The Affordable Care Act: Who Was Helped Most(nytimes.com)
nytimes.com
The Affordable Care Act: Who Was Helped Most
http://www.nytimes.com/interactive/2014/10/29/upshot/obamacare-who-was-helped-most.html?_r=0
17 comments
It actually makes health insurance worth a damn now.
Before if you had minor medical stuff insurance was there. But as soon as you got legitimately sick (e.g. cancer) they quite literally went back through every form you ever filled out looking for an error, typo, or omission in order to cut you.
Worse still they actually designed forms to increase the chance of error for exactly this reason. Did you ever wonder why you have to sign it three different times on different pages? That is why.
Plus if you got laid off previously you were in deep trouble since your new employer's insurance company would reject you and you'd struggle to work while sick regardless.
Honestly Obamacare improved things decently. Only short-sighted greedy people are unhappy. Next challenge: Unlink health insurance completely from employment.
Health insurance from your employer is bad for everyone. It reduces consumer choice (e.g. you have the "choice" to either go with the company your employer picked or nothing), and it makes SMBs much less competitive than large corporation.
Startups in particular struggle to offer employees health insurance even if they can afford to offer a competitive income (as they pay disproportionately more for health insurance than a much larger company).
At least an argument can be made for why the "public option" (nationalised health care) is a bad idea, I've heard no good arguments for why unliking employment from health care is. Except "I get really good healthcare right now and I am too lazy to shop around for it."
The only organisation that should be allowed to offer their own health insurance/care is the US military, and that is more for practical reason.
Before if you had minor medical stuff insurance was there. But as soon as you got legitimately sick (e.g. cancer) they quite literally went back through every form you ever filled out looking for an error, typo, or omission in order to cut you.
Worse still they actually designed forms to increase the chance of error for exactly this reason. Did you ever wonder why you have to sign it three different times on different pages? That is why.
Plus if you got laid off previously you were in deep trouble since your new employer's insurance company would reject you and you'd struggle to work while sick regardless.
Honestly Obamacare improved things decently. Only short-sighted greedy people are unhappy. Next challenge: Unlink health insurance completely from employment.
Health insurance from your employer is bad for everyone. It reduces consumer choice (e.g. you have the "choice" to either go with the company your employer picked or nothing), and it makes SMBs much less competitive than large corporation.
Startups in particular struggle to offer employees health insurance even if they can afford to offer a competitive income (as they pay disproportionately more for health insurance than a much larger company).
At least an argument can be made for why the "public option" (nationalised health care) is a bad idea, I've heard no good arguments for why unliking employment from health care is. Except "I get really good healthcare right now and I am too lazy to shop around for it."
The only organisation that should be allowed to offer their own health insurance/care is the US military, and that is more for practical reason.
>"Before if you had minor medical stuff insurance was there. But as soon as you got legitimately sick (e.g. cancer) they quite literally went back through every form you ever filled out looking for an error, typo, or omission in order to cut you."
This is pure truth in my experience [1].
Yes, all of it, but it's not just your forms - they'll scour phone calls too. Anything you've communicated can and will be used against you.
Problem is, it's the sort of thing that seems too unlikely or simply too far off until, out of blue, it hits you on the backside of a routine visit. More insidious is the way the scheme necessarily limits the number of people who survive to talk about it.
1: I spent years fighting this on behalf of a terminally-ill family member and I witnessed the lengths a company will go to in order to avoid making payouts first hand while working for an insurance company.
This is pure truth in my experience [1].
Yes, all of it, but it's not just your forms - they'll scour phone calls too. Anything you've communicated can and will be used against you.
Problem is, it's the sort of thing that seems too unlikely or simply too far off until, out of blue, it hits you on the backside of a routine visit. More insidious is the way the scheme necessarily limits the number of people who survive to talk about it.
1: I spent years fighting this on behalf of a terminally-ill family member and I witnessed the lengths a company will go to in order to avoid making payouts first hand while working for an insurance company.
When you hit lifetime limits it's pretty harsh to... After 6 years, I'm finally under $10k owed to medical debt, and that's still quite a lot. I'd had to defer those collection companies that wouldn't negotiate, or wanted monthly payments that were disproportionately large, which are now all that is left. Though, my credit score now hovers around 600 as a result of the negative statements (all medical).
I think the biggest problem with Obamacare is the sheer number of exceptions for existing insurance plans... most of which still don't meet the minimum requirements for new plans. Also, I think that an NPO insurance organization is needed to provide a competitive baseline, which we also don't have.
I'm strongly against taxes for simply being alive... that said, there are definitely things that could/should have been done to make things more effective and less costly overall. Clearing import restrictions would go a long way... reducing the strength of derivative medical patents, and the terms of copyright on government funded research papers would as well.
I think the biggest problem with Obamacare is the sheer number of exceptions for existing insurance plans... most of which still don't meet the minimum requirements for new plans. Also, I think that an NPO insurance organization is needed to provide a competitive baseline, which we also don't have.
I'm strongly against taxes for simply being alive... that said, there are definitely things that could/should have been done to make things more effective and less costly overall. Clearing import restrictions would go a long way... reducing the strength of derivative medical patents, and the terms of copyright on government funded research papers would as well.
Only short-sighted greedy people are unhappy.
http://kff.org/interactive/health-tracking-poll-exploring-th...
That neither agrees nor disagrees with what I said.
But if you want to make broad sweeping statements about political party affiliation and views on social good Vs. personal wealth/greed, then it more supports what I was saying than anything (see political party Vs. views on Obamacare graph).
