ACA reversal/change?

[DawnM]

I am not trying to be political, but I really feel for those of you who are affected currently by ACA healthcare.

 

I am told we will ALL be affected at some point.

 

What I can't find is info on what can be done to change it.  Can the next president change it?  

[maize]

Reversal would do much more harm than good; many people who now have access to health insurance would be left without it as they were before. One huge benefit I am aware of affecting many, many families is the ability to keep young adult children on a parent's insurance longer than used to be possible.

 

There are things that need fixing. Increasing costs need to be dealt with. The gap that occurred in states that did not expand Medicaid needs to be fixed.

 

I'd like to see a government option added.

[maize]

As for can a president change it: this is a matter for the legislative not the executive branch. It was Congress that passed the initial legislation, not the president though of course he played a significant role in promoting it and signed off on it.

Edited November 5, 2016 by maize

[Pawz4me]

Reversal would do much more harm than good; many people who now have access to health insurance would be left without it as they were before. One huge benefit I am aware of affecting many, many families is the ability to keep young adult children on a parent's insurance longer than used to be possible.

 

There are things that need fixing. Increasing costs need to be dealt with. The gap that occurred in states that did not expand Medicaid needs to be fixed.

 

I'd like to see a government option added.

 

:iagree:

[Carol in Cal.]

The thing is, though, when the ACA passed, there was a long period of time before it was implemented.  And it has not even been fully implemented--there are parts of it that were quietly dropped (how can they do that if it's the law???), and they are still adjusting the fines and subsidies annually to nudge people into compliance.

 

So it's not something that can change quickly, because there just won't necessarily be plans to replace it from the medical insurers.  They have to set up policies, assess them actuarially, get them through the state insurance departments, and educate whoever sells them--that is a lengthy process.  

 

I'm really happy for those who could not get medical insurance before but can do so now.  However, almost everyone I know personally who has had to buy an independent policy is very unhappy with it.  They are paying far more, and their deductibles are so high that they can't use the insurance they have anymore.  It hasn't hurt my own family appreciably, but that's because we get employer coverage, and our employers have been generous, so although we are paying more for our coverage and higher copays, it's still a reasonable amount of out of pocket expense for us.  But my friends with their own businesses or who work for small employers who don't offer insurance are really struggling with the sudden, expensive change.

 

Locally there is so much evidence that employers are keeping employee hours down to avoid paying for their medical that there is actually a ballot proposition to require businesses to use existing employees for extra work rather than bringing in temps, so that those employees can require health insurance to be provided.  So not only is people's income flowing toward the medical professions instead of the broader economy, but also their incomes are being depressed by the push toward having fewer hours.  It's quite a hardship for many, many people here. 

[maize]

Oh, another thing that needs fixed if I understand the issue correctly is the deal where you can't buy on the exchange of your employer offers any coverage at all.

[maize]

I'd personally be all in favor of expanding Medicare (with some tweaks) to everyone, then having an open market for secondary coverage.

 

The insurance industry will fight that tooth and nail though so I don't have much hope.

[mom2samlibby]

Reversal would do much more harm than good; many people who now have access to health insurance would be left without it as they were before. One huge benefit I am aware of affecting many, many families is the ability to keep young adult children on a parent's insurance longer than used to be possible.

 

There are things that need fixing. Increasing costs need to be dealt with. The gap that occurred in states that did not expand Medicaid needs to be fixed.

 

I'd like to see a government option added.

 

I read just the other day that the numbers have not changed at all.  It's still the same amount of people that don't have insurance as before the ACA.  So, really,  nothing has changed.  Some were able to get it that didn't have it before, but now others don't because they can't afford it.

 

I'll see if I can find that article.  

[Carol in Cal.]

I'd personally be all in favor of expanding Medicare (with some tweaks) to everyone, then having an open market for secondary coverage.

 

The insurance industry will fight that tooth and nail though so I don't have much hope.

I liked that idea, too, until I realized that EVERYONE pays into Medicare, but only people 65 and older actually can use it.  So, to expand it to younger folks would mean that Medicare taxes would go up A LOT.  I'm not sure how reasonable that is.  Right now the economics work out because like Social Security everyone pays in while they are working, but only retirees get benefits.

