Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[twa]

 But you just keep on thinking you're somehow being cheated by Obamacare. I know how much that means to you.

 

 

 

I'm not being cheated, ya'll might get to feeling raped though    

I've said all along it would help me retire early with ya'll helping.

I would feel bad if ya weren't so insistent.

[chipwhich]

Speaking of no context, you mentioned that your premiums went up. You do realize that you and your employees are probably getting more coverage for the additional money, right? That and the increases you'd have inevitably incurred even if Obamacare never existed are some things to take into account in the overall evaluation...among other things I'm sure. Obviously, I don't know that anyone can say whether that evens out with the premium increase but there's more to it than just "my employee premiums went up. Stuff it left!"

 

I was being sarcastic with regards to ASF post.  My point was, saying premiums went up or down without any context means nothing.  It doesn't mean Obamacare caused them to go up or down.  It means absolutely nothing.  There is no context to the post.  My premiums went up for a combination of factors, ACA being one, the top 20% of my employees and the amount of care they used being two, and the average age of my population being the third.  You see, year one in the ACA just like year one in my plan, insurers make an estimate on what they think the population enrolled should spend.  If the population exceeds that, it will cause rates to rise, if it is less, the rates could lower.  The simple fact is we won't know what rates will look like in years 2 and 3 everyone being in the system.  This is re-evaluated every year.

 

 

As for the "high deductible doosies" comment, in most cases the ACA increased requirements for coverage. That's why folks with the high deductible or bare bones coverage plans that didn't meet the requirements of the ACA were all up in arms that they couldn't keep their coverage. Their policies weren't going to be offered any longer because they were deemed inadequate.

 

My plans all met the ACA requirements with maybe the exception of free birth control.  As Larry likes to opine, health care costs rise every year.  I can tell you a portion of my health care rise in cost was due simply to paying for setting up the exchanges in the ACA.

 

The average family deductible in the ACA is $6,078.  The average monthly premium is $328.  That's $10,000 a year for a family if they use their insurance.  You think that's affordable?  If the medium income of all families is around $45,000, where is that $10,000 coming from.  Now if you are lucky and don't use your deductible because you are healthy, you basically pay $4,000 a year for a health checkup, some other free checkups, and some basic free prescriptions like birth control.  $4,000 can buy a lot of free.

 

My issue is with the affordability although SMD will attack me and claim I don't want her to have insurance.  I do, I just think it's not affordable.  And it will get worse.  Once the sick population gets enrolled, watch out.

 

 

Finally, I think there's another thing that gets overlooked in all of the "my premiums increased" and "my policy isn't being offered any longer" type stuff. While that may create short-term pain for you, it benefits the system as a whole which in turn individuals benefit from by lowered costs over the intermediate term, not to mention better health. To use the colonoscopy example from above, how much does it cost for the colonoscopy vs. treating a preventable colon cancer later? Is your life/health worth the thousand or so bucks paid at the time of the procedure?

 

Again, my stance on all of this is that ACA is driving the high deductible plans at historic rates.  I can tell you based on renewals in my own microcosm.  A high deductible in the bronze plan for example, which is almost $11,000 on average in the ACA is basically American's self insuring.  Meaning the insurance company knows they won't pay much if anything unless a catastrophe or major illness occurs.  In my world, that's 20% of my employees.  The other 80% don't tilt the scales.

[The Sisko]

Nobody ever said it was perfect, certainly not me. Based on Clinton's foray into healthcare reform, everybody knew going in that if they weren't able to get the major players on board, i.e. insurance co's., healthcare providers, big pharma, etc. that it was going nowhere fast. So the only way to get it done was to let 'em eahrn. The only other option was probably to expend literally every bit of political capital Obama had in his first term to get a single payer system. IMHO it was the better option but political capital or no, the chances are good it wouldn't have passed anyway and would have probably derailed his presidency.

 

$11K is self insuring for some people. For others, their prescriptions alone can come close to this number. At some point most people cross over from the self insuring side of that to the side of using more than they're paying for at which point you get at least some or all of it back. Well, unless you die early. It's the nature of insurance. Now aside from allowing all the major players to get a cut in exchange for their support, this cost also represents the removal of lifetime caps, preexisting conditions etc. which the majority of people say they want, as well as paying for previous cost shifting from the uninsured. What people don't want is the mandate, i.e. to pay for the benefits. Again, there's no free lunch though. We Americans, especially out in "real" 'Muricuh, seem to have a problem with that concept...well, except when it concerns an inner city welfare queen (who is as likely to actually be a rural poor person, but nevermind the facts).

