22 ms·

When my wife and I looked for insurance just before ACA, the private plan without subsidies, because they didn't exist, was $250. It was a basic plan with a hig

When my wife and I looked for insurance just before ACA, the private plan without subsidies, because they didn't exist, was $250. It was a basic plan with a high deductible and an HSA. It was pretty much what my employer offered. After the ACA, same plan, by name, now cost $530. Sure it had more bells and whistles, but I didn't want nor need them. This priced me out. This same plan today is $780 a month without subsidies. We are now on an ACA plan. $270 with subsidies. Think about that. The government doubled the price of the plan or more, and is paying with our tax dollars the difference between my $270 and $780. The ACA helped many people. It helped people under 26. It helped people with pre-existing conditions. It helped give free or low-cost health care to people that couldn't afford it because now the government is picking up the lion's share of the tab. As much as people like to rag on the Republicans, and they deserve it, I don't think they will throw out the good parts. I think they will look at the industrial recommendations such as expanding risk pools across states (Commerce Clause allows this regulation), and other rational plans. Will it be perfect? No. Will it be better than the current ACA? Maybe.

alphabettsy 10y ago
What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere...
- virmundi 10y ago
  It's at least correlated. Within 1 month's time, the plan cost doubled. The ACA required insurance to cover things like mental health care. As a result, the plans had to be more expensive since they needed to cover more.
- JonFish85 10y ago
  If you're looking for something directly in the law, you're not going to find the government saying that prices should be raised. It's a second-order effect; there was minimal cost control in the ACA, and plenty of room for companies to raise their prices. In a lot of ways, it was a sweetheart deal to insurance companies: they had essentially a mandate for people to buy their insurance, demand was through the roof, so they could charge more.
  - deleted 10y ago
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- rdtsc 10y ago
  > What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere. My evidence is that the premiums for my insurance went up even before ACA passed just in anticipation. That is exactly what the health insurance representative told us. It was pretty clear why it happened. After ACA passed it kept going up a higher rate for us than in previous years (I have data for 3 years before). > What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere... Isn't it a bit disingenuous to suggest that the increase in health insurance is unrelated to legislation regulating health insurance. Or to put it another way is there evidence that government regulation didn't affect the prices and something else did?
  - JacobJans 10y ago
    If you look at the numbers, the rate increases didn't change significantly when the ACA was put into practice. The only exception is the first year, when companies weren't sure what the appropriate pricing should be. http://blogs-images.forbes.com/mikepatton/files/2015/06/Health-Ins-Prems-Personal-Income-2005-2014.jpg?width=960 http://blogs-images.forbes.com/mikepatton/files/2015/06/Heal...
    - rdtsc 10y ago
      It did for our company, we had an HMO as the insurance provider for us. Company of about 40 people or so.
  - usefulcat 10y ago
    The government does not, so far as I am aware, set the prices of the plans. Therefore it is nonsensical to claim that "the government itself doubled the price". Now, if one were to claim that the government failed to do anything that had the effect of reducing the cost of health care or health insurance, then I would completely agree. For example, there is nothing to prevent someone from signing up for insurance, having some expensive medical procedures performed, and subsequently dropping the insurance. I have personally heard reports from insurance agencies that some people do in fact do this. And I can't say I'm surprised, either; even after factoring in the tax penalties, it's probably a completely economically rational thing to do in a lot of cases.
- jerrycruncher 10y ago
  There is no evidence because government did not raise the price - the insurance companies did, all while raking in record profits. Premiums in states which refused federal money to expand Medicaid generally rose much, much more than states (like CA) which did not[1]. Cynically, this was likely a designed play by Republicans to kneecap the effectiveness of the ACA by skewing the risk pool towards the elderly (who require more medical care, in general). [1] https://www.consumeraffairs.com/news/health-insurance-industry-rakes-in-billions-while-blaming-obamacare-for-losses-110116.html https://www.consumeraffairs.com/news/health-insurance-indust...
  - rgoddard 10y ago
    A couple additional pieces to keep in mind. Insurance companies are essentially capped at how much profit they can make on average per subscriber. For large groups 85% of every dollar collected has to be spent on medical expenses, and for small group / individual 80% has to be spent on medical expenses. If they don't meet those standards, the companies need to refund the premium to make up the difference. In the linked article most of their profit would be coming from the large group market. The individual exchange is a separate segment and where they would be suffering those loses. So the desire to not remain in an unprofitable segment is not really negated by being profitable in a completely different segment.
- kobeya 10y ago
  There is basically no real cost control in the bill, with the logical consequence being that insurance companies will do what they can get away with to raise premiums so that the new premium rate minus subsidies equals the old premium rate. The extra requirements of the ACA, and the lack of universal roll-out basically ensures that there are plenty of excuses for doing so.
  - nradov 10y ago
    False. The ACA imposed a minimum 80-85% medical loss ratio on insurance companies. This is a cost control. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio.html https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In... But there aren't any real cost controls on providers, drug companies, medical device companies, and other suppliers.
    - kobeya 10y ago
      > But there aren't any real cost controls on providers, drug companies, medical device companies, and other suppliers. That's what I said.
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    - koolba 10y ago
      > False. The ACA imposed a minimum 80-85% medical loss ratio on insurance companies. This is a cost control. That's not a cost control. That's a price inflater! If the only way for them to make more money is to have the price of things go up, what do you expect they're going to be in favor of? In a perfect world (from the perspective of the insurance company), everything from premiums to procedures goes up X% so that their profits go up X%. That's a seriously messed up system and may be the most egregious part of the entire ACA.
      - 10y ago
stinkytaco 10y ago
> As much as people like to rag on the Republicans, and they deserve it, I don't think they will throw out the good parts. It would politically unpopular to "throw out" the parts you spoke of. But the question is can we keep those parts and not keep the insurance mandate?
- namlem 10y ago
  Sure, with even larger taxpayer handouts to insurance companies.
- 09bjb 10y ago
  Not true. The senate has already voted down the pre-existing protections plan, letting young adults stay on their parents' plans, and keeping contraceptive coverage. American's don't follow the actual machinations of the senate much so it's not "politically unpopular" to do this. We think electing a President every 4 years who's a radical departure from what we had before will fix all our problems and prevent us from actually having to pay attention to the details.
  - learc83 10y ago
    The Senate can't remove the pre-existing conditions protections or letting young adults stay on their parents plans through budget reconciliation. They can remove funding for subsidies through budget reconciliation, and let the system collapse on its own, but they don't have the votes to overcome the filibusterer they'd get if they tried to remove those protections directly. 1 of 2 things will likely happen. 1. They will repeal and delay. Meaning they will remove funding through reconciliation, but delay implementation until 2020. Then depending on what happens in 2018 who knows what might happen. This is the bad option because it could cause the collapses of the individual market even before it takes effect. 2. They will repeal and replace. Most likely they will replace it with the new Health and Human Services Secretary's plan to keep the preexisting conditions protection plan, as long as you maintain coverage. If you don't maintain coverage you'll go into a high risk pool with higher rates until you maintain coverage for 18 months. Plan 2 is very similar to what we currently have, but it replaces the punishment for not maintain coverage with higher premiums instead of a tax penalty. What they should do is to increase the tax penalty to force more people into the pool and simultaneously add a public option, but that's not going to happen.
cptskippy 10y ago
It's odd that you expect the people, who fought to prevent ACA from happening and have tried to repeal it weekly since it's inception, are now going to fix it.
- noobermin 10y ago
  And since people have an issue with recentism, just look at recent events that prompted sama's post, Republicans in the senate repealed half of the good things in the ACA.
Retric 10y ago
There are no high deductible ACA plans. So, no it's not 1:1. The cheapest option is a 60% coverage plan with a $7,150 annual limit for out of pocket costs. http://obamacarefacts.com/out-of-pocket-maximums-and-deductible-limits-for-2017-health-plans/ http://obamacarefacts.com/out-of-pocket-maximums-and-deducti... The ACA lowered the costs of people with insurance by reducing the pool of people without insurance adn thus the free rider costs. Free markets however continued to raise prices just like they have for the last 30 years. http://www.motherjones.com/files/blog_premium_growth_2014.jpg http://www.motherjones.com/files/blog_premium_growth_2014.jp...
- Amezarak 10y ago
  I'm a little confused. The page you linked describes high deductible ACA plans (aka HSA eligible plans.)
  - Retric 10y ago
    To clarify. HSA require a deductible of at least $1,300 for one person, so people have starting calling that a 'high' deductible from 2003 or so. Before ACA you could by health insurance with a 15,000$ deductible as an individual. After, ACA the individual out of pocket maximum is $7,150 per year for an individual. So, now legally the maximum is below the old pre HSA threshold for 'high' deductible.
    - TillE 10y ago
      Deductibles are insane, period. It's a horrendous concept unless you're rich. You don't get them in most (all?) countries with universal coverage, not even in hybrid systems like Germany's with their public insurance options.
