<p>I don’t think you’ve thought this through, busdriver. Let me repeat this: Goldenpooch’s insurance woes have nothing to do with the subsidies. Goldenpooch’s insurance premiums are not going to subsidies. Goldenpooch has to pay higher rates because of community rating (everybody of the same age paying the same rate). Even if not one person got subsidies, Goldenpooch would still have the exact same insurance rate. Goldenpooch is not being screwed by poor people getting subsidies, but by sick people getting treatment.</p>
<p>So, maybe you want to go back to the good old days when the insurance companies could cherrypick, and offer healthy people cheap insurance, and sick people nothing. But then we’d have sick people who couldn’t buy insurance. So then what would we do-- just pay for their health care directly? As soon as insurance companies discover that if you get sick, the government (us) would pay, poof, they’d cut off anyone who had so much as a sniffle. I don’t think that system would be tenable.</p>
<p>Cardinal Fang you are partly right, but don’t forget all the mandated benefits that were not required before. First dollars of preventative care, maternity and pregnancy care, expanded mental health and substance abuse services, autism spectrum disorders, domestic violence screening and counseling, family planning services, etc. I don’t have a problem with any of these services, but if I was allowed to choose, I would not pay for any of them. I am paying for stuff I don’t want.</p>
<p>I don’t actually think that the mandated benefits are what is driving the price up for you though. Not many people in our risk pool are getting pregnant, for example; not many people in our risk pool are taking contraceptives; not many are getting autism spectrum treatments because those are generally for children. I think it’s people who are sick with things you’d want to be covered for: cancer, heart disease, infectious diseases, results of accidents.</p>
<p>I think this was mentioned earlier in the thread, but there is something wrong when I am subsidizing a poor person who eats unhealthy food, is overweight, drinks too much and generally puts their lives at risk by living a very unhealthy lifestyle.</p>
<p>Our risk pool cannot be charged three times more than younger people. So insurers have raised the premiums significantly for young people and older people pay a multiple of this amount. All these mandated benefits affects every risk pool. Regardless, I would prefer not to purchase any of these mandated benefits.</p>
<p>Well, the other Blue Cross and Anthem customers who get their treatment at their local community hospital don’t want to subsidize patients getting unnecessarily expensive treatment at overpriced facilities, so there you have it. (You’ve been outvoted)</p>
<p>Yep, but those will only be achieved over the long term. Many people know so little about the factors which contribute to the healthcare crisis, and so little about the law, and are so caught up in the momentary problems with ACA, that they are not seeing the long-term benefits. I’ve said before that I don’t think we can do a fair assessment on ACA for at least 5 years. Until then, it’s just snapshots.</p>
<p>I do believe that ACA will make people healthier, through preventive care and earlier intervention, and hopefully someday through a shift in focus from disease to wellness. But that will take many years. I think we’ll see the other factor, lowering the cost of health care, exerting downward pressure on premiums much sooner. Hospitals who have been way out of whack from community averages will have to start lowering their prices if they want to be in networks. </p>
<p>Goldenpooch, I vote with calmom. Why should I pay for your desire (not need) to go to a hospital which charges 3 or 4 times what its neighbors do? And BTW, we actually do have a system like Switzerland’s. We call it Medicare.</p>
<p>LasMa, if I was allowed to purchase a policy that met my needs, no one would have to pay for the healthcare providers I choose to use. Like I said earlier, I would dispense with many of the mandated benefits and would prioritize an expanded network in choosing a health insurance policy. If there was a true marketplace with many choices at varying prices, I am sure I could find what is right for me. You may have different priorities, and you would be free to pursue them. We shouldn’t have a system where one size fits all.</p>
<p>BTW, in your version of the utopian system, I guess you and the supporters of this law get to choose who subsidizes whom. Will see how that turns out.</p>
<p>Medicare is hardly what they have in Switzerland.</p>
<p>There isnt a healthcare plan that can insure an additional 20 million people that doesnt take from one group of people and gives to another. That includes ACA.</p>
<p>So Busdriver11, who are you going to take from?</p>
<p>I am with LasMa - I hope that preventative care and prenatal care will over time reduce costs. It may not be a zero sum game. I’d rather subsidize someone’s asthma inhaler than their ER visit. I also agree that for most situations, going to the expensive research hospital is not necessary. I acknowledge the problems with ACA and I sympathize with those facing increased costs, but I think this law gets us closer to where I think we need to go (access for all and not linking employment to health care). I would LOVE to see incentives for healthy behaviors/good health. And, to raise a really prickly issue, we need to reign in end of life costs. There have been entire threads about that topic. I think an assessment of medical expenditures is crucial to keeping insurance premiums down(ish).</p>
<p>"So it won’t work to simply “declare” yourself self-employed "</p>
<p>If I am consultant, it is a question of w-2 or 1099. It won’t work if I am an employee somewhere trying to make a little consulting money on the side.</p>
<p>I agree with CFs post about GP’s premiums in 1080. He is subsidizing the unhealthy members of the pool since it is now an open pool compared to being in a pool of healthier pool of people with no pre-conditions. This has nothing to do with actual income based subsidies which kick in after the premium has been set.</p>
<p>I suspect that unless the healthcare costs keep rising, these premiums should drop once they figure out the designated unhealthy people don’t cost an arm and leg as the insurance folks seem to be predicting when they set these rates up. If ACA works as written, may be GP will get some money back with 85% rule despite the CEO of his insurance company making $ 5 Million.</p>
<p>There was an article that students that go to Cal States are going to be targeted. Lots of young healthy people go to Cal State schools. Also, insurance companies know where the young healthy people live and are going to target those people.</p>
<p>For those of us who have lived thru multiple years of double digit rate increases, as more and more people are insured, health insurance costs will rise closer to the increase in costs of health care.</p>
<p>So, if health care costs increase 5 percent a year, insurance costs should rise close to 5 percent a year plus increases due to age( for those states that use age to set premiums). No more 20 percent a year increases. </p>
<p>That is big for many. </p>
<p>It is true that some people are going to have difficulty paying for insurance under ACA. Hopefully things will be tweaked over time. Going back to policies before ACA is not benign either. </p>
<p>Eliminating preconditions costs money.</p>
<p>I was trying to avoid medicaid. One reason was many doctors dont like to take medicaid patients. At least that is what I was told. Kaiser takes medicaid patients. I am going to look at Kaiser.</p>
<p>The Mail annualized that as 2 million subs. Obamacare needs 7 million subs to get to solvency. Probably too soon to tell- I’d imagine most people who intended to sign up would be in the first month not necessarily the first week. </p>
<p>The Times article said CA had 20,000 “certified enrollment counselors” which must have meant a dozen or so per sub.</p>
<p>“If the state-run exchanges were to have a similar response rate for six months, the national enrollment total would be approximately 2 million.”</p>
<p>This number is a damning indictment of the federal web site operations, and says nothing one way or the other about the number of people who will buy through the exchanges through March.</p>
Kaiser takes medicaid patients. I am going to look at Kaiser.</p>