[chipwhich]

Nobody ever said it was perfect, certainly not me. Based on Clinton's foray into healthcare reform, everybody knew going in that if they weren't able to get the major players on board, i.e. insurance co's., healthcare providers, big pharma, etc. that it was going nowhere fast. So the only way to get it done was to let 'em eahrn. The only other option was probably to expend literally every bit of political capital Obama had in his first term to get a single payer system. IMHO it was the better option but political capital or no, the chances are good it wouldn't have passed anyway and would have probably derailed his presidency.

 

$11K is self insuring for some people. For others, their prescriptions alone can come close to this number. At some point most people cross over from the self insuring side of that to the side of using more than they're paying for at which point you get at least some or all of it back. Well, unless you die early. It's the nature of insurance. Now aside from allowing all the major players to get a cut in exchange for their support, this cost also represents the removal of lifetime caps, preexisting conditions etc. which the majority of people say they want, as well as paying for previous cost shifting from the uninsured. What people don't want is the mandate, i.e. to pay for the benefits. Again, there's no free lunch though. We Americans, especially out in "real" 'Muricuh, seem to have a problem with that concept...well, except when it concerns an inner city welfare queen (who is as likely to actually be a rural poor person, but nevermind the facts).

 

Ya still didn't explain where someone with a medium income can find 11K affordable.  Not to mention that numbers gonna rise faster than income.

 

Meanwhile American's eat prescription drugs like candy.  Skittles.  Beast mode.

 

Hope they work it out so I can retire as cheap as possible and get a reasonably priced health care.

[skinsmarydu]

The ACA is applied to all insurance, as I've understood it...it makes sure my insurance works as it is supposed to, not how it has in the past, denying coverage for pre-existing conditions that have nothing to do with what a patient needs...we all know the horror stories.

Chip, once again, I only gave facts. Your posts are more of a warning of the future, with a "shove it" on the end. I know...it's harder to shovel facts than empty thoughts and predictions...and that's how we know you won't try.

I'm not emotional. Simply giving the facts.

Again.

add: to the point that you pay your employees' deductibles, I'm assuming premiums as well?

If, (heavy emphasis on "if") this is the case, they might be at the doc for every little thing...and this is probably what's driving your costs upward. Maybe a meeting with your accountant would be in order.

But I'm sure you've done that...and since you've had no quibbles with paying for your employees' health care in the past, were you happy that they were hampered by pre-existing conditions or lifetime limits? Did they complain to you or your HR department?

Are they happy now?

If they are, why aren't you? Happy employees are golden. They tend to spread their happiness around.

Just sayin'.

Edited May 20, 2014 by skinsmarydu

[Burgold]

 Not to mention that numbers gonna rise faster than income.

 

Gonna?  They've been rising at multitudes faster than income for years, possibly decades now.  Part of the reason that health reform was wanted was because the process was so broken.

[skinsmarydu]

Meanwhile American's eat prescription drugs like candy.  Skittles.  Beast mode.

And on that note, instead of getting prescription Flexiril at $6.50,(for a month's supply) which would put me to sleep in about 20 minutes, I'm paying $19/week for natural muscle relaxers that help me get through this back injury while allowing me to stay awake...a novel idea, don't ya think?

See, it's a choice. I realize some folks don't have the extra $ to stay away from Big Pharma. My husband has brought up the cost difference to me, but understands why I'm choosing to manage my pain this way. He's not necessarily happy about it, but OK with me "practicing what I preach", so to speak.

[The Sisko]

Ya still didn't explain where someone with a medium income can find 11K affordable.  Not to mention that numbers gonna rise faster than income.

 

Meanwhile American's eat prescription drugs like candy.  Skittles.  Beast mode.

 

Hope they work it out so I can retire as cheap as possible and get a reasonably priced health care.

Please explain how they find even a minor trip to the emergency room affordable? Here's how. And if you've got kids, the chances are pretty good that you haven't been "getting lucky" and avoiding the doctor and/or ER most years.

[chipwhich]

The ACA is applied to all insurance, as I've understood it...it makes sure my insurance works as it is supposed to, not how it has in the past, denying coverage for pre-existing conditions that have nothing to do with what a patient needs...we all know the horror stories.

