Affordable Care Act and Ramifications Discussion

Parent Cafe
681

<p>“the default is to throw every resource at the illness [More or less, depending; look into medical ethics.”</p>

<p>So the incentives on employer-based care were just the opposite. The idea was/is that it is a benefit to keep workers healthy and productive - whether that be through preventative care, or minor procedures, or care for the kids so that not too much energy is expended away from the workplace. But NOT catastrophic care. If there is a catastrophe that is going to eat away at the employer’s bottom line (through insurance), the incentive is to find ways to sever the employee as quickly as possible. I know of far too many cases where that has happened, and I am extremely grateful to labor unions who fought for years to make that much more difficult for employers to do that, whether the workplace is unionized or not.</p>

682

<p>Thank you, lf. :)</p>

683

<p>Another distortion that’s caused by our employment-based-insurance model is that it’s short-sighted as regards the employee’s health. As you point out, mini, employers see a clear benefit in paying for care that will keep employees on the job and productive. But paying for care that’s aimed at making sure the employee is still healthy 20 or 30 years down the road? Not so much.</p>

<p>When Nicorette was first introduced, lots of insurance plans wouldn’t pay for it. Employers didn’t demand it. The thought process was, “Why should we pay for coverage for this? Chances are the employee will no longer be working here by the time he/she develops lung cancer.” Good for the employer’s bottom line. Not so good for the employee, ultimately.</p>

684

<p>‘I know their long term MDs are treated well’… Hmmmm… “and get very generous pensions”, true, if you survive it.</p>

685

<p>I think we have to carefully distinguish between products, meds and services that become available, which we may want, and what’s proven to be effective, enough to make it feasible. There were many items and categories not approved for payment until some time passed and studies proved out. Acupuncture is still up in the air. PT has better coverage now than before. Chantrix is covered by some plans, not others. Is it that they’re trying to kill us? Or something else?</p>

<p>The employee will leave before lung cancer or the product isn’t shown to be so effective? Or this or that?</p>

<p>I lived in CA when there were many complaints abut HMOs, needing and not getting approvals for specialist visits, treatments, or limits that didn’t allow full treatment. I did not have that problem on my (non-HMO) plan- I got mammos (what are the chances I would develop breast cancer and still be employed there?) and etc.</p>

<p>And how do you say, on one hand, that docs are running up charges needlessly, including preventative, then complain the insurers don’t cover everything conceivable?</p>

686

<p>“When I was young, vaccines were free. As a child, I remember lining up for the polio vaccine and the rubella vaccine. No payment involved.” </p>

<p>"Well, can’t beat free. I thought my oldest son was the record. Born in a military hospital, only cost was $8 for a box lunch. "</p>

<p>Just because YOU didn’t pay for it doesn’t make it free!</p>

687

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<p>There is/there are and it doesn’t (as I keep pointing out). </p>

<p>From the Congressional Budget Office (2009), in response to a question on whether the preventive care in the ACA would result in savings:</p>

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688

<p>Exactly. Not to mention the fact that the EOL care is where the expense is, and it really doesn’t matter when that happens. This idea that somehow it will get less expensive if people make healthier choices is ludicrous. People die. They may die younger or older, but nobody costs more than patients with althzeimers and dementia, and the risk goes up with age exponentially after 60. </p>

<p>I wish they wouldn’t market this as a cost cutting measure. It’s not going to cut costs.</p>

<p>Can’t it just be that we want everyone to have access to health care? It will cost us money. End of sentences? </p>

<p>Why lie?</p>

689

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<p>I’m surprised by this. What’s accounting for this cost?</p>

690

<p>I’m listening, but what do you propose be done with Alzheimers patients?</p>

<p>Btw, my friend’s mom with A is 90-something. The place where she is, the need for assistants 7am-7pm, has cost her hundred of thousands of dollars of her own money, over 10+ years. For the right medical reasons, my friend took her off nearly all the meds (they contributed to swelling, lack of balance, falls, low bp, a sorts of unnecessary side effects) and decided against various suggested interventions- and there she is. I know you wouldn’t say, send her off to some warehouse where maybe she gets fed and taken to the bathroom. Or not. But that would be cheaper.</p>

<p>(That’s too anecdotal, sorry.)</p>

691

<p>[Animated</a> video illustrates ObamaCare enrollment - The Hill’s Healthwatch](<a href=“http://thehill.com/blogs/healthwatch/health-reform-implementation/311943-animated-video-illustrates-obamacare-enrollment?utm_campaign=hillhealthwatch&utm_source=twitterfeed&utm_medium=twitter]Animated”>http://thehill.com/blogs/healthwatch/health-reform-implementation/311943-animated-video-illustrates-obamacare-enrollment?utm_campaign=hillhealthwatch&utm_source=twitterfeed&utm_medium=twitter)</p>

