Only in states where the governor and/or state legislature cynically decided to reject coverage for those very people. But that was never the intent of Obamacare. The intent of Obamacare was that every state would be like my state: The very poor would have Medicaid and everyone else would have access to the marketplace where they could get private insurance, with a subsidy to help pay for it if need be.
So in places where adults DO have a hard time getting Medicaid, they should be asking their state officials for an explanation as to why they turned down the coverage which Obamacare wanted them to have.
Actually, the insurance company will only credit the LOWER charge, which is the “usual and customary” one, towards your deductible. It doesn’t matter what the hospital/doctor actually bills you. Making it even less likely that you will ever meet your deductible.
@mom2cpllegekids, back then we were both self employed. Or rather, H worked for a company remotely, but was considered an independent contractor, so he had no benefits and had to pay both sides of Social Security. When he got a regular job, we had real insurance through his employer again. Which was a good thing, because by then I had been diagnosed with T2 diabetes and he had had prostate cancer. We would have been uninsurable as individuals before the ACA.
We switched to a high deductible two years ago, since our healthcare expenses are high and fixed. We generally hit the $2500 threshold by March, for example, then pay our co pays until about September, and then 10% until we start all over again. It has saved us hundreds, but only works if you have the cash flow to support it.
ACA has made S2’s future healthcare possible. He would be seen as unisurable, and likely unemployable for the expenses associated with his medical care. As it is, his upfront costs for healthcre (based on S1’s experience finding coverage) will not be affordable on a new grad salary, so we continue to accumulate cash to help him with those expenses once he ages out of family coverage.
We had 22K of medical billing since July. Most of that was written off as a “negotiated discount” between our provider and insurance. If we did NOT have insurance, we would be expected to pay that entire 22K. Where is the logic there? An MRI costs what it costs. There should not be a myriad of discounts and scales and alternate costs – that, to me is the underlying problem with US insurance, not uninsured people in ERs. Our provider and our insurance company are currently embroiled in a statewide lawsuit over that kind of refusal to pay — hospitals can’t stay open with that percentage of denied coverage, and insurer retaliates by denying coverage for that provider’s services. Basically, they are playing chicken in court, while people like us wait to see what happens.
Balance billing at hospitals is a travesty and should be banned nationwide. In my state, I don’t have to worry that if i go to an in network hospital, I could still get hit with a huge bill. They’re not allowed to do that here.
I do know adults on medicaid in my state, so it is possible. And, these people don’t seem like the type to have jumped thru crazy hoops. They qualified based on whatever was needed to qualify.
I guess that to be fair, some of the funding for medicaid should come from a source that “hits” the unnecessary purchases that people like this 30 year old spend money on, so that those who are working under the table indirectly pay into it as well.
In the case that I presented, this isn’t some “down on his luck” 30 year old who was employed, but due to the economy lost his job. This is an able-bodied single 30 year old who CHOOSES to only work under the table occasionally (for cig and booze money…and the occasional new video game or Pay Per View).
I’m guessing that unless his booze or cigs have an extra tax that will go towards medicaid, there may be less interest in expanding medicaid to include people like him.
While I want him to have healthcare access (we don’t want sick people with no place to go), I do think that his “luxury” purchases should be additionally taxed and go towards medicaid. Everyone should pay in. I’m guessing that the states that don’t want to expand are thinking that they don’t want to enable situations like this 30 year old…a single able-bodied adult.
In CA before ACA there was a plan offered to people who were rejected from insurance. My sister had pre-existing condition and she told me about it. But it was more expensive than her Cobra.
Not only were those high risk plans extremely expensive, there were long wait lists to get them and a lot of sick people were just SOL. I’ve recently seen them proposed again as part of “replacing” ACA. They don’t work.
But as I pointed out, that seems to be largely a parental problem: he’s got a mom he walks all over who provides free room and board.
Government programs have to be designed broadly, to deal with broad classes of people: our country is also full of people who fit the category of “working poor” – they work very hard but don’t have the education or skill for much
better than a minimum wage job, and/or they have service jobs in industries that don’t guarantee them full time hours.
For the most part, young people like him aren’t the beneficiaries of expanded health care-- the bulk of health care costs are used by us older folks. I mentioned above that my son was able to get onto Medicaid easily in his state. He probably was on Medicaid for a little over a year. He never used it. Not once. He’s the same age–early 30’s - and he simply didn’t get sick. He needed the coverage as a safety net.
@DrGoogle First, that’s just one state. And while “only” 500 very sick Californians couldn’t get really expensive insurance and had no coverage at all, that’s 500 too many. But maybe that’s just me.
Second, high-risk coverage varied wildly from state to state, with 15 states providing none at all. Even what seems like a short waiting list could take years to get through, since the people who were lucky enough to have them would do anything to keep them. Usually death was the only thing that opened a spot. Florida closed enrollment in its high-risk plan way back in 1991. And in early 2013 – almost a year before guaranteed-issue became the law – the feds suspended enrollment altogether. So basically, if you were really sick before ACA, you also needed to be really lucky.
It is very expensive to insure sick people. These plans are the very definition of adverse selection, since only the very sickest are willing to jump into them. The only thing that makes any sense at all is for everyone to be in the same pool, and the bigger the pool, the better.
ETA – Agree with @calmom. The housekeeper’s problem in the OP isn’t the health insurance system. The housekeeper’s problem is that she doesn’t have the gumption to throw her lazy mooching son out of the house.
Re: " I don’t have to worry that if i go to an in network hospital, I could still get hit with a huge bill."
Quite some time ago, my wife had a surgery. We were careful about selecting an in-network hospital and an in-network surgeon. In the end, the hospital could still charge us a lot. The reason? The hospital would make sure that their “team” for this surgery, except for the surgeon himself, were “hired” from an outsourced company which is NOT in any network. This is the “normal” practice there.
These hospitals have all kinds of “clever” ways to rip off the patients.
When I myself was sick a couple of years ago, whenever the hospital could get reimbursed to the amount they think they are entitled to in the timely way, they would either write or call me to threaten me. I think I had been charged to my annual maximum and they still tried to go after me (My insurance company in the end paid that amount (or sone discount amount) in the end. I think that after our family had likely paid almost $8000-10000 out of our pocket (excluding the premium) in that year, they still “threatened” me (and I had a health insurance.)
Sometimes I am not sure who are more evil, those people from the hospital or those fat cats on the Wall Street! When I was really old/sick, I would rather die than letting these people wipe out my savings (if I still have any saving left by then.)
I have a dream: The distingishment between the in-network and the out-of-network will someday be eliminated from the surface of the Earth. It is a loophole that many “interest groups” can take advantage of in order to rip off the patients.
Unless you happen to have huge medical expenses in a given year (you are also protected by the maximum OOP payment – thanks to ACA here), I sometimes feel that the most critical benefit to me when I buy an insurance policy is that the hospital could no longer set the price as their will. This is because the insurance company is also a “big guy” that the hospital may not be capable of pushing the big bad insurance company around like they could push us little guys. These two big guys need to negotiate with us; none of them need to negociate with us. (The other big bad guy is the government but most of often than not, the government might have been mostly bought out by those rich and powerful who have financial interests in this – not many other business may be so profitable to these people.)
My insurance was/is a private one (through my company.) But I think the law is not much different there.
ACA does prevent the insurance company from not insuring someone with a pre-existing condition, and prevent the insurance from discontinuing a person’s insurance one he is sick, and prohibit the insurance company to set a life-time maximum limit.
BTW, I think ACA is just a set of laws. It is not an insurance.
