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White House: Get ACA Insurance Coverage, Launch Start-Ups
dcblogs writes that the Obama Administration is urging tech entrepreneurs "to sign up for health insurance under the Affordable Care Act, and said having the coverage will give them the 'freedom and security' to start their own businesses. 'There is strong evidence that when affordable healthcare isn't exclusively tied to employment, in more instances people choose to start their own companies,' wrote White House CTO Todd Park in a post to launch its #GeeksGetCovered campaign. Bruce Bachenheimer, a professor of management at Pace University and director of its Entrepreneurship Lab, said the effort is part of a broader appeal by the White House to get younger and healthier people to sign-up for Obamacare, and is in the same vein as President Obama's recent appearance on Between Two Ferns." Removing the tax structures that make companies by default intermediaries in the provision of health insurance, and allowing more interstate (and international) competition in health finance options would help on that front, too, aside from who's actually footing the insurance bill.
I was on my own with a full-time consultancy, but I scaled it back to off-hours and went back to a forty-hour-a-week corporate job for the health insurance. The cost of individual health care plans was insane, and the crappy ACA plans provide worse coverage with fewer providers - and they're even more expensive!
I really think what the feds are up to here is trying to kill off as many individual and small business operators as possible. After all, it's a lot easier to monitor and tax large corporate entities than it is to chase after a bunch of little ones.
I had (at the time) a high deductible plan, basically what used to be called "major medical", for needs if I got hit by a bus, etc.. The deductible was only about $1200.
I coupled that with a HSA (Health Savings Account) which unlike the FSA's are not use it or lose it, they roll over annually. I socked away about $3K pre-tax annually and out of that, I paid my routine med visits and drugs.
I really liked this, it only cost me about $240/mo for premiums. This is what would usually best server young people, which I'm not....I got this and was happy with it and I have pre-existing conditions.
I'm looking to go that route again, but man...I looked at the health sherpa site that shows what obamacare offers in my area, and deductibles on anything but near gold plans is over $3K?!?!?
I would end up on many plans paying about $3K a year in premiums AND $3K+ in deductibles before I started having any insurance kick in. WFT?
I looked at the GOLD plan with no deductible, and it is about $590/mo...but no deductible and 100% pay. Interesting range of choices, no?
Sadly, I think we're stuck with obamacare, and it won't be repealed, but it needs to seriously be altered. Why not remove so many of the minimums for the insurance coverage (as an older man, I don't really need prenatal coverage), and open up insurance competition to allow it to cross state lines. I mean, I can buy motorcycle insurance from a national company across lines, why can't I buy health ins across state lines?
I think we're good with disallowing the pre-existing conditions, but aside from that, I can't see much that helps me or most people at my level of IT income or stage of life that is good about ACA as it currently stands...
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
>> few hundred bucks a month for health care
You don't have a family with kids..who occasionally get sick and broken bones, do you?
Spreading the government propaganda.
Get paid for that?
You know what would help startups?
LOWER TAXES, LESS REGULATION and a government doing its job by enforcing the laws equally between the little guy and the mega corp... rather than giving preferential treatment to whomever pays the most.
Like advertising for Obamacare.
We'll provide you with health care through the ACA and you'll be able to start your own business!
Then after you realize that government regulations are so onerous that its really difficult to get a business started, you'll have to go back to working for a big company.
Seriously? I don't know of anywhere in the US where contraception is not available. They sell rubbers at all drug stores and most every grocery store I've ever been to. I'm born and raised in the south of the US, and I've never seen anywhere that doesn't have multiple forms of contraception unavailable with or without a prescription. There are no cities I know of that ban them by law.
And as for the Rep. govenors that refused the Medicaid expansion, they did the cost analysis. It basically is a ticking time bomb of yet another unfunded Federal Mandate type deal. Sure they give you money at first, but that is limited and after that runs out, and the states have expanded (greatly) the Medicaid rolls, they states are then on the hook to pay for it ALL themselves, when the fed money spigot shuts off.
Some governors plan long term and not just short term.
Hell, many if not most states right now are in budgetary crisis, and not needing to heap this on top of an already bad fiscal situation.
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
Most of the ACA plans include all kinds of shit for kids, which is why single young people don't want it, but for you it's actually a great deal, so as DogDude said, I call bullshit.
It is the same problem as in poor parts of Africa too. People don't WANT to be helped.
If you look in the areas that are against that kind of healthcare, its often poor people in the south, and the ones that are for it are frequently upper middle class in rich cities.
I'm in Boston. Pretty much everyone is for universal healthcare. No one (in my circles) would benefit from it. We all have pretty much perfect company funded healthcare with little to no deductibles, often with premiums paid by our employer, which let us go to one of the best hospital in the world (MGH) for pretty much no money. If they were to get the money from it from taxes, the same people would be disproportionately affected by them (already in upper tax brackets, at the bottom end of the groups affected by AMT....it hurts)
Yet these same people who would get NO BENEFIT from it, and would lose a lot of money in the process, are in favor of it. And those who'd get the free lunch are against.
Now, don't get me wrong. In its current implementation they have a point sometimes: poor people who aren't poor enough to get subsidies and now have to pay premiums are getting hit hard by them, especially if they see themselves invincible and haven't seen an hospital bill in their life. But that wouldn't be an issue if it was fully funded healthcare, not just the bastardized in between that we currently have.
Yeah, how'd that work out for banking? Interstate competition was supposed to do things like drive down credit card interest rates.
Instead, almost every credit card in the US is issued out of Delaware or South Dakota. And interest rates are quite high. Why? Interstate competition also means competition between state legislatures for laws that are most favorable to banks.
So what would happen with interstate health insurance? Legislatures would compete for the most insurance company-friendly laws. Which would be the least consumer-friendly laws.