      - deleted 10y ago
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      - jimmyk 10y ago
        What is insane about wanting to pay a low monthly premium in exchange for insurance that only kicks in for very expensive events?
splintercell 10y ago
> The ACA helped many people. It helped people under 26. It helped people with pre-existing conditions. And the cost is being borne by everyone else.The art of economics consists in looking not merely at the immediate but at the longer effects of any act or policy; it consists in tracing the consequences of that policy not merely for one group but for all groups.
- AlexandrB 10y ago
  The cost of people not being to afford basic care is also borne by everyone else. I do not understand why the US can't join most of the western world in instituting single-payer public healthcare. It would be a huge boon for small business and startups, who would no longer have to factor in medical benefits into their compensation structure and whose owners would no longer have to risk being uninsured for an extended period when they start the business. Moreover, it's the morally right thing to do. It's shameful that the world's premier economic superpower does such a poor job of looking after its most vulnerable citizens.
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  - mikeash 10y ago
    The reason is relatively simple: approximately half of the electorate and half of our political system is caught in a feedback loop opposing public health care. Lots of voters are convinced that public health care is a disaster. One of our two major parties wins votes by accommodating that. Further, that party ensures votes in the future by pushing misinformation which helps convince more voters. Until and unless we can get people to examine the facts, this will continue.
    - Futurebot 10y ago
      58% of Americans support federally funded universal health care, including 40% of Republicans: http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx http://www.gallup.com/poll/191504/majority-support-idea-fed-... Opposition comes from the wealthy, whose taxes would go up, and insurance company execs (and employees) since it keeps them in business.
vinhboy 10y ago
> I don't think they will throw out the good parts You are mistaken. The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up. It's basic economics. The Republicans do not have a plan to fix that. If there was a way to fix it, don't you think it would already be implemented? You think they're purposefully keeping your rates high just to fuck with you? Not to mention suffer all the political fallout of it? Don't forget. Obamacare is the Republican plan. This repeal and objection to Obamacare is all politics, not an attempt to fix a broken system.
- JustSomeNobody 10y ago
  What makes your insurance go up is the fact that insurance companies are beholden to investors and not the people they insure. They must exceed each and every last quarter or they take a hit.
  - maxerickson 10y ago
    Many insurers are private non profits, often owned by the people they insure. Here's one with 8 million members: https://www.bcbsil.com/company-info/who-we-are https://www.bcbsil.com/company-info/who-we-are
- deleted 10y ago
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- nugget 10y ago
  Everyone knows how to fix the problem in the short/medium term. The solution is money. Specifically, money from the Federal Government. The real behind-the-scenes debate in DC this month is about, first, the best mechanism to transfer funds (direct subsidies, state subsidies, Federal reinsurance pool for the sickest cases, etc ... each of which create distinct winners and losers whose lobbyists are currently out in force), and second, how much of an annual budget deficit the fiscal-hawk Republicans (now led by Rand Paul) are willing to tolerate. The longer-term solutions have much more to do with diet, lifestyle management, and other behavioral health issues than with access to providers and drugs (e.g. look up how much of last year's medicaid/medicare budget was spent on type 2 diabetes treatment alone). Unfortunately it doesn't seem like we can tackle these issues at scale until after the current debate on affordable universal access to care is settled.
acomjean 10y ago
My understanding is The "good parts" like keeping kids on till 26, pre-existing condition are the ones that make the insurance more expensive, the requirement to get insurance was supposed to get the insurance pool big enough so that it wasn't a big problem. So it works as a totality but not in pieces
acomjean 10y ago
My understanding is The "good parts" like keeping kids on till 26, pre-existing condition are the ones that make the insurance more expensive, the requirement to get insurance was supposed to get the insurance pool big enough so that it wasn't a big problem. So it works as a totality but not in pieces
bduerst 10y ago
Just being insured doesn't mean you're covered. Those private plans you researched had crap coverage compared to the standards that the ACA set for all health insurance. By raising the standard, premiums have gone up on some private plans and overall healthcare costs have been reduced for all Americans.
- ctdonath 10y ago
  Deductibles have shot up as well. Long details short, I have a $30,000 deductible when a pre-ACA plan had a 3-digit deductible. I'm covered, but the ceiling is unreachably high. Costs have gone way up; they've just re-arranged where the money comes from, and punish you for not putting more money into the system. Ensuring everyone is covered by making it illegal to not be covered is not an acceptable solution.
  - bduerst 10y ago
    That doesn't make sense, are you sure you're not being scammed? Maximum out of pocket for a family on an ACA bronze plan is $14,300, including drug costs.
  - fooey 10y ago
    Yeah, that's not true. There is no legal way for a deductible to be that high http://obamacarefacts.com/health-insurance/deductible/ http://obamacarefacts.com/health-insurance/deductible/ > The maximum deductible is equal to the maximum-out-of-pocket limit each year ($7,150 for an individual and $14,300 for a family for 2017).
    - bzbarsky 10y ago
      > There is no legal way for a deductible to be that high That's the theory. As I noted in https://news.ycombinator.com/item?id=13393287 https://news.ycombinator.com/item?id=13393287 experiment suggests otherwise for the out-of-pocket limit, at least....
      - 10y ago
joering2 10y ago
> We are now on an ACA plan. $270 with subsidies. Think about that. The government doubled the price of the plan or more, and is paying with our tax dollars the difference between my $270 and $780. Can you provide any proof of that? According to Obama, an average insurance will be as affordable as a cellphone bill. Perhaps your plan had some perks in it, no? Also there was a lot of fake stories about people getting tripled their insurance cost, all have been pretty much debunked as not real. Even Harry Reed was mentioning that in his speech.
- cylinder 10y ago
  Are you kidding? Go on any states healthcare exchange and price out a plan for a family of four. Subsidies only cover low incomes, apparently $70k for a family of four in NY is rich and can afford $18k/yr premiums with $14k deductible. There are some really piss poor regional plans with weak provider networks that are cheaper but you'll end up getting hit by out of network bills. The major carriers are charging astronomical rates if they are providing Exchange plans at all in 2017.
  - jjeaff 10y ago
    Ya, these prices that you see politicians touting are from the cheapest providers and hmo only. In the Los Angeles area, the closest gp was an hour away with a 30 day lead time to get an appointment if you go with the budget plan. For those that don't know, in an hmo, you have to go see your gp for a referral for everything. In grown tonail, go to gp when you know he will refer you to a podiatrist. With a ppo, you can go directly to the specialist. But ppo under aca are the "premium" plans.
  - joering2 10y ago
    Well I don't know the details I have to admit. But I go with what President of USA said - it will be as cheap as your phone bill: "less than a hundred bucks a month". Here is the proof if you don't believe me: https://www.youtube.com/watch?v=_lT4VzH5xY8 https://www.youtube.com/watch?v=_lT4VzH5xY8
- virmundi 10y ago
31reasons 10y ago
I have borderline high cholesterol and family history of heart disease. Before ACA, health insurance companies quoted me minimum $1200/month for basic coverage even though I am in my 30s and healthy and rarely visit doctors office.
sigmar 10y ago
Whenever I see people talk about their costs going up, I wonder if they realize that health care costs were projected to go up even without the ACA. There's plenty of Government reports and private company reports on this topic and most reports I've read show that ACA is helping. I wonder if people have spent time reading up on quantitative assessments before basing their views on personal observations.
- yellow_postit 10y ago
  But without a real counterfactual these reports can be conviently dismissed if it doesn't fit the person's world view.
colemickens 10y ago
>I don't think they will throw out the good parts The Senate has already voted to remove provisions that your praise in your post...
- zaroth 10y ago
  This same comment has showed up a half dozen times and it's a false characterization of the actual vote last night. From the NYT: "Senate Republicans took their first major step toward repealing the Affordable Care Act on Thursday, approving a budget blueprint that would allow them to (gut the health care law) without the threat of a Democratic filibuster." So take out the editorial "gut the healthcare law" and replace with "repeal and replace" and you have a clear reporting of what actually happened. Two paragraphs down the actual non-editorialized reporting states the real truth; "The action by the Senate is essentially procedural"
  - gibrown 10y ago
    The Republican Senate and House have voted multiple times to repeal the whole of the ACA over the past years. The only thing that has stopped it has been a presidential veto. Here's one: http://www.cnn.com/2016/01/08/politics/obama-vetoes-obamacare-repeal-bill/ http://www.cnn.com/2016/01/08/politics/obama-vetoes-obamacar...
    - zaroth 10y ago
      Don't confuse showmanship or grandstanding with actual political intent. It's why the reporting on Trump is so often wrong and misleading. Now that the vote counts just see what actually happens.
  - colemickens 10y ago
    So, they voted to repeal it, offered no plans for replacement, and you want to act like "repeal and replace" is a more fair characterization? The GOP has been talking about repeal for year(s) now and has nothing to show for a replacement plan. Meanwhile, as part of the resolution passed, they took aim at specific provisions that, again, were things praised in the grandparent comment.
fooey 10y ago
The only thing that operating across state lines actually accomplishes is enabling a race to the bottom. It means that whatever state manages to make their regulations the most attractive to the insurance industry is the state that all the providers will "move" to, and that's the quality of insurance the rest of the nation gets stuck with. For the most part, the insurance companies are huge, and they operate nationally already. There's really not any economies of scale that are going to produce direct savings. The savings come by slashing everyones coverage.
