<p>Actingmt, it’s conventional to put quotes in a quote box, or at least put quote marks around them, so we know what you wrote yourself and what you’re quoting.</p>
<p>
Busdriver, I think that you are in a different risk pool than the non-union employees. I also think that the number you are seeing on the W2 reflects out-of-pocket costs for the past year, so you would probably need to see numbers from several years to get a sense of what average costs were. Maybe the company just had a better than usual year in for the union employees in 2012.</p>
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</p>
<p>Obviously employers save money by self-insuring, otherwise they wouldn’t do it. By going the self-insurance route, they can better control administrative overhead and cut out the middleman’s profits. But my guess is that represents maybe a 10% or so cost savings, not 50%.</p>
<p>I think the biggest reason your self-insuring employer has lower health care costs than the general population is probably the risk pool. A company that employs mostly younger, healthier workers is going to have low health insurance costs per employee. </p>
<p>What kind of company would that be? Well, one that had recently undergone a large expansion of its workforce would probably hire a lot of younger, healthier people. An expanding company in which a large number of jobs required relatively low skills but some physical strength and stamina might tend to hire a large number of younger, stronger, more athletic, and more physically fit workers. A company that required a lot of shift work in the evenings and at night might tend to attract more younger workers, less tied down by conventional family obligations. Also, perhaps, more single workers, so that offering family coverage is less costly because its workforce has a higher percentage of single-person households. </p>
<p>In short, a company like UPS or FedEx would probably tend to have a much younger, healthier, and more single workforce than the general population, and consequently its cost of providing health care to its workforce would tend to be much lower than that for other employers, and much, much lower than for the population at large.</p>
<p>Here is the bottom line:</p>
<p>Paying $13,320 a year for a plan that has a $5,000 deductible and a $6,350 out of pocket maximum with none of my doctors in the network. Under this crappy ACA plan I have to pay the first $18,320 (except for a wellness visit) before the insurance company pays a nickel for doctors I do not want to see.</p>
<p>I don’t care what any of the ACA apologists say in this thread, this plan s*cks.</p>
<p>PS. Actually, it is even worse. If you include my wife, we have to pay $23,320 before the coverage kicks in.</p>
<p>Buy a gold plan instead (no deductible).</p>
<p>You are playing games with the math, adding your premium to your deductible. $13,320 premium dollars per year for 2 people equates to $555 per person, per month – which is about $30 less than my premium would be at age 60 under my current plan (but that premium would go up to $645 based on the pending rate increase).</p>
<p>So basically, you are kvetching endlessly about paying a lot less for insurance than I would be paying with or without Obama care. The main difference is that we have established through other posts that you earn a lot more than I do (I’m guessing at least twice as much).</p>
<p>My son worked as an EMT this summer which is why he was under the impression that going to the emergency room for small stuff was the norm. He rode in the ambulance that drove people there for cuts, fevers, and panic attacks. When I told him that those trips came with four-figure bills he refused to believe it. He knows now. So, I don’t think it’s a huge stretch to say most folks who are using the ER for routine medical care are not planning to pay the bill and that drives up the cost for everyone else. It’s expensive because they have staff and equipment there makes no sense. Of course, they do. When my H had a true emergency the cost of going to the ER or waiting till morning was a real issue. Even with health insurance this stuff isn’t free unless you have an unusually generous policy.</p>
<p>I don’t really understand why people are bickering about this.</p>
<p>" Emergency rooms typically treat everyone, regardless of ability to pay at the time of the visit. People know this and they use it to their advantage."</p>