[maize]

I liked that idea, too, until I realized that EVERYONE pays into Medicare, but only people 65 and older actually can use it. So, to expand it to younger folks would mean that Medicare taxes would go up A LOT. I'm not sure how reasonable that is. Right now the economics work out because like Social Security everyone pays in while they are working, but only retirees get benefits.

We're all paying for health insurance right now. Rather than requiring employers to provide private insurance for employees, if they paid a similar amount into Medicare that would offset a lot of the cost increase.

Edited November 5, 2016 by maize

[mamaraby]

All big legislation (Social Security, Medicare, etc) has required adjustments. In the past they've passed legislation to fix it. It may have been debated, it may have been something some section of the public/legislators disagreed with, but they passed further legislation to fix it. They could do that with ACA, too. It's just unrealistic to expect a "one and done" when it comes to something like this. Even if one "repeals and replaces" the ACA, it's entirely likely that whatever it's replaced with will also need further adjustment.

[TranquilMind]

I read just the other day that the numbers have not changed at all.  It's still the same amount of people that don't have insurance as before the ACA.  So, really,  nothing has changed.  Some were able to get it that didn't have it before, but now others don't because they can't afford it.

 

I'll see if I can find that article.  

 

One thing has changed. Now the little guy gets fined if he can't afford insurance. 

 

Insurance companies still rake in their billions in profits though, so all is well (sarcasm).

Edited November 5, 2016 by TranquilMind

[Crimson Wife]

One really easy fix would be to open up the Federal Employees Health Benefit Plan to self-paying exchange customers. A big problem with many states now is that there simply aren't enough potential customers buying through the exchanges to make it cost efficient. But if those customers could "tag along" with the 8+ million civil servants & dependents on the FEHBP, then that solves the volume discount issue.

[TranquilMind]

One really easy fix would be to open up the Federal Employees Health Benefit Plan to self-paying exchange customers. A big problem with many states now is that there simply aren't enough potential customers buying through the exchanges to make it cost efficient. But if those customers could "tag along" with the 8+ million civil servants & dependents on the FEHBP, then that solves the volume discount issue.

 

Agreed. The Federal insurance plan used to be great (my family had it when I was growing up). 

 

 

Why can't we just open that to everyone?

 

Apparently this has been repeatedly suggested.

 

How it works:  The employer pays an amount up to 72 percent of the average plan premium for self-only or family coverage (not to exceed 75 percent of the premium for the selected plan), and the employee pays the rest. This dollar amount is recalculated each year as health care costs and plans' premiums increase. Certain employees (such as postal workers) have a higher portion of their premiums paid as the result of collective bargaining agreements. The precise percentage of the average paid by the employer is relatively unimportant to the design of this program and has changed over time to become more generous. What is important is that it is a "capped premium" design, in which the entire marginal cost of joining a plan with a premium near, at, or above the all-plan average is borne by the enrollee. In other words, enrollees pay the entire cost of their costly choices, but reap rewards if they make frugal choices. This creates constant pressure on the plans, since to attract enrollees they must hold down costs, while balancing this incentive against benefit offerings and customer service, to reach a position that will maximize their enrollment revenues and profits. This feature of the program is arguably its greatest strength and the primary reason that one expert summarized it has having "outperformed Medicare every which way—in containment of costs both to consumers and to the government, in benefit and product innovation and modernization, and in consumer satisfaction," decade after decade.^[3]

Edited November 5, 2016 by TranquilMind

[ChocolateReignRemix]

Oh, another thing that needs fixed if I understand the issue correctly is the deal where you can't buy on the exchange of your employer offers any coverage at all.

 

I believe you can still purchase on the exchange but you are not eligible for a subsidy if your employer offers any level of coverage.  So if you are low income but your employer offers a plan outside what you can afford, or even if the employer doesn't pay anything towards family coverage, you are cannot access a subsidized plan.

 

One of several provisions that was negotiated at the end which made the law significantly less effective.

[ChocolateReignRemix]

Agreed. The Federal insurance plan used to be great (my family had it when I was growing up). 

 

 

Why can't we just open that to everyone?

 

For starters, there is no Federal Insurance plan.  Federal employees are offered a range of plans to choose from (FFS, PPO, and HMO) through a range of companies (Kaiser, United, Cigna, and others; dependent upon where you live).  The plans are the same ones available to private employers and the total premiums are similar.

