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Go on your state's Obamacare exchange. Hypothetically you are a mid 30s individual with a spouse and two young children. Look up 2017 numbers. You are looking a

Go on your state's Obamacare exchange. Hypothetically you are a mid 30s individual with a spouse and two young children. Look up 2017 numbers. You are looking at $12,000 - $24,000 per year in premiums alone and then massive deductibles and coinsurance of 30% to actually access services. Who can bootstrap a business like this? So people are staying with their powerful big corporations if they can't get millions in funding for a startup (and outside of tech this is simply not even a consideration). Edit: and if at some point you hire an employee, you will need / want to provide them with health insurance, and it will cost just as much. Large corporations have an advantage in that they negotiate lower premiums in bulk. Add this as yet another barrier to entry, along with their lobbying for protectionism, tax loopholes, their ability to hire huge teams of tax lawyers and accountants, and if you really start to get their attention, they can sue you baselessly by throwing lawyers at you to keep you in court. Merely defending yourself and getting to the point of dismissal is unaffordable for a budding small business. Take a look at S&P500's profit margins. They are at record highs and not coming down as economics teaches us, meaning new entrants are not coming into the market.

ceejayoz 10y ago
Here in upstate NY, $20k/year for a mid-30s with family of four gets you a Platinum no-deductible, copay-only plan with a $4k/year out-of-pocket cap (my exact situation - 2016 premium is $1,700/month). Bronze plans are dramatically cheaper, and if you're doing a bare-bones startup you're also likely to be in the income range that gets subsidies.
- cylinder 10y ago
  Here's a junk Bronze HMO with 50% coinsurance and $5,500 per person deductible in Albany at over $16,000/yr: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/38594?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... I am sticking to the major carriers as I'm skeptical of the networks these small no-name providers have. But even if I browse all carriers, the cheapest platinum plan is $20,000/year: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/43003?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... Subsidies - let's say you pull $70,000 your first year. Your subsidies will be $4,000 per year, so the platinum plan is still $16,000/yr net. After-tax on $70k is $54,000. That means your healthcare premiums alone are 30% of your post-tax income even with the subsidy! That means only $3,150/mo remains for your rent, transportation, food, utilities, etc...
  - ceejayoz 10y ago
    Here's mine: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/33810?county=Monroe&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2016&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... Per this calculator: http://kff.org/interactive/subsidy-calculator/#state=ny&zip=12201&income-type=dollars&income=70000&employer-coverage=0&people=4&alternate-plan-family=two_adult_children&adult-count=2&adults%5B0%5D%5Bage%5D=35&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=35&adults%5B1%5D%5Btobacco%5D=0&child-count=2&child-tobacco=0 http://kff.org/interactive/subsidy-calculator/#state=ny&zip=... subsidies in Albany are $578/month for an income of $70k, with an average cost of Silver plans being about $500/month post-subsidy. At ~9% of income, that's also tax-deductible spending.
clavalle 10y ago
If you are in a state with subsidies you are in pretty good shape. Also, you're numbers are a bit inflated if my experience is anything to go by. I have insurance through my company but my wife is on an Obamacare plan (because it was cheaper and better than what my company offers through a national HR company) for herself and our three children. We pay about $6000 per year for normal deductibles and a plan comparable with what she had working for the state of Texas (really good) before she went back to school. My only complaint is that this insurance company (Humana, I think) is very particular about the prescriptions it allows but I think you get that with any insurance company.
- cylinder 10y ago
  Texas is definitely cheaper than NY. However, Texas has been approved for one of the biggest premium increases for 2017, but their numbers have not yet been released (they will in a few days). You should anticipate at least a 30% increase in your wife's premiums, unfortunately.
  - clavalle 10y ago
    Disappointing, but not surprising. We were surprised the insurance was so good for so (relatively) cheap, honestly.
iamthepieman 10y ago
my company pays 2000 dollars a month for our insurance premiums. This is a plan with a 2k individual/6k family deductible per year. We are saving 1.37% next year by going to a plan with 3k individual 9k family deductible. If we didn't do that premiums were going to rise by 10.4% next year. Our rates have gone up every year since I've been working here. The total EOB (Explanation of Benefits) costs value for the medical care my family got last year was under 6k. This was unusually high because we had two minor surgeries. The two years prior were much closer to our baseline of about 3-4k of medical care. This includes shots for the young kids, regular checkups, the occasional prescription and one semi-emergent emergency. One year a kid broke her arm, the other my wife needed an MRI. I know I represent a young family with relatively few health problems but so far, just since being on my current plan, we have paid 90,000 dollars (costs were slightly lower than our current premiums in prior years if you are doing the math) and received (at the high end) 18,000 dollars worth of medical care. I have paid 72,000 over just 4 years for insurance against catastrophic illness, disease or trauma. As I sit here writing and calculating this I have this question in the back of my mind - Is it worth it? I don't know. I think that question is ridiculous but I don't know what other question to ask.
