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As Flossy responds, that’s all this thread is now. It’s probably why many posters have left. I checked in on this thread for the first time in quite a while this morning. Same 'ol, same 'ol. Many have probably also left because of the CA-centric nature of the thread. </p>
<p>Although there seem to be sinister motives attributed to those will stop paying premiums where people get treatment and stop paying premiums, there is a very simple explanation where it might happen for a majority of folks. 2 new tires might just do the trick in a month that they were not expecting to pay for.</p>
<p><a href=“Nearly Half of America Lives Paycheck-to-Paycheck | Time”>Nearly Half of America Lives Paycheck-to-Paycheck | Time;
<p>“Nearly Half of America Lives Paycheck-to-Paycheck”</p>
<p>Kmc mom. Your post should be read by everybody at least twice. Thank you for sharing your families anxieties trying to get your son health insurance and the fears that go with this. </p>
<p>Our daughters cobra would have run out in April. What in the world would we do then. She works full time but her company is small and doesn’t offer insurance. She was seriously considering marrying her friend (which he offered) just to get on his insurance. Ugh…that was the LAST thing I wanted to hear her say but she thought this was a viable option.</p>
<p>Good grief.</p>
<p>Texaspg, that is an important issue that goes beyond health care.
Kmcmom, your story blows me away. That was a stress that nobody needs to have. The same with Sax’s daughter.</p>
<p>My niece and her BF, when they were living in SF, registered as domestic partners so she could go on his insurance. They did, eventually, get married. </p>
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<p>A generous company, which must have been self-funded. California law specifically excludes different-sex couples from the domestic partner rules.</p>
<p>^ I believe the City of San Francisco has their own domestic partnership law and it extends to heterosexual partners, also. </p>
<p><a href=“Anthem to raise some premiums up to 25 percent”>Anthem to raise some premiums up to 25 percent;
<p>"Thousands of Anthem Blue Cross individual customers whose policies were unchanged by the nation’s new health care law could see their premiums jump as much as 25 percent unless California regulators step in.</p>
<p>The increases — 16 percent on average — are slated to go into effect April 1 for up to 306,000 people, the Los Angeles Times reported Thursday (<a href=“Anthem to raise some premiums as much as 25%”>http://lat.ms/1cCP6rs</a> )."</p>
<p>The LA Times link is more detailed.</p>
<p><a href=“http://touch.latimes.com/#section/-1/article/p2p-79108767/”>http://touch.latimes.com/#section/-1/article/p2p-79108767/</a>. </p>
<p>"Amid the fury last fall over canceled health policies, consumer advocates and state officials warned people that holding onto grandfathered policies purchased before the federal healthcare law was enacted in 2010 wouldn’t shield them from significant rate hikes.</p>
<p>Walter and Kathy Warner of Westlake Village are facing a 25% rate increase, for a total of $1,822 per month. Their premiums had already jumped 53% since 2010, not including this latest change."</p>
<p>Ratings… </p>
<p><a href=“http://touch.latimes.com/#section/-1/article/p2p-79079027/?related=true”>http://touch.latimes.com/#section/-1/article/p2p-79079027/?related=true</a></p>
<p>I have no idea whether a 16% premium increase is justified. But it’s a reasonable guess that the people who remained in the Anthem grandfathered plans are sicker than the ones who left for another plan. In the past, healthy people joined plans each year. Then some of them got sick, but they couldn’t be thrown out of the plan for getting sick. Now, no new healthy people can join grandfathered plans, so premiums are bound to go up.</p>
<p>A 16% increase for grandfathered plans is pretty mild compared to the 65% increase I was hit with for going from a non-grandfathered plan to an Obamacare plan. The grandfathered plans are still much cheaper for the unsubsidized than the junk exchange plans. I doubt these people are going to be cancelling their plans anytime soon.</p>
<p>Texaspg – for the families living paycheck to paycheck – the difference now is that they have more options. If there is a downturn in income overall, they may qualify for a larger subsidy. If things are really rough, in half of the states they can shift onto Medicaid. </p>
<p>I understand that you are also positing the example of a family whose income hasn’t changed but who just are having a rough time juggling expenses – but that’s not a new problem. I think the difference is that many of those types of families couldn’t have afforded insurance in the first place – so they also faced the potential disaster of that $600 emergency room visit. Those who have weathered that sort of problem in the past might just place more importance on maintaining insurance, especially if they qualify for a CSR policy (for those at or under 300% of FPL) - which come with reduced deductibles and extremely modest copays. If you have an insurance policy that allows you to take your kid to the doctor for $5 – isn’t that something you might want to hang onto even when times are tough? </p>
<p>I’ve also been in that position of month-to-month juggling, with less money coming in than was needed to pay the bills – and one thing I learned very quickly was to recognize which bills needed to be paid right away and which could wait. Rent or mortgage had to be paid on time; bills for insurance and utilities could generally be paid a few weeks late, after receipt of the cancellation notice- and the notices generally said “pay now” - but didn’t have a late fee. Old unpaid medical bills could be stretched out for a long time, especially with a partial payment once in awhile – my dentist was very flexible and understanding. </p>