 

Unless the federal government subsidized the premiums the same as it does for employees, allowing access to those plans would not solve the issues of access to insurance plans.

[TranquilMind]

For starters, there is no Federal Insurance plan.  Federal employees are offered a range of plans to choose from (FFS, PPO, and HMO) through a range of companies (Kaiser, United, Cigna, and others; dependent upon where you live).  The plans are the same ones available to private employers and the total premiums are similar.

 

Unless the federal government subsidized the premiums the same as it does for employees, allowing access to those plans would not solve the issues of access to insurance plans.

 

I'm sorry I wasn't clear.

 

The government has a complicated system to subsidize people for ACA, so what's the difference (except that the ACA subsidies look pretty darn small from what I have read). 

 

The Federal Employee's Health Benefit Plan already has good infrastructure. 

 

Why can't we just allow all Americans to access this if they like? 

[ChocolateReignRemix]

We're all paying for health insurance right now. Rather than requiring employers to provide private insurance for employees, if they paid a similar amount into Medicare that would offset a lot of the cost increase.

 

Correct.  There is a reason the U.S. spends a larger % of its GDP on healthcare than other nations, and it starts with adding a layer of profit taking in between consumers and the healthcare market. 

 

Expanding Medicare could be done either via a tax model, a fee for access model (which could be employee and employer funded), or my personal preference which would be a fee for access for users based on a sliding income scale.

 

There was initially a proposal in the ACA which would have allowed for government sponsored plan option (essentially an expanded Medicare plan) that was nuked by the insurance industry.

[ChocolateReignRemix]

I'm sorry I wasn't clear.

 

The government has a complicated system to subsidize people for ACA, so what's the difference (except that the ACA subsidies look pretty darn small from what I have read). 

 

The Federal Employee's Health Benefit Plan already has good infrastructure. 

 

Why can't we just allow all Americans to access this if they like? 

 

I see no reason we can't (other than Congress), but without subsidized premiums it won't have an impact (again, Congress).

[AmandaVT]

I believe you can still purchase on the exchange but you are not eligible for a subsidy if your employer offers any level of coverage.  So if you are low income but your employer offers a plan outside what you can afford, or even if the employer doesn't pay anything towards family coverage, you are cannot access a subsidized plan.

 

One of several provisions that was negotiated at the end which made the law significantly less effective.

 

I actually know the answer to this because we're looking into offering our employees a health plan and I've been talking to BCBS and our health connect people all week. 

 

If your employer offers insurance, you cannot access any subsidies, unless the plan is considered unaffordable. The rate for that is 9.5% of your income. So, if your premiums through your employer program are less than 9.5%, you can't apply for subsidies, but if they're more than 9.5%, you can still get subsidies. 

 

It's hard - we have a couple of employees that would have premium payments just a bit under the 9.5% of their income mark, so if we did get a small group rate, they would be worse off (they currently get subsidies and those would stop). For DH and I, we currently pay about 20% of our take home income in premium payments, so technically we could go to the exchange and get a subsidy, but according to our health connect company, we don't qualify for the subsidies. We're in a no win situation at the moment here and as a company, we're stuck paying the penalty tax every month to avoid screwing our employees with an employer plan. We actually have a meeting about this today. 

 

It's a mess and I'm hoping VT figures out single payer health care soon!

[ChocolateReignRemix]

I actually know the answer to this because we're looking into offering our employees a health plan and I've been talking to BCBS and our health connect people all week. 

 

If your employer offers insurance, you cannot access any subsidies, unless the plan is considered unaffordable. The rate for that is 9.5% of your income. So, if your premiums through your employer program are less than 9.5%, you can't apply for subsidies, but if they're more than 9.5%, you can still get subsidies. 

 

It's hard - we have a couple of employees that would have premium payments just a bit under the 9.5% of their income mark, so if we did get a small group rate, they would be worse off (they currently get subsidies and those would stop). For DH and I, we currently pay about 20% of our take home income in premium payments, so technically we could go to the exchange and get a subsidy, but according to our health connect company, we don't qualify for the subsidies. We're in a no win situation at the moment here and as a company, we're stuck paying the penalty tax every month to avoid screwing our employees with an employer plan. We actually have a meeting about this today. 