But if you want to make broad sweeping statements about political party affiliation and views on social good Vs. personal wealth/greed, then it more supports what I was saying than anything (see political party Vs. views on Obamacare graph).
OK, then the majority of independent voters are short-sighted, greedy people. Your polemics undermine your arguments.
Except the US spends $8,362 per person per year. The UK spends $3,480 per person per year. http://www.theguardian.com/news/datablog/2012/jun/30/healthc...
What's your point? The US outspent all the other countries prior to the ACA as well.
My point is that the US is spending extra-ordinarily amounts of money on healthcare system which is not universal, nor free at the point of delivery. Obama did want to put in a national healthcare system, but the opposition was just too much, so ACA was the best compromise that his administration could get through congress.
There was so much disinformation put out about nationalised healthcare systems. My favourite was the people in the States where being told that Canadians and Britons where not allowed to choose their doctors.
Overtime American healthcare costs should come down as people who where previously excluded from the American Healthcare system get treatment and advice for non-acute conditions. Before ACA, they would have had to wait until the conditions where serious enough for Emergancy treatment.
There was so much disinformation put out about nationalised healthcare systems. My favourite was the people in the States where being told that Canadians and Britons where not allowed to choose their doctors.
Overtime American healthcare costs should come down as people who where previously excluded from the American Healthcare system get treatment and advice for non-acute conditions. Before ACA, they would have had to wait until the conditions where serious enough for Emergancy treatment.
You should watch the (very excellent) Frontline special on comparative national health insurance plans. It's an evenhanded take from a left-leaning source with serious investigative journalism chops.
Over the long term, the ACA produces a system that most closely resembles that of Switzerland. Switzerland's health insurance system was the least fraught of the options Frontline looked at.
It is not reasonable to suggest that the UK NHS and Health Canada are without problems. They have significant issues, particularly with regard to allocation of specialist care.
Over the long term, the ACA produces a system that most closely resembles that of Switzerland. Switzerland's health insurance system was the least fraught of the options Frontline looked at.
It is not reasonable to suggest that the UK NHS and Health Canada are without problems. They have significant issues, particularly with regard to allocation of specialist care.
The US spends 17.9% of its GDP on Healthcare. The UK by contrast spends 9.6%. (Canada is 11.3%) I read another article that says the US has 2.2 administrative workers per office based physician, Canada is 1.1.
It just seems to me that the 'Private' system that many Americans insist is better than the 'Public' systems that the rest of the 1st world is simply not the case.
I think that if you either are fantastically rich, or work for a company like Microsoft, then the average person is better off with public healthcare system of a 1st world economy (or Cuba).
Hope I don't appear defensive with this, but I don't think I ever came close to suggesting that 'the UK NHS and Health Canada are without problems' and that for you to suggest the issues they have are more significant than the issues facing American healthcare is totally disingenuous. Simply put, all users of the health care system from unemployed worker right up to the Royal family have access, and use the same system.
I have significant (anecdotal) experience with the American, French, Canadian (BC), and British (England and Scotland) systems with family and friends with geriatric, orthopaedic, and oncology care. I can tell you definitively that you are better off anywhere but the USA. The care that was/is given in the Canada, the UK, and France was excellent. It seemed to us that only thing that mattered in the States was who was going to pay the bills.
http://www.theguardian.com/news/datablog/2012/jun/30/healthc... http://www.bbc.co.uk/news/uk-19317991
It just seems to me that the 'Private' system that many Americans insist is better than the 'Public' systems that the rest of the 1st world is simply not the case.
I think that if you either are fantastically rich, or work for a company like Microsoft, then the average person is better off with public healthcare system of a 1st world economy (or Cuba).
Hope I don't appear defensive with this, but I don't think I ever came close to suggesting that 'the UK NHS and Health Canada are without problems' and that for you to suggest the issues they have are more significant than the issues facing American healthcare is totally disingenuous. Simply put, all users of the health care system from unemployed worker right up to the Royal family have access, and use the same system.
I have significant (anecdotal) experience with the American, French, Canadian (BC), and British (England and Scotland) systems with family and friends with geriatric, orthopaedic, and oncology care. I can tell you definitively that you are better off anywhere but the USA. The care that was/is given in the Canada, the UK, and France was excellent. It seemed to us that only thing that mattered in the States was who was going to pay the bills.
http://www.theguardian.com/news/datablog/2012/jun/30/healthc... http://www.bbc.co.uk/news/uk-19317991
Perhaps worth noting, France is not a single-payer system. It has nonprofit private insurers, an individual mandate, and no exclusions for preexisting conditions. It adds good electronic medical records and a national price list for medical services.
Source: The Healing of America by T.R. Reid.
Source: The Healing of America by T.R. Reid.
My central point, as a percentage of GDP, the French economy spends 11.9% on healthcare in aggregate. The French system is user pay, government refund, based on means. The US spends 17.9%. The better question is why does the American Healthcare industry occupy such a large fraction of the American economy? It is especially interesting 47% of that figure is private spending, and that 53% is government spend. Canada has nearly 30% private spend on its healthcare, France 22%, Britain 16%. Per capita, the States spends the 4th largest amount. In very broad terms it seems to me that Americans are getting bad value for money for their healthcare system.
http://www.theguardian.com/news/datablog/2012/jun/30/healthc...
http://www.theguardian.com/news/datablog/2012/jun/30/healthc...
Well put. Unfortunately, too many people can't get past "the government is taking my money".
It is a bizarre consequence of our modern politics that so many have become so enchanted with this mantra, as if there is "correct" portion of each dollar that should go to the government, and whatever is currently being taxed is too much, regardless of what needs to be or should be paid for.
