<p>I don’t want to be ‘holier than thou’. But I do believe in personal responsibility. We subsidize unhealthy eating by allowing food stamps to be used for junk food and then we subsidize the results: diabetes, joint problems, heart disease, and on and on, with subsidized health care. </p>
<p>I am under the impression one can choose to increase their deductibles in order to reduce their premiums. To me this means when premiums go up, people choose to increase their deductible to keep the premium affordable.</p>
<p>Is that not LasMa’s case? Do insurances automatically increase deductibles on their own for the same plan while increasing premiums?</p>
<p>Or pay a bit more to reduce deductibles. And there are some cases where some particular plans are designed for especially low income/family size/number under 18, etc, so wouldn’t fit various ordinary income levels at attractive rates. This is part of why it’s not so simple to hear someone’s exchange options don’t compare favorably to before- to be analytical, you have to know more about that family’s particulars, including income, then look at the plans. Eg, via one provider here, my rates would be double-- that provider and its plans are not meant for my situation. </p>
<p>GP, you are wrong about whether having one-year or five-year or twenty-year age blocks will change the AVERAGE premium paid. The AVERAGE premium is the total sum the insurance company gets from all subscribers, divided by the number of subscribers. </p>
<p>Insurance company actuaries set the premiums so that they will add up to the right number. They know the premium structure for their company-- whether it’s one year bands or five year bands, whether women can be charged more than men. For a given mix of people, then, the AVERAGE premium is going to be the same no matter the premium structure, because it doesn’t depend on the premium structure. The actuaries start with the average premium and work toward individual premiums, not the other way around.</p>
<p>If couples where one spouse is much younger than the other pay lower premiums in one particular premium structure, then couples where both spouses are the same age pay higher premiums. If the premium structure for that plan was changed to use the higher-aged spouse instead of the lower, the May-December couple would pay a lot more and the equal-age couple would pay less. And the average would be exactly the same, because, as I said, the average doesn’t just happen-- it is chosen by the actuaries.</p>
<p>tex, yes, there’s a tradeoff between premiums and deductibles among other things, both before and after ACA. Here’s how the cycle worked for us for 20 years: For a few years, we would be able to keep our premiums affordable by increasing the deductible. But the big problem was that after 3 or 4 years, we’d reach a point where the premium was astronomical even with a huge deductible (premium was more than our mortgage payment a few times). That’s when we’d step down in coverage. Then the same spiral would start, and we’d step down again after a few years. By the time ACA came along, DH and DD basically had major medical only, and the premium was accelerating toward the mortgage-payment level again. </p>
<p>At one point, we were able to get good coverage and a reasonable deductible for a manageable premium, only because the Superior Court of San Mateo County intervened. For that one year, our insurance was in order. The next year, that premium jumped by more than 25%, so I suspect that they closed that plan to new subscribers as well. That was a very common and despicable trick they used to isolate and, they hoped, get rid of expensive subscribers.</p>
<p>Thank you, LF. No media outlet would be interested in our story, because it was so common that it wasn’t news. We were in the large uncounted ranks of the underinsured.</p>
<p>LasMa’s situation was business as usual. Insurers didn’t want to insure her family. Of course they didn’t-- they wanted to insure family’s like GP’s, who have been healthy, not LasMa’s, which have a higher risk of expensive treatment. So they did everything they could to make LasMa go away.</p>
<p>Either we can have a system where GP and LasMa pay the same for equivalent coverage, or we can have a system where GP pays less than LasMa for equivalent coverage. “Personal responsibility” here means punishing people who have the temerity to get sick by charging them higher premiums or denying them insurance. “Personal responsibility” means it’s dstark’s daughter’s fault that she got cancer and she should never be able to buy insurance again. “Personal responsibility” means it’s my niece’s fault that she got cancer and she shouldn’t ever be able to buy insurance again. “Personal responsibility” means calmom’s grandson shouldn’t have health care coverage because his parents don’t have much money. “Personal responsibility” means Rom shouldn’t be able to have health care coverage because she can’t afford it. No thank you.</p>
<p><a href=“http://medcitynews.com/2014/02/covered-california-takes-doctor-list-much-bad-data/”>http://medcitynews.com/2014/02/covered-california-takes-doctor-list-much-bad-data/</a></p>
