn't mean you should marginalize the effects on the budgets of the hundreds of thousands of people in GA on private insurance. 

 

No, we shouldn't use market share rates to weight the premium increases.  There is no guarantee Humana will grow their market share when their increase is out of line with the others.  You can't declare the most likely consumer behavior when we don't know how consumers will react.

[mommytobees]

Maybe we could offer free medical school (and education for nurses and other health care practitioners) for anyone willing to work on a salary at a government owned facility. Maybe we should also drop the requirement of a bachelor's degree before medical school. We also need more residencies available. I've read there aren't enough available for all medical school graduates.

 

Maybe we could revamp the system in some way that has the med students start out as nurses or something and gradually gaining more responsibility as they go through school. (Maybe this idea is nuts. Someone working in the medical field will need to chime in.)

 

I agree that something needs to change for Med School, however, I've known some fantastic doctors who would have made Bad Bad Bad nurses!!! 

 

Kris

[JumpyTheFrog]

My kids' doctor is switching to a hybrid concierge/insurance model soon. It will be $1500 per year for two kids to be her patients, on top of what patients were already paying with insurance. She is trying to reduce her practice from 1600 families to 250. Under her new model, she will see 8 patients a day instead of 30 and parents will be given her cell phone number.

 

We will be finding them a new doctor. I understand not wanting to deal with insurance, but paying all that money and then still having to deal with insurance is a deal breaker for me.

[maize]

I wonder what would happen if employers and individuals were allowed to buy into medicare at a competitive rate? Seems like the easiest way to transition, and the private insurance companies could stay in the game as long as they want by competing for customers and offering top up plans.

 

Can I run the government for just a couple of years? I want a chance to try my experiment.

[ChocolateReignRemix]

I wonder what would happen if employers and individuals were allowed to buy into medicare at a competitive rate? Seems like the easiest way to transition, and the private insurance companies could stay in the game as long as they want by competing for customers and offering top up plans.

 

Can I run the government for just a couple of years? I want a chance to try my experiment.

 

That was one of the original ideas floated with the ACA. 

[Josh Blade]

Ten years ago, when I was in my 30s, we were paying >$1500 a month for our insurance. Now we pay $238 a month (family of 5). Insane premium prices are not the fault of the ACA, and the companies that tell you that are lying to you.

 

It's not he fault of any one bill or company either. But I can anecdotally say I paid $126 for a family of 3 in 2013 and am paying $509 for family of 4 now with a higher deductible, higher copayments, and less choice in doctors. How would guaranteeing the sickest among us insurance coverage, when they previously didn't have it not necessarily cause premium increases (not that I think we should have uninsurable people)? The cap on profits as a percentage of revenue also incentivizes higher premiums. Literally the only way for an insurance company to increase profits now is to allow increased prices on services matched with a proportional increase in premium payments. Ie it's not in the insurance company's interest any more to cut long term costs as their profits are tied to those costs. If they pay out less overall, then their potential profit is also lowered due to the ACA.

 

Congratulations on being in a state that most likely expanded medicaid and has competition. What makes your positive anecdote any more valuable than my negative anecdote? 

 

I'm glad that the previously uninsurable are able to get some kind of coverage now, that doesn't mean everything about the ACA was sunshine and roses for everyone. There are winners and losers with the changes brought about by the ACA. I happen to be in the loser category due to Age/Health/Geography. We should work toward a more equitable solution for everyone. It shouldn't matter if you live in CA or GA.

[Josh Blade]

No, we shouldn't use market share rates to weight the premium increases.  There is no guarantee Humana will grow their market share when their increase is out of line with the others.  You can't declare the most likely consumer behavior when we don't know how consumers will react.

 

The issue with that is not all providers listed are available everywhere in GA. Many counties only have 2-3 options currently (I saw many articles last year about rural areas in GA with only 1). 3 Providers currently have 90% of the market share. One of those is going away. It's a pretty safe assumption that in many cases one of those others is going to be the only option now.

[Mergath]

That was one of the original ideas floated with the ACA.

Which, I'm guessing, the lobbyists for the insurance companies shot down pretty quickly. Can't give people access to affordable, decent coverage, after all, or they won't have to pay a fortune for crappy policies that hardly cover anything.

[mommytobees]

and many insurance companies won't pay if tests aren't ordered by a doc in their system. And they often need the tests run at a lab that they approve. And many insurance companies need a referral from a primary doctor in their system and will only cover specialists in their same network.

