DC Health Exchange- all options are really expensive?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I know several families who currently have health insurance, they're self-insured, and who will save money under ACA because of their states' ACA offerings. (NJ, PA, MI). That's great, but it doesn't address the uninsured issue, does it?

Also, why did it take FOUR YEARS for this to come together? The President signed this into law in March 2010.

The whole thing, from the delays and the website that doesn't work to the Tea Party lunatics, is just so dispiriting.

It took 4 years because the law itself is poorly written AND its the government. Slow as syrup.

ITA it doesn't solve the uninsured problem. Many people will not find plans for under $750 and just pay the fine instead or lie on their taxes (whaaaat people lie on their taxes?!?)

It took four years as a compromise with conservative Democrats and Republicans who wanted to slowly phase the ACA in so they could have more time to kill it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

When you say, "non-ACA compliant" what you're describing is a low cost insurance plan that doesn't actually cover anything, and could be canceled when the policy holder tried to make a claim. This is a bit like passing a law that says "everyone must have a functioning smoke alarm in their home", and then being upset when folks who own a cardboard box that's painted red and stuck to their ceiling must be replaced by an actual, functioning smoke alarm.

"I *had* a smoke alarm, and now I have to buy a more expensive one???"


Also, there's exactly zero evidence that significant numbers of people have had their hours reduced below 30 hours. In fact, some have had their hours increased.

[Anonymous]

From what I hear, the specialists come out okay--it is the family doctors who will be hurt. good luck getting that appointment.

[Anonymous]

Anonymous wrote:If you really look at that map, it's not purely political whether the states challenge or accept the law. In fact, few outside of CA and the northeast accept the law entirely.

The states that challenged the law are almost entirely red states, or states who have a right-wing ideologue as governor. There are exceptions, such as Kasich in Ohio who is trying to expand medicaid over the objections of the legislature.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

When you say, "non-ACA compliant" what you're describing is a low cost insurance plan that doesn't actually cover anything, and could be canceled when the policy holder tried to make a claim. This is a bit like passing a law that says "everyone must have a functioning smoke alarm in their home", and then being upset when folks who own a cardboard box that's painted red and stuck to their ceiling must be replaced by an actual, functioning smoke alarm.

"I *had* a smoke alarm, and now I have to buy a more expensive one???"


Also, there's exactly zero evidence that significant numbers of people have had their hours reduced below 30 hours. In fact, some have had their hours increased.

A smoke alarm makes an alarm noise in response to smoke. A cardboard box painted red does not. So that never was a smoke alarm to begin with

Could be isn't the same as will be.

I am self-insured and have been for 12 years. Never a hitch and I've had surgery, tests, etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

When you say, "non-ACA compliant" what you're describing is a low cost insurance plan that doesn't actually cover anything, and could be canceled when the policy holder tried to make a claim. This is a bit like passing a law that says "everyone must have a functioning smoke alarm in their home", and then being upset when folks who own a cardboard box that's painted red and stuck to their ceiling must be replaced by an actual, functioning smoke alarm.

"I *had* a smoke alarm, and now I have to buy a more expensive one???"


Also, there's exactly zero evidence that significant numbers of people have had their hours reduced below 30 hours. In fact, some have had their hours increased.

A smoke alarm makes an alarm noise in response to smoke. A cardboard box painted red does not. So that never was a smoke alarm to begin with

Could be isn't the same as will be.

I am self-insured and have been for 12 years. Never a hitch and I've had surgery, tests, etc.

Just so we're clear, "self-insured" means that you do not have a traditional insurance policy, and instead you set aside money to cover any eventualities. Or did you think it meant something else?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

At the end of the day, the next time it snows, the streets could burst into flames, but it is extremely unlikely.

It seems that you are looking for problems where they don't exist. If young people pay the fine, then the number of insured people does not go down. And what is the point of dropping the hours of employees who already have company-paid health insurance? Not much, unless their plans are worse than the ACA ones. And the bar is not especially high on the bronze and catastrophic ACA plans.

At the end of the day, it's really hard to imagine a world in which the government subsidizes a benefit and yet fewer people enroll.