<p>They typically (and are required by law to) treat the emergent condition, but not the underlying cause. If a person has fainting spells linked to cancer, they treat the fainting spells, but not the cancer. If a person breaks a bone because of osteoporosis, they set the broken bone, etc., etc., It’s a myth that many people use the ER for routine medical care - most hospitals will not provide routine medical care (though I do know several hospitals that have set up clinics next to the hospital for this purpose - because they can be a profit center.) People DO go to the ER for routine care…but they usually don’t get it. (But they are diagnosed - at huge expense - before not getting it.)</p>
<p>In our state, we have a pilot project of Medicaid-linked health centers open from 5 p.m. - 10 p.m. - when working people can actually get there.</p>
<p>Sometimes, hospitals will work to admit people to the hospital who do not need it - even if they can’t pay. This may sound counterintuitive. But hospitals, through something called the “certificate of need” process, have to demonstrate the need for a certain number of beds within a community. A hospital system that is trying to expand has to convince state regulators that it is filling an unmet need. So it is best to take a loss on a certain number of low-need, no-pay patients in order to expand the number of high-pay, low-need patients they can attract. There are professionals in each large hospital system that have this down to a science.</p>
<p>Nope, I don’t think I’m in that risk pool, bclintock. If I am in the risk pool calmom surmises (union vs non-union), which makes sense…I’m not grouped with a bunch of young, healthy, single people. I’m grouped with people averaging an age in their mid fifties, not a spectacularly healthy group, mostly married, and many over age sixty. We should be really costly, unless it is that when we get very sick we die, instead of requiring lengthy, expensive medical care. There’s something I’m not seeing.</p>
<p>I find this interesting…
[Emergency</a> Room Cost - Hospital Overcharging, ER Bill Lawsuit](<a href=“Emergency Room Overcharges Lawsuit News & Legal Information”>Emergency Room Overcharges Lawsuit News & Legal Information)</p>
<p>GP and Calmom could spin this same issue endlessly, but what gets a lot of folks is that we will be required to shell out what could be the cost of a new car, each year - and still not get what we had before. </p>
<p>Yes, I get how the coverage for everyone might be “richer” with benefits.</p>
<p>I also get how the cost has to be spread over all the population to make the math “work”.</p>
<p>I get how “lucky” some are to have “better” coverage for “cheaper” for years. </p>
<p>The idea, for many, is hard to take that we all have to buy an insurance product on the free market that has so many regulations and that is not underwritten based on age or gender or even need, that may just be our biggest individual or family expense each month. </p>
<p>If you wanted to buy a Honda, but I wanted to buy a Ferrari, we wouldn’t buy the “same” underwritten coverage, would be?</p>
<p>No. The risk pools would be different, based on age and experience and even, zip code. We wouldn’t have to purchase coverage with every bell and whistle. </p>
<p>So yeah, everyone will either suck it up and figure out a way to purchase insurance or hope they get a job with coverage or pay the penalty - but the system will still have uninsureds out there. And people who cannot afford coverage. </p>
<p>There will still be folks who cannot or will not purchase, or millions kicked off policies who our President has now said they do not have to be and now it is up to insurance commissioners in each state, and big insurers figuring out how to revamp this program. </p>
<p>The real winners will be the insurance companies. If I had money, I would invest heavily in buying healthcare stocks. Because they are going to clean up in the coming years. </p>
<p>And that economy thing? It will continue to putter along for the unforeseeable future, with companies still unsure of healthcare costs for possibly years to come. </p>
<p>Seriously, you can’t make this stuff up.</p>
<p>“Nope, I don’t think I’m in that risk pool, bclintock. If I am in the risk pool calmom surmises (union vs non-union), which makes sense.”</p>
<p>Maybe it’s simply the difference between the size of the two groups? Usually management is a significantly smaller number of people than the union employees.</p>
<p>Flossy, what I was disputing was not emergency department charges for routine care, but emergency department charges in total. I didn’t think that the majority of all emergency room care was uncompensated.</p>
<p>But it turns out I was wrong.</p>
<p>[American</a> College of Emergency Physicians | News Room - Fact Sheets](<a href=“http://newsroom.acep.org/index.php?s=20301&item=29928]American”>http://newsroom.acep.org/index.php?s=20301&item=29928)</p>
<p>
</p>
<p>Here’s the actual abstract of the relevant article.