 

It's a mess and I'm hoping VT figures out single payer health care soon!

 

Thank you.  I do remember that provision, but is that % based only on the employee-only coverage?  I seem to recall examples where the employee plan fell well under that mark, but the family plan would be significantly higher, which meant coverage was still out of reach for the family unit.

 

[AmandaVT]

Thank you.  I do remember that provision, but is that % based only on the employee-only coverage?  I seem to recall examples where the employee plan fell well under that mark, but the family plan would be significantly higher, which meant coverage was still out of reach for the family unit.

 

 

That's a great question. The reps I spoke with led me to believe that it is the total amount of the premium, but they were also trying to get me to sign up our business at the time. I'll need to call back on Monday to get an answer to that question. Ugh, the joys of co-owning a small business - we all get to wear lots of hats and I seem to have acquired the insurance person hat! 

[LucyStoner]

Oh, another thing that needs fixed if I understand the issue correctly is the deal where you can't buy on the exchange of your employer offers any coverage at all.

You can but you are not eligible for subsidies unless your employer's cheapest plan is exceeds a certain percentage of your income/cost level.

 

We are in the situation where insuring me is the only OOP cost for our good employer-provided insurance. The kids and my husband are 100% employer paid. Which is a great benefit and one reason why my husband works where he does but the cost for that plan for me is more than we would pay if I could have bought on the exchange and recieved the subsidy level our income qualified is for. Because there is a cheaper plan available via my husband's employer, not eligible for assistance. But switching to the lower cost plan just for me is not an option (every one has to be on the same plan) and switchingy kids to the lower plan would compromise the frequent ASD related services they receive.

 

It's basically moot as my husband is switching to a higher pay level of work very soon and actually just got a raise but over the last couple of years, this has cost us about $12,000 extra OOP on a very modest income (since my husband was in school).

 

Overall I am a supporter of healthcare reform, but I wish people could just buy into Medicare or Medicaid on a sliding scale.

Edited November 5, 2016 by LucyStoner

[kroe1]

The healthcare crisis is multifactorial. But, ACA has replaced a mass of uninsured with an even bigger number of "underinsured". These are people who still cannot afford medical care because of high deductibles. Healthcare visits they used to pay for out of pocket are now spent on outrageous premiums. Since small problems are no longer treated rapidly, many medical problems are becoming emergent requiring even higher costs to the sick "underinsured." This is what screwed some of the original actuarial estimates of ACA cost. This is why insurers have lost money and are pulling out.

 

Cutting healthcare costs has two necessary components, neither politically correct or easy for Americans to accept. But, these are issues already dealt with in single payer countries.

 

1. Litigation costs. This is a huge direct cost of medicine, as well as an even bigger hidden cost. Way too many unnecessary medical tests are done on unsuspecting patients because physicians are too afraid of missing that one in a million chance of something worse. Over time, people have come to expect these tests even when the risks of the test outweigh potential benefits. Repeated CT scans and MRIs for chronic problems like migraines and back pain are just one example.

 

2. Over ninety percent of healthcare dollars are spent in the last five years of life. Single payor countries have decreased this huge expense by denying ridiculously expensive medicines and procedures to prolong a fatal diagnosis. Here in the US, however, we keep people alive at all costs to the bitter end. ( I am not saying one philosophy is better than the other. I am just trying to explain why American healthcare is so different and expensive.). For example, here we place pacemakers in 90 year olds, repeatedly hospitalize a COPD exacerbation, and fight cancer with repeated rounds of futile expensive treatments. In England a diagnosis in an elderly of renal failure might get one dialysis treatment to give someone time to get his affairs in order. In the US, however, we would spend $25,000 monthly to keep the person alive for several more years.

 

Both of these issues must be addressed before the US can come to grips with its healthcare costs. Blaming an insurance industry with a less than 7% profit margin is not where the problem lies. Companies deserve the opportunity for profit. Other industries have a much better chance of that than insurers.

 

Working in an ER, I am just sick of what is happening to patients who can no longer afford basic healthcare. Dollars which should be spent on doctor visits and medicine is spent on insurance premiums. By the time the patient waits it out, he is much worse requiring emergency care. This is far more costly to society than if the person was uninsured.