 

Sort of makes me LOL when people talk about how government shouldn't get between doctors and patients. The insurance companies have been there a very, very long time. They control who you can see, how often and what can be done.

 

Again, cash only practices are not really sustainable except for a very small number in the larger cities.

 

Which is worse: the government dictating what the patient can/not do, or the insurance company?

 

One of the MS drugs that the Neuro wanted to put my son on has a high chance of PML caused by a virus. There is one lab in the country that tests for the virus. My son has Tricare, active duty dependent and we had to justify why we used this lab. Turned out we needed a prior authorization and didn't have one. An easy fix after the fact, Neuro ripped them a new one and that solved that. (FTR: I _hate_ with a passion UHC and miss TriWest....for anyone who actually understands that sentence.) 

 

Either way we look at it...._someone_ is going to be in our business. It can be the cooperation who is trying to make money or it can be the government entity who is running the program.

 

The Business makes money when the patient makes the payment of premiums. Thus, has no investment in keeping/making the person a productive member of society.

 

The Government makes money when the patient has a job and pays taxes. Thus, the investment of the patient's health is a priority.

 

Kris

[Guest]

Unless that catastrophic thing happens earlier or the under 26 is still on the parents insurance. My ex, when we were married, caught a routine virus, never noticed it, until it infected his heart and put him into heart failure. He developedmi cardiomyopathy and was sent to a teaching hospital to be evaluated for a transplant. Oh, and he also had a kidney disease, totally random, that has caused him to have one kidney transplant already, and he will need another soon. He's 42, these problems started in his 20s.

 

Or the guy I know that tripped on a curb and need total reconstruction of his knee, then almost died from blood clots,

 

Or the woman who had a stroke while pregnant in her 30s and was in the ICU for weeks before dying.

 

Or the young woman who had a premature baby that needed open heart surgery.

 

Any one of these things is well beyond what even a very frugal saver could plan for.

Exactly, and that is how major medical worked in the 80s. One paid for routine, one was covered for extraordinary. The difference between now and then is cost sharing and premium are dramatically different. Different enough that it impacts one's budget to the point that the middle class is having a hard time eating well and educating the children. Without those two, it gets harder to maintain health, and we spiral into costly costly chronic illness. I would rather the family have enough remaining in their budget to prevent illness, and subsidize the health care of others by a different means of taxation, where everyone shares the burden.

 

Note the example above of the guy tripping...that is an accident and may not be paid for via his medical insurance company. I know, I am dealing with the paperwork for my child's nonvehicular accident. Insurance is seeking to recover as personal injury from the owner of the property that the accident occurred on.

Edited August 17, 2016 by Heigh Ho

[ChocolateReignRemix]

Which, I'm guessing, the lobbyists for the insurance companies shot down pretty quickly. Can't give people access to affordable, decent coverage, after all, or they won't have to pay a fortune for crappy policies that hardly cover anything.

 

That provision was public enemy #1.

 

[JumpyTheFrog]

That means I had to pay for vaccinations out of pocket.  Do you know how much those cost? They cost about 400$ a

 

 

It sounds like they charged you one of the fake prices I am always complaining about. Around here, regular childhood vaccines cost $50-100 (cash price) at the chain pharmacies, which means they are profitable at far less than $400. Uninsured patients can get them for free at the health dept.

 

 

I haven't run across doctors who don't take ANY insurance.

 

My doctor doesn't take insurance. It costs about $120 for a 45 minute appointment. I can't imagine ever going to a doctor for a 7 minute appointment (unless it was something like an injury). Chronic illnesses can't be managed in such short appointments.

[liber]

I hear about waits in Canada. (which has the slowest care out of the western world, it's faster in the UK and elsewhere). But if it was "wait a few months" versus "never get treatment because you can't afford it" the waiting doesn't seem so bad. I'd rather we all have a wait, because everyone gets treated, then not have a wait because a sizable number of people just have to go without. 

 

People do die here waiting for care or for beds to open up so they can get treatment.  If it isn't life threatening it can be months sometimes years, waiting in pain.

