Higher deductible plans will be available in the exchange.

It's such a small percentage, that I think the government could fairly heavily subsidize it and not really blink an eye. Maybe it would end up costing the person more on a premium basis than a family without those, but it would still be doable. The government does this on a regular basis with the disabled, underage parents and kids somehow not covered.

I think if you just say "we got this" on pre-existing conditions, you're going to see that 2-3% really increase. Like JIMGA is saying (I can't believe I said that, I may need to wash my mouth out with soap), it defeats the purpose of having insurance for a lot of people.

A high deductible plan is worthless, especially for those who work part time. It only makes sense for someone who has a pre-existing condition and knows they will go over that deductible amount. But of course that pre-existing condition wouldn't be covered under the current system and even if it was, the lifetime cap (which is eliminated under ACA) would be reached pretty quickly. And your 3% number is not accurate.

The issue is more than places have to cut someone's hours and potentially have them pay more for insurance coverage. I'm pretty sure even the high deductible exchange plan will be more than the $40 a check that this home depot plan cost (family, $2500 deduct). The most comparable ACA plan I found was around $400. So, now that person just lost 3-4 hours of work a week and is now forced to pay $300 more a month for insurance.

The other problem is many lower income people, small businesses and others without employer insurance sometimes opt to have extremely cheap private plans with deductibles in the $5K to even $10K range. With the ACA, there's a cap on that deductible amount which means their premiums could also drastically increase.

You don't see that with disabled or low income - it seems like that would be a lot easier to "fake" than a serious pre-existing condition that prevent normal coverage. Again, oversight would be needed, but it's already done in the above examples. There are conditions like Fibro where you can get on disability (with insurance) and there's no real way to prove you have it.

It makes perfect sense for those who can't afford normal coverage or who are young and have families. If they get in a massive auto accident, they are only out $5K worst case. That's the purpose of insurance. It's not to cut prescriptions down from $50 to $10. I think we have forgotten the entire concept of what level of base health insurance is "needed".

This is the kind of thinking that needs to change in order to reduce medical trend. The point of insurance is not for the buyer to only buy it if they think they'll get something out of it -- it's to protect the buyer from catastrophic losses.

And if medical costs had any basis in reality, I'd agree with you.

Healthcare providers & health insurance providers have one of the biggest scams running in American history - a step under our financial institutions.

That is the number referenced for people with pre-existing conditions that cannot get coverage either through an employer or an existing public program.

The problem is that you don't have to fake it -- just let it happen. I mean, it's called a pre-existing condition -- so you got the condition before you had insurance. The easy way to let it happen is to just not buy insurance. I don't think there could be any kind of oversight that will say, "yes, you have this pre-existing condition, but, see, we've determined that you really should have bought insurance, so tough break" -- the only thing that comes close is an individual mandate.

This is a key point. The goal of health insurance is not to allow everyone access to $10 doctor copays and $5 monthly prescriptions. It's to ensure they don't get wiped out by unforeseen/catastrophic events. I think the level of entitlement on what everyone should be given when it comes to health insurance options is not a good thing. It may not make everyone happy, but the idea that some guy who works full time at a factory should get access to cheaper doctor visits than someone out of work isn't a terrible thing.

That would be wife's sister's long-time boyfriend. He has had 4 major wrecks in the past 18 months or so. No way he should be on the road at this point.

At least he is a giant leach on the side of Connecticut's taxpayers as well.

And my point is that especially for someone who is working part time, the high deductible plans mean they could suffer a catastrophic loss before they receive one dollar of benefit.

But what's the advantage? If you don't have it - you get cheaper options through your employer or outside broker. If you happen to get the condition, then you are forced to go with a public option that is more expensive, a higher deductible and has worse coverage. This is because you are now grouped with higher risk people.

I don't see too many people going "well, I could go through my employer or a local co-op without my pre-existing condition. But, if I can somehow get cancer or heart disease, I can pay more for less coverage on this public plan. Let's do it!" :eek:

I think most high deductibles fall under the "sucks ass" category of losses, rather than the "catastrophic" -- even for part-time folks.

We've decided that some basic health care is a right in this country. The question is what is that level?

With pre-existing conditions, the word "insurance" is pointless. The event has happened and someone needs to pay for medical treatment.

One big problem is that insurance is tied to the workplace. The implication being that health care requires a productive worker. That and treating health care as a right are incompatible concepts.

