<p>“But you will still have that. Your insurance hasn’t been costing $200/month – that is just the SHARE you paid, while your insurance was picking up the bulk. The way you find out what it is really has been costing is to ask your HR department for the COBRA number.”</p>
<p>I realize that, and somebody who is retiring soon told me that he will be paying the full cost, about 14-15K/yr, for the same plan for his family. I’m assuming that is the Cobra rate. I’m not worried about my family getting stuck with this. I’m just commenting that I think these plans (at least for my state) are outrageously expensive, with poor benefits, if you make a higher income. It may work well for those who don’t have to pay as much for them, but if nobody signs up who isn’t getting it highly discounted…uh oh.</p>
<p>The insurance companies are getting the total premium dollars. The federal government is paying the subsidies, which is tied into the income tax system… (It’s a tax rebate but structured so that it can be paid directly to the insurers). </p>
<p>If we had a government run, single payer system, the government would also pay for it, depending on a somewhat different tax structure. It would be simpler, but then the higher end earners would be griping about their increased taxes. </p>
<p>It makes no difference to the insurance company whether their income comes from the insureds or the government, no more than the university cares whether its tuition dollars come from the student or a Pell grant or federal loan. The money comes in just the same. Government is probably somewhat more reliable over time about paying its bills on time.</p>
The preventive care is cheap and predictable - and saves money in the long run because of avoiding the need for more expensive services down the line. </p>
<p>The only preventive care the young healthy people will get is going to be once-a-year physicals, vaccinations, and well-baby visits for their offspring. What else is there? My insurance will also pay for a mammogram once a year, but I don’t think they do that for anyone under age 40 (unless there are risk factors to justify it) – and I can also get a colonoscopy, but that one requires being age 50. I have to wait until age 65 before my insurance will spring for a bone density scan… and, um, I think maybe by then I’ll be on medicare.</p>
<p>Keep in mind that “preventive” care doesn’t mean everything that happens after you go into the doctor.</p>
<p>If the doctor finds something wrong that requires followup visits, then those are no longer “preventive” – they are visits subject to whatever copay the plan specifies. </p>
<p>But again, still a lot cheaper than providing the same services in the emergency room.</p>
<p>“The only preventive care the young healthy people will get is going to be once-a-year physicals, vaccinations, and well-baby visits for their offspring. What else is there?”</p>
<p>Well, I wouldn’t call this preventive care, but sometimes the simple visit to the doctor for a sinus infection can generate an entire battery of blood tests. Funny the things they’re willing to do when they know you’re insured. Lower income young people who are highly subsidized are not going to be a large financial benefit for these plans.</p>
But if you are on the private market, there is nothing better. If there were, there wouldn’t be a need for the exchanges in the first place. The main difference is that Obamacare eliminates a lot of plans with cut-rate benefits from the market – for example, a plan with low maximum payout.</p>
<p>Put it this way – when my d. was in college, her college health plan was quite inexpensive --but the maximum payout was $5000. It doesn’t take a rocket scientist to figure out that an insurance policy that won’t pay any expenses over $5000 is not good enough. The college offered the option of buying supplemental coverage – I opted instead to simply keep my daughter on an individual policy, but raise the deductible to $5000. (So her weak college policy would pay for the first $5000, and presumably after that the high deductible policy would kick in – of course all expenses had to be submitted through both insurers, first to the high deductible policy, then again to the college policy). </p>
<p>I think that Obama care will do away with those types of minimal coverage policies – my son is a graduate student at the Univ. of Washington, and I know that the cost of student insurance went up there, but the former low-ceiling on maximum benefits is also a thing of the past.</p>
<p>just chiming in to say I also have two adult kids, grads, who are remaining on my health insurance, in fact my plan keeps them on dental and vision as well. My s’s employer in another state, offers health insurance but he receives a credit ($60 mo) if he opts out, which he enjoys. as someone with congenital heart defects, I effectively had pre-existing condition since birth, so I am very grateful for ACA while recognizing limitations and frustrations. </p>
<p>sorry to hear about such large increases NYsmile and others, seems reasonable that you are reconsidering providing health insurance with no cost to your employees. </p>