 

Just my opinion.

[goldberry]

2. Over ninety percent of healthcare dollars are spent in the last five years of life. Single payor countries have decreased this huge expense by denying ridiculously expensive medicines and procedures to prolong a fatal diagnosis. Here in the US, however, we keep people alive at all costs to the bitter end. ( I am not saying one philosophy is better than the other. I am just trying to explain why American healthcare is so different and expensive.). For example, here we place pacemakers in 90 year olds, repeatedly hospitalize a COPD exacerbation, and fight cancer with repeated rounds of futile expensive treatments. In England a diagnosis in an elderly of renal failure might get one dialysis treatment to give someone time to get his affairs in order. In the US, however, we would spend $25,000 monthly to keep the person alive for several more years.

 

 

You want to kill grandma!  You hate old people!  You want death panels!

 

(sarcasm here...  I agree this is a real problem but I don't see it addressed any time soon, since even a brief mention brings the previous reaction.)

[Carol in Cal.]

I like your post, but when I read your examples of 'inappropriate' end of life care, I disagree with them.  I don't see any reason why someone who has paid into insurance his whole life shouldn't be able to get dialysis and live a few more years.  I don't believe that someone with COPD should be left at home to suffocate when there are relatively easy and noninvasive treatments available that will keep him more comfortable and prolong both the quality and length of his life.  I think that cancer treatment should be the choice of the patient, but if they want to pursue it, insurance should cover it.  In general, i don't think medical care should be denied to people just because they are old.

 

Where inappropriate end of life care comes in, for me, is things like rib breaking CPR on an elderly, terminally ill person who has died.  And here, again, it should be up to the patient, not the insurance company.

 

One of the reasons why we have so many interventions is that insurance companies will try to avoid paying for whatever they can.  It is entirely unacceptable to me to have the law support them on this, and to have it tilt toward pushing folks to consider themselves worthless and pressure them toward suicide 'to save money'.

 

 

2. Over ninety percent of healthcare dollars are spent in the last five years of life. Single payor countries have decreased this huge expense by denying ridiculously expensive medicines and procedures to prolong a fatal diagnosis. Here in the US, however, we keep people alive at all costs to the bitter end. ( I am not saying one philosophy is better than the other. I am just trying to explain why American healthcare is so different and expensive.). For example, here we place pacemakers in 90 year olds, repeatedly hospitalize a COPD exacerbation, and fight cancer with repeated rounds of futile expensive treatments. In England a diagnosis in an elderly of renal failure might get one dialysis treatment to give someone time to get his affairs in order. In the US, however, we would spend $25,000 monthly to keep the person alive for several more years.
 

 

[poppy]

 

 

Working in an ER, I am just sick of what is happening to patients who can no longer afford basic healthcare. Dollars which should be spent on doctor visits and medicine is spent on insurance premiums. By the time the patient waits it out, he is much worse requiring emergency care. This is far more costly to society than if the person was uninsured.

 

I kind of  agree, but, I'm not morally OK with bankrupting families with preexisting conditions in order to save the cost to society. That is unacceptable.

[FaithManor]

I think that a lot of end of life care/expense decisions would resolve themselves with more information for patients. Let's be honest, most people receive no education on this at all, and the default becomes fight to the bitter end no matter how much suffering because the process of dying is so mystical that people believe it will be worse than the fight. Sigh...My mother's husband has been kept largely in the dark about what will happen to him without chemo for his terminal cancer, so he chose chemo as the go to default which was not good in his situation. He thought he couldn't get his lung drained - he felt like he was suffocating - unless he fought the cancer, and the hospital was not remotely clear on this. Of course he could have his lung drained, of course he could have the chest tube put in, and of course he could have supplemental oxygen so he felt better. None of these quality of life, easing his distress interventions would be denied just because he was no longer fighting the cancer. But it wasn't made clear so he chose the chemo. Now he is in a position to have had his life unnaturally extended, and their situation is VERY bad. Had he foregone the chemo, and passed away this past spring, he would be out of pain and suffering, and her situation would be so much better. My brother and I tried to get the information for them, but they did not want to listen to us, and medical professionals cannot arbitrarily talk to us or listen to us since they refused to put us on the share medical information list for HIPPA.