It is a bizarre consequence of our modern politics that so many have become so enchanted with this mantra, as if there is "correct" portion of each dollar that should go to the government, and whatever is currently being taxed is too much, regardless of what needs to be or should be paid for.
So post-menopausal women are now required to buy a more expensive plan that includes maternity coverage because, "insurers aren't allowed to exclude sick people anymore." Sure...that makes sense.
The idea that a typical post-menopausal woman could easily obtain any kind of health insurance on the individual market prior to the ACA is laughable.
I didn't just make that up and this woman that I know really did have insurance before ACA (sans maternity coverage, for obvious reasons).
I have zero doubts that there are post-menopausal women who were able to obtain coverage before the ACA, just like I would not bet every dollar I had to my name if I found myself holding AA before the flop.
Or for that matter if you ever spontaneously change genders (statistically speaking), because getting health insurance prior to guaranteed issue was treacherous for women. We were routinely denied family coverage.
If your rates went up, but your previous coverage was never actually put to the test in a serious way you might want to consider the very real possibility that the old plan never would have paid out [1].
"Since insurance companies now won’t be allowed to collect premiums while you’re healthy only to yank coverage when you get sick, they have no choice but to pre-emptively cancel plans that wouldn’t be financially beneficial to actually pay out."
1: http://www.slate.com/articles/business/moneybox/2013/11/obam...
"Since insurance companies now won’t be allowed to collect premiums while you’re healthy only to yank coverage when you get sick, they have no choice but to pre-emptively cancel plans that wouldn’t be financially beneficial to actually pay out."
1: http://www.slate.com/articles/business/moneybox/2013/11/obam...
Yep. My employer based insurance was cheap but they dropped me when I got cancer. They wouldn't have covered much anyway I later found out.
I don't know much about the politics or economics of the health insurance industry, but I'm pretty sure if you're posting on HN, you're not part of the group the law was enacted to help. It was never claimed that it would make healthcare cheaper or better for everyone. We have options.
Yes, I'm sure there are some true rags to riches stories around here; but we're talking about right now. I am grateful and lucky to have the background and skills to be able to take for granted that I can afford health insurance. Moreover, since it's not socialized, I'm happy to pay for it. I don't worry about finding bottom dollar on this particular thing.
Yes, I'm sure there are some true rags to riches stories around here; but we're talking about right now. I am grateful and lucky to have the background and skills to be able to take for granted that I can afford health insurance. Moreover, since it's not socialized, I'm happy to pay for it. I don't worry about finding bottom dollar on this particular thing.
Wow is this ever wrong. Guaranteed issue is an enormous win for entrepreneurs. When you work for your own tiny company, you obtain insurance on the individual private market. Prior to the ACA and its guaranteed issue rule, insurers routinely denied coverage to family members based on cryptic "DO NOT COVER" condition lists. Coverage denial didn't merely mean the insurer wouldn't cover a particular worrisome condition (which is bad enough) --- it was a blanket denial of any coverage at all.
Young male entrepreneurs didn't run into this problem because they were male, which conveniently dodges more than half of the "DO NOT COVER" list, and because they usually don't yet have families. But cross 30, get married, have a kid, time travel back to 2007 and try to insure your family. You'll see, like I did, how helpful the ACA is for startup founders.
Young male entrepreneurs didn't run into this problem because they were male, which conveniently dodges more than half of the "DO NOT COVER" list, and because they usually don't yet have families. But cross 30, get married, have a kid, time travel back to 2007 and try to insure your family. You'll see, like I did, how helpful the ACA is for startup founders.
Fair enough. I was responding to commenters that I felt were being glibly dismissive of the ACA. I am a strong supporter of it for a number of reasons.
And if you own or work for a startup, are under 27, and have middle-class-or-richer parents, you obviously benefit as well.
I don't really understand this comment. If you're posting on HN you probably care about startups. And generally, startups don't or can't provide health insurance to their early employees. Which leaves the startup game to the very young and very healthy. The ability for everyone else to have the opportunity to leave their existing job (aka healthcare source) and strike out on their own should surely increase due to this.
I mostly got burned by ACA -- I had $80-120/mo HSA+HDHP which was awesome, and then got forced into $280/mo inferior coverage (a "Bronze" plan) with fewer doctors. (I ended up canceling all coverage a month later, getting a $750k "insurance, temporary" plan for 364 days at $30-60/mo, and ended up having a job with employer care before that expired.)
Now I have employer-provided health care which is "free" but objectively the worst insurance I've ever had (in terms of number of doctors, etc.) HRA rather than HSA, so not very useful there, either.
I hate the idea of employer-provided healthcare. If I had "interesting" medical issues, I'd probably just pay for insurance out of pocket vs. sharing health data with an employer. I'm pretty sure my coverage costs employer more than $300/mo, too.
Now I have employer-provided health care which is "free" but objectively the worst insurance I've ever had (in terms of number of doctors, etc.) HRA rather than HSA, so not very useful there, either.
I hate the idea of employer-provided healthcare. If I had "interesting" medical issues, I'd probably just pay for insurance out of pocket vs. sharing health data with an employer. I'm pretty sure my coverage costs employer more than $300/mo, too.
>> I hate the idea of employer-provided healthcare.
Yup. The most obvious problem is that when you change jobs, you change providers. That alone is undesirable and contributed to the problem of rejections due to pre-existing conditions.