One way to help solve this problem would be government expansion of free clinics, focusing on non-emergency immediate care and preventative care. Doctors could trade having their medical school costs paid by spending a few years in one of these clinics - like we do with the armed forces universities. But it wouldn't be as good as what's available privately. Nurse practitioners could also play a big role in these clinics.

Expecting employers and insurance companies to solve these fundamental problems is a very strange and inefficient way to attack the problem.

You're not factoring in the subsidies for lower incomes.

Then they should pay a higher premium every month to get a $1000 plan instead of a $3000 or $5000 one. Everyone has choices. Some people decide that they would rather save the $200-300 a month and spend it on other things and "risk" a $5000 plan. Other people prefer the peace of mind and stick with the $500 to $1000 deductible plan that costs more a month. Maybe they don't get to go out to dinner as much or drive a worse car, but they have that choice.

At our company, people can choose a $250 deductible plan for $350 a month or a $2500 plan for $30 a month. A lot of people choose the latter - for many it's a smart move as they just put another $100-$200 a month in a medical expense account they can roll over and save the $100-$150 a month in premiums.

True, if it's a lower income person they may get a small tax break for upgrading their plan. But, the minimum amount they can pay for "base coverage" is going to be more because the deductible max that the ACA institutes. Remember, there's a pretty heavy "employer paid piece" in their current $40-50 a check. The total cost for the plan is probably over $300 and the employee only pays $50. Even if the tax break is outstanding, it's not going to cover 80% of the premium.

Which is all I could get as a self-employed person. But Michigan is better than most. So what will happen with Obamacare is my premiums will rise about 10%, my deductible will remain about the same, and I will have insured access to fewer doctors. It's a blow, but not a huge one.

In some states, like New York, where many of the Obamacare mandates were already in place, which meant the price of individual insurance was so high that it didn't make sense for most insurance companies to offer it, this opens up the individual market. Costs go down because healthy people will now offset the cost for those with expensive conditions, who were setting the price of this insurance. Any examination of the cost of implementing Obamacare should reflect what it is people are actually getting, because saying New York benefits ignores the scale of who receives that benefit. It's apples and oranges there. In Michigan, it's a little more realistic. In some states, where the individual market was already competitive, Obamacare may well double premiums - or more - because a high percentage of the new clients are in that 1-3% with serious pre-existing conditions. Analysis is not rocket science here.

Honestly, most people who have insurance paid through work have absolutely no idea of what health care costs in this country. Low co-pays are a very expensive benefit.

This is exactly right. I have seen the "employer paid" part of most benefits and it is staggering. Here's a table that shows it globally:
http://www.bls.gov/news.release/ebs2.t04.htm

At our company, it's around the normal 70%. For the $250 deductible plan, the employee pays around $350 and company pays around $800 on top of that. If we all got dropped to the exchanges tomorrow, what do you think the impact would be on current employees with that plan?

Yeah - I was kinda wondering that myself. Somebody working 28 hours a week at a minimum wage job is totally going to qualify for some level of the subsidies.

:D

SI

To be fair, I still think it's a giant turd. But what we have now is a giant turd. My hope is that a public option comes out of this and that we have to take a step back to take two steps forward. If that doesn't happen, then we're all screwed anyway as this is a giant sloppy kiss for insurance and drug companies, as you stated above.

public option >>>> current system > ACA

SI


The problem is that the bolded fact means nothing. The 85-90% rate of return for Congress is all they care about. Who cares if the group you're a member of has a 10% approval rating if it means nothing. It might cause you to lose a little sleep at night for a bad working environment. But you only run a 10% chance of losing your job every 2 years and that job has a LOT of perks. Even worse, because of the gerrymandering, your districts get more red and more blue so even if you fire your Congressman, it's for someone more extreme, not less.


Nah, that's in 2 weeks for the debt ceiling debate. Ready for that one next?!?

SI

Can't you just look on the exchanges and find out?

I am not a fan of ACA. Of course I am in a bit of a unique situation. Family of 5, my wife's employer provides us all with health insurance. She works 24 hours a week but is paid for 40 hours (she works Sat and Sun 7pm to 7am so overnight and weekend shifts gives her 2 pay differenials and the hospital considers her full time despite it being 24 hours.)

We have a fairly average health plan that costs a few hundred a month. If she were to lose these benefits due to her 24 hours of work then in CT, the exchange board happily says that the "affordable" health care costs for my family would be in the $700-$900 range per month. I would pay double.

Not cool.