<p>We will most likely lose small group status January 2015 and get forced into the private individual market. This is terrifying. Under discussion at our house is whether or not to have H undergo an (at this point) elective procedure - which carries some risks - while we still have access to doctors. Come '15 who the blazes knows. So, as H said ‘The White House is already dictating my health care choices’.</p>
<p>Pre-existing conditions do not only happen to people who smoke, drink or eat to much. Anyone that has lived with a family member that had the unfortunate experience of getting a chronic illness through no fault of their own knows the HC system was broken and unfair.</p>
<p>ACA may not be perfect but it is at least a step in the right direction. The direction of attempting to deal with a serious problem.</p>
<p>Dietz, I couldn’t find the discussion you referred to earlier today, except that it’s small business.<br>
It’s not the White House that didn’t offer Cedars through the CA plans or that impacts Dietz’s decisions. It is the system in your state. If your state (or sub state) plans are whacked, look there.</p>
<p>Btw, my brother in CA always had this sort of decision re surgery. And similar to LasMa, his costs kept rising, over the past 10 years, with his only possibility to raise deductibles. His back (and some skin cancer history) are his pre-existing and he was stuck. Two years ago, he said to me: my deductible is $x, I’ve almost met it. But in three months, my premiums go up, deductible will be 2x and I can’t get a date for the surgery before the change.</p>
<p>While some were high on the hog with their employer or other coverage, and would like things to stay that way, many others were eeking their way through these decisions. Also real people. My brother, save for those two issues, is the sort of client you want- low BMI, exercises, eats healthy, non-smoker, manages stress, no hbp or chol issues, diabetes, etc. </p>
<p>Best of luck to you and your husband, dietz. </p>
<p>You cited a two month old article. Do you have more recent information about the situation? By now, people in individual plans in Santa Cruz have been seeing their doctors for a quarter. I would guess that the provider lists might be more accurate by now.</p>
<p>If I were the Queen of the US and could make legislative changes, I’d start imposing big big fines on insurers with inaccurate provider lists. Narrow networks don’t bother me as long as they are adequate (that is, I don’t think people need 1000 oncologists per 10,000 people, but they do need an adequate number so that everyone who needs an oncologist can see one). But inaccurate provider lists drive me nuts. There’s no excuse: if the insurer’s billing department knows who is in-network, then that information can be put up on the web. </p>
<p>And the other thing I’d do if I were Queen of the US is make it so if people go to an in-network hospital, they only pay in-network charges for all the care they get there. If, somehow, the hospital sends out-of-network providers to care for me in my in-network hospital, the hospital, not me, would be responsible for the balance billing. I should not be responsible for vetting every care provider when I’m sick and incapacitated; insurers should not require me to do something that is impossible.</p>
<p>The pre-existing conditions that caused the denial of my insurance pre-ACA were ones that I was born with and developed in childhood.
Not a lot of “lifestyle choices” I could’ve made to avoid them 
</p>
<p>Wait, I thought you had Blue Shield, Romani. There were months of you deciding between keeping your old policy and going on Medicaid. How is that possible if you were denied coverage? Maybe, I missed something</p>
<p>If I was King of the US, I would terminate CF’s employer-provided insurance and force her to buy an unsubsidized Obamacare policy</p>
<p>You’re mean. LOL!</p>
<p>“get forced into the private individual market. This is terrifying.”</p>
<p>I think there are situations that are more terrifying. 
</p>
<p>Terrifying is when your daughter develops a brain tumor. Private individual insurance? Not so terrifying. ;)</p>
<p>“private individual market.”</p>
<p>oxymoron</p>
<p>You’re probably going to get your wish, GP, if Mr. Fang retires early as he is thinking of doing. And then… it won’t matter. It won’t matter at all, not one bit. I’ll be fine. Terrifying is hearing my niece has cancer. Buying insurance? Not terrifying.</p>
<p>Dietz, you live around Santa Cruz?</p>
<p>If your husband is considering elective surgery, please tell him to have the surgery now. I don’t want him to affect my rates. (I am kidding ).</p>
<p>I would check and see if his doctors are also covered.</p>
<p>The UCs and many Sutter hospitals are covered by Anthem.</p>
<p>I used to play tennis with a doctor that specializes in infectious diseases and was chosen as one of the top 100 doctors in America. Anthem covers him last I looked. </p>
<p><a href=“Health Insurance Plans | Stanford Health Care”>For Patients & Visitors | Stanford Health Care;
<p>“I used to play tennis with a doctor that specializes in infectious diseases”</p>
<p>If Dietz’s husband gets Malaria, he should be fine under Obamacare.</p>
<p>Checked your Stanford link for Anthem:</p>
<p>Anthem Blue Cross
PPO and HMO: Hospital services only, all physician services are out of network. SHC is not in-network with the EPO plan</p>
<p>Looks like some of it could be out of network.</p>