Chip, once again, I only gave facts. Your posts are more of a warning of the future, with a "shove it" on the end. I know...it's harder to shovel facts than empty thoughts and predictions...and that's how we know you won't try.

I'm not emotional. Simply giving the facts.

 

SMD, thanks for being less emotional today, makes the discussion a little easier.  Yes the ACA is applied to all insurance.  My point about you not being on Obamacare is that you didn't buy insurance from the exchanges.  You have your husbands company insurance.  My insurances is better than what the exchanges offer.  Your probably is too, but I wouldn't know without a better understanding of what your husbands company offers.  So it is true both of our companies health care plans have ACA rules applied, but neither one of us have ACA insurance.  So when you give a response that you went to the doctor and it cost you .37 cents, it's not because of the ACA, it's because you have insurance, something I have fortunately enjoyed my whole life.

 

I hope you don't get forced into the exchange, that $1,500 deductible you have is quite manageable.

 

 

 

Again.

add: to the point that you pay your employees' deductibles, I'm assuming premiums as well?

If, (heavy emphasis on "if") this is the case, they might be at the doc for every little thing...and this is probably what's driving your costs upward. Maybe a meeting with your accountant would be in order.

But I'm sure you've done that...and since you've had no quibbles with paying for your employees' health care in the past, were you happy that they were hampered by pre-existing conditions or lifetime limits? Did they complain to you or your HR department?

Are they happy now?

If they are, why aren't you? Happy employees are golden. They tend to spread their happiness around.

Just sayin'.

 

There are no pre-existing clauses in my insurance, I have a group policy.  So yes they were happy.  And I never have heard anyone I know discuss worry over lifetime limits other than a discussion on Obamacare.  Pre-existing clauses are real to the general population, lifetime limits aren't generally understood.

 

The only reason I pay what I do is I have to be competitive in my industry.  My competitors pay it all, so I have to as well.  But thanks for your concern.  No need to see my accountant.

[chipwhich]

Gonna?  They've been rising at multitudes faster than income for years, possibly decades now.  Part of the reason that health reform was wanted was because the process was so broken.

 

No the reason for health reform was to insure the uninsured.  None of the process has been fixed.  As long as Americans have a prescription drug epidemic we will have health care costs spiraling out of control.  That's what needs to be fixed.

The funny thing about everyone attacking me is I am trying to defend those who get these costs levied upon them.  I still want to know how the uninsured are gonna afford 11,000 a year and rising.   Most of the people in that group don't have that kind of coin.

[skinsmarydu]

So we agree! The ACA is working!

I still fail to see where I got emotional tho. Maybe my happiness came through, sorry.

[chipwhich]

So we agree! The ACA is working!

I still fail to see where I got emotional tho. Maybe my happiness came through, sorry.

 

I never said the ACA isn't working LOL.  People pay premiums and high deductibles and they can get insured.  That certainly works. 

 

Viva La ACA

[The Sisko]

BTW, where are you getting that $11K figure? HHS says it's more like $4K for the mid tier option. Subsidies make the actual number even lower for most. At less than $4K, one trip to the ER could easily put you in the black.

http://www.nbcwashington.com/news/health/NATL-ACA-328-Average-Monthly-Health-Insurance-Cost-Under-the-Affordable-Care-Act--225324422.html#

"Recent data shows that Americans will pay an average monthly premium of $328 for mid-tier or "silver plan" health insurance. The online exchanges under the Affordable Care Act open next week on Oct. 1.

Most Americans will qualify for government subsidies to lower that price.

The figure is the broadest national estimate for the cost of coverage based on data for approved insurance plans in 48 states.

The Obama administration estimates and is counting on 7 million Americans to sign up for health insurance through the new exchanges – including 2.7 million younger and healthier consumers needed to offset the costs of sicklier customers.

Insurance rates were significantly higher in states with fewer insurance companies offering plans under the ACA. Prices will vary across the nation...."

Edited May 20, 2014 by Yusuf06

[chipwhich]

BTW, where are you getting that $11K figure? HHS says it's more like $4K for the mid tier option.

http://www.nbcwashington.com/news/health/NATL-ACA-328-Average-Monthly-Health-Insurance-Cost-Under-the-Affordable-Care-Act--225324422.html#

"Recent data shows that Americans will pay an average monthly premium of $328 for mid-tier or "silver plan" health insurance. The online exchanges under the Affordable Care Act open next week on Oct. 1.