Luckily, it doesn't appear they will take away her benefits.

I approve the CA, but the affordable part is not true at all.

It's too bad Tom Clancy never wrote a book about a member of the president's cabinet stealing the trillion dollar coin and using it to fund a coup (somehow).

Actually, some of that should be the goal of comprehensive health care reform. Incentivize people financially to do preventative care so catastrophic care is less necessary.

I want everyone to get their scheduled colonoscopy because early tests and outpatient surgery are much cheaper than long term end of life care for even 10% .

I want anyone with TB to pay their $5 for a perscription and take their meds because drug resistant TB doesn't care about your insurance status when it infects you and it's damn expensive to treat and sometimes fatal.

Hell, I would have loved to have a sin tax on sugar and I LOVE SUGAR (tho do not have diabetes). Whether the government is doing it or whether Anthem is doing it, someone is passing along the cost of the premiums from a diabetes patient to me in terms of higher premiums to cover that person and higher hospital costs because insurance companies don't have any incentive to bend the cost curve.

It's all interconnected whether the government is doing it or whether some insurance company is doing it. And prevention is a lot cheaper than treatment so financial incentives towards prevention save us treatment money in the end.

SI

They did make a Simpsons about it, tho:
http://www.snpp.com/episodes/5F14

Then again, it was season 9 and by then, things were starting to get silly

SI

I'm not sure where they're getting the funding from, but we're open for business through Friday. Monday, 40% will be sent home while the rest of us get to work without pay until they pass a budget.

It's hard to tell because they don't list all the coverage. But, a $250 deductible plan for Blue Cross/Blue Shield (what I currently have) is listed for between $700 and $1200 a month in AZ. Given our household income is above the floor for subsidies, the approximate increase in cost for us if our company dropped coverage appears to be atleast double what we pay now - and maybe a lot more. Let's hope it doesn't happen...

That was answered 1986 when Reagan signed a law that said doctors are required to treat emergencies regardless of the patients ability to pay.

All this stuff is just an extension of that. It's really not a huge change in who receives health care, it's a change in how it's done. Currently hospitals have to bill us extra to cover the costs of those who can't afford it. That's why you're paying $10 for an Aspirin.

This is why the complaints over a mandate are stupid. We are paying for uninsured people as it is since that bill in 1986 was passed. Nothing is really changing. We aren't all of a sudden stuck footing the bill for other people's health care. We have been doing that since 1986. This just organizes it better and hopefully saves money by not having all the uninsured running into a hospital and costing 10x more than what it would be to just see their doctor.

I guess one way of looking at it is that the bill is stupid because our whole system is stupid. We could just join the rest of the industrialized world at some point.

Again, we have a great system for a vast majority of the working public. Why not come up with ways to cover those who are uninsured and leave the rest of us who have very affordable healthcare (with 70% of our premiums paid for by our employer) alone?

What is your guarantee that if there were no ACA, that there wouldn't be any changes to your healthcare coverage?

And by what basis do you arrive at the conclusion that we have a great system for the vast majority of the working public? By your own experience? Our system of healthcare ranks towards the bottom of the industrialized world, both for affordability and expected life span.

Well most people don't agree with your first sentence, so that's your answer to the "Why not" in your second sentence.

And let's not pretend that Republicans are trying to replace Obamacare with some alternate plan. They just want it overturned immediately and nothing else.

Of course, the Republicans don't want to come up with an alternate plan, because if they do, some Democrat is gonna propose it in 20 years and they'll once again look foolish opposing something they once supported.

Your employer isn't paying that. It's a pass-through cost, just like your 401k and other benefits you receive. It's built-in to your salary. If employers didn't have to pay for health insurance, you'd take home the difference.

There hasn't been for the last 12 years I've been with this company and it's doubtful it would change - that is unless the government came out with a new system that our company could use as a justification to offload us and save some cash.

By the plans offered by most companies. For most fulltime workers, they have access to company subsidized plans with reasonable deductibles ($250 to $750) ranging in the $250-$500 a month premium cost to employee. We do a benefits study every year and this is what we find. This is significantly cheaper for those deductible levels than anything you find in these new exchanges.

Again, as long as companies don't start dropping coverage, we will all be fine. But why setup a way for them to do that under the cover of Obamacare? It's almost like the administration is hoping a bunch of companies drop coverage, people are faced with double their premium cost per month and come crying to Obama/democrats to make it a public option for cheaper. The cynic in me thinks this could be the endgame. Of course, in the interim, we may be faced with numerous families looking at massive premium hikes to receive similar coverage they had with their employer.