- cylinder 10y ago
  Yes, many people are asking that question now. Those who work for a company and receive a W-2 form can look at Box 12 on the W-2 to see how much their employers paid for their side of their health insurance policy (coded with "dd"). You might think "who cares" but that's money that could have gone towards your salary.
  - spoonie 10y ago
    To which they would then have to spend on their own, more expensive health insurance plans?
    - digikata 10y ago
      One should also question why an individual healthcare purchase should be charged more than a work based group plan. Shouldn't the operative "group" of patients basically be everybody who is a customer of the insurance company (or at least everybody at some tier of the insurance plan).
berntb 10y ago
That is a lot of money. :-( So it is true, the bad US health care system really is a startup limitation. Maybe it is time for countries with nice weather and cheap health care to woo Silicon Valley...? Something like: "Get here for less than a month's health care, do Skype meetings and you'll need a telescope to see the end of your startup's runway". :-) Kenya and Tanzania have some good beaches and they got OK Internet now? Or most places in Asia? How cheap is it to live in a small fishing city in Japan? I smell a business opportunity.
- cylinder 10y ago
  It's not really tech startups I'm worried about as they are more likely to receive VC/angel and can be started by young hackers. I'm talking about your average small business, whether it be a self-employed consultant, a small hardware shop, a bakery, mechanic shop, cafe, etc. I observe that small business has been decimated in America and giant chains have proliferated. When you drive through small towns in the US you will usually find a few large chains like WalMart, McDonalds, Jiffy Lube, etc on the Main St and not much else. When I travel UK, Australia, NZ, Europe, small business seems to be in better shape. Much of this is due to active skepticism of large corporate chains and their scale advantages (trading hour restrictions come to mind).
  - pjc50 10y ago
    I think there may be some confirmation bias there; the UK is also discussing the question of what it calls "clone towns", where all the high street shops are either national chains, charity shops, or empty unlet units. The big ones like ASDA/Walmart are out of town. I think the only place small businesses are really thriving in Europe is Germany.
    - samscully 10y ago
      It depends on the town a bit I think. In Brighton there are lots of small business and some areas have no chains at all. Not sure if that is because of planning policy or for another reason.
PaulHoule 10y ago
It was worse before Obamacare. If you had a common prexisting condition such as high cholesterol or high blood pressure you probably could not get health insurance at all on the individual market. It's a problem with "Health Insurance in the US" as opposed to Obamacare.
- cylinder 10y ago
  I am not blaming Obamacare. I have reflected your exact sentiment in my other posts online. This is a result of the disaster that is the US healthcare system as a whole. Obamacare was a patch, but not enough to stop this from happening. I do advise that people not write-off criticisms of ACA as right-wing hysteria right now; the 2017 increases are really unbelievable in many states (Minnesota: 50%+). Everyone can browse these rates online.
  - ceejayoz 10y ago
    Left-wing criticisms of the ACA are that it should've had a public option (or single payer) - which may get some momentum with ongoing premium hikes. The right-wing hysteria part is the (false) idea that premiums didn't go up like this pre-Obamacare, as well as the idea that "roll it back" is a tenable solution.
    - merpnderp 10y ago
      10-20% rate growth was common before the ACA. Now my state is looking at a 74% hike. It is false to claim these kind of hikes were normal before the ACA.
      - ceejayoz 10y ago
        Your state is an outlier. http://www.latimes.com/business/la-fi-obamacare-premiums-20160919-snap-story.html http://www.latimes.com/business/la-fi-obamacare-premiums-201... > A new analysis from the Urban Institute found that the average unsubsidized premiums in the Affordable Care Act exchanges, commonly known as Obamacare, are actually 10% lower than the full premiums in the average employer plan nationally in 2016. http://www.newsweek.com/fact-check-trump-clinton-claim-obamacare-512605 http://www.newsweek.com/fact-check-trump-clinton-claim-obama... > According to the Kaiser Family Foundation the average cost of the second lowest priced silver metal plan, also known as the benchmark plan that is used to set subsidies, will see its price increase 9 percent next year. That's significantly higher than the 2 percent increase for these plans this year, but it's south of the figures provided by Trump.