 

It isn't all sunshine and rainbows here.  Our medical plan through our employer when we lived in the US was far superior than the one we had here in Canada, if you are lucky enough to have an employer who can offer you one.  Every province is different in what they will cover.  I have a cousin who has type 1 diabetes.  New Brunswick doesn't cover supplies in the same way that Nova Scotia does and even at that it is limited.  He pays over 20,000 out of pocket because insurance plans won't cover him because it is a pre existing condition.  In Manitoba, supplies for type 1 diabetics are covered until they are 16, then it is OOP.  If you do have a medical plan with an employer, there are limits what they will cover.  For speech therapy, our plan covered $500/a calendar year/per person here in Canada. I have two kids in speech.  That means it covers two months and then we are the hook for the rest.  In the US it was covered at 80% and no limits.  Testing for LD's, OOP here in Canada.  Huge waiting lists for mental health services.  Don't want to wait, OOP for a private psychologist.  I had a family member wait months for a psychiatrist. Two year wait for a dermatologist, if your GP will refer you.    I don't know, personally I liked our insurance plan that we had in the US, compared to what we have in Canada.

[MaeFlowers]

Where are you getting the 50% from? The latest projections (from healthcare surveys) I saw were in the range of 5% (average) for employer provided plans. The ACA plans vary, but I think the silver plan increase was still around 10% (average).

Link: http://mobile.nytimes.com/2015/07/04/us/health-insurance-companies-seek-big-rate-increases-for-2016.html?referrer=

 

If that doesn't work, search insurance rate hikes June 2016. Most of the major news outlet have done reports.

[JumpyTheFrog]

I wonder what would happen if employers and individuals were allowed to buy into medicare at a competitive rate? Seems like the easiest way to transition, and the private insurance companies could stay in the game as long as they want by competing for customers and offering top up plans.

Before switching to that, maybe we could end the employer mandate, but also allow everyone to buy on the exchange. I think it is insane that people can't use it if they are offered terrible, overpriced coverage at work.

[Guest]

I hear about waits in Canada. (which has the slowest care out of the western world, it's faster in the UK and elsewhere). But if it was "wait a few months" versus "never get treatment because you can't afford it" the waiting doesn't seem so bad. I'd rather we all have a wait, because everyone gets treated, then not have a wait because a sizable number of people just have to go without.

You will change your mind the day you realize you have a stage III cancer, as you watch it progress into stage IV while you wait. You could have lived for decades if immediate treatment was available (depending on which cancer type it is), if the line wasnt clogged with people with self induced illnesses, or illnesses that could easily wait a little longer, or end of life surgeries that extend their time by a few months. Or if you had enough money after your health insurance premiums to afford to eat well and never developed cancer in the first place.

[mommytobees]

Here the working poor are fill up the supposedly nonprofit hospitals. Because though they might have state medical (many toe the line of not quite qualifying and most in my state do not have it if they are adults) it's a PITA to get into a dr that will accept it. And many of the working poor have the worst jobs to navigate dr appts around. Even if they have the dr and the medical coverage, they can't get in to be seen between 9-5 M-F. So regardless of coverage, many working poor can't use regular dr offices.

 

ETA: and again, why do you accept its okay to refuse some of the working poor due to payment method and not others? There's a lot of working poor who can't pay either way.

 

:hurray:  :thumbup1:  I'm shocked each and every single time I end up in the ED with one of my kids (more times in the past year than in the previous 17 years). The last time, there was a mom in the next cubicle with her 10yo daughter. They were there because mom couldn't afford to get her T1 diabetic daughter the rest of her supplies and there were 10 days left in the month. Access (the state Medicaid option) didn't authorize enough supplies. 

 

The time before that, while waiting for the MRI machine to open, I had a conversation with the mom of a child (who was in the MRI) with Epilepsy. She had health insurance through her work, but it wouldn't cover the dosage of pills for her son because he was overweight and only 8yo. The drug cost was outrageous in the US and she usually purchased his from Canada, but her sister, who lived in Seattle, died and she can't go get it herself.

 

Healthcare should not be only for those who can afford to pay the exorbitant costs that the US has inflated to having. The costs affect everyone, but the upper-middle class finds ways around it through good health insurance to budgets with a higher amount of money left over after the bare bones are paid for and the wealthy even more so.

 

And, before anyone thinks I'm whinging out of turn, I divorced and went back to school and am holding a 3.85 GPA (even after Fall 2015's term of hell--kid in hospital doesn't equate to great times) to be able to do something for myself. But, I have a true fear that my 18yo Senior in High School will not be able to manage college. The brain damage he has from the MS is awful. I believe in hard work, but what about him and people like him, unable to make a better life. Are we going back to the days where the wealthy thrive and those with bad luck don't.

