Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
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<p>^cpt, I’m with you on that.</p>

<p>And should clarify this Michigan phenom re subsidy and Medicaid per

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<p>They WILL write it, it just WON’T be subsidized! In Medicaid-expansion states you are only eligible for subsidy if you earn 138% of FPL! If Romani runs the Kaiser Calc and uses Mi or any expansion state, she will see that at 12k she is not eligible for subsidy because she is eligible for Medicaid.</p>

<p>Think about it…it’s just like having insurance from an employer…which also makes one in eligible for subsidy. The rationale holds that if you’re eligible for other coverage that is not more than 9% of income, the gov does not want to subsidize. I’ve gotten this confirmed 3 times now and will try once more today when I see my agent.</p>

<p>Also, someone asked I think about reduced copay, deductible and cost sharing on the exchange. Here’s an example…I’ve read this policy to get a handle for mcson and employee, the actual summary provided by BCBS, to understand whether I could give the latter the “same” level of coverage:</p>

<p>At 138-150% FPL, its a 94 plan, which means they pay 6 percent of ded and OOP, with 90/10 splits.</p>

<p>The “87” plan (150%-200%) means they pay roughly 13% of deductible (in this case 600 for family with 2800 OOP max).</p>

<p>The 73 plan likewise covers the next tier with roughly 27% portion of deductible and OOP max.</p>

<p>That’s where a tiny employer group like mine would be kinda cruel to keep group with a hefty deductible and 9k OOP max…if it were possible for employees to qualify for an 87 or 73 plan where the worst an employee could face would be 2800 OOP and a 600 deductible.</p>

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<p>I like cpt and kmcmom13’s posts.</p>

<p>"They WILL write it, it just WON’T be subsidized! In Medicaid-expansion states you are only eligible for subsidy if you earn 138% of FPL! If Romani runs the Kaiser Calc and uses Mi or any expansion state, she will see that at 12k she is not eligible for subsidy because she is eligible for Medicaid.</p>

<p>Think about it…it’s just like having insurance from an employer…which also makes one in eligible for subsidy. The rationale holds that if you’re eligible for other coverage that is not more than 9% of income, the gov does not want to subsidize. I’ve gotten this confirmed 3 times now and will try once more today when I see my agent."</p>

<p>Ok… But, medicaid is a subsidy and the subsidy with an exchange is a subsidy so we are talking subsidy or subsidy. </p>

<p>Does the govt prefer people go on medicaid rather than people sign up on exchanges and receive other subsidies? I guess that is the net effect but why is this preferable? Because payments to those in the medical profession are less under medicaid?</p>

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<p>Well, since Medicaid is for the poor it would be a little odd for the government to prefer most people end up in that situation. But it does seem to be where this is headed. Isn’t Medicaid for all basically single-payer?</p>

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<p>Medicare for all would be single payer. The ability to buy supplemental policies to Medicare is private insurance.</p>

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<p>cpt, anyone can find anecdotal examples of how they were irreparably harmed by the present system. Guess what, there will be plenty of people equally abused by ACA. If you have to pay $15 to $20 thousand before coverage kicks in, I can already hear the sob stories of despair and desperation of people who can’t afford health care. Also, when life-saving drugs and treatments are denied for people with cancer and other catastrophic diseases because insurance companies need to figure out some way to pay for all the unhealthy people signing up for medicaid and subsidized insurance on the exchanges, I am sure there will be plenty of unhappy people. </p>

<p>As I have said earlier in the thread I wish we could have an ACA system or even a single payer system for the people who want it and a consumer driven, regulated free market system for everyone else who rather take responsibility for their healthcare. It seems unreasonable to impose a solution on 1/2 of the country by the other half, and that goes either way.</p>

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<p>Are you sure about that? In this thread, the invaluable Calmom has repeatedly stated that in expansion states, people from 100-138% of poverty can choose either Medicaid or subsidies. Google is indeed my friend, but a quick Google search didn’t help me find who is right about this. My money is on Calmom.</p>

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<p>We have never really tried a consumer driven system, where transparency and choice are the driving forces. First, you could have insurance sold across state lines and give consumers far more choice than they have today. Second, there should be no mandated benefits. The consumer can decide what they want covered and, yes, there will be people who make unwise choices, but you can’t outlaw all ill-advised decisions some people will always make.</p>