Minimums are needed because cross subsidisation is rather integral to having affordable healthcare for everyone. Meaning those who are in the stage of their life that don't need much medical care pay more, but those that do are able to afford it.
I definitely agree with the suggestion that you need to break the link between healthcare and employment. Because there's obviously a very strong link between unemployment and needing medical care. I love living in a country with universal healthcare funded by taxation. Sure it means that I end up paying a lot more than I otherwise would, but it provides a safety net for everyone - including me should I happen to get unlucky and end up sick and unemployed. People don't end up having to declare bankruptcy because of medical bills or go without life saving medical care. And everyone is able to access a reasonable standard of healthcare (and the wealthier are not restricted from getting gold plated service if they wish to pay for it). But hey I realise that for a lot of Americans that concept is just communism so it'll never happen
I too could not afford it, it's not a "few hundred bucks!" I have a family of 4 total and it was going to cost me $1800 /month with a $5,000 - $10,000 deductible. I don't remember the exact deductible but I recall it being of $5K. It did not pay for doctor visits until I hit the deductible amount. Basically a High Indemnity plan for $1800.00 a month! I had just left a corp. so I signed up for COBRA which gave me a PPO for $1400.00 /month and a $800 deductible with $35 doctor visits. But COBRA is temporary, it expires.
The ACA plans are joke!
Not true, I know how to read for myself my policies. I had the same good coverage for an emergency that I have now on a W2 gig. The chief difference was that I just paid my own way for routine Dr. visits and meds.
Insurance is supposed to be there for EMERGENCIES, not to run you $10 copay for routine Dr. visits. That needs to be something you save and pay for, just like any other necessity of modern life, like utilities, food and gas.
This is the type of policy and situation that is usually perfect for healthy younger folks that don't need tons of coverage for routine things.
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
Availability is a loaded word in this case. Go buy condoms as a 14 years old in an area where religious people want to burn people who use contraceptive on a stake....good luck (of course IMO they shouldn't need it at that age but the reality is different). You may also be in an area where your doctor will try to convince you not to get contraception. They'll prescribe it if you INSIST....
Compare that to an area where schools have someone on staff who can prescribe pills, or doctors will insist you consider it...
You end up with 2 totally different world. They're available in both cases, its just a different definition of available.
Is the day I'll sign up for my own insurance.
Right now, the market is so muddled I can't even tell from my non-functioning state website whether I qualify for subsidies or not, let alone be willing to put 1/6th of my paycheck towards health insurance that has such a huge deductible it will only pay if I get in a major accident.
SJW: a person who perceives an injustice, and while correcting it, commits a greater injustice.
I'm skeptical of any anecdotes I hear about obamacare. On top of the fact that anecdotes aren't real evidence, there have been several well-publicized obamacare horror stories that have turned out to be far-right funded lies.
The other way is also true. The "strong evidence" that obamacare is going to make many more startups doesn't seem to be much more than a theory. Here's the study they're referring to. Seems odd that they don't show self-employment increasing in Massachusetts, given that Romneycare is basically Obamacare and happened there eight years ago.
In Oregon, there's actually a program to make "Double-Dipping" legal. Basically, if you can find a way through self employment to earn up to 25% of your unemployment check, you can. If you earn more than 25%, your check is reduced dollar for dollar to 125%, at which point it disappears (and presumably, at which point you're the equivalent of fully employed at about $1 over minimum wage anyway, and no longer need the check).
SJW: a person who perceives an injustice, and while correcting it, commits a greater injustice.
The cost of individual health care plans was insane, and the crappy ACA plans provide worse coverage with fewer providers - and they're even more expensive!
I have exactly the opposite experience. I got a better plan for roughly the same cost and I had numerous to choose from. I also was able to get a Health Savings Account which is a great deal if you are eligible for one. My out of pocket maximum is around $4800 per year which I can easily manage if I have to. Most importantly my ability to get and keep health insurance is no longer tied to a specific employer which is LONG overdue. It should never be the case that losing your job should cause you to lose your health insurance. That's just morally wrong.
I really think what the feds are up to here is trying to kill off as many individual and small business operators as possible.
I run a small business (a manufacturing company) and the Affordable Care Act has been hugely helpful to us. Our employees were able to get similar coverage to what they had with our company plan, usually for less money out of pocket. Plus the company did not have to pick up any of the cost which saves our company roughly $10,000 per year. Basically we were paying roughly $550 per employee per month and the company picked up half the cost for an HMO. Now our employees are paying between $130-250/month out of pocket and the company doesn't have any of the cost.
>> but for you it's actually a great deal
Now there's the BS - you sound like the people who encourage everyone else to ride public transportation (without riding it themselves) right now.
Trust me - I did the math. ACA's benefits, including access to providers, were well below what I was getting with my expensive individual insurance policy a few years ago. With a couple of kids doing sports and the occasional illness, the difference between paying out of pocket for my own health insurance vs. snuggling back up to a megacorp (and dodging the self-employment tax) made it a no-brainer.
Before we continue, please tell me that you already signed up and paid for your ACA policy, and love what it does for you.
You must have skipped the fine print on this one.
The Feds will pay for the Medicaid expansion for the FIRST THREE YEARS. After that, the State is on the hook to cover it.
Which is why cost is an issue, since the States are generally in the same shape as the Feds in regards to budgets - not enough money, too many obligations.
"I do not agree with what you say, but I will defend to the death your right to say it"
The vast majority of bankruptcies in America were related to medical bills as recently as last year, even with people who had insurance.
Depending on where you go, a "routine" doctor's visit can range from $50 to $200. Still, it's much cheaper for both you and an insurance company to cover a once a year "wellness" visit and catch anything early on than it is for you to skip the yearly visit since it costs an extra $50, and then suddenly learn you've had a slow growing tumor in your ear and now you're going deaf.
Occasionally living proof of the Ballmer peak.