 

Kris

[ChocolateReignRemix]

Link: http://mobile.nytimes.com/2015/07/04/us/health-insurance-companies-seek-big-rate-increases-for-2016.html?referrer=

 

If that doesn't work, search insurance rate hikes June 2016. Most of the major news outlet have done reports.

 

1.) Those are requested increases.

2.) The article you linked didn't mention anything about average increases of 50%.

[FaithManor]

And my paranoid mother is rambling on and on and on about death panels. Gah!

 

My dad has stage four cancer, completely

incurable, can't even be put into remission, and yet he insists on fighting it and is racking up an obscene amount of money in medical bills not one of which has EVER been denied by medicare. Not one. He has total, 100% access to anything. Meanwhile on our private pay insurance, we fought for a year for 52 year old dh to get a routine colonoscopy from an in network provider, and every single time we use our damn BCBS we have to fight to the death to get them to pay any covered service.

 

I brought this up to my mom. "The only death panels we have are insurance companies and they kill people every, single, day." Her response, "Too bad for you. My generation doesn't want anything to change."

 

And there you have it right there folks. They represent a massive voting block, and they don't give a damn about anyone but themselves. They want what they want when they want it no matter who it hurts or kills. People talk all the live long day about selfish millenials, but in my experience the most selfish group of voters out there are my parents and their friends. I don't know if anything can change while so many of them run the government/hold public office.

[ChocolateReignRemix]

Before switching to that, maybe we could end the employer mandate, but also allow everyone to buy on the exchange. I think it is insane that people can't use it if they are offered terrible, overpriced coverage at work.

 

By far the largest flaw in the ACA.  And it wasn't by accident.

[TechWife]

There were some states who refused to expand their Medicaid program under ACA because the expansion was federally funded. I wonder if insurance rate hikes in those states are disproportionately high when compared to rate hikes in states where Medicaid was expanded? I'm not sure how to search out this information, but it's an interesting thing to consider. 

Edited August 17, 2016 by TechWife

[Murphy101]

I am curious about how this works and where it is. For example, my homebirth midwife, who is legal in my state but is not covered by any insurance network charged more for for my homebirth almost 12 years ago than what you pay now. I believe I had to pay 4,000 for all nine months of care and the birth. It could have been 5,000, but I don't think so.

 

A friend's son did not have insurance. His wife (also no insurance) had to have a C-section in California and it was 10,000 just for the section, not the care or the hospital stay. I have no idea how much that was, but I would not be surprised if they owed 20,000$ in total. It was about 5-6 years ago

My OB/cesarean is only for her. I have no idea what the hospital side of things will be because no matter what they can't give a number when I call and I can't make arrangements either. Which is completely stupid if them but not something I can control. And not something that would be any different if I had insurance. Sure in theory it would be 20-40% of whatever, but that wouldn't mean I'd have that 20-40% either.

 

I can see a chiro here, but my insurance does not cover it. Technically, it is covered by my insurance, but there are no chiros they allow into their network. So I have to pay cash. It costs me about 50$ a visit, but no establishing fee and no x-rays are done at this practice. But I don't consider chiro care to be comparable to seeing a GP, and my chiro is quick to point out what she is and is not allowed to treat or diagnose.

I don't use my chiropractor as a GP and he is also very clear about what he can or can't do. However his set up is typical of the no insurance GPs and internists around here. There's an initial appt where we meet, go over the medical history in detail, a thorough exam, discuss what we are looking for in medical care and what the dr offers, this establishes the client with the dr (if the patient decides this is for them) and thereafter future appts are significantly less. The GP my husband sees was $200 to start and the first appt took roughly 3.5 hours where they went over his entire medical history with him, did a complete physical, and talked about his current needs and health goals. After that, we pay $100 a month (not per appt) and he can go into the dr as often as he needs to for no additional charge. Yes, this is not free or cheap, but it is way less than any of his insurance options copays and deductibles without even factoring in the premiums.

 

Are you getting a cash discount, IOW, are these providers providing you care for cash but seeing other people in their practice, or another practice, with insurance, or are these practices 100% cash for everyone? Are they carrying malpractice insurance? That is what drives up the cost with many OB practices. It it only your OB who is 100% cash? Do you have a pediatrician for the kids who is also 100% cash? How are things like vaccinations covered?

Some of the Drs don't take any insurance. Some only take a few for current patients bc they don't want to cut off their current patients.