- virmundi 10y ago
  I'm invoking the commerce clause. So the States can only make more onerous regulations. You see this with California emission standards. The Federal government has a minimum and California say, "You got to do better." This prevents a race to the bottom.
  - fooey 10y ago
    Seems to me, the GOP's entire point for letting insurers sell across state lines is precisely to force a state like California to allow substandard plans to be sold to their citizens
    - virmundi 10y ago
      Depends on the Federal requirements. Something that's lost in this whole conversation is the idea of insurance. I have auto insurance because I could be hit. I've gone 15 years without being hit, at least not enough to make a claim. I keep it just in case. Going to the doctor for an annual physical is not something that should be insured. It's a known cost. You, as the individual, should pay that out of pocket, or get another extended coverage policy or rider to covert that. It's like my auto insurance paying for oil changes. As a result, our costs are too high.
      - fooey 10y ago
        If car insurance had to cover a 6+ figure operation replacing an old engine that was was seized up because of poor maintenance, it would make financial sense to cover oil changes as a preventative measure. A health disaster is several orders of magnitude more expensive than an automotive disaster, and you can't just total out a human being and pick up a new one at the local dealership if it's too expensive. Preventative maintenance is a money saver long term.
leshow 10y ago
I'm not American so forgive my ignorance, but is that the amount you pay monthly?
- virmundi 10y ago
  Yes. When I was working on a contract, my income put me out of the subsidies range. I would have had to pay $780 for the cheapest plan per month. Essentially a mortgage. Actually $130 more than my current mortgage.
  - leshow 10y ago
    Jesus, no wonder so many people don't have coverage. I have never had to pay anything, even benefits are largely covered by my employer. I think I pay 15 bucks a month for a family plan on vision/dental/eye/drugs/physio etc.
    - angry-hacker 10y ago
      It's called taxes you pay, assuming your a fellow European. I pay 33% of my income to Healthcare so these rates you Americans say you pay are really small, you're just spoiled :)
      - mikeash 10y ago
        We pay those taxes too. Our per-capita government expenditure on health care is higher than many developed countries with single-payer systems. Our government then spends this vast amount of money to provide care for a fraction of us.
- jtuente 10y ago
  That looks like a monthly amount, yes.
- attaboyjon 10y ago
  I have a family of six, 2 adults and 4 kids. I pay $1400 per month for a plan with a deductible high enough that I will pay for all of my expenses.
yardie 10y ago
What are the bells and whistles that weren't needed? Like, I don't have mental issues so I don't need the mental health parts. I don't have cancer so I don't need the cancer coverage. Previous to the ACA people would buy "health insurance" with a deductible so high they realistically couldn't use it anyway. I'm talking working class people with $10k deductibles and $2000 in actual savings. And they were freely sending insurance companies $100-200/month knowing there is no way they could actually use it.
- virmundi 10y ago
  I won't ever use mental health services. Personal choice. The old plan didn't offer that. I could get another plan to cover that. Why should I be forced to purchase something I have no intention of using? Insurance, as a product, was highly customizable. You could get riders and other policies to cover various risks. You see this all the time with fleet insurance. Health insurance use to be the same. The ACA set a floor on the offerings. If you don't those features, you can get a non ACA approved plan. You then have to pay the tax penalty. Now the penalty is an oddity. There is no lean. The government removes from your refund $X until you either pay the penalty or have no refund. I looked at such a plan. Best I found was $438. Assuming an income of > $100,000 (I thought that 2017 insurance rates were set using 2016 actual income, I was wrong), the penalty was north of $3.5k total for my wife and I. This made the ACA plan cheaper since I didn't have to worry about filing quarterly estimates since I always have a refund (I'm giving a price to the time and effort required to file). So the subsidies make the ACA plan cheaper that the non-ACA plan. I went with that. The question I pose to society is "Should we require government, funded through taxes, handout to make medical costs affordable?"
  - ahfagfddash 10y ago
    > I won't ever use mental health services. Personal choice. The old plan didn't offer that. I could get another plan to cover that. Why should I be forced to purchase something I have no intention of using? You are ignorant and heartless. In the worst and most expensive cases, patients do not even have a choice. And your subtext is completely clear here. No, you should not get to pick and choose what conditions are worthy of treatment because you don't have them and don't think they are legitimate, and therefore make coverage more expensive or unobtainable for others.
ahfagfddash 10y ago
What I get from this is you and your wife are healthy and didn't go to the doctor and after the ACA your premium went up $20 a month. > Sure it had more bells and whistles, but I didn't want nor need them. Like FREE preventative care. That's not a bell and whistle. That's worth more than your $20/month right there. Go to the doctor already. And more importantly, that premium is identical regardless of what condition you were in. Without ACA, if you had cancer, you would die and/or be financially ruined. Worse yet, if you just had something like depression, or high blood pressure, or diabetes, then you'd be screwed out getting affordable insurance even in the event you got cancer or something unrelated but deadly.
- virmundi 10y ago
  > What I get from this is you and your wife are healthy and didn't go to the doctor and after the ACA your premium went up $20 a month. My taxes, and everyone else's taxes go to pay this $500 dollar difference. The Federal government didn't some how magically create the gap funds. They have to increase taxes through fines and other sources to pay this. They've effectively hidden these costs for the subsidized individuals. I'm not paying $780 per month with a large refund at the end of the year. I'm paying a few hundred. Most people don't think about the revenue impact this has on the country. We now have to fund these subsidies. We now remove even more money from people that could have go into stocks, local economies, or services. The plan should be $280. That's it. Not $280 + subsidies. Just $280.
  - ceejayoz 10y ago
    > We now have to fund these subsidies. Maybe, maybe not. Here's a case of a death that cost $250k for want of a $80 tooth extraction: http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html http://www.washingtonpost.com/wp-dyn/content/article/2007/02... We were already paying for uninsured folks via bankruptcies etc.
    - chimeracoder 10y ago
      > Here's a case of a death that cost $250k for want of a $80 tooth extraction It didn't "cost" $250,000. That's the sticker price of what they billed for the services, but that's not what they expected to be paid by insurance. That's a crucial distinction. Just as you don't pay sticker price for a new car, the insurance company doesn't pay what the provider bills them for; they pay some agreed-upon rate, which is specified as a multiple of what Medicare pays. > We were already paying for uninsured folks via bankruptcies etc. Not exactly. Contrary to public misconception, it's well known in the medical world that preventive care is not cheaper in the long-run. (It generally results in better care, but not always, and it always results in greater utilization either way, so the end result is more expensive). You can make the argument in favor of routine and preventive care on the grounds that it's the right thing to do, medically or morally. But it does result in greater costs overall, and that still has to be paid for.
jrs235 10y ago
>It helped give free or low-cost health care to people that couldn't afford it because now the government is picking up the lion's share of the tab. But it didn't and doesn't provide care. It provides free or low-cost health care insurance to people that couldn't afford the insurance. They still have to pay for their actual health care with high, up front deductibles. Which many probably still can't afford. But the insurance companies are running to the bank with the mandated policy coverage and flow of federal tax dollars (via subsidies).
mikeash 10y ago
I have a hard time interpreting this comment. Reading only the factual statements, I come away thinking, "What a great system, for a couple hundred extra dollars a month a ton of people were helped." Yet the language around those statements seems to be intended to paint all of this as a really bad thing. I don't see how Republicans could not throw out the good parts. When you boil it down, the good parts of the ACA are the requirement to cover pre-existing conditions, and the individual mandate. The former is what's needed to ensure people aren't completely fucked over at the slightest opportunity, and the latter is needed to avoid destroying the insurance industry in the presence of the former. Republicans appear to be fundamentally opposed to both of those. Without them, what's left?
- rtpg 10y ago
  Not that it matters (Republicans want to throw it all out), but two other things that come to mind: - a cap on profits on insurance companies, enforcing that a certain amount of revenue is going towards client coverage - Allowing people up to the age of 26 to stay on their parents plan There's a couple other bits like this as well.
vpeters25 10y ago
I think expanding risk pools across states is a very tricky problem. It would imply overriding states' self-determination regarding regulation of insurance companies which is a big no-no for Republicans.
thinkcontext 10y ago
> Sure it had more bells and whistles, but I didn't want nor need them. You don't want them now but you might want or need them later. > The ACA helped many people. It helped people under 26. It helped people with pre-existing conditions. It helped give free or low-cost health care to people that couldn't afford it because now the government is picking up the lion's share of the tab. There are a few important things it did that you missed. It ended lifetime maximum caps and it capped the difference in what you can charge the based on age to 3x. That last one in particular is greatly under appreciated. Yes, the young are now paying more than before but they will also pay less than otherwise when they get older. Everyone gets older so everyone eventually benefits from it. > I think they will look at the industrial recommendations such as expanding risk pools across states Nothing prevented them from passing this since they were in control of Congress. My guess is this is much harder to accomplish than it sounds.