The less talked about aspect is that large companies are self insured. Meaning they cover all the costs and just have an outside company manage the plan. The issue with self insured companies is that on average, working folks are healthier than non-working ones. That means it shifts the higher costs to the non-corporate plans - medicare/medicaid.
Just taking away the incentives for this and having people get their own plan would have gone some way toward a better system.
Yup. The most obvious problem is that when you change jobs, you change providers. That alone is undesirable and contributed to the problem of rejections due to pre-existing conditions.
The less talked about aspect is that large companies are self insured. Meaning they cover all the costs and just have an outside company manage the plan. The issue with self insured companies is that on average, working folks are healthier than non-working ones. That means it shifts the higher costs to the non-corporate plans - medicare/medicaid.
Just taking away the incentives for this and having people get their own plan would have gone some way toward a better system.
Similar experience for me. Had insurance I was happy with. Had the plan forcefully cancelled out from under me. Then found less benefits for more money. Now I can't see one of my doctors without paying cash [1]. Nothing affordable about this for me.
http://www.huffingtonpost.com/2014/04/10/obamacare-patients-...
http://www.huffingtonpost.com/2014/04/10/obamacare-patients-...
If you're young and relatively healthy and you're not paying out of pocket for at least most of your first year's worth of medical expenses, you're paying too much in insurance premiums. You want an HSA-qualifying high deductible plan, and you want to manage the pool of money that finances the deductible yourself, rather than signing it over to an insurer as a higher premium every month.
This.
I'm only saving $100 gross per month right now by getting a HDHP+HSA through my employer, but they also contribute a sizable portion to my HSA each month for the cost they save. Assuming nothing catastrophic happens in the next few years, I will have a sizable pool of money set aside in my HSA earning interest, and I can choose to lower my monthly cost at that point if I want.
I should point out that I am also married and have a single child, since routine care is covered even under HDHP thanks to the ACA I don't expect to need to spend much out of my HSA unless something major happens.
I'm only saving $100 gross per month right now by getting a HDHP+HSA through my employer, but they also contribute a sizable portion to my HSA each month for the cost they save. Assuming nothing catastrophic happens in the next few years, I will have a sizable pool of money set aside in my HSA earning interest, and I can choose to lower my monthly cost at that point if I want.
I should point out that I am also married and have a single child, since routine care is covered even under HDHP thanks to the ACA I don't expect to need to spend much out of my HSA unless something major happens.
All my reasonable Bronze options in Illinois as HSA/HDHP-qualifying, and they have the same doctor networks as the Silver or Vanadium or whatever plans.
As an European
>in terms of number of doctors
what does that even mean?
>in terms of number of doctors
what does that even mean?
Out of the 2k doctors in SF (?), only 200 or so seem to take Cigna (my current insurer); 1500 would take Blue Cross/Blue Shield (previous).
If your doctor doesn't take your insurance, it's considered "out of network", and you end up paying ~50% of the cost, vs. 0-10%.
If your doctor doesn't take your insurance, it's considered "out of network", and you end up paying ~50% of the cost, vs. 0-10%.
This is sad. I was under the impression whole reform was supposed to turn healthcare from business into utility.
I have no problem with a subset of doctors choosing to price themselves above the point where I should be forced to pay for someone else's use of them -- differentiating on ease of scheduling, etc.
I'm just annoyed when this is a majority.
A lot of the "ACA individual plans" are even WORSE than my company-provided plan for coverage.
I'm just annoyed when this is a majority.
A lot of the "ACA individual plans" are even WORSE than my company-provided plan for coverage.
Young, healthy people will get screwed by any mandatory government healthcare system, but my view in general is that having strong government oversight of healthcare is just a good thing. With reference to this Guardian article, the US spends $8,362 (Private individuals, Government, and insurance combined) per person. Contrast that to the UK which spends $3480 per person. While I hate paying taxes just as much as the next person, I do think I get very good value for money for my National Health Service.
Universal healthcare is just a good thing.
http://www.theguardian.com/news/datablog/2012/jun/30/healthc...
Universal healthcare is just a good thing.
http://www.theguardian.com/news/datablog/2012/jun/30/healthc...
Please define "screwed". Paying more than you take out does not count, provided older people are paying less than they take out (I hope I don't need to remind you that young people eventually turn into old people).
I mean, it sounds like you're just pointing out that, if health insurance/coverage is mandatory, then you are getting 'screwed' if you don't use the healthcare system. That's like saying I'm getting 'screwed' by public transportation if I own a car.
I mean, it sounds like you're just pointing out that, if health insurance/coverage is mandatory, then you are getting 'screwed' if you don't use the healthcare system. That's like saying I'm getting 'screwed' by public transportation if I own a car.
Yes, exactly. Similarly old people get screwed by the public Education system. And publicly funded universities and colleges.
Yes, and when your economy is a smoking crater because half the population is illiterate, you can at least take some comfort in the fact that you're not getting screwed by a public education system.
Eventually young and healthy people turn into old people. Also, you should qualify that with the gender. You maybe be a young and healthy female but you would have been hardpressed to get independent coverage once you hit 'motherhood' age.
you're young and healthy until your first visit to ER without insurance
I'll be the dick. On paper, it's helped me, yes (girl problems that would have run $16K by June just mainly for tests): I met an OOP early (yay! Didn't even know what OOP=out-of-pocket WAS!), so after that I didn't have to pay anything until next year! (Who's heard of such a thing?!)