 

Yes, these Drs have everything any other Drs has. Decent office with all the usual supplies and equipment, licensing and coverage, and hospital privledges. My OB came highly recommended. These are not shoddy Drs who can't find any other work.

 

My kids are covered by state medical, but it doesn't work very well. It's hard to find decent Drs and get appts. Our ped has been ours for nearly 20 years. So I usually just call and work something out with him. It's never been more than $150, and that is when he comes out to the hospital to check up on the newborn. We do vax, but we are selective and on a different schedule. I suppose if my ped was getting too pricey, I'd take them to the health dept and get the free shots offered at the start of every school year. I don't like going that route bc the health dept has long lines, it's only on certain days/times and you can't select vaccinations, it's all or nothing. (Actually I *think* you can but they make it such a nightmare and insinuate so strongly that you can't that most don't know they can or aren't confident enough to do so. Not sure. It's been years so maybe that's all changed.)

 

I'm not saying everyone should do what we are doing. I completely agree that this wouldn't work for cancer or a life altering car wreck. But most people who file bankruptcy with medical bills do have medical insurance, so it's not like that is some security fail safe.

 

I'm for an universal healthcare program.

I don't think Medicaid/care is all that great, it's got a lot of the same problems that insurance has. For every story of how it's awesome and no hassle, there's a story of how it's just as much a failure as private insurance. I have not seen it work well for my elderly and or disabled relatives and friends.

 

I'd like to see nonprofit hospitals be truely nonprofit. (Don't even get me started on that!) And for the hospitals to pay those who work in their facility, rather than this crazy separate billing for every person, which may or may not be covered and may or may not have even been known to the patient.

 

I'd love to be wrong about universal Medicaid/care. I do think a program that gives the state's their own programs instead of it being a federal program would be better received by people.

 

Also, not directed to you, but I forget who commented - CR?, I completely disagree that pharmaceuticals are not a healthcare issue. That's crazy talk. Medications are a life requirement for many people and that has got to be treated as a medical healthcare issue. It's flat out stupid that the exact same insulin here is $200 for one vial and I can order a 3 month supply from London or Ontario for less than $60 including shipping. Or that an epi pen here is $400-600 and I can order one from there for less than $250.

 

I'm not sure what the perfect answer is.

I'm just very sure insurance and our current set up isn't it.

[mommytobees]

I've had government health care my entire life, and have worked in a mini-version of a single payer system, the Indian Health Service. It's not medical Nirvana.

 

Well, I agree with you there! Indian Health Services sucks!! When I did my single-payer review, I looked at what we have here in the US. Tricare has problems, but overall is a good system...when we aren't fighting with the contractor agency to cover something that should be covered (I know Tricare VERY well). However, the IHS is horrid! I did a series of interviews with a few people here in Phoenix and O.M.Goodness!!!!! The horror stories I heard.

 

Personally, I think IHS was formed out of guilt and funded out of guilt and eventually, people got tired of feeling guilty. 

 

Just my opinion and I don't have anything more than stories and other people's opinions to go off of---IHS wasn't a big focus for my review.

 

Kris

[mommytobees]

I didn't say it works well, I said I've had good experiences. I think there are two major issues at play here.

 

The first is that military people live in a medical bubble, some/many joined the military at 18 and haven't ever dealt with medical insurance. Their doctor and Tricare, especially as active duty members, handle everything for them , and in many places getting care is fairly quick and painless. So they get out of the military and surprise! You get to deal with all the waiting and red tape that pretty much the rest of the US population has always had to deal with.

 

The second issue is that you always hear the bad. Nobody hears about my good experience because the bad ones are more interesting/fit the rhetoric/make the government look incompetent, etc.

 

Just as a side note, this is why I like the ICE system. I was always giving the good alongside the bad.

kris

[Murphy101]

Fine by me. Someone going to medical school solely to get rich, and who would walk away the second they realized they weren't going to make as much money, would probably be a horrible doctor anyway. I'll gladly take the people who have a passion for medicine over the people who have a passion for money.

I don't think that's necessarily a fair statement. With the exception of a few people, I don't know anyone who has a passion for being buried in debt for 30-50 years. And most would call them idiots for making that choice, not passionate. I don't think not wanting to live under a dark cloud of debt for the rest of their lives is the same as just looking to get rich either.