I'm in exactly the same situation. We had a group plan with Blue Cross / Blue Shield of Texas. We spent a good amount of time shopping for a plan that fit our needs well, with the right coverage and the right deductible for us. In the last two years the cost has nearly doubled. I left the business I'd had for 17 years and am now working for a government agency related to security.
The government doesn't set prices for procedures. The fed could extend the medicare pricing list to everyone instead of having to deal with each insurance company's "negotiated pricing" and arcane "most favored nation" contract rules. Or maybe employers could be required to offer up the cash that would have been spent on the company health plan so you can shop for yourself. Shopping for insurance across state lines would certainly be nice! Also, repealing state regulations that limit the size/capacity of hospitals.
My HSA should stay that way, if it's my money, no one should be able to take it but me! ...Actually, I wish my HSA could be grown and used as some kind of bond-like health insurance that also lowers my own premiums over time.
There are lots of political problems that could be fixed without repealing the ACA. 99% of it is removing greed, the #1 killer in America.
Why can't all fpga/microcontroller manufacturers just release free optimizing compilers???
I was with a start-up for a little over a year. One of the conditions I had for joining with them was that they would cover my COBRA expenses, because a) I couldn't afford it with my start-up salary and b) I couldn't get independent coverage because of a few preexisting conditions with me and my family. People forget about that clause. And lord help you if you are pregnant or have a pregnant wife (or want to get pregnant soon). Impossible to get coverage (or so I was told by two different brokers). Say what you want about Obamacare, but just the change of getting reasonably priced insurance even with preexisting conditions is enough for some people to have the freedom to jump into start-ups. Whether it's "right" or "wrong" is a completely different story.
A few hundred? Try $800/month which is the cheapest plan the ACA offers where I live. And that plan was total garbage, didn't cover half of what you'd expect and had huge co-pays.
The problem with ACA is that it MANDATED HMO's... Not health insurance. Some people don't need an HMO... if you're running a moderately successful home business you're usually making enough money to cover your families medical expenses out of pocket. What you couldn't afford is catastrophic injuries like car accidents, cancer, heart attacks, etc... So you'd get a very limited policy for that. It wouldn't pay for prescriptions and such but if you started getting $200k hospital bills it would kick in. Those plans were pretty cheap... in the $200/range.
ACA made those kinds of plans illegal. Now you have to buy plans that cover all those things you didn't need... and they cost a fortune. If I tried to get the plan I have with my employer through the ACA exchange it would be over $1600/month. That's insane! And yes, I actually looked it up.
Ironically, one type of small business is flourishing because of all of this. My best friends father is an insurance salesman. When the ACA passed he was terrified... he'd go out of business. He's an older, cranky, eastern European man and hates democrats so that made it even worse. But when the reality finally dawned on him and everyone's insurance policies got canceled, he suddenly LOVES Obama. You see, he makes a commission on insurance sales. Because all of his clients now have to re-sign up for their insurance, he's basically making back all the money he already made off all of his clients the first time he signed them up.
I ran into this myself and was shocked.
I paid quite a lot into the unemployment system while working through my own company, but when I lost contracts and was in between job, I could not collect unemployment, even though I'd paid into the system.
Honestly, if I ever win the powerball, I'd take the money to hire legal guns and fight shit like this just on principal.
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
I'm looking to go that route again, but man...I looked at the health sherpa site that shows what obamacare offers in my area, and deductibles on anything but near gold plans is over $3K?!?!?
I got a technically silver PPO plan (effectively gold if I stay in network with Blue Cross) that is compatible with an HSA. (HSAs are great) Cost to me is about $300/month and I get no subsidy. $4800 out of pocket max and $3K deductible. Everyone worries about the deductible but that isn't the important bit. The important bit is the out of pocket max. Health insurance isn't supposed to be to pay for your regular checkup. It's to keep you from going bankrupt if something serious happens.
I would end up on many plans paying about $3K a year in premiums AND $3K+ in deductibles before I started having any insurance kick in. WFT?
That's what an HSA is for. You put in $3K pretax and use that to pay the deductibles. Any plan compatible with an HSA has a minimum deductible of $1250/year. Only "high deductible" health insurance plans are compatible with HSAs.
Sadly, I think we're stuck with obamacare, and it won't be repealed, but it needs to seriously be altered
Sadly? I disagree. I think changes will (and should) be made in due time, but the basic goals it accomplishes are good ones. It removes the tie between employment and health insurance, it eliminates the pre-existing conditions problem and it prevents insurance companies from dropping you when you get sick. We can debate the details of how to deliver those things but the fact that they are possible now is a Good Thing.
I think we're good with disallowing the pre-existing conditions, but aside from that, I can't see much that helps me or most people at my level of IT income or stage of life that is good about ACA as it currently stands...
You are missing the other really important bit, namely that your insurance is no longer tied to your employer. No one should lose health insurance simply because they lost their job.
The absolute maximum yearly out of pocket allowed under the ACA is $6700 iirc. So your insurance company is required to cover 100% of any bills once you've hit that cap.
Occasionally living proof of the Ballmer peak.
People, particularly young people, who want to start their own businesses, usually have to scrimp and save to come up with the initial capital. One method of doing this was to forgo health insurance for a few years, or to buy catastrophic medical coverage.
No more. Cheap, high deductible policies are no longer allowed. And if you forgo coverage, the gov't will take it out of you in the form of a penalty.You can sign up for low income assistance, but forget trying to amass any startup capital or you'll run afoul of the means test.
I feel sorry for young people who are trying to get ahead. I've been self insured for years and now, thanks to the ACA, my medical insurance costs will be passing my housing costs. And I don't live in a cheap area. I can practically spit on Bill Gates house from here.
Have gnu, will travel.
If the Federal government mandates something, then sure as hell the Federal government should pay for it.
If a State wants to provide free healthcare for everyone in the State, and can pay for it, I've no issue whatsoever with them doing it.
