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Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each

• clamprecht 11y ago
  You're not alone. In Texas, they cancelled almost all (or maybe all) individual PPO plans (affecting about 367k people), leaving us to choose HMO or EPO plans (the lesser of two evils). And about a 20% increase (per year) in insurance cost for the last 3 years. I at least hope some folks are benefiting from the ACA, I'm certainly not.
  • vonmoltke 11y ago
    > In Texas, they cancelled almost all (or maybe all) individual PPO plans (affecting about 367k people), leaving us to choose HMO or EPO plans (the lesser of two evils). I know Scott and White[1] is still offering PPOs, but apparently they only service 77 counties in Texas. A quick check of healthcare.gov tells me that none of the big insurers are offering PPOs, though. I don't know if there are other small-ism nonprofits like SWHP serving other parts of the state and providing PPOs. [1] https://swhp.org/en-us/ https://swhp.org/en-us/
  • parfe 11y ago
    What'd you have before the ACA?
    • clamprecht 11y ago
      I had an individual PPO plan. Also, my current plan isn't an ACA "marketplace" plan, it's a non-marketplace HMO plan.
  • azinman2 11y ago
    In CA, that's not the case. Our insurance went up maybe $50/person, but we got mental health care, acupuncture, and various other benefits we didn't have before. Oh and we have pre-existing conditions that would prevent us from being insured if we didn't have employer-based. And this is all PPO.
    • DrScump 11y ago
      You have coverage, but having care is a little different. For each of those features, do you have local providers who are willing to take on new patients and provide that care at the offered reimbursement rates? In much of CA, the answer is no.
      • azinman2 11y ago
        For me in SF, it hasn't been an issue. We are PPO blue shield which everyone takes.
        • DrScump 11y ago
          SF proper has Healthy SF public coverage as well.
      • DrScump 11y ago
        Here's an example of the concept just today: Fecteau’s story illustrates a common complaint by health-care advocates here: Dental insurance doesn’t mean access to care. Part of the problem: Washington has one of the nation’s lowest reimbursement rates for dental care provided through Medicaid..." http://www.seattletimes.com/seattle-news/times-watchdog/washington-dentists-lobby-is-blocking-low-cost-care/ http://www.seattletimes.com/seattle-news/times-watchdog/wash...
• itbeho 11y ago
  Same here. Had a plan I liked cancelled out from under me. Result is higher premiums, higher deductibles and much higher max out of pocket fees. Lots of little things not covered that were before. And I wasn't able to keep my doctor either.
• pbreit 11y ago
  Are you getting subsidized or do you make $85k+? Why only catastrophic?
  • djrogers 11y ago
    likely because the incredibly high base deductibles (6k per person for example) on most exchange plans mean that most people will never actually utilize any insurance.
    • ploxiln 11y ago
      Well, that's not traditionally how health insurance works in the US, but it's how all types of "insurance" should work - it should not be for routine costs. Insurance, generally, should be for unlikely unexpected costs. Otherwise, it's just involving an extra middle-man in payment, and that middle-man is going to make a profit. It's unfortunate that in the US, even for completely routine medical costs, you can't skip the middle-man, because prices are hidden and fake, and the real prices are negotiated between the middle-men and the medical provider (as well as which tests or procedures are allowed, under what conditions). I think the fixation on "everyone should have good health insurance" is making this dysfunctional situation permanently unfixable.
      • lotsofpulp 11y ago
        Yes, it's funny to me how so many educated adults are in this conversation, when the problem is mostly political. On one hand, you have a population that believes that no one should be left to die if they show up at a hospital (probably due to their religion and whatnot). A significant portion of the same population also believes that everyone should stand on their own two legs and that offering healthcare to all via increased taxes is socialism. Conclusion: We end up with a system where all costs are distorted and people are given this illusion that they buy access to subsidized health care (aka health insurance), but they get to satisfy their egos by pretending to deserve the health insurance they have and they get the satisfaction of knowing that their neighbors aren't getting free handouts from their taxpayer money. Side benefit for employers: You get a trump card over an employees' mobility because the best value for health plans is via health insurance plans tailored for employers, ideally white collar due to the type of work.
• mecameron 11y ago
  Personal experience with nearly all health care insurance plans since the 90's: Each year the premiums go up, the out of pocket costs increase, and benefits decrease (beyond more than general inflation).
  • mgkimsal 11y ago
    I understand premiums going up annually. I don't understand 30-50% increases year on year.
    • Frondo 11y ago
      When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services. And, to be totally frank, having had a pre-existing condition that kept me from buying any insurance (literally no one would sell to me pre-ACA), the law's been a net positive for me. I feel bad for people in other states, in Oregon it was been a pretty sweet deal for me.
      • mgkimsal 11y ago
        Yeah, it's pretty crappy in NC. First year of ACA we only had one company even offering any insurance in my county. And yeah, it's county-based for some reason - if I lived 2 miles in another direction I'd have had multiple options about 10-15% cheaper than what I had available. Second year we had another option in our county which was about 15% higher than BCBS (which had gone up about 25% from the year before). Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing? We are > 100% from where we were wrt premiums from 2012. I expect some increase every year. I don't expect > 100%. Colleague of mine is now facing > $1800/month health insurance pricing. He's... early 50s, married, 3 kids. This is with a $10k deductible. Another colleague with just one spouse and a child was facing going from $1300->$1650 this year, again with a fairly hefty deductible. Given that this is effectively only something you'll get any benefit from if you're in a horrific accident of have a massive illness, this is now just really expensive catastrophic insurance. I might feel slightly better about some of this if I actually knew anyone personally (beyond Frondo now!) who's benefitted. In my social circles, this has not even been close to a win for anyone. Either insurance has gone way up for people who can afford it, or it's still too expensive for some of my friends who are still unable to afford it (because they don't make enough money to qualify for the 'subsidized' pricing). Bring on single payer...