[Murphy101]

My kids' doctor is switching to a hybrid concierge/insurance model soon. It will be $1500 per year for two kids to be her patients, on top of what patients were already paying with insurance. She is trying to reduce her practice from 1600 families to 250. Under her new model, she will see 8 patients a day instead of 30 and parents will be given her cell phone number.

 

We will be finding them a new doctor. I understand not wanting to deal with insurance, but paying all that money and then still having to deal with insurance is a deal breaker for me.

Some have done that here too and I agree, no way. From a patient POV, it makes no sense to me either.

[Josh Blade]

By far the largest flaw in the ACA.  And it wasn't by accident.

 

Agreed. The clerical staff in my office who make ~$10/hr can get an individual plan for just under 9% of their income after our company's $150 subsidy that they give to everyone (bring the price from $300ish to $150ish). This is roughly in line with individual plans offered on the exchange except they can't get the exchange subsidy, which they would certainly qualify for. Even worse is that the family plans range from $1150 to $2000 per month. The company subsidy that they give everyone brings it down to $1000 for the cheapest family plan. The clerical staff take home about 1200-1400 per month depending on if they do 401k and other insurance options or not. It's literally not possible for our clerical staff to buy a family plan, but at the same time, they aren't eligible for subsidies.

[MaeFlowers]

Cash only? Who could reasonably do that and maintain a medical practice. I had to pay 'cash only' because my doctor wouldn't take our insurance. I had to pay for everything out of pocket and get reimbursed. That means I had to pay for vaccinations out of pocket. Do you know how much those cost? They cost about 400$ a piece. I've had to write checks for 800$ and hope I got reimbursed a portion. I had to pay 300$ for a pap, not counting the 125$ for the office visit. I never got a mammogram when we had that (non) insurance, but I can't even imagine how we could pay for it

 

I doubt many doctors who went to cash only would get much business. Most people can't afford it. A single pediatric well visit could easily run over a thousand dollars. It's just not sustainable.

It may be area dependent. I don't pay near that for services.

 

I have read articles from drs who quit taking insurance. Their income goes up due to reduced costs. One Dr said her income doubled even though she was seeing half the patients.

[mommytobees]

People do die here waiting for care or for beds to open up so they can get treatment.  If it isn't life threatening it can be months sometimes years, waiting in pain.

 

It isn't all sunshine and rainbows here.  Our medical plan through our employer when we lived in the US was far superior than the one we had here in Canada, if you are lucky enough to have an employer who can offer you one.  Every province is different in what they will cover.  I have a cousin who has type 1 diabetes.  New Brunswick doesn't cover supplies in the same way that Nova Scotia does and even at that it is limited.  He pays over 20,000 out of pocket because insurance plans won't cover him because it is a pre existing condition.  In Manitoba, supplies for type 1 diabetics are covered until they are 16, then it is OOP.  If you do have a medical plan with an employer, there are limits what they will cover.  For speech therapy, our plan covered $500/a calendar year/per person here in Canada. I have two kids in speech.  That means it covers two months and then we are the hook for the rest.  In the US it was covered at 80% and no limits.  Testing for LD's, OOP here in Canada.  Huge waiting lists for mental health services.  Don't want to wait, OOP for a private psychologist.  I had a family member wait months for a psychiatrist. Two year wait for a dermatologist, if your GP will refer you.    I don't know, personally I liked our insurance plan that we had in the US, compared to what we have in Canada.

 

I agree, your plan in the US was better than what you are receiving in Canada...but you are missing one point:

 

You only had Health Insurance in the US while you (your Dh) was employed.

 

If he lost is job, died, was seriously injured, you are out of insurance (unless you can afford Cobra).

 

Yes, if you compare Plan A to Plan B, you have the ability to say: this is good and this isn't as good. But, what about stability?

 

My son is 18 and he graduates from HS in Dec. At that point, my XH is able to remove him from his health insurance. This insurance costs him nothing; the dental costs $30 per month for ALL dependents (1 or 25, it's still $30) and he's married, so he pays the dental anyway. What are my 18yo child's options?

 

(I'm now sharing stuff I don't normally share...)

 

Because of MS, my son can't drive a car.

We live in Phoenix until I graduate and MS is greatly affected by heat. Yesterday was 110.

He can't drive. He can't take the bus, the nearest one is 1.5 mile from the house.

How does he get a job? I have to drive him. Plus, he can't work outside 8-9 months of the year.

No job that he can get, and he's been trying for 6 months now, is going to give him health insurance.