<p>"The Kaiser Family Foundation, a nonprofit research group, released its seven-minute Web video Thursday. </p>

<p>The clip takes viewers on an easy-to-understand tour of the Affordable Care Act, including the law’s impact on employer-based health coverage, Medicare and Medicaid. "</p>

<p>[The</a> YouToons Get Ready for Obamacare - YouTube](<a href=“The YouToons Get Ready for Obamacare - YouTube”>The YouToons Get Ready for Obamacare - YouTube)</p>

692

<p>No, I don’t think it’s too anectdotal, at all, looking forward. I think that is where we are heading.</p>

<p>Look, if we all become the health police (we’ve made this the new puritanism and Americans LOVE puritanism in all of it’s shape shifting forms), we are going to still end up with the costs at the end of life.</p>

<p>I say, let’s lighten up on it a little. Live a little. Our health care costs are NOT out of line with the rest of the worlds, except as we age, get near death. So, we need to ease up on this a bit.</p>

<p>We are all going to die. This is not preventable. And I think this is the usual baby boomer belief that they can muscle their way through it and come out alive on the other end.</p>

<p>This baby boomer generation has had it’s way for it’s entire adult life. They are not going to live forever no matter how much they deny the rest of us our enjoyment of life.</p>

<p>The real, true, premise underlying this affordable health care is flawed. And it’s not going to make the boomers immortal. They should leave a little fun in the country for the rest of us.</p>

693

<p>Nodding. But health insurance doesn’t cover nursing home care. So while astronomical (approx $100k/year where I live), that cost isn’t relevant to a discussion about health insurance. </p>

<p>Are Alzheimer’s and dementia actually the most costly for insurance companies?</p>

694

<p>I hope you guys don’t mind – I’m going to go back to issues about the Exchange rates & “metal” plan comparisons – the practical, dollar issues raised earlier in this thread.</p>

<p>There were several posters pointing out that the “Bronze” plan, which pays only 60% of medical costs, seemed substandard.</p>

<p>So I did a little math. </p>

<p>I found out that in my age and rate category (for unsubsidized rates) – the differential in premium costs is higher than the differential in reimbursement rates. That is, when you pay the insurance company a higher premium for the “better” plan (with the lower copay) – you are paying MORE in premium dollars. </p>

<p>They key is to look at the annual maximum patient responsibility for each plan. That is the same for the Bronze/Silver/Gold - ($6350 individual, $12,700 family) - a little less for the Platinum Plan ($4000/$8000). I’m looking at the California booklet to get these numbers - <a href=“http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf[/url]”>http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf&lt;/a&gt; - I believe that these maximums are the same nationally.</p>

<p>Obviously a plan that limits your maximum family out-of-pocket to $8000 and pays 90% of all expenses (Platinum) seems like it would be a lot better than the plan with a a maximum $12,700 out of pocket & only paying 60% of expenses — but the problem is that the Platinum plan buyers will be paying more than the maximum $4700 differential in premium dollars. For example, a family of 4 with parents age 40 living in Marin county (area 2) - pays $774 monthly on the Anthem Bronze plan, $1444 on the Platinum. That’s +$670/month - or $8,040 per year, more than double the “savings” from the lower maximum out of pocket. So assuming that family hits their maximum out of payment level, the maximum annual health costs, including premiums, are under $22K for the bronze plan, but over $25K on the Silver. </p>

<p>I honestly think the “Affordable Care Act” should have been called the “Insurance Company Welfare Act” - because as far as I can tell, the private insurers make out like bandits. They’ve even got the federal government pimping the somewhat higher cost “Silver” plan for them in, when it is obvious that the consumer comes out best with the Bronze plan. </p>

<p>The math might be a little different for individuals and families who qualify for large subsidies – but that’s simply because the government is paying their premium for them. The insurance companies still come out ahead every time someone opts for a “Silver” or “Gold” plan rather than “Bronze.” </p>

<p>I’m sure there will be more nuances to explore once details of real insurance plans are released – for example, none of the information in the California brochure seems to contemplate any patient deductible. </p>

<p>But as I start doing the math, all of the confusion is kind of boiling down to something of a no-brainer for me: assuming I will not qualify for a subsidy, I’ll probably do best by going for whatever plan has the lowest premium. </p>

<p>This is pretty much the calculation I have been doing all along when choosing a deductible amount – I always looked at how much of the difference in deductible I was prepaying in premium dollars.</p>

