<p>TatinG, how many people were in the state risk pools? How many people have preconditions and couldn’t buy health insurance? How much do you want to spend for those with precondition problems? </p>
<p>How much does it cost the majority of young people to pay for health insurance under ACA?</p>
<p>All I know is that years ago, a family member with a pre-existing condition was in the high risk pool for a few months, until he went back on employer insurance. Not a problem. I don’t know if every state had high risk pools. I don’t know whether they cost the taxpayers more or less than subsidizing through the ACA. I only know this anecdotal experience. </p>
<p>Tatin, again, you have to go to the Kaiser blurb to see it in context. That’s a link up top after you click acting’s link</p>
<p>“Those who feel they’ve been negatively impacted by the law are most likely to point to high costs of health care and insurance as the reason. With official data showing that only a very small share of the public overall have enrolled in the ACA’s coverage arrangements so far, these shares likely reflect people’s perceptions of being helped or harmed by the law, rather than actual experiences with new insurance options under the ACA.”</p>
<p>Ok…</p>
<p>I know somebody who was in the high risk pool in California. No problems. The person had breast cancer and could not buy insurance in the individual market so she used the high risk pool. And the cancer did not recur so she made it thru and is now on medicare. However, her annual cap was 25,000. That is all the coverage she had. </p>
<p>I wonder why with this limited information you have, your anecdote, this information is sufficient to decide that the small pools work? There isnt a big precondition issue and young people are being charged too much.</p>
<p>What is the amount that young people are being charged that is too much? Are you in favor of young people staying on their parents’s plans until they are 26? Or do you want to end this? </p>
<p>The small pools are expensive. Who do you want to pay for the small pools?</p>
<p>Do you want to cut the employee health insurance tax benefit to pay for the poor and the sick?</p>
<p>I don’t remember any news coverage on any significant problems with the high risk pools for the majority of the users of the high risk pools. But that’s all water under the bridge at this point. </p>
<p>Well…health costs were about 32,000 a person under the federal program pcip. (that number is from memory).</p>
<p>But let’s forget the pools. </p>
<p>I agree with you that covering the sick and the poor isnt free.</p>
<p>Do you want to cut the health insurance tax subsidy for employees? </p>
<p>Are you against keeping young people on their parents’ plans until they are 26?</p>
<p>What is an acceptable amount a young person should pay for insurance? </p>
<p>Holy cow, you note “users,” but on this thread we linked reports about the issues getting to all the right folks. Issues getting the word out to the right people, determining if they likely qualified and would likely pass the approval process and then going through the process. </p>
<p>One of my favorite authors (actually, a husband-wife team) has a blog, and one of the recent entries is about how amazing the new Obamacare silver policy is vs. what they used to have to purchase from their insurer in Maine. Drug costs hugely lower when they went to the pharmacy to fill prescriptions this month, premiums lower (they get subsidies) and a comment about their old $700/month policy that basically provided no coverage. They’re in their early 60s, I’d guess, and the kind of authors who manage, mostly, to make a living by writing, but not in any way a luxurious living. </p>
<p>My favorite: "Our previous policy with Anthem was scheduled to rise to $700 a month this month, for a “plan” that covered nothing, and where the co-pay wouldn’t even kick in until we had bankrupted ourselves paying medical bills. This is the “Anthem’s Stockholders Earn Big, You Lose” Plan.</p>
<p>The MCHO plan that we chose is a Silver Plan, which means, among other things, that none of our generic drugs can cost us more than $15. This is the, “You Don’t Have to Be Afraid to go to the Doctor” Plan."</p>
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There is also something called “responsibility”. There are thing that are required of people by their government that they have to do whether they want to or not. </p>