 

So, his only option, if his dad drops him is Access (Medicaid). 

Access might cover his $2100 per month drug......or it might not.

 

My 15yo daughter is planning on getting her degrees, first a BS in Psychology then some sort of PhD in a more narrow field, and then she plans on emigrating to Australia, or UK, or Sweden, or the Netherlands, or ____________. Most of the places she is looking at she doesn't even need to learn the language prior to going (though she is planning on it) because they'll allow immigration with English and the degree and teach her the language when she gets there.

 

Why? Because she doesn't want her children to face the same problems her brother is facing.

 

Kris

[maize]

So...we can hash stuff out here and come up with better solutions, but is there any actual hope that the People in Positions of Power will do anything to improve the situation? Seems I haven't even heard much about it in this year's campaign discussions. 

 

Setting aside the Presidential race, what is going in in the legislative branch? Who out there is not owned by the insurance lobby?

Edited August 17, 2016 by maize

[mommytobees]

You will change your mind the day you realize you have a stage III cancer, as you watch it progress into stage IV while you wait. You could have lived for decades if immediate treatment was available (depending on which cancer type it is), if the line wasnt clogged with people with self induced illnesses, or illnesses that could easily wait a little longer, or end of life surgeries that extend their time by a few months. Or if you had enough money after your health insurance premiums to afford to eat well and never developed cancer in the first place.

 

(note: I'm reading this as though the patient is Canadian....if I'm wrong, I apologize.) 

 

Um, how about being in the US and finding out that you can't afford to pay for your treatment. Yes, now that patient would qualify for Medicaid (by whichever name it is called in that state), but that doesn't suddenly mean the doctor will see you. Or that the treatment is free. Or that you'll ever get the treatment.

 

I know a lady right now who is trying to fund her chemo treatment.

 

Kris

[purplejackmama]

Ten years ago, when I was in my 30s, we were paying >$1500 a month for our insurance. Now we pay $238 a month (family of 5). Insane premium prices are not the fault of the ACA, and the companies that tell you that are lying to you.

Wow!! How is yours so cheap?

[maize]

Wow!! How is yours so cheap?

 

Clearly it is being subsidized by someone.

[maize]

The Christian cost-share programs seem to work well for many, does the AFA make provision for a secular version of those? Does that exist?

[Guest]

She is still ahead of the person who cant get in the door.

 

You all do realize that the annual oop max is a budget buster for middle class right? These people are choosing between food, heat, and health care due to the enormous premiums and co-pays.

Edited August 17, 2016 by Heigh Ho

[Haiku]

Wow!! How is yours so cheap?

 

My husband works for a company that was recently purchased by a larger company. The parent company is family owned, and the owner is committed to treating his employees well. He has the bargaining power to negotiate good prices and the humanity to do so. :D

[FaithManor]

The Christian cost-share programs seem to work well for many, does the AFA make provision for a secular version of those? Does that exist?

I do not think a secular version exists. It would have to be charitible, but I think the exemption was specifically a religious exemption so not likely that a secular version would be included.

[ChocolateReignRemix]

So...we can hash stuff out here and come up with better solutions, but is there any actual hope that the People in Positions of Power will do anything to improve the situation? Seems I haven't even heard much about it in this year's campaign discussions. 

 

Setting aside the Presidential race, what is going in in the legislative branch? Who out there is not owned by the insurance lobby?

 

Nothing substantial is going on.  Rather than fixing issues around the ACA, the current solution seems to be repeal it and...well, it kind of stops right there.

 

Edited August 17, 2016 by ChocolateReignRemix

[TechWife]

The Christian cost-share programs seem to work well for many, does the AFA make provision for a secular version of those? Does that exist?

 

It's a religious exemption, so no, I don't think so. The cost sharing programs have their benefits and their drawbacks. 

[MaeFlowers]

1.) Those are requested increases.

2.) The article you linked didn't mention anything about average increases of 50%.

I said if and I said as much as.

 

ETA: Does it matter? Even a 10% increase is going to make it more difficult and more people are going to drop it. And, it's going to go up each year. It's just not sustainable.

Edited August 17, 2016 by MaeFlowers

[MaeFlowers]

The Christian cost-share programs seem to work well for many, does the AFA make provision for a secular version of those? Does that exist?

I looked into this myself. They do have to be religious and they had to exist before Obamacare was implemented. So, no new ones can be created. Many of the ones that did exist have already gone under.