695

<p>"I honestly think the “Affordable Care Act” should have been called the “Insurance Company Welfare Act” - because as far as I can tell, the private insurers make out like bandits. They’ve even got the federal government pimping the somewhat higher cost “Silver” plan for them in, when it is obvious that the consumer comes out best with the Bronze plan.’</p>

<p>That’s really what it sounded like to me to. Seems with all these new customers, insurance companies should be offering a massive group discount.</p>

<p>Interesting about the analysis on the bronze over silver plan. That does seem like an obvious choice for those who are paying it.</p>

696

<p>Back to the preventive care issue – I think there’s a public policy issue those of us who already have insurance and an established relationship with a doctor or medical center might be missing: At the lower end of the economic spectrum, individuals and families who are uninsured and can’t afford basic medical expenses are likely to get their medical care from emergency rooms or, at best, urgent care centers – even for the type of thing that might be handled with a phone call or a short visit to a primary care physician. </p>

<p>By getting everyone insured and offering free preventive care, it gets people to establish a relationship with a regular (lower cost) care provider. Once you’ve filled out all the paperwork and know where the doctor’s office is, it makes a lot more sense to call up Dr. Jones when the baby has an ear infection than go sit in the emergency room for 5 hours waiting to see whoever is on duty. To the insurance company that is a huge difference in billing rate. </p>

<p>But if you don’t have insurance or the ability to easily pay out of pocket for the routine stuff – you don’t even have or know a doctor you can call for the minor stuff. Many private medical practices won’t even see you or accept you as a patient if you don’t have insurance – plus there is the whole in-network, out-of-network issue. </p>

<p>So the benefit to the insurance company of giving you a free annual physical or free well baby checkups is simply that it gets you signed up with a primary physician, who in turn charges a lot less for urgent care or treating an acute or chronic illness than the local hospital.</p>

697

<p>The bronze plan is the way to go if you are healthy. </p>

<p>The bronze plan may be the way to go period, but it depends on whether you would get to the maximum costs in all the plans…</p>

<p>Edit… Actually… It would depend what your costs in addition to your premiums are.</p>

<p>The costs of treatment do vary in each plan. I admit I dont know the answer but I appreciate calmom using marin county in her example even if though I am not 40.</p>

<p>Calmom, I am going to try and get to your link later today.</p>

698

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<p>That’s not really something new with the ACA. It is the math I’ve been doing for years whenever purchasing insurance – it’s why I went to the HSA & high deductible years ago. I simply don’t have a reason to see a doctor regularly-- I can’t remember any time that I saw a doctor more than 3 times in a year since the birth of my younger daughter. So why pay extra in premium dollars for services I don’t use? </p>

<p>On the other hand, the insurance is needed to protect against a catastrophe – so the maximum dollar figure I can ever expect to pay out is important as well. The big difference with ACA is that it limits how high that maximum can be, and it prevents the insurance companies from capping benefits. So there is no longer some dirt-cheap insurance policy with small print that says that the maximum annual payout is $20K-something I always had to pay attention to before ACA – so on the high end of things, ACA really does benefit the consumer. </p>

<p>But yeah – for day to day costs, assuming no subsidy, then it’s probably better for most people to go with whatever plan is the cheapest from whichever insurance provider they are most comfortable with. I qualify that with a provider preference because I do think that some insurance companies are worse than others when it comes to customer service and processing & paying claims.</p>

699

<p>Have to go back and read 694 a fourth time, with my own numbers. But what strikes me (again) is how confused we all are, despite that we are 10 or 12 very savvy individuals. How precisely calmom had to work this out- and then each of us has slightly different factors. This is Hercules and the Hydra. Lob off one of the 7 heads and 7 more questions grow in its place. </p>

<p>Calmom, did you run into the fact that under a certain income level, there is no mandate for individual insurance? Or undocumented folks. And, if costs exceed x% of income (I see 8%-?) (after subs, if they apply,) you aren’t mandated. Huh? So a 100k family that happens to not be covered by the employer, isn’t mandated if costs exceed 10k or 835/mo? Hope I am wrong. I kept going back, trying to clarify with no success.</p>

<p>Hoping someone can explain that.
I’m still in favor of clinics. And still trying to find a parallel example that helps this make sense.</p>

<p>edited</p>

700

<p>Calmom, I dont disagree about looking at maximum costs. </p>

<p>I have done the same and I use high deductible plans. </p>

<p>My brother in law said he was going to buy the platinum plan because my sister is disabled and he uses a lot of healthcare.</p>

<p>So… What you wrote is very interesting to me.</p>