jdavis703 10y ago
I just ran my numbers, the cost is about $2500/year for me (and this is with roughly the same Kaiser Permanente plan I have at work). That's about two months rent out here in the Bay Area. I've worked at three startups here so far, only one has had an older CEO with kids and the wife, so I think your numbers might be on the high side.
- cylinder 10y ago
  The article is about small business creation in the US, not Bay Area tech startups (they use the term "startups" in the headline disingenuously as clickbait; people don't really say "I'm doing a startup" when they open an auto-body shop).
- toomuchtodo 10y ago
  34 here, 32 yr old wife, newborn, Florida. $12k/yr. silver plan. We're discussing me working remotely (all of us relocating) from Panama or Belize; same first world income without the requirement to buy US health insurance (requirement is waved if you reside outside the country for 330 days/year). Our costs then drop to $3k/year for family coverage.
  - ttyltrful 10y ago
    Come to Panama! I looked hard at both and Panama is better for a ton of reasons. Don't worry about the language barrier. There is small and growing foreign tech community here. I moved here 6 months ago from SF and it has been the best decision of my life! Reply with your contact details if you want to know more.
- neksus 10y ago
  As someone from the Bay Area, please tell me where $2500 will get you 2 months of rent. Unless of course you mean a single room with a handful of roommates.
- r00fus 10y ago
  $2500/mo doesn't even get you a 2bdrm where I live in SFBay - and it's not the priciest area, either. Are you rooming?
debacle 10y ago
Where are plans like this so expensive? My family plan's premiums for very good PPO insurance are $23k/yr (including employer contributions). HDHP plans were in the realm of $5k per year when I was insured by one, just a few years ago.
graeme 10y ago
As a Canadian, this is astonishing. All our governments spend around $4500 usd per capita on health. That's about $6000 Canadian. That's for full coverage. No deductibles. Only things not covered are dental, vision and prescription drugs. I have dental, vision and paramedical insurance for $1000 us annually. This covers most of my expenses, and also covers some things like massage therapy and physio. It's also as business expense, and avoids the need to pay into my provincial drug plan. So I more or less break even on this. Prescription drugs? Depends on the province. In Quebec, if you have no other insurance, the public plan will take around $500 per year off your taxes and give you full coverage. Personally, I have full coverage through my private health plan (the one that costs $1000 per year). I got it by being, among other things, a writer. That lets me get the group plan for writers. Most professions will have such an organization. Failing that, en entrepreneur can join their chamber of commerce form $150 or so a year, and get a similar plan for similar rates. I would have been knocked out of business 3-4 times over without this. Major health issue that required surgery three years ago. Cost me $0. And in my first year I had to get my wisdom teeth out: fully covered by my plan. There's been a few other expenses, and also the ability to do physio et al for RSI due to computer work. I can't fathom doing it the American way. My taxes are somewhat higher in Quebec, but the difference in health costs more than makes up for it. In particular, I can't believe that with all those medical costs, you still have to pay large deductibles. Oh, and the services here are good, and fairly for for things that aren't elective. And a private system exists too if you need to go faster.
- refurb 10y ago
  My taxes are somewhat higher in Quebec High tax bracket in Quebec... $103K+ = 25.95% Lowest tax bracket in Canada (BC)... $106K+ = 14.7% That's added on top of the highest federal bracket of 33% for income over $200K. I'd say Quebec taxes are a LOT higher. [1]https://en.wikipedia.org/wiki/Income_taxes_in_Canada#Quebec https://en.wikipedia.org/wiki/Income_taxes_in_Canada#Quebec
  - graeme 10y ago
    What are typical American taxes? It was hard to find info, the calculators are confusing. I also heard some cities like manhattan have income taxes too. What would a New Yorker or Californian pay? We do have a 13% national sales tax which I don't think states have. Yeah, for those earning over $200K it's quite punishing, and would probably amount to more than the health savings. I think there aren't corporate structures that make it less rough though.
ap22213 10y ago
Can you suggest ways in which 'barely wealthy' people can help new potential entrepreneurs? For example, I don't have enough money to be an angel or involved with an incubator or VC, but I have enough money to subsidize someone's health care costs, if that's all that's needed.
forgetsusername 10y ago
>Take a look at S&P500's profit margins. They are at record highs and not coming down as economics teaches us, meaning new entrants are not coming into the market. It's not possible for this stuff to adjust instantaneously. The economy takes a long time to move. Profit margins are cyclical; they will decrease as inflation creeps in and wages and capital costs rise at a rate higher than prices can increase. Input costs are extremely low right now. Take a look at the data; we have 10 years of above average margins following 10 years of below average margins.