agar 10y ago
Far too few people realize that much of the ACA plans' cost increases is due to Congress reneging on a government promise to mitigate risk in the early years through "risk corridor" reimbursements. Undermining an opposition program, then pointing to its collapse as if it was always fundamentally flawed, is a very clever and effective piece of politicking. Insurance companies did not know the health, and thereby the cost, of previously uninsured people buying coverage under ACA. To reduce risk of the unknown, the government committed to reimbursing money lost due to underestimating risk (conversely, insurance companies would pay into a pool if they earned above certain thresholds). Over time, prices would meet an equilibrium as policy costs stayed low, allowing more healthy people to join the pool, which lowers coverage costs, which then lowers policy costs. Prices could be raised modestly to account for the difference, and government payments to insurers would ultimately end. However, Congress rejected payment into the risk pool and ultimately paid out only 12.6% of the promised funds. Many co-op insurance groups had to fold, others needed to dramatically increase premium costs to account for (a) the lost money, (b) the increased cost of the uninsured, and (c) the increased risk that the government wouldn't fulfill its obligations.[1] The current situation - limited choices, high premium costs, and resultant lower healthy person participation potentially leading to a "death spiral" collapse - is a direct consequence of these actions, not an inherent failure of the ACA. However, Obamacare gets the blame and Republicans can point to a failing market that they can repeal and, perhaps, replace. Very effective politics indeed. Just ignore the human cost, which certain politicians seem to have no trouble doing. [1] https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affordable-care-act.html?_r=0 https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-o...
- dmix 10y ago
  > then pointing to its collapse as if it was always fundamentally flawed On the inverse, I see many people on the left pointing to the number of people who have signed up as the primary indication of it's success as well. Which contains it's own notes of ignorance. Was the government not handing out fines to people who didn't sign-up? So they were basically forcing people onto the program? How could the numbers of sign-ups be meaningful then? Also, I couldn't imagine going without health care. You have to take what you can get otherwise the risks are significant. So considering it's an essential service, saying "look at the number of people using it" as an success indicator is like saying "plenty of people are calling the firemen, clearly they are doing a good job". There is a serious human cost here when people have their health plans doubling in cost... while the rest of the world has worked out far more functional systems. So those cost calculations should be relative to this high level reality, not some internal benchmarks between stages of mediocrity. It seems by not deciding to be free market nor socialized that the US is getting the worst of both worlds. It's easy to blame the republicans for this but the half baked socialized system that the democrats put forward was hardly a good solution. > Far too few people realize that much of the ACA plans' cost increases is due to Congress reneging on a government promise Have you considered that maybe the entire Democrat plan of getting to a socialized system via cuts and slivers in one direction, knowing full well that cuts and slivers will be done in the other direction is a terrible idea? Stop pretending that private companies can function efficiently in an ever more legislated environment, as if only more thousand page bills get passed that it will finally start working well... history has continued to indicate otherwise. Either a) embrace markets or b) go hard on selling the public on the idea of single payer public insurance. (I should note I'm in favour of public health insurance after living with it in Canada, despite typically being in favour of markets elsewhere)
JohnTHaller 10y ago
First, the Republican-lead senate already voted to throw out the good parts like insurers not being able to exclude pre-existing conditions. This causes rates to up (basic economics). So now, me donating a kidney can be used to refuse me insurance. Second, I can't figure out what your insurance was that was only $250 before the ACA. The only people I know who pay that little were on catastrophic plans. Insurance for me in NY state as a healthy (I was never without insurance so the kidney donation didn't count against me) single male in my 30s on a private insurer was creeping up to nearly $10,000 a year for complete coverage under an HMO like I used to get when I worked for a Fortune 500. Under the ACA, I pay half that for similar coverage.
imagist 10y ago
> The government doubled the price of the plan or more, and is paying with our tax dollars the difference between my $270 and $780. Do you have evidence that the government is the main cause of the increase of the price of the plan? It could have merely been the companies using the ACA as an excuse to raise prices.
drodgers 10y ago
"the private plan without subsidies... was $250" But that plan was only available to healthy people without any pre-existing conditions. Now, the $780 version of that plan is available to everyone. You are a healthy person who could get healthcare before and still can for roughly the same price. The ACA wasn't meant to change things much for you: it was meant to increase coverage. Now people who are older or who have a chronic condition or a bad family history can get the same health insurance as you. That's what your tax dollars are paying-for.
- losvedir 10y ago
  > But that plan was only available to healthy people without any pre-existing conditions. > Now, the $780 version of that plan is available to everyone But you're making a political statement that the government should ensure sick people should have access to health care (which is fine, e.g., I support welfare). It's just odd that you think this program should be paid for primarily by middle class Americans, unlike most other government safety nets which come from taxes which mostly target higher income individuals.
speaktruth 10y ago
>Sure it had more bells and whistles > [...] >this same plan today is $780 a month without subsidies The problem with your comment is that your prices are very exact but the consumed goods (insurances) are described only vaguely. The country I live in, introduced obligatory health insurance 1996. The first proposition by our Democratic Party goes back to 1960. After 30 years of intense political fight we now have a system that is supported by all of the parties. So I think our system is as balanced as it gets. Plus we have a highly competitive system between insurence companies, and you are allowed to switch the insurance company every year, which then is done by lot of people. The absolute most important thing is a rock-solid legal description of the minimun that every insurance company has to deliver. Here are the + and - after 10 years of practical experience with obligatory healthcare: + High competition, disciplines insurance companies to work efficiently, and allows new, small and innovative companies to enter the market. + It's a pretty fair non-discriminatory system, nationwide and across all insurance companies + Simple system once it is established + Vulnerable persons are well protected. + The common health of the people is rising. - The costs are rising every year because the is no direct interest in keeping the costs down - The insurance companies get more powerful every year due intense lobbying, this not in our interest. - There is explosion of special health services, very expensive treatments, rising salaries in the health economy TLDR: Obligatory healthcare is good and you live longer. But it comes with a price.
god_bless_texas 10y ago
> the government is picking up the lion's share of the tab Oh yeah? Where do they get their money from?
xtiansimon 10y ago
@virmundi, In what state do you live? To my understanding each state has the option to set up it's own State Healthcare Marketplace or use the Federal Marketplace. Different states have more or fewer healthcare providers to choose from, so the state you live in makes a big difference.
enobrev 10y ago
I went about eight years without health insurance because I was freelance and in NYC it was somewhere around $550 per month for the worst of plans for a perfectly healthy twentysomething with no medical conditions whatsoever (besides being a smoker at the time) I ended up taking a job at a start-up when I turned 30 because I figured at 30 I should probably start going to the doctor more often and it was the only way I could afford health insurance. I was finally able to go back to freelance a little over a year ago because a decent plan only cost about $700 total per month for both me AND my wife, and She has pre-existing conditions, which is to say she had gone even longer without insurance before we'd met. I was merely hedging bets according to my age. She actually needs it. Of course, BCBS-IL keep cancelling our plans as is their apparent loophole to raise rates. Because even though the non-profit had a surplus of 14B in early 2016, the absolutely perfect plan we were on wasn't making enough money for them, so they killed it. That's twice in a row, so we switched to Cigna this year, which I don't assume will be much better. It's expensive,. They're all expensive, whether I use the marketplace or not. But they're nowhere near as expensive as they were four years ago. Especially for my wife who literally could not be insured before the ACA.
emcq 10y ago
The average spending per individual in the US per year is $10000 [0]. For an all inclusive insurance plan, if you have say a $5000 deductible and are spending less than $416/month per person you are contributing less to the pool than is being spent on average per individual. You're doing good, and are de-risked for potential health costs. A healthcare plan where you get dumped the second you have a preexisting condition removes the de-risking benefit of insurance. The only benefit then left is the negotiating leverage of an insurance company able to pay $50k for a surgery that would out of pocket be $100k, lower ambulance bills, etc. [0] http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/ http://www.pbs.org/newshour/rundown/new-peak-us-health-care-...
- jfnixon 10y ago
  Heh, negotiated leverage. Providers aren't stupid, and they jack up the "rack rate" so they can offer the demanded discounts to insurers. The main result of this is cash patients pay through the nose. If you really want to fix this, have ACA:NG prohibit any cash price exceeding the lowest 'negotiated' rate. Similarly, if you want to avoid the problem of expensive drugs that sell for significantly less in Canada, legally require Big Pharma to sell in the US for the lowest 'negotiated' price among all the national healthcare systems.

