<p>“In 2009, a quarter of all health spending went to treat 1% of people, who each had medical costs of over $50K that year.”</p>
<p>Move that back to 2007, and I did, AND my wife did. And we were ages 57 and 50 respectively. In my wife’s case, the kind of health insurance she had actually determined her course of treatment - we were told that point blank by her cancer doc, who is also a friend. </p>
<p>As for me, I was dead, so there would have been great savings to the health care system had I not received treatment. My absence might have improved College Confidential, too. Who knows? :)</p>
<p>Had an interesting discussion with D…she brought up some of the stuff she and her friends are discussing regarding the effect of ACA on their personal (college student) lives. Frankly, she brought up a couple of concerns that had never crossed my mind. I was wondering if anyone here knows for sure when it comes to the following;</p>
<ol>
<li> As of January 1, 2014 everyone is required by law to purchase health insurance.</li>
<li> One of the most services most frequented by college students is PPH (or other ‘free’ type clinics)</li>
<li> Up until now, these clinics have had a sliding fee scale. They will ask the patient for their current insurance info and bill accordingly. Or provide free services.</li>
<li> It is not uncommon for students to not give insurance info if they are on their parents’ policy and wish to keep this type of visit private. (Yes, I know HIPAA protects their privacy, but the policy holder will receive the subsequent bill and thus know what’s up.)</li>
<li> Currently if a student is uninsured many services and prescriptions at this type of facility is free. What happens January 1, 2014?</li>
</ol>
<p>Will a client of PPH be required to show proof of insurance ( as required by law)? What if they don’t have insurance (let’s face it , most college kids leave this up to their parents to manage and deal with). What happens? Actually, how many young adults in this phase of life will have the initiative to figure out the stuff that’s caused #1440+ comments amongst those most in the know? Can PPH still give out ‘free’ BC pills? What happens to ‘free’ clinics now that everyone has health insurance. Since the ability to pay is now normalized through premium subsidies…will the clinics charge a UCR? Most clinics are not ‘in-network’.</p>
<p>Yes, student health insurance and student health services provide some of this type of coverage BUT…they may not offer the type of prescription, or in the case of D…it can take 2 months for this type of appointment. </p>
<p>Another item under discussion relates to the mobility of college students. If the parents pay for coverage in State A where parents reside, but student attends college in State B…an HMO( and probably EPO) plan will be useless (for anything not covered by student health services). Will the student be required to carry insurance valid in the state where they are attending college.</p>
<p>How many of the current existing college health insurance plans will be ACA compliant? If they are not compliant…will the costs remain affordable…especially is OOS student needs to purchase a plan even if ‘covered’ under parents.</p>
<p>Frankly, I was very impressed that D and her ilk were considering the ramifications. And, like all of us…they are confused.</p>
<p>I have not heard that providers will require proof of insurance: you’re required to have insurance, not to use insurance. In any case, some people are not required to have insurance: non-citizens and people for whom it would be too much of a financial hardship (this hardship is specifically defined in the law) do not have to have insurance. People who are below the poverty line, but who live in states where Medicaid is not being expanded, are not required to have insurance, for example, because they can’t afford it.</p>
<p>If providers can’t ask for proof of insurance what good is the whole will they require cash up front? What good is the whole thing if the one providing the service still doesn’t know who will pay?</p>
<p>College students are usually required to have insurance by their school, unless they can prove they are covered under some other (parents’) plan. PPH probably knows this but they may not know whether their patients are students or not. Therefore, college students should be treated no differently than anyone else - although I wonder too whether they will be asked to show proof of insurance or what PPH will do.</p>
<p>It’s legal to pay cash for medical services. The provider can ask for some proof that the services about to be provided will be paid for, but a credit card or cash presumably is adequate for clinic visits.</p>
<p>I think it would be a problem for students to be paying cash or charging. Basic charges for some visits seem to run to 150 or 200 dollars unless they have a flat cash rate vs an insurance one.</p>
<p>So the cheap student health plans mentioned earlier in the thread, that had ridiculously low caps, would be noncompliant. And plans would be noncompliant if they had any lifetime caps on “essential health benefits” at all. Annual caps are grandfathered in for policy years starting before Jan. 2014.</p>
<p>Bladder cancer is a funny one because, caught early, it’s considered treatable. The form I know of is also considered very slow growing, at first. LasMa, you’d need specifics- and I know you do try to be on top of all that.</p>
<p>I wanted to comment on this: “If you are among the 50% who have no health care costs in a particular year-” (Re: 1430 high deductible with self pay up to a limit.)</p>
<p>That’s only good in hindsight. I was one of those who had maybe three visits- annual, gyn and maybe some illness. Until. No one could have predicted that. A high deductible based on prior experience would have been horrible. I was 40. After that, it was back to the maybe 3 visits. </p>
<p>Very interesting to listen in on the recent conversation, btw.</p>
<p>lookingforward, it is treatable. He’s had the BCG treatment 8 or 10 times (I think that’s what it’s called, where they surgically remove the tumors and then for 6 weeks insert bacteria into the bladder). That kills it, but it always comes back. </p>
<p>The surgeon has offered us that option again, but in the past it’s been no picnic. Last time, they had trouble bringing him out from under the anesthesia, and he’s sometimes had to go to ER for post-surgical bleeding, and always develops a urinary infection from the treatments. And his baseline today is lower than it was the last time he had it done in February, so while he’d likely survive the treatment, it would probably be even harder on him. And then we’ll be back at this same point in 6 months. </p>
<p>I talked to the surgeon again today and he’s not very high on bladder removal either, because of the fairly significant risks of the surgery and post-surgical complications. I’m going to take Fang’s advice and talk to Dad’s primary, who’s pretty good at looking at the big picture and can maybe help us think about quality of life issues, instead of just aggressively attacking the presenting problem without regard to context.</p>