<p>I do not believe my father particularly wanted to go off to war in Europe at age 18. But there was a war on and a draft, and so he went. I also grew up during a war and a draft that did not stop calling up free male citizens until I was halfway through college. I opted for a first career in a field that depended on free citizens showing up for jury duty when they were summoned, and diligently and seriously attending to their task, despite the fact that (in my experience) the vast majority would rather not be there. </p>
<p>When people use medical services without paying, they are passing the cost onto others, every single time. </p>
<p>Every time some person living paycheck-to-paycheck decides to skip out on an emergency room bill, that cost is passed onto others – the others being either the taxpayers (me) – or all users of medical services, who see those unpaid costs translated into skyrocketing medical costs. The price of every single medical service sold in this country is pushed up in order to recoup the parts that are unpaid; and as the cost of medical services go up, so does the cost of insurance premiums. </p>
<p>It’s not about the finances of the “free” person who chose not to buy insurance – its about the fact that the rest of us have been forced to carry those people over the years, with no end in sight. Your choice hurts my pocketbook. </p>
<p>No one is forced to buy insurance in any case: you still have a choice. You can choose to properly insure yourself or your family, or you can choose to pay a small surtax on your income to the IRS come tax time. That the tax is called a “penalty” doesn’t change the fact that it essentially is a tax that a person can pay for the privilege of choosing to opt out of the insurance system (for now). Sooner or later those free people exercising their choices will find that they really do need insurance – and some will face significant hardship. But all will have the option of buying insurance during the next open enrollment period – and perhaps some who have discovered the hard way that the cost of mending a broken wrist is a lot more than replacing the tires on a car will change their mind about the choices they want to make. </p>
<p>^^Sure it sounds huge, but you have to be a bit more specific. At this point, I don’t think any of us have energy to go to other states’ plans for a look-see or try out different plans at different income levels, to see where you got that number. My indiv deductible is far less, even our family ded is less. </p>
<p>Lots of things in our lives have a mandatory aspect. </p>
<p>Sam, I don’t think you understand how deductibles work.</p>
<p>Or how ACA works on the lower end of the economic spectrum.</p>
<p>If a person makes enough money that they do not qualify for subsidies, and decides to save on premiums by buying a low cost “Bronze” plan in my state, then they will have a $5000 deductible. But that does not mean that they will have spent $5000 up front in order to get services. That person will get free routine preventive care. That person will pay $19 to fill a generic prescription. If the person goes to the doctor, it will cost $60. If the person goes to the emergency room, it will cost $300. All of those payments will also apply toward the deductible. But the deductible won’t become particularly significant unless the person has major expenses, like hospitalization or surgery. And then the person is going to be seeing, say, a $25,000 medical bill, of which the insurance will pay around $19,000 or more, given the limits of the policy out-of-pocket maximum. Is that person going to be happy about the $6000 some odd dollars they owe? Probably not – but when they see what they are paying vs. what their insurance is paying, they are probably going to feel relieved.</p>
<p>Let’s say the person opts for a Silver plan instead. Now the deductible is down to $2000, same free preventive health visits, the prescriptions are still $19 to fill, the primary visit copay is down to $45, the emergency room $250. And the insurance company still pays around $19,000 of that $25,000 hospital bill, because even with the lower deductible, that bill is large enough to run to the patient’s out-of-pocket max. </p>
<p>If the person’s income is lower, they will qualify for cost sharing reductions on the Silver plan - their premium will be lower, their deductible will be lower, their copays will be lower, their out-of-pocket max will be lower. </p>
<p>Well, now hold on. I assume that 300 is just to enter the ER. right? Treatment is another story.</p>
<p>Funny enough just last night someone we know had an allergic reaction to Tylenol (weird, I know) and decided to wait out the nausea, dizziness, and extreme fatigue for about 6 hours. I learned this when I called work and discovered him sitting in a back room trying to recover. This guy has Kaiser and the hospital is a mile away.