alphabettsy 10y ago

What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere...

virmundi 10y ago
It's at least correlated. Within 1 month's time, the plan cost doubled. The ACA required insurance to cover things like mental health care. As a result, the plans had to be more expensive since they needed to cover more.
JonFish85 10y ago
If you're looking for something directly in the law, you're not going to find the government saying that prices should be raised. It's a second-order effect; there was minimal cost control in the ACA, and plenty of room for companies to raise their prices. In a lot of ways, it was a sweetheart deal to insurance companies: they had essentially a mandate for people to buy their insurance, demand was through the roof, so they could charge more.
- deleted 10y ago
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rdtsc 10y ago
> What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere. My evidence is that the premiums for my insurance went up even before ACA passed just in anticipation. That is exactly what the health insurance representative told us. It was pretty clear why it happened. After ACA passed it kept going up a higher rate for us than in previous years (I have data for 3 years before). > What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere... Isn't it a bit disingenuous to suggest that the increase in health insurance is unrelated to legislation regulating health insurance. Or to put it another way is there evidence that government regulation didn't affect the prices and something else did?
- JacobJans 10y ago
  If you look at the numbers, the rate increases didn't change significantly when the ACA was put into practice. The only exception is the first year, when companies weren't sure what the appropriate pricing should be. http://blogs-images.forbes.com/mikepatton/files/2015/06/Health-Ins-Prems-Personal-Income-2005-2014.jpg?width=960 http://blogs-images.forbes.com/mikepatton/files/2015/06/Heal...
  - rdtsc 10y ago
    It did for our company, we had an HMO as the insurance provider for us. Company of about 40 people or so.
- usefulcat 10y ago
  The government does not, so far as I am aware, set the prices of the plans. Therefore it is nonsensical to claim that "the government itself doubled the price". Now, if one were to claim that the government failed to do anything that had the effect of reducing the cost of health care or health insurance, then I would completely agree. For example, there is nothing to prevent someone from signing up for insurance, having some expensive medical procedures performed, and subsequently dropping the insurance. I have personally heard reports from insurance agencies that some people do in fact do this. And I can't say I'm surprised, either; even after factoring in the tax penalties, it's probably a completely economically rational thing to do in a lot of cases.
jerrycruncher 10y ago
There is no evidence because government did not raise the price - the insurance companies did, all while raking in record profits. Premiums in states which refused federal money to expand Medicaid generally rose much, much more than states (like CA) which did not[1]. Cynically, this was likely a designed play by Republicans to kneecap the effectiveness of the ACA by skewing the risk pool towards the elderly (who require more medical care, in general). [1] https://www.consumeraffairs.com/news/health-insurance-industry-rakes-in-billions-while-blaming-obamacare-for-losses-110116.html https://www.consumeraffairs.com/news/health-insurance-indust...
- rgoddard 10y ago
  A couple additional pieces to keep in mind. Insurance companies are essentially capped at how much profit they can make on average per subscriber. For large groups 85% of every dollar collected has to be spent on medical expenses, and for small group / individual 80% has to be spent on medical expenses. If they don't meet those standards, the companies need to refund the premium to make up the difference. In the linked article most of their profit would be coming from the large group market. The individual exchange is a separate segment and where they would be suffering those loses. So the desire to not remain in an unprofitable segment is not really negated by being profitable in a completely different segment.
kobeya 10y ago
There is basically no real cost control in the bill, with the logical consequence being that insurance companies will do what they can get away with to raise premiums so that the new premium rate minus subsidies equals the old premium rate. The extra requirements of the ACA, and the lack of universal roll-out basically ensures that there are plenty of excuses for doing so.
- nradov 10y ago
  False. The ACA imposed a minimum 80-85% medical loss ratio on insurance companies. This is a cost control. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio.html https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In... But there aren't any real cost controls on providers, drug companies, medical device companies, and other suppliers.
  - kobeya 10y ago
    > But there aren't any real cost controls on providers, drug companies, medical device companies, and other suppliers. That's what I said.
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  - koolba 10y ago
    > False. The ACA imposed a minimum 80-85% medical loss ratio on insurance companies. This is a cost control. That's not a cost control. That's a price inflater! If the only way for them to make more money is to have the price of things go up, what do you expect they're going to be in favor of? In a perfect world (from the perspective of the insurance company), everything from premiums to procedures goes up X% so that their profits go up X%. That's a seriously messed up system and may be the most egregious part of the entire ACA.
    - 10y ago

stinkytaco 10y ago

> As much as people like to rag on the Republicans, and they deserve it, I don't think they will throw out the good parts. It would politically unpopular to "throw out" the parts you spoke of. But the question is can we keep those parts and not keep the insurance mandate?