But the hospitals/docs didn't file right, or didn't get preauths? Basically, providers aren't getting paid; and while AHCA says "ignore bills you've met your OOP!", I'm seeing bills from people I've never seen before because while a doc was "in coverage area", their test readers weren't, and I've actually been served a DEBT WARRANT (by the police!) now. So basically, I'm paying what AHCA said NOT to pay because I don't want to be sued (hire lawyer, get tripped up in legalese, ...it's just cheaper to PAYOLA); plus, I figure radiologists or labs did their job and should get paid (plus their phone calls are scary). I find the entire thing ridiculous, but the debt warrant is scary. NGL.
But the hospitals/docs didn't file right, or didn't get preauths? Basically, providers aren't getting paid; and while AHCA says "ignore bills you've met your OOP!", I'm seeing bills from people I've never seen before because while a doc was "in coverage area", their test readers weren't, and I've actually been served a DEBT WARRANT (by the police!) now. So basically, I'm paying what AHCA said NOT to pay because I don't want to be sued (hire lawyer, get tripped up in legalese, ...it's just cheaper to PAYOLA); plus, I figure radiologists or labs did their job and should get paid (plus their phone calls are scary). I find the entire thing ridiculous, but the debt warrant is scary. NGL.
What is a debt warrant? Isn't this a civil matter?
I have no idea; IANAL. All I know is a "local" (not really) doc says I owe him money for some tests he ran on a sample, and nobody will pay him. I pay my bills, but I didn't take the sample, wouldn't have known who to send it to even if I had taken the sample, etc. I spent months faxing copies of bills to the doc who took the sample AND to my insurance, then finally the "claimant" had this debt warrant hand-delivered by the po-po to my home! I'm supposed to show up in court (albeit no time soon). I faxed copies to doc and insurance, and (though I wasn't going to, but I chickened out) I gave it to my lawyer.
My rates increased 40 percent for a HDHP+HSA bronze care plan with no preexisting. So, you can say I'm am one of the ones that really got screwed with ACA.
No you didn't. Just that your future risk was finally accurately priced into your premiums (whereas before you would likely have just been dropped if something drastic happened).
So as a freelancer I was paying $140 a month with a $500 deductible.
Now with Obamacare I am paying $260 for the same level of coverage.
How is that helpful to me? I'd love to hear some positive stories, because I'm just paying more and making less in my pocket, while people who don't work are getting health care for free.
Now with Obamacare I am paying $260 for the same level of coverage.
How is that helpful to me? I'd love to hear some positive stories, because I'm just paying more and making less in my pocket, while people who don't work are getting health care for free.
About 5 years ago, at age 25, I found out I had a thyroid tumor for the second time in my life. My employer based coverage dropped me citing a surgery I received at 16.
Not only was I employed full time, I was restarting school. I lost everything. Tuition I paid, loan privileges, I had to sell everything, my credit sucks. Until the ACA went into affect I avoided doctors, even for big stuff because I was terrified of getting my family dropped.
I can go to the doctor and many people I know from cancer support groups can get insurance now, I'm not just talking about those who don't work, it was really hard to just get a company that would cover you when you've had cancer multiple times.
I know it sucks for some people but it's helping so many people who really needed the help.
Not only was I employed full time, I was restarting school. I lost everything. Tuition I paid, loan privileges, I had to sell everything, my credit sucks. Until the ACA went into affect I avoided doctors, even for big stuff because I was terrified of getting my family dropped.
I can go to the doctor and many people I know from cancer support groups can get insurance now, I'm not just talking about those who don't work, it was really hard to just get a company that would cover you when you've had cancer multiple times.
I know it sucks for some people but it's helping so many people who really needed the help.
This is a story about rescission, which, thanks to the ACA, is now illegal across the entire US.
One way to think about it is that you're paying an extra $120/mo for protection against rescission.
Another way to think about it is that you're paying $120/mo for the guarantee that you'll be able to obtain coverage for your spouse and children in the future. That guarantee did not exist at any price prior to ACA.
I'm not sure how to respond to your last point, because people who don't work have always received health care for free. The backstop for health care financing has never been "no health care". The backstop is bankruptcy, which isn't an issue for the unemployed poor.
By extending health care to people who can't afford it, the ACA has probably lowered your costs over the long term. That's because the most expensive possible way to provide coverage is through emergency room visits, which is how the uninsured obtain coverage.
Another way to think about it is that you're paying $120/mo for the guarantee that you'll be able to obtain coverage for your spouse and children in the future. That guarantee did not exist at any price prior to ACA.
I'm not sure how to respond to your last point, because people who don't work have always received health care for free. The backstop for health care financing has never been "no health care". The backstop is bankruptcy, which isn't an issue for the unemployed poor.
By extending health care to people who can't afford it, the ACA has probably lowered your costs over the long term. That's because the most expensive possible way to provide coverage is through emergency room visits, which is how the uninsured obtain coverage.
... the most expensive possible way to provide coverage is through emergency room visits, ...
By which time a generally very treatable condition has become acute, and then very expensive to treat no matter what.
By which time a generally very treatable condition has become acute, and then very expensive to treat no matter what.
Hence why even HDHP include preventative care without meeting your deductible. Everything is easier to treat when it's addressed early, ensuring everyone has access to appropriate care at the correct stage will only benefit the population as a whole over the long-term.
> How is that helpful to me? [...] while people who don't work are getting health care for free.
- Your phrasing of "people who don't work" implies to me that you feel disdain towards them, and that they could work, but are just lazy. (and now they can "freeload" health care too!) If this is not the case, then I would change the phrasing to something like "people that are unemployed."
- "What's in it for me?" isn't always the best measure of the value of something. For example, Bill Gates can afford to pay all his health costs out-of-pocket. Would you agree with him if he said that we should dismantle the entire health insurance industry because he doesn't need it?