 

I am no fan of deciding by economics who lives and who dies. But I do think we also need to be practical. I don't know how it is more moral to pay $250,000 a year for dialysis for a medically fragile, very elderly patient while children die of treatable diseases for lack of healthcare. There is a reasonable middle ground. Our problem is that America is not known for seeking and sticking to the middle ground, and most Americans are bizarrely uninformed about the process of dying too. The unknown coupled with lack of support often makes many elderly, fragile, and suffering patients choose painful, prolonging treatments that they might not have wanted if they had been properly educated and given support for making the other decision if that is what they wanted to do.

 

The other issue too is that other countries really don't have to do all the rationing that we think they do because since people can see the doctor as necessary, preventive medicine is more prevalent. Problems are far more often nipped in the bud, brought under control before a crisis. The crisis is always the expensive part. Finding a cancer at stage 1 is WAY less expensive than stage 4. Finding an autoimmune disorder and treating early is far less expensive than later. Treating renal issues early prevents dialysis or prevents the need for early dialysis. This list goes on and on, yet in America due to deductibles and high co pays, disallowed tests, etc., often the only care people get is crisis care after minor issues have morphed into the Incredible Hulk of problems. There is a lot of lower cost benefit related to preventative and maintenance medicine over the life of the patient. But really, insurance companies pretty much want you to not be able to use your insurance, and then be so sick, so injured when you finally do, that you end up dying right away because that scenario right there is where the big profit is.

 

As long as profit stands between patient and doctor, this is the mess we will have.

[Crimson Wife]

For starters, there is no Federal Insurance plan.  Federal employees are offered a range of plans to choose from (FFS, PPO, and HMO) through a range of companies (Kaiser, United, Cigna, and others; dependent upon where you live).  The plans are the same ones available to private employers and the total premiums are similar.

 

The premiums may be similar to those of LARGE employers but they are much lower than the individual exchange plans in many states. So yeah, allowing buy-in of the FEHBP would go a long way towards fixing the issues with the Obamacare exchanges.

[ChocolateReignRemix]

The premiums may be similar to those of LARGE employers but they are much lower than the individual exchange plans in many states. So yeah, allowing buy-in of the FEHBP would go a long way towards fixing the issues with the Obamacare exchanges.

 

Source? 

I just pulled the numbers for the Kaiser Permanente Gold plan ($500 deductible/single coverage) on the Georgia exchange and compared it to the KP plan for federal employees in Georgia.

The exchange plan rate (no subsidy) is $435.95.  The federal employee standard self from KP has a total premium (employee + employer) of $465.23.  The federal employee deductible is lower ($250).

 

I am sure other plans vary, but I am not sure there is much evidence that you will find allowing access to the FEHB plans will make a tremendous difference.

[Carol in Cal.]

We're all paying for health insurance right now. Rather than requiring employers to provide private insurance for employees, if they paid a similar amount into Medicare that would offset a lot of the cost increase.

I don't think you quite got my point.

Medicare is paid for by taxes on the working folks and premiums on those who are enrolled in Part B.

It only covers people ages 65 and up.  That costs a certain amount of money.

 

If we said, OK, let's let it cover everyone, then it would cost a lot more money.  So much more that I don't think it would be a small reasonable amount of tax on working people, like it is right now.  Rather I think it would be an impactful amount of increase.

[Crimson Wife]

The average Obamacare premium is way higher than $435.95 in many states. Scroll down to the 2nd graphic on this NYT article and see how many of them are >$700/mo: http://www.nytimes.com/2016/11/05/upshot/see-obamacare-rates-for-every-county-in-the-country.html

[Crimson Wife]

Insurance companies are increasingly saying "nope, not participating" for the Obamacare exchanges but they're much less likely to refuse to participate in the FEHBP because of the sheer volume of customers.

[Laura Corin]

I think that a lot of end of life care/expense decisions would resolve themselves with more information for patients. Let's be honest, most people receive no education on this at all, and the default becomes fight to the bitter end no matter how much suffering because the process of dying is so mystical that people believe it will be worse than the fight. 