Most Americans will qualify for government subsidies to lower that price.

The figure is the broadest national estimate for the cost of coverage based on data for approved insurance plans in 48 states.

The Obama administration estimates and is counting on 7 million Americans to sign up for health insurance through the new exchanges – including 2.7 million younger and healthier consumers needed to offset the costs of sicklier customers.

Insurance rates were significantly higher in states with fewer insurance companies offering plans under the ACA. Prices will vary across the nation...."

 

11K is the cost of the premium plus the deductible.  That's if you go Silver.  If you go Bronze, it could get really ugly over the years.

 

http://www.healthpocket.com/healthcare-research/infostat/2014-obamacare-deductible-out-of-pocket-costs#.U3tp4S-RJxM

 

Yusuf you got 11 grand expendable income?

Edited May 20, 2014 by chipwhich

[twa]

it would be interesting to see which posters have ins thru the exchange w/ ded and premiums

 

me and the wife pay 970(before subsidy) a month w/ 2500 ded for a silver plan

Edited May 20, 2014 by twa

[The Sisko]

11K is the cost of the premium plus the deductible. That's if you go Silver. If you go Bronze, it could get really ugly over the years.

http://www.healthpocket.com/healthcare-research/infostat/2014-obamacare-deductible-out-of-pocket-costs#.U3tp4S-RJxM

Yusuf you got 11 grand expendable income?

I do but it's only because I'm leeching off the likes of good, honest, hardworking 'Muricuns like you and twa. :-D

A couple of things. First, the subsidy still reduces premiums below the $4K mark for many which you haven't backed out of your number. Second, deductibles only get paid when you're using services (skin in the game, remember?) and if you need care, you were going to have a bill anyway so that's the comparison to make, not the deductible vs. zero. Oh, and don't forget to take the "premium" you pay for being uninsured. Health plans negotiate discounts so the uninsured pay/paid more for the same procedure than the insured. Again, one relatively minor incident could easily make up for that. Moreover, when the uninsured show up and pay nothing, the provider gets the same, i.e. nothing, mostly for expensive care provided in the ER. This way the provider gets paid and ACA includes mechanisms to divert non-emergency care to less expensive care settings. This saves the provider, the system and the patient money. Again, a win-win.

Unfortunately, there's more to the ACA than many would have you believe. It is a very comprehensive law with a lot of good stuff and some not so good stuff. I'll leave it to you to determine which is which. As with most things it pays to do some research beyond the partisan talking points on both sides and your own anecdotal experience.

Edited May 20, 2014 by Yusuf06

[chipwhich]

Unfortunately, there's more to the ACA than many would have you believe. It is a very comprehensive law with a lot of good stuff and some not so good stuff. I'll leave it to you to determine which is which. As with most things it pays to do some research beyond the partisan talking points on both sides and your own anecdotal experience.

 

Oh I know.  I am not speaking partisan.  Speaking as the Master of Coin.  Sorry GOTR reference.  Who has that kind of cash?

 

And the sickly who are signing up will spend all of that.  Guess they have that cash.

 

I want to retire without a huge health care bill ACA, isn't getting me where I want to be.

 

If you take the uninsured, many of which have no expendable income, and impose a health insurance cost on them I just wonder how they will pay for it.  There isn't partisan in that.  And like I said, the real costs will come during the next two years renewal time.

Off to watch the Blue Angels.  The joys of living in Annapolis!

[skinsmarydu]

Unless I'm crazy (that case could be made, lol), policies can also be purchased outside of the exchange!

[Wrong Direction]

it would be interesting to see which posters have ins thru the exchange w/ ded and premiums

 

me and the wife pay 970(before subsidy) a month w/ 2500 ded for a silver plan

 

Sort of an aside, but it will be interesting to see satisfaction rates for people in the exchanges and compare to programs like Medicare, VA and Mike Pence's program.

 

VA care is notoriously sub par (access primarily), but I have no idea how their satisfaction rates are.

 

Second, deductibles only get paid when you're using services (skin in the game, remember?