- You haven't explained what level of coverage you think that the "non-working" people had before. Do you think that their level of coverage has improved or declined?
> Now with Obamacare I am paying $260 for the same level of coverage. [...] How is that helpful to me?
Insurance companies now have to account for the risk that if you get sick in a chronic/expensive way that they can't find some technicality to drop you. Whether you see this as a benefit or not is probably correlated with your belief that those things "happen to other people."
- Your phrasing of "people who don't work" implies to me that you feel disdain towards them, and that they could work, but are just lazy. (and now they can "freeload" health care too!) If this is not the case, then I would change the phrasing to something like "people that are unemployed."
- "What's in it for me?" isn't always the best measure of the value of something. For example, Bill Gates can afford to pay all his health costs out-of-pocket. Would you agree with him if he said that we should dismantle the entire health insurance industry because he doesn't need it?
- You haven't explained what level of coverage you think that the "non-working" people had before. Do you think that their level of coverage has improved or declined?
> Now with Obamacare I am paying $260 for the same level of coverage. [...] How is that helpful to me?
Insurance companies now have to account for the risk that if you get sick in a chronic/expensive way that they can't find some technicality to drop you. Whether you see this as a benefit or not is probably correlated with your belief that those things "happen to other people."
There's no guarantee, with your old plan, that they would have kept you had you gotten really sick with expensive medical bills. The Slate article above touches on some of this.
Some people are getting subsidized care but the only people getting it for free are those who are eligible to enroll in Medicaid. Not all states have agreed to increase their Medicaid rolls however. Plus, as a Medicaid patient, it is not that easy to find doctors, especially specialists, who are willing to see you. I had a Medicaid patient who had surgery for a wrist fracture a few weeks ago. The orthopedist who operated on her would only agree to see her in follow up in a separate clinic for 'caid patients, and that appointment would be in February. Fortunately we were able to encourage the surgeon to see them sooner. Im guessing that's not the kind of healthcare you want, even if it's free.
Some people are getting subsidized care but the only people getting it for free are those who are eligible to enroll in Medicaid. Not all states have agreed to increase their Medicaid rolls however. Plus, as a Medicaid patient, it is not that easy to find doctors, especially specialists, who are willing to see you. I had a Medicaid patient who had surgery for a wrist fracture a few weeks ago. The orthopedist who operated on her would only agree to see her in follow up in a separate clinic for 'caid patients, and that appointment would be in February. Fortunately we were able to encourage the surgeon to see them sooner. Im guessing that's not the kind of healthcare you want, even if it's free.
...people who don't work are getting health care for free.
From the article:
Critics of the Affordable Care Act have
often warned that the program would be unfair
to the young because it limits the ability of
insurance companies to charge higher rates to
older customers, who tend to be sicker. But
young adults show the largest reductions in
being uninsured of any age group.
Didn't it really just increase the number of insured people primarily because of broad expansions of medicaid and medicare?
As the map clearly shows, the people who were helped most are all the new people who joined Medicaid when it was expanded.
Compare this map to states that accepted or refused Medicaid expansion: http://i.huffpost.com/gen/1119617/thumbs/o-MEDICAID-EXPANSIO...
Have any states attempted to take control of medical care and negotiate doctor wages / drug prices? Works reasonably well for Canadian provinces. There's got to be a reason it hasn't been done in the states. What is it?
I'm skeptical of the existing comments in this thread - they strike me as too on message to be four separate individuals with identical concerns.
You think the person with 27,254 comment karma on a 2,304 day old account, with identifying info in his profile is posting anti-ACA comments as part of some conspiracy?
I have not looked at this particular case, but if you have an agenda to push, it makes sense to take time to establish a solid looking reputation. Also, high "comment karma" means lots of activity. There have been times on HN when I noticed similar things and wondered...
I agree with your observation, but in this case, it makes sense. As someone with a permanent preexisting condition, I am the only person I know that benefited from the ACA. Huge portions of my family and friends were impacted very negatively. Many of them had their rates go up 30-40% and ended up with worse insurance plans.
I am a bit bothered that the NYTimes chose to ignore a wealth of data for a major current societal problem, and just cherry-pick some category that ended up "better" to make a map and article.
I am a bit bothered that the NYTimes chose to ignore a wealth of data for a major current societal problem, and just cherry-pick some category that ended up "better" to make a map and article.
My wife and I want to start an astroturfing tracker website. Perhaps we have a few candidates? A ShowHN someday?
Whenever a congressional law passes, just take the opposite view of the Act name and it shall be true. For example, there's nothing affordable about the ACA. My old healthcare plan was eliminated and replaced with a more expansive and less beneficial because of ACA regulations.
Then for people who are forced into ACA plans, they'll have their rates raised conveniently after the Nov 4 midterm elections...
Then for people who are forced into ACA plans, they'll have their rates raised conveniently after the Nov 4 midterm elections...
> more expansive and less beneficial
Really? Reporters and politicians have searched for these mysterious slighted people who have had their premiums go up for the exact same plan. You should call the O'Reilley factor, you could be a star!
A lot of people could not buy crippled insurance plans with insanely high deductibles and severe limits on coverage, because those were outlawed by the plan. Also, some people were bumped from subsidized plans to fend on the open market, but that's shitty employers taking advantage of their employees, and not the fault of the ACA.
Finally, with the heavy subsidies to your premiums, the same plan usually cost less under the ACA. You could however talk about the cost of insurance in 5 years when the subsidies start to wear off, but, hey, I imagine the republican leadership has plenty of ideas to help the common folk with that.