 

Indeed.  My father had three lines of cancer treatment, the last one experimental.  At each stage, he was taken through the risks and rewards, and at that point he decided for palliative care.  I think that the education was good (UK) and he made a good decision.

 

FWIW, the following article suggests that the previous description of dialysis for the elderly in the UK is incorrect:

 

http://ndt.oxfordjournals.org/content/18/10/2122.long

 

'All units have an open access policy for accepting patients onto dialysis, with no upper age limit.'

Edited November 5, 2016 by Laura Corin

[ChocolateReignRemix]

Insurance companies are increasingly saying "nope, not participating" for the Obamacare exchanges but they're much less likely to refuse to participate in the FEHBP because of the sheer volume of customers.

 

I am still stuck on how that option will be cheaper, which is what you claimed.  Have you found a source yet?

[ChocolateReignRemix]

The average Obamacare premium is way higher than $435.95 in many states. Scroll down to the 2nd graphic on this NYT article and see how many of them are >$700/mo: http://www.nytimes.com/2016/11/05/upshot/see-obamacare-rates-for-every-county-in-the-country.html

 

And other federal employee plans are more expensive as well.  I simply pulled one example I could make an apples to apples comparison with.

 

I would love to see the comprehensive comparison of exchange rate plans and the federal employee equivalent to see if indeed that is a cheaper option.  If it is, I would support that as an option.  I suspect it is unlikely to have the impact you seem to think it will.

 

[ktgrok]

Thank you.  I do remember that provision, but is that % based only on the employee-only coverage?  I seem to recall examples where the employee plan fell well under that mark, but the family plan would be significantly higher, which meant coverage was still out of reach for the family unit.

 

 

Right. This is probably the single biggest problem right now with the ACA. Trying not to get too political, but fixing that issue is one of the things pledged by one of the presidential candidates. The one that doesn't want to repeal it. 

[goldberry]

I think that a lot of end of life care/expense decisions would resolve themselves with more information for patients. Let's be honest, most people receive no education on this at all, and the default becomes fight to the bitter end no matter how much suffering because the process of dying is so mystical that people believe it will be worse than the fight. Sigh...

 

And yet when they tried to include exactly this into the ACA, it was rejected as trying to talk people into dying.  Something has to change.  There will always be people who don't want to hear the reality.

[ktgrok]

I don't think you quite got my point.

Medicare is paid for by taxes on the working folks and premiums on those who are enrolled in Part B.

It only covers people ages 65 and up.  That costs a certain amount of money.

 

If we said, OK, let's let it cover everyone, then it would cost a lot more money.  So much more that I don't think it would be a small reasonable amount of tax on working people, like it is right now.  Rather I think it would be an impactful amount of increase.

 

Yes, but would that increase be more or less than what they are paying in premiums/deductibles/healthcare now? Pretty much every model shows that the increase in taxes would be significantly less than people now pay for health insurance/healthcare. 

[kroe1]

Your link is a study of the costs. It is not how people are actually treated in the U.K. Unless one wants to pay for it in the private sector. Nonetheless, the point is that single payer countries are less likely to pay for expensive life prolonging treatments in fatal diseases than the US.

 

Indeed. My father had three lines of cancer treatment, the last one experimental. At each stage, he was taken through the risks and rewards, and at that point he decided for palliative care. I think that the education was good (UK) and he made a good decision.

 

FWIW, the following article suggests that the previous description of dialysis for the elderly in the UK is incorrect:

 

http://ndt.oxfordjournals.org/content/18/10/2122.long

 

'All units have an open access policy for accepting patients onto dialysis, with no upper age limit.'

[Carol in Cal.]

Yes, but would that increase be more or less than what they are paying in premiums/deductibles/healthcare now? Pretty much every model shows that the increase in taxes would be significantly less than people now pay for health insurance/healthcare. 

What they are paying now is unaffordable and already dragging on our economy both in terms of reducing funds available for consumer spending (two thirds of the economy!) and in incentivizing employers to keep employee hours below the mandatory health insurance limit.  

 

It's really a mess, and getting worse.

[Laura Corin]

Your link is a study of the costs. It is not how people are actually treated in the U.K. Unless one wants to pay for it in the private sector. Nonetheless, the point is that single payer countries are less likely to pay for expensive life prolonging treatments in fatal diseases than the US.