<p>So yes: some people will sign on to buy insurance, run into a financial difficulty, and be unable to pay their premiums. Again, the only thing really new about that is the fact that they they have the option to get affordable insurance in the first place, or that they will be able to get reinsured during the next open enrollment period after a lapse in coverage. But the ones that are actually using their insurance benefits are also the ones who are likely to want to hang onto them – they are going to to be thinking about the last trip to the emergency room and what it would have meant if they didn’t have that heavily subsidized insurance plan. The ones who will let their premiums lapse in a pinch are more likely going to be the ones who aren’t using it – the people who will rationalize – “I’ve been paying $125/month for this policy and I’ve never used it – I’ll just drop it for now and I can always sign up again next October.” </p>
<p>It might be more of a temptation for people to sign on but not pay during the last two or three months of the year. I believe if they have coverage for 9 months, they avoid the tax penalty. They could pay for policy #1 in 2014, then sign on in November for a different policy (different insurance company) to start January 1, 2015 – and simply stop paying the old policy toward the end of the year, extending out whatever grace period they have and waiting for a cancellation notice. If they actually used services during that period, they could pay to reinstate their coverage - if not, they simply could let the old policy lapse knowing that they have coverage in January. (Any subscribers who tend to run late with payments will probably become very familiar with the time frame for those cancellation notices … I know that back in the day I pretty much knew exactly how many days I could run behind before water and utilities would get shut off. I never stopped paying insurance premiums - though - it was just to scary a proposition with 2 kids.) </p>
<p>Do these policies cover emergency room visits? Because that would actually be something new if it’s the case. I have always had insurance but never got out of an ER with less that a $600.00 bill.</p>
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<p>No – my son did the same thing when his then-girlfriend got pregnant – and he was in a state that did not recognize different-sex domestic partnerships. But his employer operated in many states – their group insurance policy had the same rules for everyone. I don’t think he had to register in-state as a domestic partner – but he did have to fill out appropriate paperwork with the insurance company. (It was true in any case – the couple were living together in a single household). It definitely wasn’t a self-funded plan – it’s just that that’s what the insurance company had agreed to with HR. Obviously a large enough company to have some bargaining power with its group plan. </p>
<p>Yes – the policies definitely do cover emergency room visits – there is a copay, and the copay for emergency is higher than the copay for urgent care, which is higher than the copay for a regular doctor’s visit – but patients on co-pay plans would not see anything like a $600 hospital bill. If a patient instead had a high deductible / co-insurance plan, they would have to meet their deductible first – but even in that setting, the insurance might reduce the cost of emergency services at an in-network facility considerably, perhaps down as low as 30% of the amount that would be billed to someone without insurance. </p>
<p>Ah, deductibles. So, a person could very easily still be in pain in the middle of the night and deciding whether an emergency room visit was worth it. I figured that and have seen a few people in that scenario, myself. They were insured. </p>
<p>Actingmt – the lower income people under ACA are going to qualify for plans that have much smaller deductibles. and copays – and a copay will kick in well ahead of a deductible. Some people may still simply opt to buy the plan with the lowest premium – but the whole point of the subsidies is that lower income people will be on plans where the deductible might be $500 and the emergency room copay $75. For some, maybe even that $75 is a deterrent – but it really isn’t the same situation that kmcmom described, with a kid who potentially might have needed urgent or emergency care multiple times each year. Many people with chronic conditions (diabetes, asthma, life-threatening allergies, seizure disorders, etc…) are in that situation. </p>
<p>I’d add that my grandson had three emergency room visits in 2013. The first two turned out to be unnecessary – xrays were normal and the kid went home. The third time was a broken leg - kid was in a full toe-to-hip cast for a month – but definitely not obvious that the leg was broken. My son was very happy that his kid has Medicaid – one of my son’s “what ifs?” was wondering whether the prospect of a high bill would have deterred him from seeking immediate care for the child in light of the two previous false alarms. </p>
<p>Yes, Calmom I am aware of people in the very situation who are not Medicaid level low-income but maybe closer to the paycheck to paycheck scenario described by Texas in the link above. For them, the subsidies are not necessarily a remedy here. It’s still expensive. Obviously, the people who get it for free will be fine. Heck, those are the people who already were getting free ER care. I know some of them, too.</p>
<p>A friend who works in billing at a local hospital told us that the ACA is looking like a boon to the hospital even for patients who can’t pay their regular copays/coinsurance, because before they couldn’t pay anything and often had large amounts written off/uncollected. Now they’re expecting payment from the insurer for the amount above the copay/coinsurance, which greatly improves their cashflow and ultimate collections. </p>
<p>Their bigger issue is with people at all income brackets who have high deductible health plans, and who don’t have enough in their HSA’s to pay the bills. </p>
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<p>Correct me if I’m wrong, dstark, but it’s got everything to do with premiums. If not this years, then the next so it isn’t something that can be swept under the rug.</p>
<p>There’s a demographic out there that’s crucial and, while they might have the money, they may not choose to cough it up on the due date. </p>
<p>You really don’t have to ask them point blank if they’re going to let it slide… just ask them if: they’re old, or in poor health, or worried about things that haven’t yet happened to them. If they say no to all, that they drive a beater, pay the minimum on the credit card, and like to throw a kegger every few weeks, you can make a pretty darn good guess.</p>