But I do have an issue with the Feds saying "we want to provide free healthcare to everyone, and we want the State governments to pay for it.
"I do not agree with what you say, but I will defend to the death your right to say it"
How about instead of cost shifting and purchase pooling we actually work on what medical care costs in the first place? In the US you can got to Cook County or the US Federal court in the Eastern District of Texas and drive up a drug company's everyday costs by suing them in a class action for side effects they already disclosed before you bought their drug. There should be some sort of grand jury or board of people with a clue who decide the merit of these things before millions are spent on lawyers.
The for-profit speculative commission-only trial lawyers are a big part of service and product costs for drug companies, hospitals, clinics, doctors, nurses, and even medical assistants and medical techs. If you want to make healthcare more affordable through insurance cost changes, change the cost of malpractice insurance so that only people who actually screw up need to pay exorbitant premiums. When I lived in Illinois it was really difficult to get a doctor's appointment within six months without crossing state lines because the malpractice rates caused several of the doctors in the area to retire early or move to more sensible states.
Also, why do we have federal and state funds going into basic research at universities that gets patented and sold to corporations to turn into products? If research comes from a largely government-funded school then the NIH or someone should be licensed to then sublicense any of those patents to all comers for a reasonable fee.
Also, why do the drug companies pay the FDA to fast-track drugs? The PDUFA means that in order to get faster drug trials, the deeper pockets get faster times to market. If we're spending billions of dollars to improve healthcare, why don't we fund the FDA sufficiently to get the best drugs approved fastest rather than the most heavily promoted ones? Why don't we partner with other developed countries to do joint trials that meet the standards of the FDA and its counterparts in, say, the UK, Germany, France, Japan, South Korea, Canada, Finland, Sweden, and Brazil with all the agencies reviewing all the data and making decisions for their own constituencies rather than repeating the trials over and over?
Here's what Krugman had to say. If you say you did the math, you might be right, but there are a lot of BS health care stories out there. The big benefit of Obamacare is that it limits your (pemium+copayments) to ~$8,000. One big weakness of Obamacare is that when you find an "affordable" plan, it might have a small pool of doctors, it might not have a doctor that you've been using, and it might not have an competent doctors at all. Single payer would have been better, but, as Uwe Reinhardt says, the American political system is too corrupt for that.
http://www.nytimes.com/2014/02...
Health Care Horror Hooey
Paul Krugman
FEB. 23, 2014
(Right-wingers convinced Americans that farms are being broken up to pay "death tax" estate liabilities, but there is not one single example. Now the Republicans are creating Obamacare horror stories, which don't hold up upon fact checking. In the GOP response to the State of the Union address, Rep. Cathy McMorris Rodgers claimed "Bette in Spokane" had lost her good insurance and was forced to pay $700 a month more. Local reporters found the real Betty, and found out [Bette Grenier had a catastrophic plan, and she refused to look on the ACA web site.] In Michigan, Americans for Prosperity, funded by the Koch Brothers, is running an ad about Julie Boonstra, who has leukemia, saying that her new policy will have unaffordable out-of-pocket costs. But Glenn Kessler of the Washington Post found that she will be saving more than she will be paying in out-of-pocket costs. [The Obamacare out-of-pocket maximum is $6,350. Her premiums were cut in half, from $1,100/mo to $571/mo.])
[T]he true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.
were well below what I was getting with my expensive individual insurance policy a few years ago.
Of course medical costs were much cheaper a few years ago. Why do you think the ACA finally got enough traction? Insurance costs are outpacing inflation at incredible rates.
It is worth remembering that insurance companies must comply with regulations requiring them to pay out a percentage of their revenue and ACA gives them more revenue in the form of previously uninsured people being forced to become customers. If your insurance went up during the last few years, it was not the ACA it was either pricier risk factors in your life, or you were underpaying to begin with and the adjusters finally got around to fixing the problem.
Let me guess; you have teenagers that may start driving soon, already have, or have daughters in an area with above average teen pregnancy rates. Your new employer's insurance will get around to rectifying things out for their own profit soon enough.
It varies from state to state! Stop saying "The ACA raise health care costs!" then "no it didn't!" "yes it did!" "no it didn't!"
If the ACA laws match what your state already had, then the plans will remain the same and the costs will remain the same. If the ACA requirements were higher/stricter than what your state required, then your insurance benefits and costs will increase. If the ACA requirements are lower than what your state required, then... I'm not sure...
I live in Maryland, where most but not all of the ACA rules were already in place. My individual health insurance plan will change very little. It was +/-10% from what my employer offered. The ACA now requires a few provisions that resulted in a nominal increase in my health care costs.
My local NPR station, WYPR, has had a program "Maryland Morning" where they have been going over this for months. They compared to other states where costs are going up because those states allowed health care plans that covered nothing but hangnails and scraped knees.
Depends on your age, I'm turning 60, and the wife is 62, health insurance for us is in the neighborhood of $1,200 - $1,900 per month; that's more than most mortgage payments! There no rhyme or reason for the prices that is appearent, there are plans with deceint coverage and high deductables that are cheaper than plans with for-crap coverage and deductables of $20,000! My subsidy is just over $900.00 which is good for me, not so good for the rest of the taxpayers.
I know this sounds outlandish, so here's Subsidy Calculator and Health insurance quote site so feel free to try different scenario yourself.
Yes I can see somebody making good money and still not being able to afford health insurance.
Apocalypse Cancelled, Sorry, No Ticket Refunds
The Harvard study they relied on? It's crap. Note that even your link only claimed 57%. I would dispute whether that qualifies as a VAST majority.
The self reported figure from the study came in at 29%, which is probably a better number. The 62%, and even the 57% in your link rely on a very broad definition of medical bankruptcy. Some with $500,000 in other debt and $5,001 in medical debt shouldn't really count as a medical bankruptcy.
