DC Health Exchange- all options are really expensive?

[jsteele]

Anonymous wrote:i hope this turns into such a disaster that single payer is enacted.

increased access to health INSURANCE is useless.....direct cost control is what is necessary. we need to focus on increased access to actual care required.

I support single payer as well, but I think you have to be incredibly naive to believe that single payer would be the outcome of an ACA disaster. Much more likely would be a resort to Republican ideas such a tort reform and allowing insurance to be purchased across state lines. That would only increase the power of insurance companies. You might get cost control as insurance companies flex their muscles in that case, but the same is true of the ACA.

A much more likely road to single payer is for the ACA to be successful and small steps are taken to resolve specific issues. For instance, if affordable plan are unavailable, maybe a public option could sneak past Congress. If that plan eventually displaced private offerings, you are on your way to single payer.

Also, the ACA does have measures aimed at cost control. What do you think all the talk about "death panels" was about? While death panels are a figment of the right's imagination, there is a panel that is supposed to do cost-benefit analysis on treatments and make recommendations for saving money. Even the restriction of insurance companies' administration costs has resulted in refunds to many companies and individuals.

[Anonymous]

Anonymous wrote:Jeff,

Re your 10:35 post, it's not clear that insurance will be affordable even with the subsidies. Less expensive, yes. But genuinely affordable, that's not clear, since the government isn't privy to households' actual cost-of-living expenses. Medicaid expansion isn't happening in all 50 states. Insurance companies have been allowing parents to keep children on their plans until age 26 for years, so not sure how much the ACA is impacting this category. Pre-existing: Yes, that's a great thing. But can states opt out of that, too? They're opting out of the marketplace and Medicaid expansion.

Net-net, with the shifts in the industry, is this a win-win? It's too early to tell. For now, the sum of it remains dispiriting.

The 26 year old rule IS the ACA. States cannot opt out of preexisting. Subsidies are based on a percentage of income.

And it appears that you are scrounging for problems but not trying to look for answers.

[Anonymous]

Low blow. Not scrounging for problems. I'm trying to understand the genuine impact of ACA. One of my biggest concerns is that subsidies still might not make this mandated insurance affordable for people on living on the edge, which is a function of living expenses, which the government cannot ascertain. Do you not get that?

Of course I see that there is some good here. But does it outweigh the bad? A fair question. If it does, I'd love to find ways to offset the bad.

[takoma]

Anonymous wrote:Low blow. Not scrounging for problems. I'm trying to understand the genuine impact of ACA. One of my biggest concerns is that subsidies still might not make this mandated insurance affordable for people on living on the edge, which is a function of living expenses, which the government cannot ascertain. Do you not get that?

Of course I see that there is some good here. But does it outweigh the bad? A fair question. If it does, I'd love to find ways to offset the bad.

I'm with you on this. I think it's nuts to let ideology force you to argue in advance that all is good or all is bad with something this complicated. When you roll out ACA 1.0, you expect to have to work out the kinks and find out what needs to be revised in version 1.1, 1.2, 2.0 and so forth. Striving for improvement is more the American way than expecting perfection (or disaster) right away. As we attempt that improvement, we'll have differences over what "improvement" means, but that seems to me to be a more healthy political approach than Cruzin' for a bruisin'.

[Anonymous]

Let me guess, PP, you love the parts of the ACA that require coverage for pre-existing conditions and allow young adults to stay on their parents coverage, but you hate the individual mandate? The former doesn't work without the latter. Simple economics.

[Anonymous]

Thanks, Jeff. We can only make policy better if we analyze its flaws, shortcomings and unintended consequences. I just read a piece from Motley Fool about the penalties and it's confusing as heck ... if do not have insurance and you sign up after March 15, you're subject to a penalty! But the IRS can't go after you for it! It's giving me a headache.

[Anonymous]

Anonymous wrote:Low blow. Not scrounging for problems. I'm trying to understand the genuine impact of ACA. One of my biggest concerns is that subsidies still might not make this mandated insurance affordable for people on living on the edge, which is a function of living expenses, which the government cannot ascertain. Do you not get that?

Of course I see that there is some good here. But does it outweigh the bad? A fair question. If it does, I'd love to find ways to offset the bad.