<p>There are no easy answers and I’m not convinced ACA helps people like this in any way. He is not poor.</p>
<p>Well the plans and copays are different in various states. I was giving you an example plan from a high cost area. Median cost for an emergency room visit nationwide is about $1200 – see <a href=“How Much Will I Be Charged at the Emergency Room? | UC San Francisco”>http://www.ucsf.edu/news/2013/02/13576/how-much-will-i-be-charged-emergency-room</a> </p>
<p>I’m sure that in a state with lower medical costs, the ACA plans and premiums are probably more generous. The insurance companies are factoring in their own costs in developing their plans and setting premiums. </p>
<p>Here’s another article that paints a good picture of what might happen with a typical patient in my state:
<a href=“http://www.contracostatimes.com/ci_23608178/barnidge-why-an-11-596-emergency-room-visit”>http://www.contracostatimes.com/ci_23608178/barnidge-why-an-11-596-emergency-room-visit</a></p>
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<p>No, on the lower end of the economic spectrum they will opt for the Silver because of the cost-sharing-reductions, which will mean a lower deductibles and copays. Only the Silver plans are eligible for the CSR’s. </p>
<p>Of course many people may not understand this – but at least in my state, I think the exchange does a a good job of pointing people in the right direction based on their economic circumstances. </p>
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<p>Not if the treatment was completed at the ER. A copay means that is the total cost for that visit. </p>
<p>If the person was sick enough to be admitted to the hospital, that would be another story. </p>
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<p>Your friend could have died. That doesn’t sound like an allergic reaction --that sounds like toxicity – it’s very easy to overdose on tylenol. It can do serious damage to the liver. (Google it-- you might be surprised to learn the risks). </p>
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<p>Well, your friend has Kaiser,so I don’t see how ACA plays into it. If people choose not to get medical help when it is clearly needed, that’s got nothing to do with insurance – that’s on them. </p>
<p>Or to put it another way: your friend could have died at home. But if he had gone to the emergency room and been admitted to the hospital for surgery – a liver transplant this year would have cost him $6,350, thanks to the ACA. </p>
<p>Well, he’s back at work today and so far so good. But, yeah I gave him a good scolding. It’s about the cost. Not entirely, but probably 80-percent money from what I gathered. The other part is not- so-young invincibleness. But he does pay for insurance. Sadly, he cannot afford to use it.</p>
<p>I wasn’t blaming ACA for this one. I blamed him, rather loudly.</p>
<p>Good grief Calmom. It’s not as though they have a stash of matching livers in the fridge and you can just pull out a debit card. It’s slightly more complicated and challenging than that.</p>
<p>(I just read your edit.) </p>
<p>“The ACA addressed hospital stays by making sure that people who have insurance were insured for hospital stays. Pre-ACA, people who had “insurance” might not be insured for a hospital stay.”</p>
<p>"Texaspg, the only posts I’ve seen that imply that ACA addressed length of stay are yours- and I think that was because of a misunderstanding of some other post. Perhaps you could point to the post(s) that led to your comments so that this can be clarified.</p>
<p>As far as I can tell, everyone else has been addressing the pre-ACA problem that many so-called “health insurance” plans did not cover hospitalization at all, or had such restrictive benefits as to be meaningless (such as a plan that pays $50 a day for hospitalization, or caps hospital benefits at $1500)."</p>
<p>I don’t accept any of these statements. It is made up benefit being trumpeted here that has not been defined anywhere. For an uninsured person, insurance is better, for a low benefit insurance person, higher benefits are better.</p>
<p>I still don’t see any defined plans doing a lot better for hospital stays because of ACA.</p>
<p>actingmt – check this web site:</p>
<p><a href=“http://www.medicinenet.com/tylenol_liver_damage/article.htm”>http://www.medicinenet.com/tylenol_liver_damage/article.htm</a></p>
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<p>I looked up N-acetyl cysteine. It’s available in generic form – and generally given intravenously for acetaminophen overdose. </p>
<p>If your friend is a drinker, combining tylenol with alcohol will drive up the toxicity and risk. I’m not sure whether that is generally known.</p>