"Pulling together is the aim of despotism and tyranny! Free men pull in all sorts of directions" -- Havelock Vetinari
So we've got young and middle aged people carrying the burden of health care costs for their elders (been that way as long as I've been alive), the least you can do is kick in for contraceptives and maternity care. It's only fair. It's not like fairness and consideration for others is a cornerstone of a functioning society or anything.
Too many people would rather burn it all down if it isn't done their way, or it benefits people they don't value.
Cheap storage VM.
I have a great plan now through work for my family and I, and I know if ObamaCare isn't changed or repealed, my out of pocket costs will absolutely jump by hundreds of dollars. Why? Because our plan now doesn't technically cover all the things that ObamaCare mandates (but crap we don't need and never will need like contraceptives, maternity, etc. etc. etc.). Once it's required to cover those things, the costs will absolutely increase, there's no getting around it.
Complain all you want about the cost of covering contraceptive. The Department of Health and Human Services has studied it and concluded that it actually costs LESS to include it:
http://aspe.hhs.gov/health/reports/2012/contraceptives/ib.shtml
And when you say "my family", do you just mean you and your wife, or do you mean you have kids too? If the latter...gee, it's great now that you already have your kids that you no longer need that maternity coverage, but perhaps you could think about somebody besides yourself. Even if it's the former (you don't have kids), or if you weren't fortunate enough yourself to have insurance when you had kids, I can't really support the idea of not providing maternity care. You could make the argument that you shouldn't have kids if you can't afford the cost of the care and delivery yourself, but the reality is, you know that's not going to stop 99% of people. Most people are going to just get pregnant (intentionally or not) and then figure out how to deal with the costs, which probably means minimizing the amount of prenatal care they get, which is a terrible idea for the health of the unborn kids (who have no influence over the care they receive but have to live a lifetime with the consequences of it)
Why would anyone think the Government could run healthcare?
Let's see, maybe because they already do through Medicare and other programs. Maybe because governments around the world do a highly competent job of it for better outcomes and lower cost than we incur in the US. Maybe because reflexively assuming governments are incapable of doing anything well is demonstrably false. Maybe because health insurance is a marketplace that is used by everyone and CANNOT be operated effectively or humanely without government involvement.
Is there any sign of competence or efficiency in Medicare, Medicade, or the VA?
Quite a bit actually. Not saying they don't have their flaws (they do) but they are hardly the debacles you seem to be implying.
There is not one single thing that the Government of the US has ever done more efficiently than the private sector.
What a bunch of crap. There are plenty of things the private sector does an absolutely crap job of. Policing, firefighting, military, infrastructure, medical care for at risk groups (elderly and poor especially), basic research, the judiciary, banking regulation, environmental protection, and quite a bit more. Any time you have a situation where market forces do not work well, the private sector is demonstrably unable to deal with the problem. I'm all for doing as much with the private sector as we can but the argument that the private sector is always better is absurd, wrong and frankly damaging to our society.
Quality. They come to go to places like the Mayo Clinic. The health care problem in the US is not the quality of the health care, its the quantity of health care. Sure maybe you can make a case that adding more health care might lower the average quality, but I highly doubt that places like Mayo are really going to be affected that much.
The vast majority of bankruptcies in America were related to medical bills as recently as last year, even with people who had insurance.
Depending on where you go, a "routine" doctor's visit can range from $50 to $200. Still, it's much cheaper for both you and an insurance company to cover a once a year "wellness" visit and catch anything early on than it is for you to skip the yearly visit since it costs an extra $50, and then suddenly learn you've had a slow growing tumor in your ear and now you're going deaf.
Your main point is right. Co-payments are terrible health policy.
Actually, the most common example is people with asthma. If they use their controller medication, they won't get asthma attacks, but the controller medication can be expensive. There were health insurance plans that covered 100% of medication costs. Then they shifted to co-payments. Even with small co-payments, people stopped taking their controller medication. They got asthma attacks, and wound up in the hospital. One ER trip will cost as much as several years of controller medication. So the plans wound up paying more under co-payments as they did with 100% payments. Same with co-payments for blood pressure medication -- more heart attacks and strokes. If you want to look this up, to make sure I'm not repeating an urban myth, it was reported in the New England Journal of Medicine by Amal N. Trivedi, who published a few other studies like that. Also see the Rand Health Insurance Experiment on Wikipedia or elsewhere.
Any of those savings (which could be considered part of an employees salary) get passed on to the employee?
Any of those savings (which could be considered part of an employees salary) get passed on to the employee?
We were able to give raises we couldn't before. The company kept some of the savings and some of it got passed on.
The challenge is that we offered health coverage to everyone but not everyone took it. That was their choice to forego the insurance. It's unfair (and can create legal problems) to give raises only to those who took insurance through our company when others are doing the same job just as well. Any time you have two people doing the same job you have to have a justification if you are going to pay them differently based on responsibilities or performance. We also offer an IRA with an employer match but not everyone chooses to participate. We don't give raises to those who don't participate.
"I was getting with my expensive individual insurance policy a few years ago."
and you left consultancy to go to the corporate world...why? No one took away expensive individual insurance policies.
YOU CAN STILL BY INSURANCE ON THE OPEN MARKET.
And you get all the benefits from the insurance reform. So if your child develops a disease* you insurnace company can't jerk you around, and later in life you child won't be denied.
You should look at any increase costs and compare them to pre-Obama insurance rate increase projections. You insurance were already going to go up, probably a lot better ACA
"Before we continue, please tell me that you already signed up and paid for your ACA policy, and love what it does for you."
That is logically fallacious. It has nothing to do with the argument. Especially considering you can still buy on the open market.
ACA says you need to have insurance the meets certain min. qualification.
That said, because of the ACA, I will be leaving my government job and starting my own small software company at the beginning of the fiscal year. I can do this because of ACA.
