<p>We are a small business consisting of two employees - DH and myself. We are paying almost 14K a year in premiums for a 2.5K per person deductible which then kicks into a 65/35 plan. The first years penalty would be 4K. The 10K savings would provide for a fantastic medical tourism trip or access to a concierge practice. I doubt we are a unique example.</p>
<p>Mathematically it makes sense to drop our current policy until the penalties exceed insurance exchange premiums. And, since one can not be excluded because of any pre-existing conditions it is not possible to buy into a fantastic policy only at the time one needs the coverage. This make the ACA something which can be advantageous to those who have been footing a disproportion amount of the costs to this point.</p>
What happens when someone who pays the penalty has a catastrophic claim? IMHO, they should have to pay every penny to the extent that they have to give everything they own and spend the rest of their lives toiling in the fields for bread and water if necessary.</p>
<p>^^^but that is not how the ACA is written. Frankly, I agree with you…anyone who NOW doesn’t carry at least catastrophic coverage should be treated exactly as indicated.</p>
<p>Yep. If we hadn’t had to worry about preserving private, for-profit insurance companies, we could have gone with single-payer, which would have been so much easier.</p>
<p>LasMa, the thing is that it only takes a few people to decide to pay the fine to have an impact on rates on others. And as Dietz pointed out, the ACA is written in a careless way that leaves open many unintended consequences.</p>
<p>Spouses are covered by their own insurance. However, under COB (Coordination of Benefits) you basically have only one coverage while paying 2 premiums (to your primary and to your secondary insurances). Now that insurance will loose many fees for secondary coverage, I can see that premiums will go higher. That alone may force more companies drop Helth coverage all together (various ways to do it, like chooseing to pay penalty instead or choosing to have only part time employees). The more drop the coverage, the less chance for insurance to survive. Yes, the law has on intend and it is going to work as intended, but it is not to benefit the sick, opposite, the sick might not find the doc. to treat her.</p>
<p>Miami, what do you mean? Some spouses only have ONE insurance plan. We stopped having coverage with both working spouses years ago. I am sure we are not the only ones. And we chose the coverage that was good coverage at a good price…but only ONE plan. Not every couple carries two insurance plans.</p>
<p>“We stopped having coverage with both working spouses years ago.”
-Most plans do not allow that, not in our area. If your own employer provides insurance, you have to participate before you can participate in your spouses’s. This is the rule here. However, as I have mentioned, you still get only one coverage becuase of COB, they will not pay the diff. So, if only $100 is covered by either coverage out of $150, then you will still pay $50 to your provider, just like as person with only one insurance. However, when you ran out, then the secondary will pick up, it has happened with my dental last year.</p>
<p>I think the catastrophic, unintended outcomes of the ACA will only be seen as it is phased in. Many employers are going to be dropping insurance, which can be a $5000-$10000 benefit depending on how good your insurance is. They can do this in good conscience as everyone will have access to healthcare now. They will, however, not compensate you that $5000 so you can go buy your own insurance, they will keep that money as profit. You then essentially take a paycut AND have to pay out of pocket for your insurance. It’s a double whammy.
While the insurance companies are certainly a problem, consumers are also a problem. I work in the ER and the STUPID things people come to the ER for are mindboggling. Your child has had a fever for an hour and you couldn’t reach your pediatrician so you came to the ER? Really? How about you give some motrin and deal with it until morning? People are ridiculous in their need for immediate gratification, and it costs a lot of money for ER care.</p>
<p>I work for a large Fortune 500. They require that you have insurance. If you don’t pick a plan at work, you get some kind of credit - maybe it goes into your 401K and you have to provide proof of coverage from some other source.</p>
<p>I work for a large company. We are required to have proof of insurance. It’s perfectly fine to be with a spouse.
I wonder going forward if my company will continue to provide coverage. I think not. Law firms are partnerships, so the partners pay full cost for their own coverage at huge amounts. Many take their spouse’s coverage if spouse has a different type of job. They are actively looking to drop employee coverage into the exchanges next year because the perception is why should the partners pay for a benefit and the administration thereof, for something that they don’t receive in the same way as employees. LIke I said yesterday, I think when one law firm goes they will all go.</p>
<p>Every place I’ve worked has had a family plan(2 parents and children) and an employee+children plan(largely for single parents) for a smaller premium. If a spouse has insurance at another employer those expenses are covered by that employee only plan and the other spouse takes the employee+children plan and those expenses are paid by that plan. Haven’t seen where the spouse has to be on their own plan and also on the family plan with coordination of benefits. </p>
<p>Around 10 years ago the place where I used to work started charging $75 per month extra for the family plan if a spouse had access to health insurance at another employer and didn’t take it.</p>
<p>I think the required participation by an employee in their company health insurance plans is mandated by the laws of group policies. By being an employee of X you are automatically part of health insurance group Y and thus you or your employer must pay for a certain base level of coverage.</p>
<p>Of course many employers could save money by dropping coverage and paying fines, but they could have saved even more money before by dropping coverage and not paying fines. Is the incentive now that their employees will have an alternative? I’m not buying it.</p>
<p>Teh estiamte is that about 7 millions lose their coverage and it is NOT by any measure unintended, very intended, destruction of insurance industry is the goal…</p>
<p>The insurance industry is a racket. People shouldn’t be beholden to their employers for coverage. Hope we will soon join the ranks of the countries providing universal care.</p>
Yes. In my specific field, the people who own the companies aren’t able to utilize the benefits provided in the same way as their employees, which turns the whole issue on its head. I can tell you from personal experience that law firms have organizations for every level of management or department in the field. They all collude. They do everything from attorney bonuses based on communication among the firms, secretarial ratios, hiring, staff salaries. EVERYTHING. One of the topics currently under discussion among the law firms is whether to drop employee health coverage. I don’t have a crystal ball to know what will actually happen down the road, but I can tell you that it is being discussed and it won’t be one firm making a decision, it will have been done among the larger group. You can either buy that or not, but it is true.</p>
<p>"People shouldn’t be beholden to their employers for coverage. "
-Definitely not. You are absolutely correct. Our enlightened leaders will solve the cost problem very easily, no treatment after certain age. It has been done in other places. Nothing is new. The smaller number of sick, the smaller cost of medicine, there is no magic. Got sick? Here is a box waiting for you and everybody is happy.</p>