namlem 10y ago
Sure, with even larger taxpayer handouts to insurance companies.
09bjb 10y ago
Not true. The senate has already voted down the pre-existing protections plan, letting young adults stay on their parents' plans, and keeping contraceptive coverage. American's don't follow the actual machinations of the senate much so it's not "politically unpopular" to do this. We think electing a President every 4 years who's a radical departure from what we had before will fix all our problems and prevent us from actually having to pay attention to the details.
- learc83 10y ago
  The Senate can't remove the pre-existing conditions protections or letting young adults stay on their parents plans through budget reconciliation. They can remove funding for subsidies through budget reconciliation, and let the system collapse on its own, but they don't have the votes to overcome the filibusterer they'd get if they tried to remove those protections directly. 1 of 2 things will likely happen. 1. They will repeal and delay. Meaning they will remove funding through reconciliation, but delay implementation until 2020. Then depending on what happens in 2018 who knows what might happen. This is the bad option because it could cause the collapses of the individual market even before it takes effect. 2. They will repeal and replace. Most likely they will replace it with the new Health and Human Services Secretary's plan to keep the preexisting conditions protection plan, as long as you maintain coverage. If you don't maintain coverage you'll go into a high risk pool with higher rates until you maintain coverage for 18 months. Plan 2 is very similar to what we currently have, but it replaces the punishment for not maintain coverage with higher premiums instead of a tax penalty. What they should do is to increase the tax penalty to force more people into the pool and simultaneously add a public option, but that's not going to happen.

cptskippy 10y ago

It's odd that you expect the people, who fought to prevent ACA from happening and have tried to repeal it weekly since it's inception, are now going to fix it.

noobermin 10y ago
And since people have an issue with recentism, just look at recent events that prompted sama's post, Republicans in the senate repealed half of the good things in the ACA.

Retric 10y ago

There are no high deductible ACA plans. So, no it's not 1:1. The cheapest option is a 60% coverage plan with a $7,150 annual limit for out of pocket costs. http://obamacarefacts.com/out-of-pocket-maximums-and-deductible-limits-for-2017-health-plans/ http://obamacarefacts.com/out-of-pocket-maximums-and-deducti... The ACA lowered the costs of people with insurance by reducing the pool of people without insurance adn thus the free rider costs. Free markets however continued to raise prices just like they have for the last 30 years. http://www.motherjones.com/files/blog_premium_growth_2014.jpg http://www.motherjones.com/files/blog_premium_growth_2014.jp...

Amezarak 10y ago
I'm a little confused. The page you linked describes high deductible ACA plans (aka HSA eligible plans.)
- Retric 10y ago
  To clarify. HSA require a deductible of at least $1,300 for one person, so people have starting calling that a 'high' deductible from 2003 or so. Before ACA you could by health insurance with a 15,000$ deductible as an individual. After, ACA the individual out of pocket maximum is $7,150 per year for an individual. So, now legally the maximum is below the old pre HSA threshold for 'high' deductible.
  - TillE 10y ago
    Deductibles are insane, period. It's a horrendous concept unless you're rich. You don't get them in most (all?) countries with universal coverage, not even in hybrid systems like Germany's with their public insurance options.
    - deleted 10y ago
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    - jimmyk 10y ago
      What is insane about wanting to pay a low monthly premium in exchange for insurance that only kicks in for very expensive events?

splintercell 10y ago

> The ACA helped many people. It helped people under 26. It helped people with pre-existing conditions. And the cost is being borne by everyone else.The art of economics consists in looking not merely at the immediate but at the longer effects of any act or policy; it consists in tracing the consequences of that policy not merely for one group but for all groups.

AlexandrB 10y ago
The cost of people not being to afford basic care is also borne by everyone else. I do not understand why the US can't join most of the western world in instituting single-payer public healthcare. It would be a huge boon for small business and startups, who would no longer have to factor in medical benefits into their compensation structure and whose owners would no longer have to risk being uninsured for an extended period when they start the business. Moreover, it's the morally right thing to do. It's shameful that the world's premier economic superpower does such a poor job of looking after its most vulnerable citizens.
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- mikeash 10y ago
  The reason is relatively simple: approximately half of the electorate and half of our political system is caught in a feedback loop opposing public health care. Lots of voters are convinced that public health care is a disaster. One of our two major parties wins votes by accommodating that. Further, that party ensures votes in the future by pushing misinformation which helps convince more voters. Until and unless we can get people to examine the facts, this will continue.
  - Futurebot 10y ago
    58% of Americans support federally funded universal health care, including 40% of Republicans: http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx http://www.gallup.com/poll/191504/majority-support-idea-fed-... Opposition comes from the wealthy, whose taxes would go up, and insurance company execs (and employees) since it keeps them in business.

vinhboy 10y ago

> I don't think they will throw out the good parts You are mistaken. The good parts, like covering pre-existing conditions is exactly what causes your insurance to go up. It's basic economics. The Republicans do not have a plan to fix that. If there was a way to fix it, don't you think it would already be implemented? You think they're purposefully keeping your rates high just to fuck with you? Not to mention suffer all the political fallout of it? Don't forget. Obamacare is the Republican plan. This repeal and objection to Obamacare is all politics, not an attempt to fix a broken system.

JustSomeNobody 10y ago
What makes your insurance go up is the fact that insurance companies are beholden to investors and not the people they insure. They must exceed each and every last quarter or they take a hit.
- maxerickson 10y ago
  Many insurers are private non profits, often owned by the people they insure. Here's one with 8 million members: https://www.bcbsil.com/company-info/who-we-are https://www.bcbsil.com/company-info/who-we-are
deleted 10y ago
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nugget 10y ago
Everyone knows how to fix the problem in the short/medium term. The solution is money. Specifically, money from the Federal Government. The real behind-the-scenes debate in DC this month is about, first, the best mechanism to transfer funds (direct subsidies, state subsidies, Federal reinsurance pool for the sickest cases, etc ... each of which create distinct winners and losers whose lobbyists are currently out in force), and second, how much of an annual budget deficit the fiscal-hawk Republicans (now led by Rand Paul) are willing to tolerate. The longer-term solutions have much more to do with diet, lifestyle management, and other behavioral health issues than with access to providers and drugs (e.g. look up how much of last year's medicaid/medicare budget was spent on type 2 diabetes treatment alone). Unfortunately it doesn't seem like we can tackle these issues at scale until after the current debate on affordable universal access to care is settled.

acomjean 10y ago

My understanding is The "good parts" like keeping kids on till 26, pre-existing condition are the ones that make the insurance more expensive, the requirement to get insurance was supposed to get the insurance pool big enough so that it wasn't a big problem. So it works as a totality but not in pieces

acomjean 10y ago

bduerst 10y ago

Just being insured doesn't mean you're covered. Those private plans you researched had crap coverage compared to the standards that the ACA set for all health insurance. By raising the standard, premiums have gone up on some private plans and overall healthcare costs have been reduced for all Americans.