(and dodging the self-employment tax)
there is no such thing. What you are doing is having a corporation pay half of the tax. It's the same amount regardless.
*As a father, I certainly hope that doesn't happen to you becasue I know how hard it is.
The Kruger Dunning explains most post on
Insurance is supposed to be there for EMERGENCIES, not to run you $10 copay for routine Dr. visits. That needs to be something you save and pay for, just like any other necessity of modern life, like utilities, food and gas.
That's one of those ideas that sounds good but doesn't work when you try them out in the real world. Most other developed countries have health care systems that pay 100% of costs (although non-American Slashdotters may be informative on that). Health insurance isn't car insurance.
The biggest problem is that once people have to pay for "routine" visits, they don't go on routine visits. Obviously you are one of those people who can afford to pay for a $200 doctor's visit out of pocket. Maybe half of Americans are in your category. The other half aren't. Doctors have no end of stories about people who didn't get routine care because they couldn't afford it, and wound up with preventable, fatal diseases. http://www.nejm.org/doi/full/1...
The other problem with "emergency" care is, "what is an emergency?" If I have to pay $100 for a doctor's visit myself, but my insurance pays for my $2,000 ER visit, I'm going to have a lot of emergencies. That actually was the problem in the Swiss health care system, which was mostly a catastrophic system which didn't kick in fully until you had passed a certain amount (It might have been $30,000). Once you reach $30,000, the insurance company has to pay for everything, 100%, so the doctors give them CAT scans, tests, specialist consultations, etc., and bill it all to the insurance company.
This is the type of policy and situation that is usually perfect for healthy younger folks that don't need tons of coverage for routine things.
Think about it. Any policy is perfect for healthy younger folks who never need coverage. The only people who need health insurance are the ones who get sick. If you develop multiple sclerosis or lupus, you can live a much more normal life if you can afford to get a lot of health care. There are drugs that can save your life and keep you out of a wheelchair for $50,000 a year.
I knew a young, libertarian Republican who had severe psoriasis, which put him in the hospital once or twice a year. The drugs he was taking were damaging his liver and kidneys. There were new, more effective, safer drugs -- but they cost $100,000 a year. What did he do? Government handouts. His wife was a government employee, and he was covered on her policy.
I have a family of four, and I am paranoid about coverage so I have a low deductible and lots of coverage.
1000 a month. Maybe you need to look around more? is there some state based thing that's getting you?
"$1800 /month with a $5,000 - $10,000 "
that's.. well stupid. Are you a smoker?
Are you sure you've actually looked at it?
Here is what I get for 1000.10 a month and my income gets no subsidies, and I live in Oregon:
DEDUCTIBLE (I): $100
DEDUCTIBLE (F): $200
OOP MAX (I): $1,000
OOP MAX (F): $2,000
PLAN LEVEL:
PLATINUM
If I got the plan with the deductible you state, it would cast me 366 dollars. I just looked it up.
Thanks for that. I am not in the individual insurance marketplace. I think obamacare is better then the alternative of doing nothing, but I really want a single payer plan. Insurance needs to be divorced from employment. If i have to pay for it anyway, why not make it a tax and do it right.
BTW, I have a pretty well fleshed out account for a sock puppet. I'm pretty sure my real name could be easily linked to this account. Unlike the AC who is calling me out and probably works for some GOP politician, or is too stupid to see the strings they are dancing at the end of...
Cheap storage VM.
I am. Cost me 12% more than last year. Which is about how much my plan went up 3 years ago, and about 4% more than it went up last year. I cover myself, wife, and child.
And you must be the shittiest consultant in the world if a 1% penalty (this year) or a 2.5% penalty (cap, in 3 years) on your AGI will cost you more than losing your consultant income. If you get taxed on $100,000 a year, it will cost you $1000 this year; $2500 next year. If you're not making at least 50% more as a consultant as you do as a grunt, you're doing it wrong.
Is it just my observation, or are there way too many stupid people in the world?
Key difference is that your premiums would have been adjusted upwards or policy canceled whenever your health has deteriorated.
Which is what happened to Brandon Boyer.
http://boingboing.net/2014/03/...
Humana screws Brandon Boyer for $100K worth of cancer bills - help him pay them
Cory Doctorow at 12:00 pm Fri, Mar 7, 2014
Our good pal Brandon "Offworld" Boyer has cancer. Lucky for Brandon, he signed up for medical insurance with Humana not long before he was diagnosed. Unlucky for him, Humana has decided unilaterally not to cover his cancer treatments and has stuck him with with a $100,000 bill.
The absolute maximum yearly out of pocket allowed under the ACA is $6700 iirc. So your insurance company is required to cover 100% of any bills once you've hit that cap.
The best way to understand the ACA is that your maximum of (premiums + out of pocket) is ~$8,000 for an individual. So whatever crazy policy you gamble on, your worst case is $8,000/year.
You do realize that Medicare fraud isn't governmental, but rather fraud perpetrated by private corporations on the Medicare insurance system, right?
Is it just my observation, or are there way too many stupid people in the world?
You need to call the GOP... I hear they're having real trouble finding ACA horror stories that don't turn out to be utter bullshit after thirty seconds of digging. Your story isn't utter bullshit like all the others, is it?
This is what you're referring to.
http://www.nytimes.com/2014/02...
Health Care Horror Hooey
Paul Krugman
FEB. 23, 2014
(Right-wingers convinced Americans that farms are being broken up to pay "death tax" estate liabilities, but there is not one single example. Now the Republicans are creating Obamacare horror stories, which don't hold up upon fact checking. In the GOP response to the State of the Union address, Rep. Cathy McMorris Rodgers claimed "Bette in Spokane" had lost her good insurance and was forced to pay $700 a month more. Local reporters found the real Betty, and found out [Bette Grenier had a catastrophic plan, and she refused to look on the ACA web site.] In Michigan, Americans for Prosperity, funded by the Koch Brothers, is running an ad about Julie Boonstra, who has leukemia, saying that her new policy will have unaffordable out-of-pocket costs. But Glenn Kessler of the Washington Post found that she will be saving more than she will be paying in out-of-pocket costs. [The Obamacare out-of-pocket maximum is $6,350. Her premiums were cut in half, from $1,100/mo to $571/mo.])