[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.

Hit the nail on the head. Costs are outrageous.

[Anonymous]

It seems that you are looking for problems where they don't exist. If young people pay the fine, then the number of insured people does not go down. And what is the point of dropping the hours of employees who already have company-paid health insurance? Not much, unless their plans are worse than the ACA ones. And the bar is not especially high on the bronze and catastrophic ACA plans.

So that they won't have to provide insurance. Costs are going up for companies, too. And, they had a waiver for this year. They are still scared of the train coming at them.

[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.

Hit the nail on the head. Costs are outrageous.

You are paying 200 a month to be insured against death. 800 a month is more than fair for a whole family given the insurance industry's assessment of your risk.

[Anonymous]

Anonymous wrote:

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.

Hit the nail on the head. Costs are outrageous.

You are paying 200 a month to be insured against death. 800 a month is more than fair for a whole family given the insurance industry's assessment of your risk.

The $200 a month is for both my husband and myself, actually -- 30 year term, $1m each, purchased at age 33. And the $800/mo rate for the bronze plan is not based on an assessment of my family's risk, since there is no more medical underwriting. It is the rate for any family with two parents our age who don't smoke and 3 children. Again, I think it is the fact that people are used to insurance being comprehensive that muddies the waters here. I don't mind insuring against catastrophic health risks, but the likelihood of those is not high enough to be worth $800/mo when there will still be out of pocket costs on top of that amount up to $12,700. Most people don't have that kind of money lying around. Maybe they should -- but getting used to a world in which we can all expect to be subject to $10k+ out of pocket exposure per year plus premiums is going to require a major paradigm shift for most people IMO.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

At the end of the day, the next time it snows, the streets could burst into flames, but it is extremely unlikely.

It seems that you are looking for problems where they don't exist. If young people pay the fine, then the number of insured people does not go down. And what is the point of dropping the hours of employees who already have company-paid health insurance? Not much, unless their plans are worse than the ACA ones. And the bar is not especially high on the bronze and catastrophic ACA plans.

At the end of the day, it's really hard to imagine a world in which the government subsidizes a benefit and yet fewer people enroll.

What you seem to be missing is that 80 percent of the people in America were satisfied with their health insurance when Obamacare was passed. It was estimated that about 5% of the 15% or so of the uninsured had preexisting health conditions that made insurance too expensive. In the attempt to get coverage for those people, and have it subsidized by healthy people, ACA imposed minimum requirements and new rules (employer mandates with a 30 hour workweek as "full time", minimum requirements for coverages for individual policies) on the 80% that were satisfied. This is the only way the ACA will work -- if young, healthy people do not enroll, the costs for the pool that is left will skyrocket, and the entire thing will crash and burn. The bad web site just exacerbates this problem, as the sick will spend any amount of time to get enrolled, and the healthy will just walk away.

Hundreds of thousands (if not millions, the article just cites numbers from individual companies in a handful of states) have had their individual policies canceled. As of Jan. 1, these people are uninsured unless they can get healthcare.gov to work or find insurance some other way. So much for "If you like your insurance, you can keep it."

http://www.nbcnews.com/health/thousands-get-health-insurance-cancellation-notices-8C11417913

Yes, they may be getting "more" coverage, but they are also, in many cases, being forced to buy insurance they don't want or need (an 80-year-old has to buy maternity coverage, for example). The cheaper plans also have high deductibles and copays (see the thread on cost). It's as though the federal government mandated that everyone buy a car, but outlawed Chevrolet's and required that people could only buy Mercedes. Even if they provide a subsidy for the monthly payment to the truly poor and lower middle class, the middle class will be stretched, and the truly poor can't pay the maintenance cost on a Mercedes at all. How many of the "insured" poor will still end up in the emergency room because they can't afford the copay for a doctor?

Finally, if you don't see the point of dropping the hours of people who already have insurance (at a time when the government mandated coverage make insurance more expensive), you must work for the federal government.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

At the end of the day, the next time it snows, the streets could burst into flames, but it is extremely unlikely.