[ktgrok]

You will change your mind the day you realize you have a stage III cancer, as you watch it progress into stage IV while you wait. You could have lived for decades if immediate treatment was available (depending on which cancer type it is), if the line wasnt clogged with people with self induced illnesses, or illnesses that could easily wait a little longer, or end of life surgeries that extend their time by a few months. Or if you had enough money after your health insurance premiums to afford to eat well and never developed cancer in the first place.

 

Again, if you can't afford care at all, like a very sizable number of people with our current system, that would happen too. And i'd say MORE people die here, of treatable illness for lack of money, than die in Canada because of waiting. 

[FaithManor]

My parents couldn't afford routine care, preventative, or diagnostic care when they were on a med share. Med share was major medical/hospitalization only so they had to pay out of pocket for everything nor related to a hospitalization. The many thousands this came to each year was more than they could afford at their income level. So often they let things like an upper repsiratory infection go so long that it morphed into bad pneumonia, then went to the ER and got admitted so that the ER visit, hospitalization, and 30 days od meds and follow up visits was covered. Over time this took a serious toll like my mom letting her blood sugar getting out of control so testing and meds would be covered due to the hospital stay which resulted in her begging for the docs to prescribe an entire year's worth of meds so she could have it filled immediately, and it would be covered. You can imagine what that did to her health.

They did this while I was a teen so I learned that no matter how sick I was, I could not speak up because the only healrhcare I could have was when I was bad enough to be in a dangerous state.

I cannot recommend these programs unless a person is going to save $10,000 or so a year dedicated to paying office calls, meds, and diagnostics.

Edited August 17, 2016 by FaithManor

[Josh Blade]

The Christian cost-share programs seem to work well for many, does the AFA make provision for a secular version of those? Does that exist?

 

They're all religious, but there is one that accepts people of other faiths/atheists (liberty health share). 

[ScoutTN]

Doubtful.  A single payer would have streamlined processing and guaranteed reimbursement.

 

 

When has anything the Federal government run ever been "streamlined" or "guaranteed"?! 

[Bluegoat]

In the UK, doctors are free to work for cash outside of the NHS, or to top up their NHS salaries by taking some private patients. Most don't, however, as there isn't a big market for their services at the GP level.

 

I know some other systems are like this too, but I've also never really hr=eard of it being a really significant problem.  I think there are a variety of ways to make sure that it doesn't happen, or deal with it if it does.  In any case, I can't imagine there could ever be huge demand.  Even with specialists, a lot of them will be doing things that only a very few could afford to pay for out of pocket.

[ChocolateReignRemix]

When has anything the Federal government run ever been "streamlined" or "guaranteed"?!

Medicare has a low operating cost. Pretty sure they make their payments.

[Murphy101]

When has anything the Federal government run ever been "streamlined" or "guaranteed"?!

About the only thing I can think of is taxes. They have got how to get taxes streamlined and guaranteed.

 

ETA which I wouldn't mind so much if they used the money like they should.

Edited August 17, 2016 by Murphy101

[Guest]

Again, if you can't afford care at all, like a very sizable number of people with our current system, that would happen too. And i'd say MORE people die here, of treatable illness for lack of money, than die in Canada because of waiting.

That would be expected due to pooulation size.

 

My point is that health care has kicked the middle class family who has no govt or union employee based insurance in to poverty (depending on the employer) and worse health, at a time when the nation is rich enough to be trotting out preventative care.

 

My insurer, for ex, is getting swamped with colonoscopies. They have stepped in and asked patients to ask about determining which option is best for their health, rather than running up the tab with blindly electing the most expensive option. There is a mindset that since its paid for by someone else, go ahead and run up the tab. Many are asking that the middle class be allowed to keep enough income that they can stay healthy and work, rather than be pushed in to poverty, say by having certain companies contribute rather than shove costs onto state taxpayers, and have an oop max that considers cola and compensation. We have to make it affordable to be healthy.

Edited August 17, 2016 by Heigh Ho

[maize]

My husband works for a company that was recently purchased by a larger company. The parent company is family owned, and the owner is committed to treating his employees well. He has the bargaining power to negotiate good prices and the humanity to do so. :D

 

What percentage of the premium does the employer pay?

 

There is no way the amount you mentioned is the full premium cost; my husband works for a massive employer that has excellent insurance options, our per month premium contribution is not far off from yours but--it is only 25% of the premium. The employer pays the rest.