[T]he true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.
Traction? Democrats have been wanting to take over healthcare for years. They finally got their chance and they ramrodded it through. There was no traction.
Ramrodded through the 1990s Republican plan, in fact. Because the 2010 Republicans would rather die than work with Democrats, even if it means repudiating their own ideas.
The old health care paradigm was broken. It was based on the idea that the majority of people went to work for a single employer and stayed there for life, so that they didn't have to deal with the "pre-existing condition" gotcha. It assumed that employment was more or less continuous, instead of months, and even years between jobs when something medically crucial might happen but no employer was there to provide insurance. And it assumed that workers weren't sliding down the income scale so that they could better handle minor medical expenses out of pocket.
Those days are gone.
With "take over" you actually mean "do anything about". The Republicans had, and still have, absolutely no ideas whatsoever about how to fix our broken healthcare system (well, they did have one idea a few years back that involved keeping a system of mainly private health insurers and stipulating a mandate that people need to sign up. But they seem to have abandoned that as of late..........)
Is her state refusing to expand medicaid?
A can't find any income level to low for subsidies, that don't get medicare.
I did my search based on a single person, 21 years old.
If she lives in a state that throwing a political fit at the cost of the poor, well.. I feel for her, but it isn't becasue of ACA.
http://laborcenter.berkeley.ed...
I did 1000, 5000, 1000, 15000 and 20000. 5,10,15 medicare, 20 was subsidized.
The Kruger Dunning explains most post on
...and dodging the self-employment tax
Well you could have just pulled a John Edwards or Newt Gingrich and funneled 98% of your income through an LLC with S-corp tax rules to avoid that pesky self employment tax. Get with the times man.
I am becoming gerund, destroyer of verbs.
"Minimums are needed because cross subsidisation is rather integral to having affordable healthcare for everyone."
Yes. Cross-subsidization (also known as "socialism") has resulted in most people I have spoken to paying 40% to 60% more on their premiums, with a higher deductible.
It has also resulted in fewer young people with insurance, because their premiums went way up. It's DUMB to raise rates on the demographic that (A) is essential to funding the program, and (B) needs it the least.
I grant that it is a good thing to get insurance away from ties to "traditional" employment. But doing so through Obamacare is kind of like cleaning your windows by taking a sledgehammer to them.
How high is "insanely high"?
For a family with two 40 year-old non-smokers and two children under 21, making the median household income of $50,054/year, the average annual silver plan premium, nation-wide would be $9700/year. That's a lot, but not unreasonable given what a silver plan covers. But here's the kicker: Uncle Sam cuts your taxes to the tune 65% of your premium, so effectively you only pay $3373/year. If you were getting anything close to silver plan coverage for much less than $281/month, I'd be very surprised. You can do this calculation for yourself at http://kff.org/interactive/sub... if you like. If you have a reasonably profitable consultancy, the prospect of paying $9/day to insure four people shouldn't be that daunting.
But some small businesses don't generate much income at first, and the tax breaks in Obamacare don't help you because you aren't paying much federal income tax yet. That's what the Obamacare Medcaid expansion is for. It covers *all* your health care expenses if you make 138% of the poverty line or less. Unfortunately about half of the states have opted not to expand Medicaid, even though the expansion woulds be entirely funded by the federal government. If you live and work in one of these states and make less than 138% of the poverty line, you need to get coverage at work or you're screwed. Even a bronze plan, at $249/month, is more than people who are supposed to be covered by Medicaid expansion can pay. Blocking Medicaid expansion at the state level is a key tactic in ensuring that working people experience Obamacare as ruinously expensive.
Finally, it's important to remember that Obamacare doesn't set insurance premiums. What you pay *for* is regulated, but the *amount* you pay for it is determined by the market. Increases in premiums, or too-good-to-be-true plans that are dropped, result from outlawing practices like dropping you from your insurance when you get sick, or raising the premiums so much when you get sick that you're forced to drop your coverage. So the increased premiums under ACA are simply the market price for insurance that actually works the way people expect it to (i.e., when you get sick, it pays for care until you are no longer sick).
If you are one of those people who pre-ACA had awesome health insurance for your entire family below $100/month, your old insurance was almost certainly too good to be true. Insurance companies dropped those policies when the ACA outlawed the deceptive practices that made them profitable.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
You're talking out of your ass. I was an army brat as well my entire childhood. You know what the two cheapest and highest rated (by those covered) healthcare programs were circa 2008? Evil, socialist VA hospitals and Medicare.
I swear to God...I swear to God! That is NOT how you treat your human!
"Well that is more or less your exact fault."
Whoa. Hold on there. I am not of the generation you are blaming but you need to step back and get a little perspective. At least I think I'm not... because "your generation" is rather ambiguous. I am probably older than you, but a lot of these things were actually done by a full generation before me. (If you define "generation", as the time it takes for someone to grow up and have children, which these days averages almost 30 years.)
Yes, the early boomers did rape Social Security "for their own benefit", and now they want later society to make up the difference. That *IS* their fault. If you know history, it's not reasonable to try to deny this. But let's look at the following sentences, one point at a time:
"Then you voted to privatize prisons, stratify wealth, defund social outreach to try and lift people out of poverty and get them into being tax payers."
Privatize prisons: yes. That was an experiment that has pretty much failed. Society needs to own up to the fact that prisons are a legitimate societal cost, and pay for them directly out of tax money.