<p>Another issue that is very distressing is that some states like Florida, are refusing to expand medicaid and refusing federal aid.</p>
<p>Last week, two health insurance coalitions that represent some of the nation’s largest corporations warned that the decision could cost the state thousands of jobs, punish businesses with millions in penalties and ultimately raise insurance premiums for employees across Florida.</p>
<p>Why not? What difference does it make to Kaiser or any other company whether the government or the policy holder is paying the premium? </p>
<p>I think you are missing the point that the subsidy= $$$ that the federal government pays the private insurance company. The more subsidized subscribers, the more $$$$. My guess it hat these private companies are going to be eager to compete to attract these subsidized young subscribers, because the insurance companies will like having all those extra federal $$$ flowing in. </p>
<p>“Subsidized” doesn’t mean that the insurance companies lose money. “Subsidized” means that federal money is paid to the companies.</p>
<p>Do you know what the private market was like before ACA in Washington? I do (my son lives in the state) – it was NOT good. The coverage on the “affordable” plans is really, truly, scary weak. Really – when my son was laid off from his job a couple of years ago I spent hours going over those plans with him. </p>
<p>You talk about outrageous prices but I really don’t think you understand what the market has been like. </p>
<p>Quite frankly, most people who earn $115K a year are getting coverage from their employers. If they are self-employed, then if they are close to a subsidy level, it’s not that hard to manipulate their income in order to keep themselves eligible – just invest a little more in the business each year, take on an extra part-time worker, whatever. (It’s just that most people who are self-employed probably would rather look at it the way I do: rather than reduce income in order to qualify for a subsidy, the self-employed like to think of ways to increase their income – raise their own rates, get more customers, whatever. )</p>
<p>Is it expensive? Yes. Is it more expensive than it would be without Obamacare? I don’t know – last year I got a rebate check from my insurance company, they said it was because of Obamacare. That looked like “less” expensive to me. (Though admittedly not much “less”) Every single year that I have had insurance the rates go up, so the planet on which there is no Obamacare but the private insurance market holds steady rates over time doesn’t exist.</p>
<p>Actuarially, that is incorrect (contrary to common wisdom). Preventive services result in a LOT of false positives which then turn into unnecessary medical procedures (for example, biopsies) and expenses, not to mention the unnecessary worry/stress while the additional procedures are ongoing. </p>
<p>Yes, plenty of anecdotes exist where a physical finds ‘something’ serious, and those individuals may "avoid the need for more expensive services down the line…’ but, collectively, preventive services are costly to society… :)</p>
<p>"Accepting the federal money would have cost the state nothing for the first three years, and only 10 percent of the expansion costs thereafter. It would have helped insure close to 1 million of the state’s most vulnerable residents and protected businesses from some of the financial penalties associated with the new law. It would have helped with the cost of providing billions in uncompensated care, a huge contributor to rising health-care costs.</p>
<p>Now that business coalitions representing companies that include Disney, Target and Wal-Mart have joined with industry associations and hospital operators in calling on the state to accept the federal money, Scott can frame the issue in economic terms."</p>
<ol>
<li> Well, that about says it all. Posters have declared medical care is fraught with pitfalls, from docs who arbitrarily order slews of expensive tests because, after all, the patient had insurance, to folks complaining they couldn’t get a procedure. Someone thinking they’re going to pay 20k for insurance, when the details aren’t even fully laid out yet.<br></li>
</ol>
<p>It freaking doesn’t make sense to diss preventative, assuming what a doc detects is garbage expense. You don’t want them to detect, say high cholesterol, because it will lead to periodic rechecks? No covered colonoscopy because they may detect something to be biopsied? Heavens, that speck may be benign. We could have avoided this…how?</p>
<p>So earlier I said my kid had an annual (preventative) that detected something. You bet they referred her for an echocardiogram. Just running up costs? You wanna play roulette, self-diagnose? Because it could be a false positive? It wasn’t. Yeah, it cost me one full week of worry. I feel an s-load better to learn the problem exists but is lower level than the doc was concerned about. No immediate follow-up needed. I did a lot of research to get my bearings. In my book, beats roulette.</p>