 

 

The costs can't exist if the treatment is not taking place.  And the institutions mentioned in the acknowledgements are NHS hospitals:

 

We thank the dialysis patients that participated in the study, D. Keir Charing Cross Hospital, B. Saunders Lister Hospital, and R. Proudfoot, S. Cano, J. Litaker and A. Steriu for research assistance. This study was funded by the North Thames Regional Health Authority Research and Development Responsive Funding Programme, London UK. The Department of Public Health Kensington and Chelsea and Westminster Health Authority, London, UK provided additional funding for interpreters.

 

https://www.imperial.nhs.uk/our-locations/charing-cross-hospital

 

http://www.enherts-tr.nhs.uk/our-hospitals/lister/

 

The North Thames Regional Health authority is also an NHS body.  

 

ETA: this study suggests that previous to the 1980s (!) dialysis was rare in the elderly in the UK (Leicester General is also an NHS hospital):

 

http://www.advancesinpd.com/adv90sup/18experiencesup90.html

 

http://www.leicestershospitals.nhs.uk/aboutus/our-hospitals/leicester-general-hospital/

Edited November 5, 2016 by Laura Corin

[ChocolateReignRemix]

Your link is a study of the costs. It is not how people are actually treated in the U.K. Unless one wants to pay for it in the private sector. Nonetheless, the point is that single payer countries are less likely to pay for expensive life prolonging treatments in fatal diseases than the US.

 

 

Source?

[ChocolateReignRemix]

What they are paying now is unaffordable and already dragging on our economy both in terms of reducing funds available for consumer spending (two thirds of the economy!) and in incentivizing employers to keep employee hours below the mandatory health insurance limit.  

 

It's really a mess, and getting worse.

 

Sounds like a reason to completely divorce healthcare from employment.

[maize]

Sounds like a reason to completely divorce healthcare from employment.

Yep.

 

I understand distrust of government. Government is big and unwieldy and bureaucratic and not good at accommodating individual human needs and experiences.

 

But government has a way better shot at being fair and accountable than employers whose bottom line is always going to be their own profit.

[Crimson Wife]

I am still stuck on how that option will be cheaper, which is what you claimed.  Have you found a source yet?

 

It's basic economics- the highest premiums for Obamacare are in places where there is little or no competition. The FEHBP has such a large number of participants that most (all? not sure anymore since it's been ages since I worked a civil service job) of the major insurance companies are willing to offer plans. The greater competition places market pressure on the companies to hold down premiums.

 

I can't see any logical argument to be made for NOT allowing "buy in" of the FEHBP.

[ChocolateReignRemix]

It's basic economics- the highest premiums for Obamacare are in places where there is little or no competition. The FEHBP has such a large number of participants that most (all? not sure anymore since it's been ages since I worked a civil service job) of the major insurance companies are willing to offer plans. The greater competition places market pressure on the companies to hold down premiums.

 

I can't see any logical argument to be made for NOT allowing "buy in" of the FEHBP.

 

I just showed a quick example where the rates were almost identical.  My guess is you think federal health plan premiums when including the employer portion are much lower than they are in reality.

You should also be aware that federal employees have limited options in some states as well.

[maize]

I just showed a quick example where the rates were almost identical. My guess is you think federal health plan premiums when including the employer portion are much lower than they are in reality.

You should also be aware that federal employees have limited options in some states as well.

Not as limited as some of the Marketplace options I'm hearing about--aren't some states down to just one or two? There are at the least a selection of nationwide plans for federal employees, though it is true that some states have more options than others.

[ChocolateReignRemix]

Not as limited as some of the Marketplace options I'm hearing about--aren't some states down to just one or two? There are at the least a selection of nationwide plans for federal employees, though it is true that some states have more options than others.

 

My point is that many states don't have a wide enough federal selection to claim that some nebulous "competition" factor will drive rates down.  Especially when I am not certain that total premiums between similar plans on the exchange and the FEHB are significantly different now.

[Carol in Cal.]

Sounds like a reason to completely divorce healthcare from employment.

You missed the reference I guess. 

The issue was whether it would cost more to allow everyone onto Medicare or to keep paying current premiums.  And my answer is that current premiums are already too high.