Really? Reporters and politicians have searched for these mysterious slighted people who have had their premiums go up for the exact same plan. You should call the O'Reilley factor, you could be a star!
A lot of people could not buy crippled insurance plans with insanely high deductibles and severe limits on coverage, because those were outlawed by the plan. Also, some people were bumped from subsidized plans to fend on the open market, but that's shitty employers taking advantage of their employees, and not the fault of the ACA.
Finally, with the heavy subsidies to your premiums, the same plan usually cost less under the ACA. You could however talk about the cost of insurance in 5 years when the subsidies start to wear off, but, hey, I imagine the republican leadership has plenty of ideas to help the common folk with that.
I would imagine most/all young (under 35 - I'm 30, personally, and had same experience as GP), self-employed people making a decent amount of money (such that they don't get subsidies) have had this experience. The plans never match up fully, but I had a high deductible "catastrophic" plan pre-ACA and for the equivalent coverage I a.) had to apply for an exemption to even get the "catastrophic" plan through ACA and b.) it still cost significantly more for a higher deductible.
Now as you note I do get certain benefits with this plan I didn't get with my other one- namely a couple doctors visits a year when my other one was only one every 2- but I had a catastrophic plan for a reason and my premium more than doubled under the ACA. Beneficial to me (and likely the GP) is being able to pay only for coverage we actually want- not additional "benefits" that we don't plan on using and would rather pay out of pocket for.
Now as you note I do get certain benefits with this plan I didn't get with my other one- namely a couple doctors visits a year when my other one was only one every 2- but I had a catastrophic plan for a reason and my premium more than doubled under the ACA. Beneficial to me (and likely the GP) is being able to pay only for coverage we actually want- not additional "benefits" that we don't plan on using and would rather pay out of pocket for.
Are you sure you wouldn't have been dropped when a catastrophe happened? Before the ACA that wasn't illegal.
What about yearly or by incident payout limits? Like max 20000$ per year in treatment or the like. That's what most of the plans canceled by the ACA were limited by.
My plan had no lifetime limits, generally awesome coverage, HDHP, and was ended. I don't believe it's because it was non-compliant, but because it was no longer economic to underwrite with 1) guaranteed issue 2) substantial minimum/preventive benefits paid per year (so, essentially a guarantee of $300-400 in reimbursements on a $1200 premium per year, with some odds of $100k or $1mm or whatever payouts in rare cases too.)
My insurer got out of the individual market.
My insurer got out of the individual market.
So, I was going to make the point that this is only true for the controversial bills (a point worth making -- most laws are tremendously boring), but scrolling through the laws passed by this congress I found an example that makes your point perfectly:
Violence Against Women Reauthorization Act of 2013
It turns out this law doesn't authorize or reauthorize ANY violence against women. It seems to do the exact opposite of what it says -- it is primarily about _punishing_ violence against women.
That is all, continue being outraged. I'm sorry your insurance costs more, that does suck.
Violence Against Women Reauthorization Act of 2013
It turns out this law doesn't authorize or reauthorize ANY violence against women. It seems to do the exact opposite of what it says -- it is primarily about _punishing_ violence against women.
That is all, continue being outraged. I'm sorry your insurance costs more, that does suck.
I can tell you who it hasn't helped: Me.
Why? I couldn't afford insurance before, and I sure as heck can't now.
For the sake of fairness, it also hasn't hurt me any either.
So basically, before the ACA if I got sick, I was doomed. And now if I get sick, I'm equally doomed. But in the long run, things will supposedly get better. Here's hoping for the best.
Why? I couldn't afford insurance before, and I sure as heck can't now.
For the sake of fairness, it also hasn't hurt me any either.
So basically, before the ACA if I got sick, I was doomed. And now if I get sick, I'm equally doomed. But in the long run, things will supposedly get better. Here's hoping for the best.
Seems like either a poor headline or the wrong metric.
I am insured now, but as someone who was rationally uninsured, I don't think I am better off. While I am only one person, the assumption that insurance necessarily makes someone better off seems a bit spurious.
Are there any metrics on whether the cost of insuring the same person has gone down? Wasn't that meant to be one of the benefits?
Edit: Did some digging and it looks like a more comprehensive review of the stats can be found here: www.nytimes.com/interactive/2014/10/27/us/is-the-affordable-care-act-working.html
As for my own question, it does look like the majority of the markets will see prices increases.
I am insured now, but as someone who was rationally uninsured, I don't think I am better off. While I am only one person, the assumption that insurance necessarily makes someone better off seems a bit spurious.
Are there any metrics on whether the cost of insuring the same person has gone down? Wasn't that meant to be one of the benefits?
Edit: Did some digging and it looks like a more comprehensive review of the stats can be found here: www.nytimes.com/interactive/2014/10/27/us/is-the-affordable-care-act-working.html
As for my own question, it does look like the majority of the markets will see prices increases.
Did you have $20,000 socked away to cover appendicitis? (If you've already had appendicitis, insert any of 100 other relatively common highly tractable medical emergencies you haven't had yet). If not: your policy of rationally forgoing insurance was being financed by everyone else in the market.
(The $20,000 figure comes from my friend, whose teenager had appendicitis a couple years back).
(The $20,000 figure comes from my friend, whose teenager had appendicitis a couple years back).
About five years ago my brother had appendicitis and, since he'd decided not to buy insurance (which he could have easily afforded), the $17K came out of his hide. So your $ number is about right. Fortunately he was wealthy enough to afford to pay up, but I have no idea what someone for whom $17K was a year's after-tax income would have done.