It seems that you are looking for problems where they don't exist. If young people pay the fine, then the number of insured people does not go down. And what is the point of dropping the hours of employees who already have company-paid health insurance? Not much, unless their plans are worse than the ACA ones. And the bar is not especially high on the bronze and catastrophic ACA plans.

At the end of the day, it's really hard to imagine a world in which the government subsidizes a benefit and yet fewer people enroll.

What you seem to be missing is that 80 percent of the people in America were satisfied with their health insurance when Obamacare was passed. It was estimated that about 5% of the 15% or so of the uninsured had preexisting health conditions that made insurance too expensive. In the attempt to get coverage for those people, and have it subsidized by healthy people, ACA imposed minimum requirements and new rules (employer mandates with a 30 hour workweek as "full time", minimum requirements for coverages for individual policies) on the 80% that were satisfied. This is the only way the ACA will work -- if young, healthy people do not enroll, the costs for the pool that is left will skyrocket, and the entire thing will crash and burn. The bad web site just exacerbates this problem, as the sick will spend any amount of time to get enrolled, and the healthy will just walk away.

Hundreds of thousands (if not millions, the article just cites numbers from individual companies in a handful of states) have had their individual policies canceled. As of Jan. 1, these people are uninsured unless they can get healthcare.gov to work or find insurance some other way. So much for "If you like your insurance, you can keep it."

http://www.nbcnews.com/health/thousands-get-health-insurance-cancellation-notices-8C11417913

Yes, they may be getting "more" coverage, but they are also, in many cases, being forced to buy insurance they don't want or need (an 80-year-old has to buy maternity coverage, for example). The cheaper plans also have high deductibles and copays (see the thread on cost). It's as though the federal government mandated that everyone buy a car, but outlawed Chevrolet's and required that people could only buy Mercedes. Even if they provide a subsidy for the monthly payment to the truly poor and lower middle class, the middle class will be stretched, and the truly poor can't pay the maintenance cost on a Mercedes at all. How many of the "insured" poor will still end up in the emergency room because they can't afford the copay for a doctor?

Finally, if you don't see the point of dropping the hours of people who already have insurance (at a time when the government mandated coverage make insurance more expensive), you must work for the federal government.

Meant to add -- 75 percent of jobs added this year were part time.

http://www.huffingtonpost.com/2013/08/21/part-time-job-creation_n_3788365.html

[Anonymous]

It's not just DC.

http://www.latimes.com/business/la-fi-health-sticker-shock-20131027,0,2756077.story?page=2#axzz2ivyEQ2ei

It's ironic that earlier in the year, California was commonly cited as evidence that Obamacare was going yo work. Some of the quotes in the article are priceless. It turns out that, when Ibama said that "If you like your healthcare, you can keep it." He didn't mean EVERYONE. Silly you.

[jsteele]

Anonymous wrote:It's not just DC.

http://www.latimes.com/business/la-fi-health-sticker-shock-20131027,0,2756077.story?page=2#axzz2ivyEQ2ei

It's ironic that earlier in the year, California was commonly cited as evidence that Obamacare was going yo work. Some of the quotes in the article are priceless. It turns out that, when Ibama said that "If you like your healthcare, you can keep it." He didn't mean EVERYONE. Silly you.

If you look at the numbers cited in the article, it puts things in perspective:

1) the population of California is over 38 million (this was not in the article, but it's what the US Census says);
2) "Nearly 2 million Californians have individual insurance";
3) "It's estimated that about half of policyholders in the individual market have those older plans" which are grandfathered and won't change
4) "About two-thirds of those people will experience a rate increase" -- "those people" refers to the 119,000 customer customers of Blue Shield of California whose insurance was cancelled.

So, in sum, of the over 38 million Californians, less than 700,000 will see increases.

On the other hand, according to this report:

http://laborcenter.berkeley.edu/healthcare/aca_uninsured12.pdf

"The number of uninsured Californians under age 65 will decrease by between 1.8 and 2.7 million."

So, it seems that on a cost-benefits basis, the program in California will be successful, albeit at a price increase for a small number of residents.