Stratify wealth: No. Just no. There is a huge assumption in this assertion that must not go unchallenged. In fact, the freer markets have been, the LESS income inequality there has been. Government programs to "help the poor" have invariably led to greater income inequality. It's history. Just look around you today. More government intervention in the economy and more entitlement spending than ever before... and the highest income inequality just about ever. You need to re-examine your assumptions here. Don't assume that just because the intent is to lower inequality, that you will get that result with a Government program. It doesn't work that way, and never has. You need to evaluate government programs by their results, not by their intentions.
Defund social outreach "to try to lift people out of poverty": since when? The early boomers didn't do this. There is more "social outreach" than when I was a child. That means my parents increased it, not decreased it. But again: it hasn't let to fewer poor people. "Try to" is the operative phrase here. That is the intent. The result, on average, has been the opposite.
"Voted to defund schools, give yourselves a tax break..."
Schools are another area that is better "funded" than when I was a child. So this assertion is false. As for tax breaks, people pay more in taxes than they did then, too, when you adjust for inflation. So these assertions are nonsense. By the way: studies have clearly and consistently shown that beyond a certain point, throwing more money at schools does not make them any better. In my area, 80% of the money spent on education goes to administration. Clearly that is a badly lopsided bureaucracy. More money won't cure it. Less government would help.
"... reform capital gains tax to actually collect income or properly fund the IRS so it can catch tax cheats (did you know it has a 7 to 1 payback at the moment?"
Capital gains taxes WERE reformed... to end the government stealing of savings that was taking place. In an inflationary market, a homeowner who buys a house, lives in it 10 years, then sells it (at a higher value, of course, because of inflating prices), hasn't earned any real capital gains. For the simple reason that buying another, similar house would cost them just as much as the sale price of their existing house. Inflation has eaten all the "capital gains". It used to be that government was taxing this money, so that homeowners actually LOST money when they sold their homes. That's one of the many insidious ways that inflation steals from productive people. Capital gains taxes were amended to prevent this government theft. But the exemption isn't supposed to apply to people who "flip" homes for a profit, or otherwise buy investment homes
Ok, they suffer the consequences of their actions.
Those consequences result in them having major operations that could have been prevented.
End of story right? Nope, they just racked up a bill that you're helping to pay off through insurance.. and to what tune? To the tune of the next 10 years of their regular check-ups and maintenance in 1 go.
So which do you want? Higher premiums or regular maintenance?
Ounce of prevention, pound of cure. It's not just a saying. You're going to be paying for my pound of cure baby... rock on! Best part is, I got my beer too.
I already signed up and paid for my ACA policy, and love what it does for me.
But I recognize the challenge for people with families. They've been subsidized by corporations at the expense of childless couples and single people for years.
I think a better fix would be for people like me to pay $50 more per month so policies for people with kids would be less. We want to encourage people to have children.
I wouldn't count on that subsidy from corporations continuing-- my last corporations had cut benefits every year of the last seven years AND rates for children and spouses had increased for at least the last three years.
In my case; the ACA has allowed me to retire and start several small businesses instead of working another 16 years (despite not needing the money) because of my preexisting conditions. Since I don't think it's likely I would have been able to find employment with insurance all the way- an uncovered period was probably in my future.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
Does the threat of violence oppress you from strolling to work nude? Do you pay for groceries under the specter of a gun? Is violence the only thing that keeps you from running your sewage line into a creek that passes through your property?
You live in a sad world. I live in a society.
Cheap storage VM.
Don't forget the roughly 25% pre-tax subsidy for employer provided insurance.
If they gave the same tax deductions to individuals- it would lower premiums by your highest marginal tax rate. For most people about 20%. For the wealthy by 39.6%.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
I call BS on that... The ACA benefits are the same for all policies whether in the exchange or not. They are the minimum ALL policies must have. And about complaining about stuff you'll never use, you don't really understand how insurance works insurance do you?
As for me, I've signed up, paid for it and am receiving benefits from it. I had gone for 2 years without and could not get insurance back because of pre-existing conditions. Now, thanks to the ACA, I have it and I have services and deductibles comparable to what I had before plus the new ACA benefits. And the policy cost is about $120 LESS per month than what I was paying before . And there is the exchange subsidy on top of that.
And if all the coverage you wanted was for hangnails and scraped knees, then why should you be forced to buy coverage for things you don't want, and in many cases will never need?
Because you usually don't pick and choose what injuries and illnesses you get. We've already decided as a society that we're not just going to let people die in the street and that medical personnel have to treat patients. So you're going to get treatment, the ACA ensures that you have actual coverage for it rather than freeloading.
It's still a totally broken system though; no way should health care have ever been tied to employment. For one thing, doing so masked the actual costs of health care and insurance from the average person.
If hospitals are making such profits on overcharging patients and insurers, why aren't insurers taking an ownership interest in hospitals so that they can see some of these profits?
Uncertain, but perhaps it has to do with the legal restrictions on the investments insurance companies are allowed to hold.
Hospitals and insurers are certainly in collusion to wipe out private practice. Typically how that works is that the practice will have a contract with the hospital where they work as well as contracts with various insurers to establish billing rates. The insurance company will approach the practice and tell them that they are going to cut reimbursement 25% this year and 10% the following year. If the practice refuses this contract, they say, then the insurer will not pay for any services billed by the practice. The insurer turns around and secretly approaches the hospital and offers them half of the money they are cutting from the private practice's billing if they will go along with it. This ensures the practice has to accept the terms, because the practice's contract with the *hospital* has a provision that the practice will service *all* inpatients at the hospital. So, either take the cut or work for free because you have to service all the insurer's inpatient policyholders at the hospital.
In case you were wondering, the doc's reimbursement is usually far less than the hospital's "tech fee". Approximately $250 of your $3,000 MRI cost goes to the radiologist. The other $2750 goes to the hospital.