<p>I do think there is a role for govt. I would make it a law that all prices for insurance and medical care are clear, transparent and easily disseminated to the public. I would also like to see uniform quality measures easily accessible for the public to peruse. This would allow people to make informed choices and give them the tools to compare and contrast health care providers. </p>

<p>I would be in favor of subsidizing people who have preexisting conditions and low income that aren’t insurable by creating high risk pools to take care of them. I don’t think we should try to include them in the same system with everyone else if they are going to raise insurance premiums to unaffordable levels.</p>

<p>You can’t say the system I am proposing won’t work because it has never been tried. Will it be perfect or solve all our problems: definitely not. But this is a clear example of not allowing the perfect to be the enemy of the good. In trying to ensure an utopian system where everyone has equal access to health care, you end up creating a system where very few are receiving high quality, responsive care.</p>

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<p>Agree that one can find anecdotal evidence for anything, but some anecdotes cover a wide spread. What one has to examine is who are the people who say they are being reamed by the costs of ACA vs those who could not afford health care before? Yes, I would be very unhappy to have pay a lot more in premiums; it would upset me greatly, but, at my income, it should be doable. For someone earhing a very low income, those high premiums are impossible. To expect $6K a year minimum in health care premiums for someone earning $16K a year, is not reasonable. You think someone earning that amount can come up with an additional $500 a month commitment?</p>

<p>But someone making $100k, who has to come up with another $6K a year., that’s a whole other story. Not saying, it’s pleasant, that they aren’t going to scream bloody murder, that it’s not going to hurt, and other things will have to be dropped, maybe they are living in a place too expensive, but it’s not at all the same thing. There are also many, many people happily paying for truly inadequate insurance, not knowing that any catastrophe, which is what insurance is supposed to cover isn’t going to be covered much at all. The true cost of insurance coverage is a big shock for many of them and they will say they don’t want to pay for it because the cost is too high. Well, the problem is that some of them will need it , not have it and then the rest of us have to pay for it or they don’t get the medical care. </p>

<p>I’ve been about as thrilled with our health insurance and having to deal with them as I am in getting a colonoscopy and DRE. But both are necessary in the event of certain events. </p>

<p>This was the best that could be eked out and it barely made it and is getting hammered every single day. Count up all the attempt to kill it. So, it’s our new starting point, and as we go forward it needs to be tempered. </p>

<p>I wish the same thing you do. But it could not happen. THis is one small step towards it. The problem is that it is unconscionable to not treat people who are in a life threatening situation and chose not to have insurance. Throw children in the picture and it just can’t be done in a first world society like ours. Just like we can’t let old folks who choose not to save their money just die. So we have social security and we need health care. ACA hopefull will force, yes, force more people to put money in the pot for health care they might need in the future, and what money isn’t used goes to those who do need it. Simplistic, I know and not the way it works but the general idea. It’s not going to cover it all, but hopefully fill in a gap that has been growing.</p>

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<p>But someone making $100k, who has to come up with another $6K a year., that’s a whole other story. Not saying, it’s pleasant, that they aren’t going to scream bloody murder, that it’s not going to hurt, and other things will have to be dropped, maybe they are living in a place too expensive, but it’s not at all the same thing.</p>

<p>Wow, that’s offensive! Someone making that amount of money with two kids in college living in a decent neighborhood may have no more disposable income than a your 16K earner in subsidized housing with a SNAP card. Should they move to a rental and suggest the kids drop out of school? Would that be better for society? Good grief.</p>

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<p>cptofthehouse, It looks like you’re new to this thread. So you might not realize that when you are talking about theoretical people who might possibly have to pay more for their health insurance under the ACA, you’re talking here to people for whom this is not a theory. A number of our posters are in this unfortunate group.</p>

<p>And that makes sense, if you think about the math. In our age group, the age group of parents of college students, a lot of people who applied for private insurance were denied. The Kaiser Foundation says that in the 60-64 age group, 29% of applicants were denied. So the insurance companies were doing a good job of cherrypicking healthy people, and offering them healthy-people rates.</p>