NP here and I agree. I finally got onto healthcare.gov on Friday and was able to shop plans, and ... yikes. And I know the cost of individual insurance well, as many people who have employer-subsidized coverage do not. For all intents and purposes, a bronze plan IS a catastrophic plan, no matter what they call it. Same deal with most of the silver plans. Even the gold plans have more cost-sharing than what people are used to. We are seriously asking people to put 10%+ of their take-home income into health care when most people are already feeling squeezed even without that expense? I am a lifelong Democrat and was always a huge supporter of the ACA but now that I see what is on offer, I am really disappointed and skeptical that this could possibly work. For my family, even $1000 of medical expenses above premiums in a year is a huge fucking deal, much less a $10k deductible, which would basically bankrupt us. We do not qualify for subsidies. Because we are basically healthy and don't utilize much care, paying premiums is essentially throwing money down a rat hole -- we're not getting anything out of it and we'll never see it again. We tolerate this for our $200/mo life insurance bill, our $150/mo car insurance bill, and our $100/mo homeowners insurance bill, but another $800-1000/mo (cost of bronze to silver plans for my family) is just TOO MUCH to throw away on the off chance that one of us might get cancer or hit by a car, with finances being so tight. We'll do it because we're risk averse that way, but I resent every single penny of it. I agree with David Goldhill that medical insurance should be for catastrophic purposes only and that there should be a functional market for other types of health care and people should budget for routine health expenses. I wouldn't mind paying $100-200/mo into a catastrophic policy and saving the rest of the money in an HSA to pay out of pocket for yearly physicals and an occasional ear infection or what have you. Prices would come down if there was real competition among providers. And yes, doctors wouldn't make as much money. But everyone else would have a much better quality of life.

[Anonymous]

13:29 Hi 12:30 here. Is this DC? Wherever it is, it's frightening. What's going to happen to plans that are self-insured outside ACA? I'm dreading higher premiums. Gulp!

[Anonymous]

NP here and I agree. I finally got onto healthcare.gov on Friday and was able to shop plans, and ... yikes. And I know the cost of individual insurance well, as many people who have employer-subsidized coverage do not. For all intents and purposes, a bronze plan IS a catastrophic plan, no matter what they call it. Same deal with most of the silver plans. Even the gold plans have more cost-sharing than what people are used to. We are seriously asking people to put 10%+ of their take-home income into health care when most people are already feeling squeezed even without that expense? I am a lifelong Democrat and was always a huge supporter of the ACA but now that I see what is on offer, I am really disappointed and skeptical that this could possibly work. For my family, even $1000 of medical expenses above premiums in a year is a huge fucking deal, much less a $10k deductible, which would basically bankrupt us. We do not qualify for subsidies. Because we are basically healthy and don't utilize much care, paying premiums is essentially throwing money down a rat hole -- we're not getting anything out of it and we'll never see it again. We tolerate this for our $200/mo life insurance bill, our $150/mo car insurance bill, and our $100/mo homeowners insurance bill, but another $800-1000/mo (cost of bronze to silver plans for my family) is just TOO MUCH to throw away on the off chance that one of us might get cancer or hit by a car, with finances being so tight. We'll do it because we're risk averse that way, but I resent every single penny of it. I agree with David Goldhill that medical insurance should be for catastrophic purposes only and that there should be a functional market for other types of health care and people should budget for routine health expenses. I wouldn't mind paying $100-200/mo into a catastrophic policy and saving the rest of the money in an HSA to pay out of pocket for yearly physicals and an occasional ear infection or what have you. Prices would come down if there was real competition among providers. And yes, doctors wouldn't make as much money. But everyone else would have a much better quality of life.

Bingo. Did you really not expect this? You cannot put so much free stuff--a la Fluke--and not expect to pay for it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Low blow. Not scrounging for problems. I'm trying to understand the genuine impact of ACA. One of my biggest concerns is that subsidies still might not make this mandated insurance affordable for people on living on the edge, which is a function of living expenses, which the government cannot ascertain. Do you not get that?

Of course I see that there is some good here. But does it outweigh the bad? A fair question. If it does, I'd love to find ways to offset the bad.

NP here and I agree. I finally got onto healthcare.gov on Friday and was able to shop plans, and ... yikes. And I know the cost of individual insurance well, as many people who have employer-subsidized coverage do not. For all intents and purposes, a bronze plan IS a catastrophic plan, no matter what they call it. Same deal with most of the silver plans. Even the gold plans have more cost-sharing than what people are used to. We are seriously asking people to put 10%+ of their take-home income into health care when most people are already feeling squeezed even without that expense? I am a lifelong Democrat and was always a huge supporter of the ACA but now that I see what is on offer, I am really disappointed and skeptical that this could possibly work. For my family, even $1000 of medical expenses above premiums in a year is a huge fucking deal, much less a $10k deductible, which would basically bankrupt us. We do not qualify for subsidies. Because we are basically healthy and don't utilize much care, paying premiums is essentially throwing money down a rat hole -- we're not getting anything out of it and we'll never see it again. We tolerate this for our $200/mo life insurance bill, our $150/mo car insurance bill, and our $100/mo homeowners insurance bill, but another $800-1000/mo (cost of bronze to silver plans for my family) is just TOO MUCH to throw away on the off chance that one of us might get cancer or hit by a car, with finances being so tight. We'll do it because we're risk averse that way, but I resent every single penny of it. I agree with David Goldhill that medical insurance should be for catastrophic purposes only and that there should be a functional market for other types of health care and people should budget for routine health expenses. I wouldn't mind paying $100-200/mo into a catastrophic policy and saving the rest of the money in an HSA to pay out of pocket for yearly physicals and an occasional ear infection or what have you. Prices would come down if there was real competition among providers. And yes, doctors wouldn't make as much money. But everyone else would have a much better quality of life.

or you could be a smart democrat and push for single payer.

methinks you are actually chatting shite and are a R or a bagger.

oh and docs still would make a truckload as long as the ama protects the supply.

imagine an h1b program specifically for doctors where if you have a med degree (anywhere on the planet) and can sit for liscening, you can practice here? there would be a flood of health care professionals which would help supply issues..but it would drive down medical wages in this country...which are better protected than almost any other sector (tech, law, finance, engineering, etc.).