[Decreasing</a> reimbursements for outpatient emerg… [Ann Emerg Med. 2008] - PubMed - NCBI](<a href=“Decreasing reimbursements for outpatient emergency department visits across payer groups from 1996 to 2004 - PubMed”>Decreasing reimbursements for outpatient emergency department visits across payer groups from 1996 to 2004 - PubMed)</p>
<p>I can’t get the actual article, so I can’t tell to what extent the study took into account sticker price versus the price paid by insurers, Medicaid and Medicare. That is, suppose the emergency department had two visitors who had the sniffles, me and an uninsured person. The hospital bills $1000 for sniffles-related emergency department visits. My insurer pays the negotiated price for sniffles, $500. The other person pays nothing. Does that count as $1500 of uncompensated care or $1000 of uncompensated care? More logically it should count as $500 of uncompensated care.</p>
<p>But we can agree there is a lot of uncompensated care in emergency departments, anyway.</p>
<p>Yes, but think of it as a “loss-leader”. Hospitals will often happily operate an ER at a paper (though not real) loss in order to fill up hospital beds (at spectacular profit).</p>
<p>“Maybe it’s simply the difference between the size of the two groups? Usually management is a significantly smaller number of people than the union employees.”</p>
<p>Perhaps size does make a difference. But it seems to me that the smaller, older, sicker group would cost more. It’s probably all accounting magic, and I wish I knew someone in that area who could explain it.</p>
<p>[Anthem</a> Blue Cross, WellPoint (WLP) Unit, Sued For Allegedly Tricking Tens Of Thousands Into Dropping ‘Grandfathered’ Health Plans](<a href=“http://www.ibtimes.com/anthem-blue-cross-wellpoint-wlp-unit-sued-allegedly-tricking-tens-thousands-dropping-grandfathered]Anthem”>Anthem Blue Cross, WellPoint (WLP) Unit, Sued For Allegedly Tricking Tens Of Thousands Into Dropping 'Grandfathered' Health Plans)</p>
<p>"Since March 23, 2010, “Blue Cross successfully enticed tens of thousands of its individual policyholders to switch out of their grandfathered health plans and forever lose their protected grandfathered status,” the lawsuits state. “Blue Cross concealed information about the consequences of switching plans and intentionally misled its policyholders to encourage the replacement of grandfathered policies.” </p>
<p>The plaintiffs says that Anthem played up the possibility, even likelihood, that premiums of grandfathered plans could go up sharply and failed to mention the possible consequences of replacing a grandfathered plan. Further, the insurer misrepresented that certain Obamacare-required benefits like no pre-existing condition limits for dependent children would be available only in non-grandfathered health plans, when in fact such benefits must be incorporated into grandfathered and non-grandfathered plans, the lawsuits argue."</p>
<p>I’m similarly baffled by your seemingly inexpensive health care coverage, busdriver. I don’t know how small your group is, but if it’s small enough, the variance of the reported number could be quite high. That is, if it’s only a hundred people, the total claims would be expected to vary by a lot year to year. I also wonder if they added in the reinsurance premium. If your risk pool is older, they are more likely to incur catastrophic costs, so the reinsurance rate could be considerable.</p>
<p>“But it seems to me that the smaller, older, sicker group would cost more.”</p>
<p>So the union employees are the smaller, older, sicker group?</p>
<p>
While management is always (I would think) a smaller group than the unionized employees, they are not necessarily much older and may well not be sicker at all.</p>
<p>On the first point, realize that many companies have a lot of young managers and that union workers (heck, ANY workers) are staying longer and longer in their jobs. The difference in mean and standard deviation within the two groups may not be large enough to account for much actuarial difference.</p>
<p>On the second point, union employees tend to have worse diets (thanks to lower pay), more physically injurious work, and worse access to healthcare. On this last point, even with good insurance, many workers have trouble literally getting in to an appointment - even ignoring the costs (which will be a proportionally larger chunk of their income) their working conditions make getting medical care much more problematic. As an engineer I just schedule around my meetings and go. When I was a technician, finding a window where I was permitted to be absent could take weeks - I didn’t go to the doctor for anything that wasn’t pretty substantial, just because I could not schedule it!</p>
<p>I suspect that management does cost more per capita, largely because of the improved plans made available. But I also think that the base actuarial calculations of the two groups will tend to assign greater cost risk to the union group.</p>
<p>""Since March 23, 2010, “Blue Cross successfully enticed tens of thousands of its individual policyholders to switch out of their grandfathered health plans and forever lose their protected grandfathered status,” the lawsuits state. “Blue Cross concealed information about the consequences of switching plans and intentionally misled its policyholders to encourage the replacement of grandfathered policies.” </p>
<p>That is the opposite of what happened to me. Anthem did not want me to switch. Why would Anthem? The grandfathered policies were more expensive. </p>
<p>When I switched, I saved almost 7,000 the first year. I
delayed switching for a year. Cost me 6,000.</p>
<p>I received multiple letters about switching. The letters stated that you would lose a grandfathered plan if there was a switch. I talked to Anthem at least 4 times about switching. The first 3 times Anthem told me not to switch. The last time I started thr call by stating I am switching so lets talk about plans.</p>
<p>“So the union employees are the smaller, older, sicker group?”
“While management is always (I would think) a smaller group than the unionized employees, they are not necessarily much older and may well not be sicker at all.”</p>
<p>Yes, the smaller group is older, sicker, and mostly non-management, union. I’m making the assumption they are sicker because as a group, they are definitely older. There’s obviously something I’m not getting, but I’ll let you know when I figure out the mystery.</p>