<p>But now, people in our age group who want private insurance have to pay regular-people rates, because the healthy among us have to cover the sick people’s costs. Inevitably, that means the healthy have to pay more. Who can blame Goldenpooch and poetgrl from blanching when they see multi-thousand dollar increases in premiums, for insurance that is at the least no better, and maybe worse?</p>

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<p>KMC, according to the calculator on BCBS of Michigan’s OWN website, I qualify for a subsidy at 104% (12k). I don’t get a Medicaid alert until after I fall below 100%.</p>

<p>ETA: I’ve looked at a few other insurance sites in MI that do the same thing as the BCBS website. I’ll go with one of them if I have to.</p>

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<p>CF, I am new to the thread only because I did not join the discussion until I had numbers and the reality. Yes, I am aware that the cost going up is a reality and a crisis. Very much so. But, yes, those for whom it goes up tend to have more income to manage it, vs those who were not able to pay at all. Who the heck can argue that if a $6K increase for a person has to be levied, it should go toward someone who has a better chance of paying for it. Can’t squeeze water out of a stone. </p>

<p>I’ve lived having to come up with 1/3 our income in a year to manage a medical catastrophe. Begged, borrowed, and took charity from family and community as well as brought the budget down to rock bottom. Some parents in our same boat lost their homes, sold their homes. When the piper’s got your kid, you pay him, none of the complaining and negotiating you get up front, you are more than glad to pay. So, yes, I even know how it feels when you have to come up with money for medical expenses when you don’t have it. </p>

<p>I can guarantee you that the vast, vast majority of time, the $16K a year person is not going to have more fat to cut than the $100K one. I know a bunch of them, some with families even and not a life one would want to swap for. If it’s that much better to earn $16K over $100k, that can be arranged very easily. No takers for that. Not so easy to swap $16 for $100K. There’d be a lot of takers for that one.</p>

<p>Believe me, I don’t like this one bit The real trouble is yet to come in the use of the new insurances and getting care. I was happy as can be in my world where I knew what was what in terms of medical THis change upsets a lot of things. If it also jacked up costs enormously, it would be even more traumatic, but not like when we did have a medical catastrophe. Never like that. That gutted me in a way that would make these consequences a scratch.</p>

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<p>**Moderator’s Note</p>

<p>This is not a forum to fight for a brand new system that pleases someone. It is only to discuss what is available and what is changing for people at the moment.</p>

<p>**</p>

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<p>An article in today’s Washington Post indicating that healthcare.gov will not be working by end of November. For people who need to be insured on Jan 1, this is not good.</p>

<p>[Troubled</a> HealthCare.gov unlikely to work fully by end of November, as White House vowed - The Washington Post](<a href=“http://www.washingtonpost.com/national/health-science/troubled-healthcaregov-unlikely-to-work-fully-by-end-of-november-as-white-house-vowed/2013/11/12/daf9670a-4bca-11e3-be6b-d3d28122e6d4_story.html]Troubled”>http://www.washingtonpost.com/national/health-science/troubled-healthcaregov-unlikely-to-work-fully-by-end-of-november-as-white-house-vowed/2013/11/12/daf9670a-4bca-11e3-be6b-d3d28122e6d4_story.html)</p>

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<p>This is from Kaiser. I’m not saying it hasn’t or won’t change. I am saying that as of TODAY, a registered MI BCBS agent assures me my son will not be eligible for subsidy unless he earned in excess of 138 BECAUSE we’re a state with expanded medicaid. That’s all I can tell you. You don’t have to believe me :wink:
Or him – because hey, not really sure any of em have the full facts ;)</p>

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<p>Article date: Oct 23, 2013
Source: [The</a> Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/]The”>How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? | KFF)</p>

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<p>The IT experts here have predicted dotgov not being ready in the last page of posts. It worries me that 5 people I have never met agreed on this before newspapers know about it.</p>

<p>What was the Medicaid limit before ACA expansion?</p>

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<p>Texas, there are people who knew about and predicted all of this but no-one listened. Newspaper reporters these days are not very enterprising. That’s my field and I could go on, but I won’t. Anyway, I’m now hearing that a fix is on the way by Friday. We’ll see.</p>

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<p>Fix for what?</p>

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<p>Absent official word, the former gets into speculation, does it not? :)</p>

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<p>I think there is official word from a White House press conference this morning. But I do not have time to look for a link, right now.</p>