ctdonath 10y ago
Deductibles have shot up as well. Long details short, I have a $30,000 deductible when a pre-ACA plan had a 3-digit deductible. I'm covered, but the ceiling is unreachably high. Costs have gone way up; they've just re-arranged where the money comes from, and punish you for not putting more money into the system. Ensuring everyone is covered by making it illegal to not be covered is not an acceptable solution.
- bduerst 10y ago
  That doesn't make sense, are you sure you're not being scammed? Maximum out of pocket for a family on an ACA bronze plan is $14,300, including drug costs.
- fooey 10y ago
  Yeah, that's not true. There is no legal way for a deductible to be that high http://obamacarefacts.com/health-insurance/deductible/ http://obamacarefacts.com/health-insurance/deductible/ > The maximum deductible is equal to the maximum-out-of-pocket limit each year ($7,150 for an individual and $14,300 for a family for 2017).
  - bzbarsky 10y ago
    > There is no legal way for a deductible to be that high That's the theory. As I noted in https://news.ycombinator.com/item?id=13393287 https://news.ycombinator.com/item?id=13393287 experiment suggests otherwise for the out-of-pocket limit, at least....
    - 10y ago

joering2 10y ago

> We are now on an ACA plan. $270 with subsidies. Think about that. The government doubled the price of the plan or more, and is paying with our tax dollars the difference between my $270 and $780. Can you provide any proof of that? According to Obama, an average insurance will be as affordable as a cellphone bill. Perhaps your plan had some perks in it, no? Also there was a lot of fake stories about people getting tripled their insurance cost, all have been pretty much debunked as not real. Even Harry Reed was mentioning that in his speech.

cylinder 10y ago
Are you kidding? Go on any states healthcare exchange and price out a plan for a family of four. Subsidies only cover low incomes, apparently $70k for a family of four in NY is rich and can afford $18k/yr premiums with $14k deductible. There are some really piss poor regional plans with weak provider networks that are cheaper but you'll end up getting hit by out of network bills. The major carriers are charging astronomical rates if they are providing Exchange plans at all in 2017.
- jjeaff 10y ago
  Ya, these prices that you see politicians touting are from the cheapest providers and hmo only. In the Los Angeles area, the closest gp was an hour away with a 30 day lead time to get an appointment if you go with the budget plan. For those that don't know, in an hmo, you have to go see your gp for a referral for everything. In grown tonail, go to gp when you know he will refer you to a podiatrist. With a ppo, you can go directly to the specialist. But ppo under aca are the "premium" plans.
- joering2 10y ago
  Well I don't know the details I have to admit. But I go with what President of USA said - it will be as cheap as your phone bill: "less than a hundred bucks a month". Here is the proof if you don't believe me: https://www.youtube.com/watch?v=_lT4VzH5xY8 https://www.youtube.com/watch?v=_lT4VzH5xY8
virmundi 10y ago

31reasons 10y ago

I have borderline high cholesterol and family history of heart disease. Before ACA, health insurance companies quoted me minimum $1200/month for basic coverage even though I am in my 30s and healthy and rarely visit doctors office.

sigmar 10y ago

Whenever I see people talk about their costs going up, I wonder if they realize that health care costs were projected to go up even without the ACA. There's plenty of Government reports and private company reports on this topic and most reports I've read show that ACA is helping. I wonder if people have spent time reading up on quantitative assessments before basing their views on personal observations.

yellow_postit 10y ago
But without a real counterfactual these reports can be conviently dismissed if it doesn't fit the person's world view.

colemickens 10y ago

>I don't think they will throw out the good parts The Senate has already voted to remove provisions that your praise in your post...

zaroth 10y ago
This same comment has showed up a half dozen times and it's a false characterization of the actual vote last night. From the NYT: "Senate Republicans took their first major step toward repealing the Affordable Care Act on Thursday, approving a budget blueprint that would allow them to (gut the health care law) without the threat of a Democratic filibuster." So take out the editorial "gut the healthcare law" and replace with "repeal and replace" and you have a clear reporting of what actually happened. Two paragraphs down the actual non-editorialized reporting states the real truth; "The action by the Senate is essentially procedural"
- gibrown 10y ago
  The Republican Senate and House have voted multiple times to repeal the whole of the ACA over the past years. The only thing that has stopped it has been a presidential veto. Here's one: http://www.cnn.com/2016/01/08/politics/obama-vetoes-obamacare-repeal-bill/ http://www.cnn.com/2016/01/08/politics/obama-vetoes-obamacar...
  - zaroth 10y ago
    Don't confuse showmanship or grandstanding with actual political intent. It's why the reporting on Trump is so often wrong and misleading. Now that the vote counts just see what actually happens.
- colemickens 10y ago
  So, they voted to repeal it, offered no plans for replacement, and you want to act like "repeal and replace" is a more fair characterization? The GOP has been talking about repeal for year(s) now and has nothing to show for a replacement plan. Meanwhile, as part of the resolution passed, they took aim at specific provisions that, again, were things praised in the grandparent comment.

fooey 10y ago

The only thing that operating across state lines actually accomplishes is enabling a race to the bottom. It means that whatever state manages to make their regulations the most attractive to the insurance industry is the state that all the providers will "move" to, and that's the quality of insurance the rest of the nation gets stuck with. For the most part, the insurance companies are huge, and they operate nationally already. There's really not any economies of scale that are going to produce direct savings. The savings come by slashing everyones coverage.

virmundi 10y ago
I'm invoking the commerce clause. So the States can only make more onerous regulations. You see this with California emission standards. The Federal government has a minimum and California say, "You got to do better." This prevents a race to the bottom.
- fooey 10y ago
  Seems to me, the GOP's entire point for letting insurers sell across state lines is precisely to force a state like California to allow substandard plans to be sold to their citizens
  - virmundi 10y ago
    Depends on the Federal requirements. Something that's lost in this whole conversation is the idea of insurance. I have auto insurance because I could be hit. I've gone 15 years without being hit, at least not enough to make a claim. I keep it just in case. Going to the doctor for an annual physical is not something that should be insured. It's a known cost. You, as the individual, should pay that out of pocket, or get another extended coverage policy or rider to covert that. It's like my auto insurance paying for oil changes. As a result, our costs are too high.
    - fooey 10y ago
      If car insurance had to cover a 6+ figure operation replacing an old engine that was was seized up because of poor maintenance, it would make financial sense to cover oil changes as a preventative measure. A health disaster is several orders of magnitude more expensive than an automotive disaster, and you can't just total out a human being and pick up a new one at the local dealership if it's too expensive. Preventative maintenance is a money saver long term.

leshow 10y ago

I'm not American so forgive my ignorance, but is that the amount you pay monthly?

virmundi 10y ago
Yes. When I was working on a contract, my income put me out of the subsidies range. I would have had to pay $780 for the cheapest plan per month. Essentially a mortgage. Actually $130 more than my current mortgage.
- leshow 10y ago
  Jesus, no wonder so many people don't have coverage. I have never had to pay anything, even benefits are largely covered by my employer. I think I pay 15 bucks a month for a family plan on vision/dental/eye/drugs/physio etc.
  - angry-hacker 10y ago
    It's called taxes you pay, assuming your a fellow European. I pay 33% of my income to Healthcare so these rates you Americans say you pay are really small, you're just spoiled :)
    - mikeash 10y ago
      We pay those taxes too. Our per-capita government expenditure on health care is higher than many developed countries with single-payer systems. Our government then spends this vast amount of money to provide care for a fraction of us.
jtuente 10y ago
That looks like a monthly amount, yes.
attaboyjon 10y ago
I have a family of six, 2 adults and 4 kids. I pay $1400 per month for a plan with a deductible high enough that I will pay for all of my expenses.