[Anonymous]

the D's on our side did not push for single payer hard enough....the grassroots should have forced O for single payer.

we had majorities everywhere...no excuses. at worst a public option....this is a heritage/right-of-center plan...its not even ours.

[Anonymous]

Remember this is the DC exchange, small pool, lager % of uninsured. I would like to see what Va and Md are offering.

[Anonymous]

jsteele wrote:

Anonymous wrote:
It is not the fault of the Supreme Court, it is the fault of the Democrats in Congress who knowingly passed a law that was unconstitutional.

Many Republicans declared that the individual mandate was unconstitutional. Yet, it was withheld. By your reasoning, all of those Republicans were knowingly lying.

When the Democrats passed the individual mandate, they adamantly refused to call it a tax. Screamed when Republicans labeled it as such. When it got to the Supreme Court, they defended it based upon upon Congress' authority to levy a tax. Who were the liars?

[Anonymous]

Anonymous wrote:

NP here and I agree. I finally got onto healthcare.gov on Friday and was able to shop plans, and ... yikes. And I know the cost of individual insurance well, as many people who have employer-subsidized coverage do not. For all intents and purposes, a bronze plan IS a catastrophic plan, no matter what they call it. Same deal with most of the silver plans. Even the gold plans have more cost-sharing than what people are used to. We are seriously asking people to put 10%+ of their take-home income into health care when most people are already feeling squeezed even without that expense? I am a lifelong Democrat and was always a huge supporter of the ACA but now that I see what is on offer, I am really disappointed and skeptical that this could possibly work. For my family, even $1000 of medical expenses above premiums in a year is a huge fucking deal, much less a $10k deductible, which would basically bankrupt us. We do not qualify for subsidies. Because we are basically healthy and don't utilize much care, paying premiums is essentially throwing money down a rat hole -- we're not getting anything out of it and we'll never see it again. We tolerate this for our $200/mo life insurance bill, our $150/mo car insurance bill, and our $100/mo homeowners insurance bill, but another $800-1000/mo (cost of bronze to silver plans for my family) is just TOO MUCH to throw away on the off chance that one of us might get cancer or hit by a car, with finances being so tight. We'll do it because we're risk averse that way, but I resent every single penny of it. I agree with David Goldhill that medical insurance should be for catastrophic purposes only and that there should be a functional market for other types of health care and people should budget for routine health expenses. I wouldn't mind paying $100-200/mo into a catastrophic policy and saving the rest of the money in an HSA to pay out of pocket for yearly physicals and an occasional ear infection or what have you. Prices would come down if there was real competition among providers. And yes, doctors wouldn't make as much money. But everyone else would have a much better quality of life.

No, we are not asking people to put 10%+ of their take-home income into health care. If the cheapest plan on the exchange is more than 8.5% of your household income, you are exempt from the individual mandate. You don't have to buy insurance; you don't have to pay the fine.

If you don't qualify for the subsidy, and yet you consider that you can't afford the cheapest plan, I'm wondering what you're assigning a higher priority to than health insurance. I also wonder why you don't resent every penny you pay for homeowners' insurance, given that your house has not yet burned down, is not currently on fire, and is unlikely to burn down in the future.

[jsteele]

Anonymous wrote:

jsteele wrote:

Anonymous wrote:
It is not the fault of the Supreme Court, it is the fault of the Democrats in Congress who knowingly passed a law that was unconstitutional.

Many Republicans declared that the individual mandate was unconstitutional. Yet, it was withheld. By your reasoning, all of those Republicans were knowingly lying.

When the Democrats passed the individual mandate, they adamantly refused to call it a tax. Screamed when Republicans labeled it as such. When it got to the Supreme Court, they defended it based upon upon Congress' authority to levy a tax. Who were the liars?

You will have to ask the first poster who are the liars. Personally, I think it is possible to have different opinions about issues without being a liar. That's why you have courts to adjudicate laws. There were justices that didn't agree with Roberts that the mandate was a tax. Ironically, some of them thought the mandate was constitutional and some thought it wasn't constitutional. Are they liars? Is everyone who has a differing opinion a liar?

BTW, there are a lot of things that are technically a "tax", but routinely called something else. Do you drive on a "toll road" or a "tax road"?