<p>End of highjack. Further developments may be found on the Parents Caring for Parents thread.</p>
<p>When I said “If you are among the 50% who have no health care costs in a particular year…” I meant that by encouraging high deductibles, you might intend for people to shop for health care considering its price, and you might think cost-conscious consumers would tend to bring prices down. But a person who has no health care costs will not be shopping; downward pressure on health care prices will not be supplied by them.</p>
<p>And if a person has very high health costs, and know that they will, they won’t supply downward pressure either. If you have a $10K deductible, and you expect your costs to be $30K, you have no incentive to try to get below your deductible, because you know you can’t.</p>
<p>I think that we need to be clear when we use terms like “high deductible.” My current individual plan has a $3500 deductible, $5000 maximum out of pocket per year. This is considered “high deductible” to qualify for an HSA. I did a little bit of math and figured out that this is actually better than what I would get with any metal plan lower than Platinum, as they have a higher out-of-pocket limit. </p>
<p>I know that the HSA regulations never allowed anything like a $10K deductible for individual, although originally I had an HSA with a $5000/deductible. (I switched to the $3500 later on because of an advantageous premium structure). Given the ACA restrictions on annual out-of-pocket, I think that’s also going to be the upper limit on any deductible.</p>
<p>So the high deductible vs. low deductible is probably only an issue going forward for those with chronic conditions that will leave them with expenses of significantly under $20K per year, depending on how co-payments after the deductible are structured. Obviously that’s still a big chunk of money, but as I understand ACA, a person will also be able to change plans during the annual enrollment period. So if you are the type who never goes to the doctor and opt for the highest deductible, lowest premium bronze plan that you can find – and then that’s the year you get an illness that costs $50K in medical bills, with an expectation of $35K+ per year for meds and followup thereafter – then in year one you hit your maximum outlay of $6250 (or whatever the precise amount is) – and then when October rolls around, you sign up for the Platinum plan (higher premiums, but lower annual out-of-pocket). </p>
<p>I do think that based on my experience with $3500-$5000 deductibles, as a low-end consumer of health care, that it definitely does encourage me to shop around. I mean, if one clinic charges $800 for a service available at another for $300, and either way I know that I’m paying the full amount, I’m going to to go for the $300 (assuming that it is at a facility that I consider to be appropriate and adequate).</p>
<p>I actually had this happen a few weeks ago – my primary physician sent me out for routine blood work. She told me that I could go the local hospital or Quest Diagnostics to get the work done, but Quest would charge less. Obviously I went to Quest. </p>
<p>Obviously at this level it is small change – but I think that every year my shopping around saves a lot more than the $64 per person that has busdriver’s employer so worried. ;)</p>
<p>Hey, they aren’t a bit worried, calmom, they’re just passing it on to the employees…particularly those with chronic or expensive conditions. Bummer for those people.</p>
<p>Actually, Busdriver, I was using the $64 to draw an analogy, related to the issue of whether there would be cost savings from consumers with high deductibles shopping around. I think Cardinal Fang’s point was that the high end users don’t have any incentive to shop around, given that they are going to hit their deductibles no matter what – and that the low end users don’t spend that much to make a difference.</p>
<p>My point was that the small change that we low end users save – $50 here, $100 there, etc. – has a cumulative impact. If you can do the math to turn a $64 fee into millions at a single company, then the math involved across the marketplace of all low end consumers of health care is also going to turn out to be millions.</p>
<p>I agree with what you say, calmom: individual businesses like Walgreens can make millions by providing low-cost preventative services.</p>
<p>But I was thinking about how such services would impact the total health spending in the US, and to a first approximation, they wouldn’t. The total US health care spending in 2010 was 2.6 TRILLION dollars. Savings of a few million is pencil dust.</p>
<p>Another useful tidbit when thinking about health care costs: on average the US spent about $8400 per person per year on health care in 2010. For the age group a lot of us are in, 45-65 years, the average was about $5500, and for the age group of our parents, 65+, the average was almost $10,000.</p>
<p>I wish that there would be a rule – like the one imposed on airlines – that prices be explicitly disclosed up front, and that for areas like lab fees & imaging that the prices were bundled all-in. </p>
<p>A few years ago I had a bad fall and my ankle swelled way the heck up, and after a couple of days of not being able to walk on it (and following RICE) I went to urgent care. Where the visit with the urgent care doc was about $125. And the x-ray that they insisted on (2 views) came to more than $700 because the x-ray machine happened to be owned by the hospital across the street, and the radiologist (who was not involved in my care and who read the x-ray long after I’d left urgent care) also charged. Apparently you’re not allowed to have an x-ray without having a radiologist examine it, even though the doctor who looked at the film while I was in urgent care said as soon as she saw it that there wasn’t a break. But was there any way for me to find out these charges ahead of time? Nope.</p>
<p>I can’t think of another service where I find out only long after I’ve purchased it what the price is. Sometimes more than a year later. </p>
<p>I like my high deductible healthcare plan, but I don’t like how – despite a fair amount of effort on my part – it is very, very difficult to have any understanding of what things cost. My insurer’s website has some numbers, but they’re missing way more than they have, and they often fail to take into account that those of use with high deductible plans aren’t paying copays. </p>
<p>I don’t know if the ACA will provide some help with this. I keep hoping. I shop for almost everything else we purchase; rather ridiculous that such a big item as healthcare is the one area where shopping is pretty much impractical.</p>
Further developments may be found on the Parents Caring for Parents thread.</p>