bisRepetita 10y ago
According to this website: http://www.ncsl.org/research/health/small-business-health-insurance.aspx http://www.ncsl.org/research/health/small-business-health-in... "On average, small businesses paid about eight to 18 percent more than large firms for the same health insurance policy" Not sure how many of those small businesses bought directly, or from the ACA exchanges.
fredgrott 10y ago
could the health exchange been better if the US Congress just used their heads and used their Medicare/Medicaid buying power and juts enroll everyone in that?
rch 10y ago
> Large corporations have an advantage in that they negotiate lower premiums in bulk Fixing this should have been one of the primary objectives of healthcare reform, and it still makes sense to try and address it now.
odonnellryan 10y ago
> Look up 2017 numbers. You are looking at $12,000 - $24,000 per year in premiums alone and then massive deductibles and coinsurance of 30% to actually access services. This is a little high, and depends on your income. More likely it's 6-8k in premiums for a plan with a ~1,500 deductible, no co-insurance. It's still way too high, but it's not that insane. Note: that deductible is yearly and applies to literally everything, even a $150 doctor's appointment.
jbarham 10y ago
I live in Melbourne, Australia, and pay $350/month for supplementary private health insurance for my family of five with three kids under ten. (All Australians of course have free access to the public Medicare health care system.) Last year I had cochlear implant surgery. The cost of the operation & implant is probably around $40k - $50k. My out-of-pocket expense was $410 for the overnight stay in hospital and $35 for painkillers. My premiums haven't changed since the operation. For a quick comparison in rates vs. Obamacare plans, here is my insurance company's website: http://www.bupa.com.au/ http://www.bupa.com.au/ Suffice it to say that I ignore emails from American recruiters.
- cylinder 10y ago
  Yeah, I am actually emigrating to there, and healthcare is a major factor. The system there works so much better. And costs aside, simply navigating payments, billings, costs, etc. even with private insurance is so much smoother and less stressful. Also of note is the way pharmaceuticals are priced in Australia. None of this EpiPen price hike type of nonsense. The government body Therapeutic Goods Administration negotiates all pharmaceuticals offered in Australia, and agrees on what they will pay the manufacturer. The public just pays A$39 for any drug, even if it costs the govt $100,000/yr.
drawkbox 10y ago
The main problem with healthcare is it is still semi-tied to employment/employers. There should be huge breaks to take out independent insurance not breaks for companies to offer it. Tying health insurance to a company is an ancient and legacy system that needs to go away. It makes entrepreneurship much more difficult and leads to things like ageism and making it difficult to change jobs or start companies. We don't get other insurance from our company, not auto, not life, not home, why the hell do we bind our most important insurance to employment? ACA was a start in that you can now actually get coverage (though not that great). In 2010 when I went fulltime on my business I got denied for about a year, under 30 and barely ever used healthcare. The same companies I was insured under at fulltime jobs wouldn't cover me individually. I was blown away and a bit scared, I knew then how bad the system before ACA was and it isn't much better now. The main cause of price disparity and risk is tying it to employment, we take the costs and hide them in insurance and employers backroom dealings, noone knows what anything costs because noone pays it directly. We need insurance companies to be consumer facing not employer facing, we need new competition in new insurance companies that are like that (more like Geico, Progressive, Nationwide for health not just auto rather than these employer focused companies in Aetna and Bluecross et al). We need to unlink healthcare from a job! It is becoming easier to start companies in any country where healthcare is not part of the normal benefits of a job. In the US we could start by making it illegal eventually to provide healthcare from a job (but providing extra money for it is ok). Eventually people will move to independent insurance or some public system like medicare for all. That way when you leave your job or start a company, it doesn't involve a heavy burden/risk on your health and insurance. Side note, every year since ACA has started I get my plan cancelled at the end of the year. They have rules in raising rates so they just end the plan and force you to jump on a new one. So every holiday season I get the joy of signing up to another freaking plan. I have no idea how this doesn't add tons of admin costs across the board. What a waste. And you can only join on enrollment not like every other insurance ever in that you can join at any time. The current insurance companies are trying to kill ACA and they were not setup to be independent insurance companies, we need better competition and a directive to remove healthcare from employment. Health insurance is the most non-independent and non-consumer friendly product in the US because it has never seen a real market, it is largely an employers service not individual consumer service.