They pay it because it's a massive writeoff for them. If they lost the incentive to pay it or were faced with a way to save money by not covering employees and save face by saying everyone can join exchanges - many companies would jump at it as it would increase their profit margin.

Basically, alot of what I'm hearing is that the fine for companies not covering employees should be much higher so the cost of offering coverage is less than the penalty they'd pay for dropping coverage. I'm totally down for that, but I certainly doubt any elected Republicans would agree.

I would be fine with that. The problem is a lot of lower wage workers would certainly be moved to part time to ensure companies aren't subject to fines if they don't want to cover 30-35 hour part time workers. But, given the alternative of a bunch of fulltime guys losing their current coverage, I would take that tradeoff in a second. There should be no feasible way that a company would stop providing benefits to fulltime employees and someone come out ahead financially.

The point of this is provide coverage to people who don't have it - not to reshape how people with existing employer paid care get coverage. At least, I *hope* that's the point here - at this point I'm not even sure what the point is of this plan.

This, this, a thousand times this. An enormous part of the problem with the entire health care system is how, somewhere along the way, insurance stopped being "insurance" and became interpreted to mean "paying for access to 'discounted' health care".

I'm not that freakin' old at the ripe age of 46. As a kid, health insurance didn't come into play unless there was a hospital stay (or at least vist) involved. Prior to going into business for myself I was fully employed by other companies for something like 14 years, of which I saw ANY employer funding health care even available only for a couple of those years (although I realize that was likely true in a minority of industries).

It got flipped on its head somewhere along the way, and it occurred relatively quickly.

Your salary is a write-off for them as well. Your benefits are all factored into your salary.

The problem is no one sees this benefit. If tomorrow, a company stopped providing health care coverage and everything shifted to an exchange, most people wouldn't realize that they just lost a pretty hefty benefit. There are ways that companies could decide as a group to no longer provide health care coverage but "work with all their employees to find acceptable replacements in the form of this marketplace exchange system". Maybe their deductible increases a bit, premiums increase a bit more, they now pay more for office visits and maybe even can't see the same doctors. But, for the rank and file workers, most wouldn't even realize they just took a massive "benefit cut".

Do you really experience a world where people are not worried about their health benefits and aren't incredibly grateful for any coverage they have? I think most polls show that health care and medical coverage is one of the number one concerns of most Americans, not something they don't realize they have.

In addition, isn't what you describe companies doing above exactly what has happened to healthcare over the last few decades, increasing premiums, increasing deductibles, less control over who they see?

One of those rare times I can say I agree with Jon. One of the biggest problems with our health care system is that everyone wants any possible medical care, no matter the cost, and they want it for free. They view insurance as a subscription model. If you talk to people about generalities they may agree there needs to be a kind of rationing, but when you talk specifics, no one is willing to have themselves or a loved one not receive a procedure that might help them because it's too expensive. I think the heart of the problem is that our medical technology has far outstripped our economy. We can do more than we can afford to do for everyone.

Where I undoubtedly differ from Jon therefore is that I think this ties back to how income for the average American has stagnated over the last 50 years. People want that discounted health care partly because the reality is most people can't afford health care anymore. If we switched to catastrophic coverage and people paid for their medical care, people would realize the salaries they receive for their work are not sufficient to cover medical care, because the average American has not kept up with cost of living expenses over the last decades. This has been hidden in part by the insurance system but now the health care costs are crushing it.

Just to be clear. Isn't this the EXACT same thing I was telling you on Facebook yesterday and you thought I was nuts to advocate delinking healthcare from employment? And now you are in favor of it today? :cool:

And I place a great deal of the blame for those costs -- which stretch back through the health care providers to the cost of their training in the first place -- on the shift in the payment model over the years.

Ain't that the truth. Before I was an Investigator with the Department of Labor, I was a Benefit Adviser, while I was in law school, and would get calls from Participants. Lots of people weren't happy with the system - we'd get quite a bit of pre-existing condition calls for one.

Isn't all of our employer provided healthcare already government subsidized in terms of tax breaks to the companies providing it?

Also, ever increasing premiums (that are passed onto workers) for coverage that still can easily result in bankruptcy is a great system for the vast majority of the working public? It's only good for those who never get sick, which if that's the case, then why have insurance at all- sounds like you're buying something that's not even worth the paper it's printed on.

SI