Indigent care. Please note, "indigent care" only applies to people who truly can't afford the care they need. If you could afford the care you need by moving into a tiny apartment and eating nothing but Ramen noodles for a decade, then you would be expected to do that.
Rationally uninsured? Care to explain your circumstances?
I don't think it was meant to reduce the cost of insuring someone but to reduce the rate of the increases. Remember how fast health insurance premiums were going up in the late Bush and early Obama years?
To answer the headline of the article I did not read... The health insurance companies?
I don't think it was meant to reduce the cost of insuring someone but to reduce the rate of the increases. Remember how fast health insurance premiums were going up in the late Bush and early Obama years?
To answer the headline of the article I did not read... The health insurance companies?
I have catastrophic insurance to cover unexpected circumstances and enough money in an account to handle normal, day-to-day healthcare. In setting up my finances in this way, I am able to cover myself and not have to fork over a premium every month. This has saved me thousands of dollars over the years, if I compare the current premium I am obligated to pay with my previous strategy of putting money into an account.
True insurance is a hedge against risk, I looked at my risks and made the rational decision that covering myself was the better decision.
Its not for everyone and so I don't want to generalize. I just offer it as anecdotal evidence that while increasing the percentage of the population that is insured, may be a nice easy metric to measure and affect, it is not necessarily an indication of improving situations for all Americans.
True insurance is a hedge against risk, I looked at my risks and made the rational decision that covering myself was the better decision.
Its not for everyone and so I don't want to generalize. I just offer it as anecdotal evidence that while increasing the percentage of the population that is insured, may be a nice easy metric to measure and affect, it is not necessarily an indication of improving situations for all Americans.
This has been my approach as well, but effective December 31 my insurance provider will be prohibited from offering a catastrophic-only policy, so I'll likely be completely uninsured come the end of the year. The Affordable Care Act will have priced me out of the market.
Just the other day I price-compared a catastrophic plan with Bronze plans, and the difference was about $20/mo.
That's just an anecdote, a more important point is that if you buy through the exchange, you get subsidized if you're really too poor to pay the premiums on your own.
The people really getting screwed are the people in the Medicaid gap, in states where Republicans refused the Medicaid expansion.
That's just an anecdote, a more important point is that if you buy through the exchange, you get subsidized if you're really too poor to pay the premiums on your own.
The people really getting screwed are the people in the Medicaid gap, in states where Republicans refused the Medicaid expansion.
> As for my own question, it does look like the majority of the markets will see prices increases.
Health spending was growing at an average of 7.2% / year from 1990-2008, vs an estimated 3.6% in 2013. Certainly the slowdown is the result of more than just the ACA, but this is the relevant metric one should use when measuring its success at cost containment, not the fact that almost everything gets more expensive from one year to the next.
http://content.healthaffairs.org/content/early/2014/08/27/hl...
Health spending was growing at an average of 7.2% / year from 1990-2008, vs an estimated 3.6% in 2013. Certainly the slowdown is the result of more than just the ACA, but this is the relevant metric one should use when measuring its success at cost containment, not the fact that almost everything gets more expensive from one year to the next.
http://content.healthaffairs.org/content/early/2014/08/27/hl...
>but as someone who was rationally uninsured
It's not rational for anyone to be uninsured. Any healthy person could get in an accident.
It's not rational for anyone to be uninsured. Any healthy person could get in an accident.
And we should all play the lottery because we might win? If the expected value https://en.wikipedia.org/wiki/Expected_value is lower than the cost, then you rationally shouldn't buy it.
The expected value of insurance is always lower than the cost, that's why someone sells it. The reason you buy insurance is to protect against catastrophic events, which are impossible to predict on an individual basis.
The utility of money is non-linear though. It can be worthwhile to pay a small amount of money in order to prevent a non-zero probability of losing a large amount of money, even if the expected value in terms of dollars is negative.
No...
Hey, if you don't want to buy health insurance fine but... Don't show up at a hospital when you are sick or hurt to drive up the cost for everyone else. Deal?
Personally, I am single payer type person. Cut the middle man insurance companies right out of the equation.
EDIT: Why is my comment being downvoted?
Hey, if you don't want to buy health insurance fine but... Don't show up at a hospital when you are sick or hurt to drive up the cost for everyone else. Deal?
Personally, I am single payer type person. Cut the middle man insurance companies right out of the equation.
EDIT: Why is my comment being downvoted?
Single payer probably looks good on paper, but I would never trust someone with that much money and power.
The US spends more, not only per capita but as a share of GDP, public funds on healthcare than some OECD countries that have single payer with generally similar outcomes.
So you (in the general sense) are already trusting the government with (or at least, not preventing the government from spending, whether you trust them or not) the money to provide single payer -- you are just doing it in a system which requires an even greater amount in private expenditures on top of those public expenditures to provide a similar overall quality of care.
So you (in the general sense) are already trusting the government with (or at least, not preventing the government from spending, whether you trust them or not) the money to provide single payer -- you are just doing it in a system which requires an even greater amount in private expenditures on top of those public expenditures to provide a similar overall quality of care.
>Single payer probably looks good on paper
And in the many first world countries that have used it for decades. It's a proven model.
>I would never trust someone with that much money and power.
That's how they're able to negotiate better rates.
And in the many first world countries that have used it for decades. It's a proven model.
>I would never trust someone with that much money and power.
That's how they're able to negotiate better rates.
People here are complaining that their insurance got pricier. The reason is that insurers aren't allowed to exclude sick people anymore. If you ever get chronically sick, you'll appreciate this change.