• tptacek 11y ago
  If you don't have preexisting conditions, you can still buy PPOs from the big insurers as non-ACA plans.
  • mgkimsal 11y ago
    Don't you then face a penalty anyway for not having an ACA compatible plan?
    • methodover 11y ago
      I think he's saying, you can buy a plan from outside the official marketplace. You still want to get a plan that qualifies as a real health insurance plan for the purposes of the penalty. It's probably pretty hard to NOT do that when buying a plan, however.
  • teuobk 11y ago
    Based on my search this year, that isn't necessarily true. Here in Denver, all of the insurers that were offering PPO plans in years past have left the individual market (not just the ACA exchange), save one: Anthem BCBS. Availability appears to vary widely, both from state to state and within states. If I lived in western Colorado instead of on the Front Range, I'd have a couple of PPO insurer options. If I still lived in Minnesota (where my previous health insurance policy was written), I'd have dozens of options from at least four different insurance companies. I really miss my insurance policy from BCBS of MN.
    • llamataboot 11y ago
      Don't miss it too much, my BCBS of MN policy just went up 45% year-over-year. It's pretty good coverage, but it's still nearly $10k/year just for the premium for my wife and I. Still, I was also one of those pre-existing conditions that simply could not buy any insurance before the ACA.
  • clamprecht 11y ago
    I spent many hours looking for this and couldn't find any individual PPO plans that cover Austin, Texas. If you know of one, please send it my way.
• x5n1 11y ago
  And so it goes, National Healthcare like Britain or Canada is what America needs and what the medical establishment does not want. But somehow I think America would screw that up as well.
  • Spoom 11y ago
    For what it's worth, I have talked to doctors who want single payer just as much as some of us.
    • jellicle 11y ago
      It is vastly less hassle for doctors to have to deal with a single entity for all reimbursements. No hiring collection agencies to hassle patients, no mysterious nonpayments, no switching networks, one set of rules to learn and that is it. They'll also probably end up paid a bit less under such a system. The tradeoff is worth it.
      • manigandham 11y ago
        Paid less maybe but save a massive amount on costs. Overall they'll come out with more margin and more time.
    • randycupertino 11y ago
      I work in health tech and all 12 of the physicians I work with think single payer is the way to go.
      • HillRat 11y ago
        Having done my time in health care startups with an emphasis on billing and reimbursement flow, let me say that I would have been overjoyed to have been put out of business by single payer (or by a U.S. version that, like Medicare, would be "single, multiple private administrators"). Medical billing is just an utterly perverse environment to deal with, and the Feds were the only player who would consistently tell you exactly what to bill, how to bill, and why to bill it that way.
• crikli 11y ago
  Same here. Texas resident on to our 3rd insurer after BCBS dropped PPO. Twice as much for less coverage with twice the deductible. F*cking Obamacare.
  • deleted 11y ago
    [deleted]
• MCRed 11y ago
  Comparing to my "free market" insurance before the ACA was passed, I had much more coverage (it was real insurance: eg: pay in advance against a risk, rather than covering pre-existing conditions which violates the definition of insurance, since you're not pooling money against risk, but paying for current liabilities.) ..... and not only did I have more coverage, but my deductibles were 1/5th what they are now and the costs were 1/5th as well. Effectively obamacare is 25X more expensive for me (and this is comparing plans in two different states since I recently moved.) AND! On top of that-- rather than just getting insurance when I needed it (Eg: you just sign up and buy it) you have to have enrollment periods and all kinds of arbitrary limitations and a 60 minute application process on a "marketplace" that really gives you minimal information about the plans, and demands to know far more about you than you really ever had to give up before to get insurance. One thing about insurance-- and Warren Buffett has made a lot of money on this-- is that they invested the proceeds between when they were paid premiums and had to pay out claims-- and so insurers paid out more than %100 of their premiums, because some of the investment returns would be spent on claims. This allowed them to keep premiums low, and they still made a profit. Obamacare basically made this illegal because now instead of selling insurance (or good insurance which was demonized as "cadillac plans" during the "Debate") you're selling "programs" -- so the incentive is to not buy until you get injured then sign up for insurance (and just claim you have a life change to get around the limited enrollment periods.) Which means the economics are on its ear and its completely unsustainable. And when it totally collapses-- I predict that people will be claiming its because "insurance companies are too greedy" After all, they complained about "greed" when insurance companies were paying out MORE in claims than they were getting in premiums (can you name any government program that has provided more benefits than it costs-- effectively negative overhead? Hell, as I understand it welfare spends %75 of its budget on overhead and only distributes %25 as benefits.) No matter how much government screws up this situation, they will blame industry and use the utter failure as "proof" that they need even more power (and even more intrusions into our lives) and even more money to "fix" it. None of this is a surprise- it was all predicted by those opposing the ACA. Fortunately, the asian countries are developing first rate hospitals and medical tourism industry. The only question is, will I be able to accumulate enough to retire to Thailand or somewhere before I get hit with a serious medical condition? Looking at how things have turned out in other countries (eg: New Zealand where if you're "old" you're just not covered and you have to leave the country for basic things like dialysis, even though there are dialysis machines in the country)... I've got a ticking clock.
• nateabele 11y ago
  From mid-2014 to early 2015, my premiums went up from ~$450 to over $1400, and the deductible increased from $5000 to $10k. This was with a single provider (BlueCross) in Pennsylvania. After the final increase I switched to an ACA-tax-exempt insurance alternative, and I no longer carry regular insurance.