ceejayoz 10y ago

Here in upstate NY, $20k/year for a mid-30s with family of four gets you a Platinum no-deductible, copay-only plan with a $4k/year out-of-pocket cap (my exact situation - 2016 premium is $1,700/month). Bronze plans are dramatically cheaper, and if you're doing a bare-bones startup you're also likely to be in the income range that gets subsidies.

cylinder 10y ago
Here's a junk Bronze HMO with 50% coinsurance and $5,500 per person deductible in Albany at over $16,000/yr: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/38594?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... I am sticking to the major carriers as I'm skeptical of the networks these small no-name providers have. But even if I browse all carriers, the cheapest platinum plan is $20,000/year: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/43003?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... Subsidies - let's say you pull $70,000 your first year. Your subsidies will be $4,000 per year, so the platinum plan is still $16,000/yr net. After-tax on $70k is $54,000. That means your healthcare premiums alone are 30% of your post-tax income even with the subsidy! That means only $3,150/mo remains for your rent, transportation, food, utilities, etc...
- ceejayoz 10y ago
  Here's mine: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/33810?county=Monroe&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2016&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... Per this calculator: http://kff.org/interactive/subsidy-calculator/#state=ny&zip=12201&income-type=dollars&income=70000&employer-coverage=0&people=4&alternate-plan-family=two_adult_children&adult-count=2&adults%5B0%5D%5Bage%5D=35&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=35&adults%5B1%5D%5Btobacco%5D=0&child-count=2&child-tobacco=0 http://kff.org/interactive/subsidy-calculator/#state=ny&zip=... subsidies in Albany are $578/month for an income of $70k, with an average cost of Silver plans being about $500/month post-subsidy. At ~9% of income, that's also tax-deductible spending.

clavalle 10y ago

If you are in a state with subsidies you are in pretty good shape. Also, you're numbers are a bit inflated if my experience is anything to go by. I have insurance through my company but my wife is on an Obamacare plan (because it was cheaper and better than what my company offers through a national HR company) for herself and our three children. We pay about $6000 per year for normal deductibles and a plan comparable with what she had working for the state of Texas (really good) before she went back to school. My only complaint is that this insurance company (Humana, I think) is very particular about the prescriptions it allows but I think you get that with any insurance company.

cylinder 10y ago
Texas is definitely cheaper than NY. However, Texas has been approved for one of the biggest premium increases for 2017, but their numbers have not yet been released (they will in a few days). You should anticipate at least a 30% increase in your wife's premiums, unfortunately.
- clavalle 10y ago
  Disappointing, but not surprising. We were surprised the insurance was so good for so (relatively) cheap, honestly.

iamthepieman 10y ago

my company pays 2000 dollars a month for our insurance premiums. This is a plan with a 2k individual/6k family deductible per year. We are saving 1.37% next year by going to a plan with 3k individual 9k family deductible. If we didn't do that premiums were going to rise by 10.4% next year. Our rates have gone up every year since I've been working here. The total EOB (Explanation of Benefits) costs value for the medical care my family got last year was under 6k. This was unusually high because we had two minor surgeries. The two years prior were much closer to our baseline of about 3-4k of medical care. This includes shots for the young kids, regular checkups, the occasional prescription and one semi-emergent emergency. One year a kid broke her arm, the other my wife needed an MRI. I know I represent a young family with relatively few health problems but so far, just since being on my current plan, we have paid 90,000 dollars (costs were slightly lower than our current premiums in prior years if you are doing the math) and received (at the high end) 18,000 dollars worth of medical care. I have paid 72,000 over just 4 years for insurance against catastrophic illness, disease or trauma. As I sit here writing and calculating this I have this question in the back of my mind - Is it worth it? I don't know. I think that question is ridiculous but I don't know what other question to ask.

