Why is the Affordable Care Act Important to Your Family

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381

Sorry, but that is incorrect, at least from an actuarial cost perspective. Yes, vaccines absolutely save money, but the other preventive services cost money in the long term. (Think of all the false positives that require additional testing, biopsies and other follow-up.)

The former budget director of the Congressional Budget office even reported this in writing, back with the ACA was under initial discussion by Congress. I’m sure his letter is available on google and even cc (since I posted the link to it years ago).

382

"Hopefully the new plans will eliminate costly coverages that many people do not want or need. "

What would you eliminate, @TatinG?

“There is a proposal from the incoming administration to make health care premiums tax deductible. That would help.”
Well, somebody has to pay for that too, no? People criticize subsidies now the plan is to give tax deductions? No free lunches here. It all costs us in the end. Six of one, half dozen of another and I wouldn’t be surprised if tax deductions are offered regardless of income level, thus benefitting the rich who don’t need it resulting in less revenue/more expenditures.

383

If we returned to the status quo ante, group health insurance plans would still be required to cover pre-existing conditions. The size of the individual health insurance market is way smaller than 100 million.

384

Sure, for those of you who are lucky enough enough to be covered under group health insurance plans.

You know who is least likely to have access to a group plan? People with significant pre-existing conditions who can’t work because of… their pre-existing conditions. Not to mention all the low wage workers who are the least likely to be able to afford plans on the individual market.

And no, medicaid/medicare doesn’t help all of us with pre-existing conditions who are unable to work. That’s a whole other rant though.

385

Yes, it is very challenging for the many of us who have pre-existing health conditions. The longer you live, the more likely you are to have SOMETHING (and actually more and more things) that is/are classified as pre-existing medical conditions. I am VERY fortunate that my H has insurance that he got from his employer that has covered us since we were married. I have rarely had medical insurance on my own and have only worked part-time most of my life and have not had benefits. Because he has benefits I have been able to work at my nonprofit without worrying about insurance coverage and other benefits and don’t have to spend all my resources trying to raise money.

Many folks with health conditions have a very tough time holding a full-time job or even work reliably part-time.

386

Pre-ACA, group plans did not necessarily cover pre-existing conditions, although that was common in larger employer group plans (I did encounter an employer who offered a choice of three plans, two of which covered pre-existing conditions, but the one with the largest benefits had a waiting period before pre-existing conditions were covered).

In an individual insurance market similar to the pre-ACA state (but reflecting today’s higher costs), self-employment or running very small business (whose premiums could be greatly impacted by one employee with an expensive medical condition) may be less attractive than working at a large employer.

http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D gives the following percentages for medical insurance coverage:



Year    Employer    Government  Non-group   Uninsured
2013    50%     33%      4%`        13%
2014    49%     34%      6%     10%
2015    49%     36%      7%      9%

The ACA guaranteed issue and universal individual mandate (starting in 2014) obviously have the most effect on the 16-17% not covered under employer or government insurance, or who anticipate finding themselves in that category (e.g. people considering self-employment or early retirement before Medicare age). However, it was not completely successful.

387

Agree that it is a little of everything, which means that controlling costs is difficult.

388

Yes and No. Group plans could only exclude pre-existing conditions for the first 12 months that you were on the plan in most cases. Further, that 12 month period would be reduced by your amount of creditable coverage. So if you jumped from Company A to Company B and you had been insured for the previous 12 months at Company A, then none of the insurance plans at Company B could legally exclude your pre-existing condition.

389

Tax deductions would not help those in lower income tax brackets (i.e. with lower incomes) as much as those in higher tax brackets. After all, according to Mitt Romney, about 47% do not pay federal income tax at all, so nearly half of the population would not be helped in affording medical insurance by a tax deduction for it.

Now, a tax *credit/i would work better for people at all income levels. It would effectively be the same as a voucher to buy medical insurance. Of course, if it were offered universally, then the guaranteed issue provision from the ACA could be retained, since everyone would have incentive to buy an insurance plan (instead of buying only upon hearing a diagnosis of something expensive). The main issue would be how to pay for such tax credits, although tax credits seem to be an easier sell to some people and politicians than functionally equivalent government spending.

390

I would like to state the above in a more fundamental way that gets to the heart of the problem - With what other product or service, besides healthcare and college, is the consumers’ costs covered by a third party and the consumer has NO CONTROL over the products and services he receives at a given price point? I say it this way because the consumer does have real incentive for the costs to be lower, as no one wants to pay a higher than required price, but the consumer in both these cases has no power to insist on lower costs.

Economically, the reason stores, such as Walmart, exist and services, such as Amazon, exist is the consumer is responsible for determining the final price paid for a good. The ability to not purchase is the control over the final price and is the built-in negotiation factor that allows for the consumer to shop around and get the best price. Thereby, leading the overall market, in the aggregate, to gravitate toward the lowest price.

However, in healthcare and in college costs, the insurance company determines price paid to the doctors/hospitals and the government pays colleges and gives students/parents loans, i.e., the consumer is totally disconnected from the payment process and thus has no control, read as no natural economic negotiation power, to demand a lower price.

This is a direct result of the horrendous decision decades ago to tie health insurance to one’s job and thus separate the consumer from the being ability to shop and get the best for the lowest price. Colleges suffer from the same structural issue because the student is separated from the loan money, as government gives the money directly to the colleges and thus the student has no control in negotiating prices.

This is economics 101 - that is, controlled third-party markets have no incentive to lower costs or to provide the best product for the lowest price because the consumer has no control over the final price paid, which leads the producer not having any repercussions for not responding to the consumer. Or put in the starkest terms, the consumer is not paying the producer and the producer knows he will always get paid regardless if consumer complains or does not like the service. Therefore, there is no incentive to care about what the consumer thinks, says, or does. The result - ever rising prices and poorer and poorer service. So predictable, and it happens every time it is tried.