<p>Just exactly whom do some of you trust? Oh, the media.</p>
I think the idea of the exchanges kind of morphed from the idea of a “public option” – that is, if single payer wasn’t going to pass, then the next best thing was seen as a marketplace where every person would have the option to choose from a government-subsidized plan or a private plan – but of course the private insurers didn’t want to be competing against the government for customers --hence the idea to have the government subsidize the premiums. </p>
<p>If it doesn’t work, then we will go to a public system. Maybe not “single payer” – but a greatly expanded role for the government – because one way or another, someone has to pay for the cost of care of people who lack insurance and don’t have the means to pay on their own.</p>
<p>So we already owe $10,000 for our out-of-pocket part of our son’s psych hospital stay and other related care. Tonight my husband had to have surgery on his foot, because he dropped a knife on it and severed a tendon. Since he has a bleeding disorder, he had to be admitted to the hospital and receive recombinant Factor VIIa, a drug that is supposedly THE most expensive med in the hospital pharmacy. A few years ago, when he had to have part of his thyroid removed, it cost $23,000 per dose and he needed two doses. So now we will owe ANOTHER $10,000!! On top of a monthly insurance premium that is almost as much as the mortgage on our house/home office. I am trying not to hyperventilate, but it’s hard. I don’t know what we’re going to do.</p>
<p>The insurers do a risk benefit analysis in figuring out which preventive services to pay for, which includes consideration of the risk of false positives vs. benefit of early intervention. That’s why they won’t pay for a bone density test for me even though my doctor would like me to have one. (But they might next year if my doctor words things exactly right to make). </p>
<p>They won’t give my 25 year old daughter a mammogram. </p>
<p>But my 3 year old grandson has all of his vaccinations-- and when there is an epidemic of measles or whooping cough in his community because of all the unvaccinated kids… he won’t get sick. And if there are some kids who weren’t vaccinated because their moms couldn’t afford to take them in for routine doctor visits, then they get vaccinated, and the more vaccinated children, the less likely that outbreak of measles. So it’s a net cost savings.</p>
<p>Another big area where preventive care pays off big time is prenatal care. Preemies are really, really, really expensive. Pregnant women by definition are at risk for all manner of conditions that complicate the process of having babies. </p>
<p>I’d note that the availability of preventive care in policies doesn’t force people to use it. I have insurance and I just had a physical-- but it’s been 4 years since my last one. (oops… I just kind of forgot to schedule an appointment for all that time because I haven’t been sick). So I think healthy people who rarely go to the doctor will keep right on forgetting to schedule appointments unless something seems to be bugging them. </p>
<p>The real beneficiaries of the insurance emphasis on preventive care are those people with the nagging problem that they keep ignoring because it just hasn’t seemed important enough to justify the expense of a doctor visit … and that’s a risk factor that really should be checked out, even if every once in awhile it results in an biopsy that comes back benign.</p>
<p>MaineLonghorn – you are talking about your existing policy (“monthly insurance premium that is almost as much as the mortgage”), right? Because your son and husband sure sound like they have “pre-existing conditions” – and I don’t know if $10K is the maximum out-of-pocket from your current insurance plan – or if you are stuck paying $20K in one year for out-of-pocket? Because your policy under ACA may be about the same or it may be an improvement – but one thing for sure-- under ACA the insurance company can’t decide to drop you because the medical bills are too high. In the past they could.</p>
<p>Mainelonghorn, I’m so very sorry for all the expenses and stress you and your family are under. It does seem GROSSLY UNFAIR. I feel extremely fortunate to had Federal Employees Health Benefits (FEHB), which have a maximum out of pocket per person at $2500 plus medication co-pays or $7,500 for the family plus medication co-pays. It would be daunting indeed to think of having to come up with $20,000 or more for only one year of deductibles or co-pays and seems outrageously unfair, especially as you’re already paying a significant insurance premium.</p>
<p>We are fortunate that H’s insurance will be 66-75% funded by his employer for the rest of our lives. H did work over 45 years for the govt and it is one of the reasons we were happy S got a job with the federal government as well. He will get his own insurance when he turns 26, and it will also be an FEHB policy, but one available where he lives or a national policy.</p>