cylinder 10y ago
Yes, many people are asking that question now. Those who work for a company and receive a W-2 form can look at Box 12 on the W-2 to see how much their employers paid for their side of their health insurance policy (coded with "dd"). You might think "who cares" but that's money that could have gone towards your salary.
- spoonie 10y ago
  To which they would then have to spend on their own, more expensive health insurance plans?
  - digikata 10y ago
    One should also question why an individual healthcare purchase should be charged more than a work based group plan. Shouldn't the operative "group" of patients basically be everybody who is a customer of the insurance company (or at least everybody at some tier of the insurance plan).

berntb 10y ago

That is a lot of money. :-( So it is true, the bad US health care system really is a startup limitation. Maybe it is time for countries with nice weather and cheap health care to woo Silicon Valley...? Something like: "Get here for less than a month's health care, do Skype meetings and you'll need a telescope to see the end of your startup's runway". :-) Kenya and Tanzania have some good beaches and they got OK Internet now? Or most places in Asia? How cheap is it to live in a small fishing city in Japan? I smell a business opportunity.

cylinder 10y ago
It's not really tech startups I'm worried about as they are more likely to receive VC/angel and can be started by young hackers. I'm talking about your average small business, whether it be a self-employed consultant, a small hardware shop, a bakery, mechanic shop, cafe, etc. I observe that small business has been decimated in America and giant chains have proliferated. When you drive through small towns in the US you will usually find a few large chains like WalMart, McDonalds, Jiffy Lube, etc on the Main St and not much else. When I travel UK, Australia, NZ, Europe, small business seems to be in better shape. Much of this is due to active skepticism of large corporate chains and their scale advantages (trading hour restrictions come to mind).
- pjc50 10y ago
  I think there may be some confirmation bias there; the UK is also discussing the question of what it calls "clone towns", where all the high street shops are either national chains, charity shops, or empty unlet units. The big ones like ASDA/Walmart are out of town. I think the only place small businesses are really thriving in Europe is Germany.
  - samscully 10y ago
    It depends on the town a bit I think. In Brighton there are lots of small business and some areas have no chains at all. Not sure if that is because of planning policy or for another reason.

PaulHoule 10y ago

It was worse before Obamacare. If you had a common prexisting condition such as high cholesterol or high blood pressure you probably could not get health insurance at all on the individual market. It's a problem with "Health Insurance in the US" as opposed to Obamacare.

cylinder 10y ago
I am not blaming Obamacare. I have reflected your exact sentiment in my other posts online. This is a result of the disaster that is the US healthcare system as a whole. Obamacare was a patch, but not enough to stop this from happening. I do advise that people not write-off criticisms of ACA as right-wing hysteria right now; the 2017 increases are really unbelievable in many states (Minnesota: 50%+). Everyone can browse these rates online.
- ceejayoz 10y ago
  Left-wing criticisms of the ACA are that it should've had a public option (or single payer) - which may get some momentum with ongoing premium hikes. The right-wing hysteria part is the (false) idea that premiums didn't go up like this pre-Obamacare, as well as the idea that "roll it back" is a tenable solution.
  - merpnderp 10y ago
    10-20% rate growth was common before the ACA. Now my state is looking at a 74% hike. It is false to claim these kind of hikes were normal before the ACA.
    - ceejayoz 10y ago
      Your state is an outlier. http://www.latimes.com/business/la-fi-obamacare-premiums-20160919-snap-story.html http://www.latimes.com/business/la-fi-obamacare-premiums-201... > A new analysis from the Urban Institute found that the average unsubsidized premiums in the Affordable Care Act exchanges, commonly known as Obamacare, are actually 10% lower than the full premiums in the average employer plan nationally in 2016. http://www.newsweek.com/fact-check-trump-clinton-claim-obamacare-512605 http://www.newsweek.com/fact-check-trump-clinton-claim-obama... > According to the Kaiser Family Foundation the average cost of the second lowest priced silver metal plan, also known as the benchmark plan that is used to set subsidies, will see its price increase 9 percent next year. That's significantly higher than the 2 percent increase for these plans this year, but it's south of the figures provided by Trump.

jdavis703 10y ago

I just ran my numbers, the cost is about $2500/year for me (and this is with roughly the same Kaiser Permanente plan I have at work). That's about two months rent out here in the Bay Area. I've worked at three startups here so far, only one has had an older CEO with kids and the wife, so I think your numbers might be on the high side.