391

Actually, this is only in conjunction with creating health saving accounts and purchasing diversified healthcare insurance plans that target different consumers’ needs, not with the ACA.

Making premiums for the ACA premiums tax deductible is irrelevant because structurally there are not enough paying users for ACA. Not because of no tax deduction, but because the families cannot afford the policies outright. No tax deduction would help here, as a tax deduction is only a small percentage, usually capped at 30% of actual cost. Peanuts, as the problem is the other 70% is still unaffordable because the plan is priced totally out of whack to what is being provided.

Overall, the most difficult part of this thread is that no one is addressing basic economic principles and then are wondering why things are a mess. Things are a mess because in terms of economics, the ACA goes against all basic tenants of economics and is structured opposite of standard purchasing behavior and goes against natural market forces.

Therefore, all the tinkering on the edges will not change the fundamental problem - the consumer is separated from the decision-making process and thus there is no incentive to lower costs and costs will always outstrip the tinkering by a large margin - so the result is nothing is solved.

392

Would your proposal for medical care/insurance reform therefore be to prohibit group and employer-provided insurance plans (or allow them only for catastrophic coverage)?

College is not really analogous here, in that students can compare net prices before committing and can get estimates before applying with net price calculators. Government loan (and Pell grant) amounts for undergraduate study are relatively small compared to the prices of the most expensive colleges. Medical care pricing is far more opaque (for both self-pay patients and those using insurance), and there is often little incentive for well-insured patients to price-shop.

393

Yes, as a consumer, I can’t compare prices for things as simple as a lung test that is standard at many different med centers. It’s even difficult to get an appointment within a reasonable time frame for such tests! Prices for blood tests and lab work vary all over the map as well–have gotten them in multiple states and med centers and they charges and final costs are strikingly different.

394

This study shows that 22% of patients with insurance are still getting surprise bills after ER visits! It appears they are often billed for services provided by out-of-network providers, even when they made sure to go to an in-network medical center or ER. This is a huge problem, especially when they have high deductibles and are already spending a lot on insurance premiums.

http://www.techtimes.com/articles/186135/20161117/many-patients-still-receive-surprise-bills-after-er-visit.htm

395

The true impact of the ACA is not being forced to buy something but rather to have the freedom to be an entrepreneur. To follow one’s dream. Or to work for someone starting on that journey.

If 133 million people have pre-existing conditions and their choices are either to be employed by a big company with a group plan, not being able to be insured, or be on Medicare / Medicaid, that leaves out a lot of the people who works for or wants to work for a small company.

These small business owners often aren’t able to or don’t want to offer health insurance. So outside reforming the cost structure of an industry, the challenge is insurance companies that want to discriminate against us citizens, and employers who don’t offer group plans.

Maybe some people would rather not pay for clean air, safe food or safe medicine. But that should not be a choice. And in my opinion, neither should be the ability for everyone to be able to be insured and not go broke if they get sick.

396

I disagree with the use of “discriminate” in the context of not covering preexisting conditions. No more than it does to say insurance companies discriminate against terminal patients when refusing to issue a life insurance policy (or pricing it at the face value of the policy). Or charging more for auto insurance for people with 10 speeding tickets or 5 accidents in a year. They do that because of economics.

I don’t have a problem with saying preexisting conditions should be covered. But I also understand that means costs for insurance will go up. Too many people want preexisting conditions covered and insurance costs to stay the same (or even decrease). Not reality.

I am all for decoupling medical insurance from employment. In addition to all the usual suspects in terms of benefits in doing that, it will help remove a disconnect in terms of cost. Employees don’t appreciate the true cost of insurance because they typically only pay a portion of it. Employers may well increase comp to cover what the employers are paying now but there would be a benefit in having people pay the full cost of coverage.

397

@bluebayou I am absolutely not “incorrect” about the things I listed (vaccines as you noted, and birth control) saving the populace money in the long term. Other examples include abortion, prenatal care, childhood screenings, diabetes testing and early intervention, and heart disease prevention.

Again, you err because you are looking at this as a healthy one-percenter whose idea of preventative medicine would be an extra ultrasound for ovarian cysts, or an MRI for back pain. Remember, poor people actually are in the position of having to weigh the importance of what you or I would take for granted, such as a prenatal doctor’s visit.

398

The pre-existing issue is not just a problem for those in lower income brackets. If the ACA provisions for this go away, watch the problem rear its’ ugly head across income brackets. Companies are cutting costs to increase profitability, etc. and with that “older” and educated workers are finding their jobs cut. Just because it hasn’t happened to you or anyone you know doesn’t mean it’s not happening in increasing frequency. With the job cut comes a loss of company healthcare. It’s not easy to find a new job at 55+, even with a good technical background. Age discrimination in hiring IS prevalent - and frankly would you rather hire a 30 year old or a 60 year old - which one will cost your company more in both salary and potentially driving your healthcare costs up. Even those Americans who HAVE adequately saved for retirement would be hard pressed to have enough $ set aside to handle a period of time without medical insurance…who can bridge a 5+ year gap until Medicare kicks in, even if you’re healthy for that age?

399

In previous ACA threads, we’ve had long discussions about patients getting surprise bills for out-of-network care at in-network hospitals. This is not an ACA problem, because it predates the ACA and will continue to exist if the ACA is repealed. It’s outrageous and should be fixed.

400

Another article about the ‘surprise’ bills after visiting ER. This one includes a map that shows where the practice is more prevalent.

http://www.nytimes.com/2016/11/17/upshot/first-comes-the-emergency-then-comes-the-surprise-out-of-network-bill.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news&_r=0