DC Health Exchange- all options are really expensive?

[Anonymous]

Friend has been trying to check prices on the exchange in Virginia since October 1. Set up account, but cannot get to rates and subsidies. Very frustrated. Sometimes spends an hour or two.

[Anonymous]

cont. Successfully got through on phone line--but still no prices. Cannot submit application on the phone, must submit it by mail--no email solution.

[Anonymous]

Anonymous wrote:Friend has been trying to check prices on the exchange in Virginia since October 1. Set up account, but cannot get to rates and subsidies. Very frustrated. Sometimes spends an hour or two.

According to the Heritage Foundation, Virginia has not finalized its rates. Let your Governor know that you are dissatisfied with his performance.

[Anonymous]

Anonymous wrote:

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.

yes, insurance companies started keeping kids on till they're 26 in anticipation of the ACA. Not something they decided to do on their own.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

yes, insurance companies started keeping kids on till they're 26 in anticipation of the ACA. Not something they decided to do on their own.

Not even in anticipation. That part of the law went into effect in March of 2010, right along with the elimination of lifetime limits and coverage for children with pre-existing conditions

[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.

What type of insurance coverage do you currently have PP? It sounds like you don't currently have employer-subsidized insurance? And how much are you currently paying for that coverage?

[Anonymous]

jsteele wrote:

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"?

I did ask who the liars are here. I agree. Disagreeing with someone else does not make you a liar. However, when you disagree with yourself, that makes you what? Would you prefer the word disingenuous?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Friend has been trying to check prices on the exchange in Virginia since October 1. Set up account, but cannot get to rates and subsidies. Very frustrated. Sometimes spends an hour or two.

According to the Heritage Foundation, Virginia has not finalized its rates. Let your Governor know that you are dissatisfied with his performance.

Virginia is on the federal website. Complain to HHS.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Friend has been trying to check prices on the exchange in Virginia since October 1. Set up account, but cannot get to rates and subsidies. Very frustrated. Sometimes spends an hour or two.

According to the Heritage Foundation, Virginia has not finalized its rates. Let your Governor know that you are dissatisfied with his performance.

Virginia is on the federal website. Complain to HHS.

The Fed doesn't pick the winners. VA does.

[Anonymous]

Anonymous wrote: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!

No, I am in Virginia.

[Anonymous]

Anonymous wrote:

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.).

Um, no. I would never vote for a Republican. I would be fine with single payer but I don't think it's realistic to think that that could happen here given that the Tea people are foaming at the mouth over Obamacare.

[Anonymous]

Anonymous wrote:

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.

It's 8.5% for PREMIUMS only, right? Once you add in the deductibles and coinsurance, it comes to a considerably higher percentage than that. Fortunately, my family will be okay because we are eligible for group insurance (at an exorbitant price) through my husband's employer, which affords us significant tax savings. I was hoping that we could save some money by going on the individual market for less comprehensive coverage, but no such luck. For what we pay now for a policy with a $500 individual/$1000 family deductible, we would have to pay more on the exchange for a much higher deductible with more exclusions.

As for the difference between other types of insurance than this, it is partly that people (including myself, despite knowing better) are used to getting their health insurance for free or close to free from their employers, which was my situation until a few years ago, and partly that $100 or $200 a month is relatively easy to part with, while $1000/mo is a really huge bite out of our budget. I found this apt: http://thehealthcareblog.com/blog/2013/09/21/rate-shock-vs-benefit-shock/

[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.

What type of insurance coverage do you currently have PP? It sounds like you don't currently have employer-subsidized insurance? And how much are you currently paying for that coverage?

We do have employer-sponsored coverage at the moment. It is a small business so their rates are pretty high -- small business rates are comparable to individual rates as I understand it. The employer subsidizes my husband's portion of the rate, we pay for the rest of the family. The total cost for the policy (an Anthem PPO in Virginia) for our family is $1700/mo, we pay just over $1200/mo of that. It is a pretty comprehensive policy with no deductible and 20% coinsurance for some things, copays for other things. Since we don't use much care in a typical year, we would prefer to have a higher deductible (but not $10k high) and an HSA and pay lower premiums, but the exchange rates are not low enough to make taking the risk of having to pay the deductible worth it. But I wonder about people who actually don't have access to an employer policy and who will be forced to accept a higher deductible than they can afford. I know that if we had a $10k deductible, I would be very anxious about the possibility of something happening. The out of pocket exposure (which I think is set by law to max out at $12,700 for a family) is really high. I just expected/hoped to be able to get something with a medium-high deductible ($2-5k family) and otherwise decent coverage for less than $900/mo and that just isn't where the rates are. Considering that we paid $600/mo for a no-deductible comprehensive Kaiser policy for the whole family as recently as 2010, it's disappointing.

[Anonymous]

Anonymous wrote:How does ACA improve access? If anyone has the funds, they can get health insurance on their own. I've been self-insured since April 2007. This is a CROCK. It's not affordable. That said, ACA may help those with pre-existing conditions get coverage for the first time, or lower their premiums. I just don't understand why the government and the health insurance industry didn't figure out a way to do this outside of the government. No reason health insurance should be linked to the IRS, with a tax penalty if you don't get insurance. Outfuckingrageous considering all the tax breaks the rich and corporates get!

Being self-insured is pretty great--so long as you don't get sick.

[Anonymous]

Anonymous wrote:9:49 ACA expanded Medicaid coverage. But it's state by state, and there are reports that millions will not be eligible.

In any event, people still need to pay for insurance under ACA. Where are the poor going to get the funds, even if ACA premiums are lower than self-insured premiums?

Rather than say, "there are reports that millions will not be eligible" why not describe it accurately and say, "Most states w/ Republican governors decided to forgo the expansion, and let their citizens go without insurance"?