cylinder 10y ago
The article is about small business creation in the US, not Bay Area tech startups (they use the term "startups" in the headline disingenuously as clickbait; people don't really say "I'm doing a startup" when they open an auto-body shop).
toomuchtodo 10y ago
34 here, 32 yr old wife, newborn, Florida. $12k/yr. silver plan. We're discussing me working remotely (all of us relocating) from Panama or Belize; same first world income without the requirement to buy US health insurance (requirement is waved if you reside outside the country for 330 days/year). Our costs then drop to $3k/year for family coverage.
- ttyltrful 10y ago
  Come to Panama! I looked hard at both and Panama is better for a ton of reasons. Don't worry about the language barrier. There is small and growing foreign tech community here. I moved here 6 months ago from SF and it has been the best decision of my life! Reply with your contact details if you want to know more.
neksus 10y ago
As someone from the Bay Area, please tell me where $2500 will get you 2 months of rent. Unless of course you mean a single room with a handful of roommates.
r00fus 10y ago
$2500/mo doesn't even get you a 2bdrm where I live in SFBay - and it's not the priciest area, either. Are you rooming?

debacle 10y ago

Where are plans like this so expensive? My family plan's premiums for very good PPO insurance are $23k/yr (including employer contributions). HDHP plans were in the realm of $5k per year when I was insured by one, just a few years ago.

graeme 10y ago

As a Canadian, this is astonishing. All our governments spend around $4500 usd per capita on health. That's about $6000 Canadian. That's for full coverage. No deductibles. Only things not covered are dental, vision and prescription drugs. I have dental, vision and paramedical insurance for $1000 us annually. This covers most of my expenses, and also covers some things like massage therapy and physio. It's also as business expense, and avoids the need to pay into my provincial drug plan. So I more or less break even on this. Prescription drugs? Depends on the province. In Quebec, if you have no other insurance, the public plan will take around $500 per year off your taxes and give you full coverage. Personally, I have full coverage through my private health plan (the one that costs $1000 per year). I got it by being, among other things, a writer. That lets me get the group plan for writers. Most professions will have such an organization. Failing that, en entrepreneur can join their chamber of commerce form $150 or so a year, and get a similar plan for similar rates. I would have been knocked out of business 3-4 times over without this. Major health issue that required surgery three years ago. Cost me $0. And in my first year I had to get my wisdom teeth out: fully covered by my plan. There's been a few other expenses, and also the ability to do physio et al for RSI due to computer work. I can't fathom doing it the American way. My taxes are somewhat higher in Quebec, but the difference in health costs more than makes up for it. In particular, I can't believe that with all those medical costs, you still have to pay large deductibles. Oh, and the services here are good, and fairly for for things that aren't elective. And a private system exists too if you need to go faster.

refurb 10y ago
My taxes are somewhat higher in Quebec High tax bracket in Quebec... $103K+ = 25.95% Lowest tax bracket in Canada (BC)... $106K+ = 14.7% That's added on top of the highest federal bracket of 33% for income over $200K. I'd say Quebec taxes are a LOT higher. [1]https://en.wikipedia.org/wiki/Income_taxes_in_Canada#Quebec https://en.wikipedia.org/wiki/Income_taxes_in_Canada#Quebec
- graeme 10y ago
  What are typical American taxes? It was hard to find info, the calculators are confusing. I also heard some cities like manhattan have income taxes too. What would a New Yorker or Californian pay? We do have a 13% national sales tax which I don't think states have. Yeah, for those earning over $200K it's quite punishing, and would probably amount to more than the health savings. I think there aren't corporate structures that make it less rough though.

ap22213 10y ago

Can you suggest ways in which 'barely wealthy' people can help new potential entrepreneurs? For example, I don't have enough money to be an angel or involved with an incubator or VC, but I have enough money to subsidize someone's health care costs, if that's all that's needed.

forgetsusername 10y ago

>Take a look at S&P500's profit margins. They are at record highs and not coming down as economics teaches us, meaning new entrants are not coming into the market. It's not possible for this stuff to adjust instantaneously. The economy takes a long time to move. Profit margins are cyclical; they will decrease as inflation creeps in and wages and capital costs rise at a rate higher than prices can increase. Input costs are extremely low right now. Take a look at the data; we have 10 years of above average margins following 10 years of below average margins.