 

This is the part that I doubt many Republican reactionaries really understand. I'd change this law in several ways, but fundamentally, R's wanted high deductibles, though maybe not this high. To me, this is a strength of the program, not a weakness. If I had my druthers, I'd buy down deductibles by expanding the window where there's cost sharing by the member and the plan and I'd get rid of 100% plan/govt. payment above that catastrophic limit. This would keep skin in the game without making it quite the barrier up front that it currently is. 

 

The long term risk, though, is the constant pressure on politicians to buy down that upfront cost sharing because it will be unpopular. This is what was done in Medicare, and it's to the point that most don't pay anything in cost sharing, so they don't care what they're being charged in a meaningful sense. 

 

That's the moral hazard of having federal politicians running the program. Over the time, the pressure will be to make the program more and more free, and that means more expensive and less efficient. That's the important philosophical divide. Not the cost sharing or subsidies actually implemented.

 

From the right, I'd claim you could accomplish the same coverage (or better) through a block grant program to states, while creating much more sustainable fiscal parameters.

[twa]

Unless I'm crazy (that case could be made, lol), policies can also be purchased outside of the exchange!

 

You can, and most are not from the exchange(so far)

They even delayed fines for plans being ACA compliant, among a number of other issues

 

 

 

WD

Going for my first Dr visit in a long while (since they require a PCP referal for a specialist appointment)

odd that a general physician is the gatekeeper on eye issues,but I guess they figure it cuts costs.

 

would you believe I've never had a general checkup or lab work visit in my life?......maybe they will find out I'm a alien 

.

[The Sisko]

Sort of an aside, but it will be interesting to see satisfaction rates for people in the exchanges and compare to programs like Medicare, VA and Mike Pence's program.

VA care is notoriously sub par (access primarily), but I have no idea how their satisfaction rates are.

This is the part that I doubt many Republican reactionaries really understand. I'd change this law in several ways, but fundamentally, R's wanted high deductibles, though maybe not this high. To me, this is a strength of the program, not a weakness. If I had my druthers, I'd buy down deductibles by expanding the window where there's cost sharing by the member and the plan and I'd get rid of 100% plan/govt. payment above that catastrophic limit. This would keep skin in the game without making it quite the barrier up front that it currently is.

The long term risk, though, is the constant pressure on politicians to buy down that upfront cost sharing because it will be unpopular. This is what was done in Medicare, and it's to the point that most don't pay anything in cost sharing, so they don't care what they're being charged in a meaningful sense.

That's the moral hazard of having federal politicians running the program. Over the time, the pressure will be to make the program more and more free, and that means more expensive and less efficient. That's the important philosophical divide. Not the cost sharing or subsidies actually implemented.

From the right, I'd claim you could accomplish the same coverage (or better) through a block grant program to states, while creating much more sustainable fiscal parameters.

The VA used to be the butt of jokes back when I was in RT school. Since that time they made great gains in quality measures to the point that they were better than many in the rest of the industry. As you said though, access is a huge problem for them. FWIW ACA implemented many similar quality measures as the VA and took it several steps further by basing reimbursement on quality measures. A very good thing IMO.

As for the skin in the game, I agree with you about 90%. Where we differ is on the block grants. The states' greater "efficiency" generally comes from limiting access - hence the uninsured problem.

[Wrong Direction]

The VA used to be the butt of jokes back when I was in RT school. Since that time they made great gains in quality measures to the point that they were better than many in the rest of the industry. As you said though, access is a huge problem for them. FWIW ACA implemented many similar quality measures as the VA and took it several steps further by basing reimbursement on quality measures. A very good thing IMO.

As for the skin in the game, I agree with you about 90%. Where we differ is on the block grants. The states' greater "efficiency" generally comes from limiting access - hence the uninsured problem.

How is the uninsured problem related to states limiting access?

[twa]

in a totally unexpected   development

 

http://www.usatoday.com/story/news/nation/2014/06/08/more-patients-flocking-to-ers-under-obamacare/10173015/

 

t wasn't supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.

That 12 percent spike in the number of patients — many of whom aren't actually facing true emergencies — is spurring the Louisville hospital to convert a waiting room into more exam rooms.

"We're seeing patients who probably should be seen at our (immediate-care centers)," said Lewis Perkins, the hospital's vice president of patient care and chief nursing officer. "And we're seeing this across the system."

That's just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.

[Larry]

Damn. Get people covered, and they actually see doctors?

[twa]

Damn. Get people covered, and they actually see doctors?

 

Woof woof