I was assuming that propping up the insurers would only be part of the fix, and the rest would be things like making the individual mandate harsher, and increasing subsidies, by fixing the cliff at 400% of poverty, maybe increasing the cost-sharing reductions, maybe upping the subsidies a bit. Making the individual mandate harsher by itself would go some way to fixing the insurance woes. I would’ve just taken people who don’t sign up for any plan, signed them up for the lowest-cost plan, and billed them on their tax return. (On edit: Yes, this would cost money. Remind me what the tax subsidy to the employer market is, again?)
$50 (to your or my favorite charity) says if the new Congress passes repeal and delay, they will also give some new goodies to the insurers on the individual market.
I’m also thinking, though I guess this is well off topic, that the state of California will take a good hard look at some serious health care reform, perhaps single payer. Those super-majorities in the legislature have a lot of power. California could just siphon off the tax cuts and put them right into health care.
I don’t think you get where I’m coming from on this issue. No way that I’m taking that bet unless you give me 8 to 1 odds
However, I don’t think you appreciate how badly Obamacare has screwed up the individual market in some regions of the country for non-subsidized people. I hear chapter and verse on it at least once a year. The ACA has winners and losers; in many regions self employed people who are making too much to receive subsidies are among the losers. They’re getting crushed.
Honestly, I kind of hope they do. It’ll be a fascinating experiment, and I’m happy to volunteer other people to be the guinea pigs. If it actually works (in reality and not just in the opinion of people who are strongly predisposed to believing that it’ll work) then we’ll have a solution that the entire country can adopt.
Some self-employed people are worse off. Not the ones who couldn’t get insurance before, though. They’re way better off. Eighteen percent of people who applied for insurance were denied, pre-ACA. For people 60-64, 29%(!) were denied. You can save a lot of money in the insurance market if you don’t insure sick people. I realize TatinG’s plan is that I can’t buy insurance at any price because I have the poor morals to have developed an auto-immune disease, but I’ve gotta say, that plan doesn’t appeal to me.
I am essentially in that cohort where I have high premiums + a high subsidy combined with self-employment income near the cut-off for subsidies.So an increase of +$2000 in income really could cost me $7500 in lost subsidy dollars.
But even though the cutoff for a single earner is around $45K (400% of FPL) – we self-employed have more flexibility than that because of other deductions we have from AGI – including a deduction for all unsubsidized health insurance premiums, contributions to an HSA account, and contributions to 401K or SEP IRA. . So basically the gross earned income threshold for a self employed individual to qualify for subsidies is probably around ~$75-$80K.
And of course we have a measure of control of our cash flow from self-employment – we can certainly make discretionary business purchases toward the end of the year or accelerate payments to offset a slightly-too-high income.
So yes it is frustrating – but it’s not as if I would be getting free insurance without ACA. So it’s something of a false construct to look at the loss of subsidy at a certain income level as lost money – I had to deal with rising premiums before ACA too.
If you make $100K, and you’re looking at a $10,000 insurance bill when before you paid $4000, you are considerably worse off. You used to be able to buy no-sick-people insurance, and now no-sick-people insurance is not available.
$10,000??? Ha! No one would be complaining if it was “only” $10,000.
Try $25,000-$30,000 (unsubsidized) for a family of 4, no major health problems. It’s true that these are really good plans with access to the best docs & health networks, but they also have high deductibles (maybe $7,000 / $14,000 max out of pocket… not really sure)
The cost has doubled over the last 3 years in our region. Pre-ACA the premiums were going up by a bit over 10% per year, and people were upset about that. Now that seems like the good old days. Frankly, I think the insurance companies are trying to get people to drop before they pull out of the market.
But as I said, some people are ACA winners. But we shouldn’t turn a deaf ear to the few million ACA losers too.
How much did their neighbors pay for health care? The ones who couldn’t get insurance because they had pre-existing conditions?
I understand about high insurance prices. We pay over $20,000 for two people. But I can’t be sympathetic to people who think they’re entitled to no-sick-people insurance and other people should just die.
The lower cost ones are generally HMO (network or Kaiser), while the higher cost ones are generally PPO or EPO. Note that there were 31 plans for each hypothetical.
^ That’s really not enough determine suitability of a plan, since deductibles, max OOP a the cost schedule for various services play a large role in decisions. Your quoted highest Gold has a 0 ded.
My closest would be a 1k ded.
BCBS, wide range of docs and hospitals. Not CA.
Age 50, smidge over 600/mo, Gold, 1k ded
Family: under 1650, 2k ded
That kind of pricing certainly was not available to me when I was age 50, well before the advent of ACA – and back in the days when I was on the healthy-people plan- and that’s a dozen years ago. I haven’t had anything less than a $3500 deductible going back that many years. It just wasn’t affordable.
It’s dawning on me how many of my fellow citizens really – literally – do think this. It strikes close to home. My D couldn’t get insurance at any price before ACA, and I simply can’t believe how many people, including people I know, are perfectly OK with that.
I read a comment on an article about ACA, a comment by a Canadian. It said simply: “Americans have cold, small hearts.” I can’t find any reason to disagree.
Or they just don’t know. I can’t tell you the number of people who told me to just “go on medicaid” after I aged off and before the ACA (so I couldn’t afford anything).
Nope. That’s not how medicaid works in MI. If I had gotten pregnant, then I’d have been medicaid eligible but somehow that didn’t seem like the right reason to get pregnant…
At 60, that plan goes up precipitously, to 915 (full price, straight from the insurer and via the exchange, no subsidy.) Sit right at the edge of the poverty level (I used 45k) and it’s 724.
I’m not comparing which plan is more feasible, depending on health issues and the usual trade-offs. But this shows part of why I consider this a state issue.
Oh, but romani, that’s how we do things. We change jobs for insurance. We get married for insurance. Insurance runs our lives under our perfectly insane system.
@LasMa boy are you right. My husband chose his current job (at age 60) based on 1) health care insurance and 2) chance of getting RIF’d because of his age (yes we know there are laws against this but…). Took big cut in pay to get 1+2. And with the election, not sure about either 1 or 2 now.
"At 60, that plan goes up precipitously, to 915 (full price, straight from the insurer and via the exchange, no subsidy.) "
This simply strikes fear into my heart. We’ve had a tough go of it over the last ten years (2008? Ugh!). Doing MUCH better now, but I’m not sure there is enough time to catch up and be ready for retirement. That big fat equity in our house is GONE. The market is not recovering here. Our jobs? If we can’t hang on to them, we’re going to be in big trouble.
I just can’t fathom paying that much for health insurance.