bisRepetita 10y ago

According to this website: http://www.ncsl.org/research/health/small-business-health-insurance.aspx http://www.ncsl.org/research/health/small-business-health-in... "On average, small businesses paid about eight to 18 percent more than large firms for the same health insurance policy" Not sure how many of those small businesses bought directly, or from the ACA exchanges.

fredgrott 10y ago

could the health exchange been better if the US Congress just used their heads and used their Medicare/Medicaid buying power and juts enroll everyone in that?

rch 10y ago

> Large corporations have an advantage in that they negotiate lower premiums in bulk Fixing this should have been one of the primary objectives of healthcare reform, and it still makes sense to try and address it now.

odonnellryan 10y ago

> Look up 2017 numbers. You are looking at $12,000 - $24,000 per year in premiums alone and then massive deductibles and coinsurance of 30% to actually access services. This is a little high, and depends on your income. More likely it's 6-8k in premiums for a plan with a ~1,500 deductible, no co-insurance. It's still way too high, but it's not that insane. Note: that deductible is yearly and applies to literally everything, even a $150 doctor's appointment.

jbarham 10y ago

I live in Melbourne, Australia, and pay $350/month for supplementary private health insurance for my family of five with three kids under ten. (All Australians of course have free access to the public Medicare health care system.) Last year I had cochlear implant surgery. The cost of the operation & implant is probably around $40k - $50k. My out-of-pocket expense was $410 for the overnight stay in hospital and $35 for painkillers. My premiums haven't changed since the operation. For a quick comparison in rates vs. Obamacare plans, here is my insurance company's website: http://www.bupa.com.au/ http://www.bupa.com.au/ Suffice it to say that I ignore emails from American recruiters.

cylinder 10y ago
Yeah, I am actually emigrating to there, and healthcare is a major factor. The system there works so much better. And costs aside, simply navigating payments, billings, costs, etc. even with private insurance is so much smoother and less stressful. Also of note is the way pharmaceuticals are priced in Australia. None of this EpiPen price hike type of nonsense. The government body Therapeutic Goods Administration negotiates all pharmaceuticals offered in Australia, and agrees on what they will pay the manufacturer. The public just pays A$39 for any drug, even if it costs the govt $100,000/yr.

drawkbox 10y ago

The main problem with healthcare is it is still semi-tied to employment/employers. There should be huge breaks to take out independent insurance not breaks for companies to offer it. Tying health insurance to a company is an ancient and legacy system that needs to go away. It makes entrepreneurship much more difficult and leads to things like ageism and making it difficult to change jobs or start companies. We don't get other insurance from our company, not auto, not life, not home, why the hell do we bind our most important insurance to employment? ACA was a start in that you can now actually get coverage (though not that great). In 2010 when I went fulltime on my business I got denied for about a year, under 30 and barely ever used healthcare. The same companies I was insured under at fulltime jobs wouldn't cover me individually. I was blown away and a bit scared, I knew then how bad the system before ACA was and it isn't much better now. The main cause of price disparity and risk is tying it to employment, we take the costs and hide them in insurance and employers backroom dealings, noone knows what anything costs because noone pays it directly. We need insurance companies to be consumer facing not employer facing, we need new competition in new insurance companies that are like that (more like Geico, Progressive, Nationwide for health not just auto rather than these employer focused companies in Aetna and Bluecross et al). We need to unlink healthcare from a job! It is becoming easier to start companies in any country where healthcare is not part of the normal benefits of a job. In the US we could start by making it illegal eventually to provide healthcare from a job (but providing extra money for it is ok). Eventually people will move to independent insurance or some public system like medicare for all. That way when you leave your job or start a company, it doesn't involve a heavy burden/risk on your health and insurance. Side note, every year since ACA has started I get my plan cancelled at the end of the year. They have rules in raising rates so they just end the plan and force you to jump on a new one. So every holiday season I get the joy of signing up to another freaking plan. I have no idea how this doesn't add tons of admin costs across the board. What a waste. And you can only join on enrollment not like every other insurance ever in that you can join at any time. The current insurance companies are trying to kill ACA and they were not setup to be independent insurance companies, we need better competition and a directive to remove healthcare from employment. Health insurance is the most non-independent and non-consumer friendly product in the US because it has never seen a real market, it is largely an employers service not individual consumer service.