yardie 10y ago

What are the bells and whistles that weren't needed? Like, I don't have mental issues so I don't need the mental health parts. I don't have cancer so I don't need the cancer coverage. Previous to the ACA people would buy "health insurance" with a deductible so high they realistically couldn't use it anyway. I'm talking working class people with $10k deductibles and $2000 in actual savings. And they were freely sending insurance companies $100-200/month knowing there is no way they could actually use it.

virmundi 10y ago
I won't ever use mental health services. Personal choice. The old plan didn't offer that. I could get another plan to cover that. Why should I be forced to purchase something I have no intention of using? Insurance, as a product, was highly customizable. You could get riders and other policies to cover various risks. You see this all the time with fleet insurance. Health insurance use to be the same. The ACA set a floor on the offerings. If you don't those features, you can get a non ACA approved plan. You then have to pay the tax penalty. Now the penalty is an oddity. There is no lean. The government removes from your refund $X until you either pay the penalty or have no refund. I looked at such a plan. Best I found was $438. Assuming an income of > $100,000 (I thought that 2017 insurance rates were set using 2016 actual income, I was wrong), the penalty was north of $3.5k total for my wife and I. This made the ACA plan cheaper since I didn't have to worry about filing quarterly estimates since I always have a refund (I'm giving a price to the time and effort required to file). So the subsidies make the ACA plan cheaper that the non-ACA plan. I went with that. The question I pose to society is "Should we require government, funded through taxes, handout to make medical costs affordable?"
- ahfagfddash 10y ago
  > I won't ever use mental health services. Personal choice. The old plan didn't offer that. I could get another plan to cover that. Why should I be forced to purchase something I have no intention of using? You are ignorant and heartless. In the worst and most expensive cases, patients do not even have a choice. And your subtext is completely clear here. No, you should not get to pick and choose what conditions are worthy of treatment because you don't have them and don't think they are legitimate, and therefore make coverage more expensive or unobtainable for others.

ahfagfddash 10y ago

What I get from this is you and your wife are healthy and didn't go to the doctor and after the ACA your premium went up $20 a month. > Sure it had more bells and whistles, but I didn't want nor need them. Like FREE preventative care. That's not a bell and whistle. That's worth more than your $20/month right there. Go to the doctor already. And more importantly, that premium is identical regardless of what condition you were in. Without ACA, if you had cancer, you would die and/or be financially ruined. Worse yet, if you just had something like depression, or high blood pressure, or diabetes, then you'd be screwed out getting affordable insurance even in the event you got cancer or something unrelated but deadly.

virmundi 10y ago
> What I get from this is you and your wife are healthy and didn't go to the doctor and after the ACA your premium went up $20 a month. My taxes, and everyone else's taxes go to pay this $500 dollar difference. The Federal government didn't some how magically create the gap funds. They have to increase taxes through fines and other sources to pay this. They've effectively hidden these costs for the subsidized individuals. I'm not paying $780 per month with a large refund at the end of the year. I'm paying a few hundred. Most people don't think about the revenue impact this has on the country. We now have to fund these subsidies. We now remove even more money from people that could have go into stocks, local economies, or services. The plan should be $280. That's it. Not $280 + subsidies. Just $280.
- ceejayoz 10y ago
  > We now have to fund these subsidies. Maybe, maybe not. Here's a case of a death that cost $250k for want of a $80 tooth extraction: http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html http://www.washingtonpost.com/wp-dyn/content/article/2007/02... We were already paying for uninsured folks via bankruptcies etc.
  - chimeracoder 10y ago
    > Here's a case of a death that cost $250k for want of a $80 tooth extraction It didn't "cost" $250,000. That's the sticker price of what they billed for the services, but that's not what they expected to be paid by insurance. That's a crucial distinction. Just as you don't pay sticker price for a new car, the insurance company doesn't pay what the provider bills them for; they pay some agreed-upon rate, which is specified as a multiple of what Medicare pays. > We were already paying for uninsured folks via bankruptcies etc. Not exactly. Contrary to public misconception, it's well known in the medical world that preventive care is not cheaper in the long-run. (It generally results in better care, but not always, and it always results in greater utilization either way, so the end result is more expensive). You can make the argument in favor of routine and preventive care on the grounds that it's the right thing to do, medically or morally. But it does result in greater costs overall, and that still has to be paid for.

jrs235 10y ago

>It helped give free or low-cost health care to people that couldn't afford it because now the government is picking up the lion's share of the tab. But it didn't and doesn't provide care. It provides free or low-cost health care insurance to people that couldn't afford the insurance. They still have to pay for their actual health care with high, up front deductibles. Which many probably still can't afford. But the insurance companies are running to the bank with the mandated policy coverage and flow of federal tax dollars (via subsidies).

mikeash 10y ago

I have a hard time interpreting this comment. Reading only the factual statements, I come away thinking, "What a great system, for a couple hundred extra dollars a month a ton of people were helped." Yet the language around those statements seems to be intended to paint all of this as a really bad thing. I don't see how Republicans could not throw out the good parts. When you boil it down, the good parts of the ACA are the requirement to cover pre-existing conditions, and the individual mandate. The former is what's needed to ensure people aren't completely fucked over at the slightest opportunity, and the latter is needed to avoid destroying the insurance industry in the presence of the former. Republicans appear to be fundamentally opposed to both of those. Without them, what's left?

rtpg 10y ago
Not that it matters (Republicans want to throw it all out), but two other things that come to mind: - a cap on profits on insurance companies, enforcing that a certain amount of revenue is going towards client coverage - Allowing people up to the age of 26 to stay on their parents plan There's a couple other bits like this as well.

vpeters25 10y ago

I think expanding risk pools across states is a very tricky problem. It would imply overriding states' self-determination regarding regulation of insurance companies which is a big no-no for Republicans.

thinkcontext 10y ago

> Sure it had more bells and whistles, but I didn't want nor need them. You don't want them now but you might want or need them later. > The ACA helped many people. It helped people under 26. It helped people with pre-existing conditions. It helped give free or low-cost health care to people that couldn't afford it because now the government is picking up the lion's share of the tab. There are a few important things it did that you missed. It ended lifetime maximum caps and it capped the difference in what you can charge the based on age to 3x. That last one in particular is greatly under appreciated. Yes, the young are now paying more than before but they will also pay less than otherwise when they get older. Everyone gets older so everyone eventually benefits from it. > I think they will look at the industrial recommendations such as expanding risk pools across states Nothing prevented them from passing this since they were in control of Congress. My guess is this is much harder to accomplish than it sounds.

agar 10y ago

Far too few people realize that much of the ACA plans' cost increases is due to Congress reneging on a government promise to mitigate risk in the early years through "risk corridor" reimbursements. Undermining an opposition program, then pointing to its collapse as if it was always fundamentally flawed, is a very clever and effective piece of politicking. Insurance companies did not know the health, and thereby the cost, of previously uninsured people buying coverage under ACA. To reduce risk of the unknown, the government committed to reimbursing money lost due to underestimating risk (conversely, insurance companies would pay into a pool if they earned above certain thresholds). Over time, prices would meet an equilibrium as policy costs stayed low, allowing more healthy people to join the pool, which lowers coverage costs, which then lowers policy costs. Prices could be raised modestly to account for the difference, and government payments to insurers would ultimately end. However, Congress rejected payment into the risk pool and ultimately paid out only 12.6% of the promised funds. Many co-op insurance groups had to fold, others needed to dramatically increase premium costs to account for (a) the lost money, (b) the increased cost of the uninsured, and (c) the increased risk that the government wouldn't fulfill its obligations.[1] The current situation - limited choices, high premium costs, and resultant lower healthy person participation potentially leading to a "death spiral" collapse - is a direct consequence of these actions, not an inherent failure of the ACA. However, Obamacare gets the blame and Republicans can point to a failing market that they can repeal and, perhaps, replace. Very effective politics indeed. Just ignore the human cost, which certain politicians seem to have no trouble doing. [1] https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affordable-care-act.html?_r=0 https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-o...

dmix 10y ago
> then pointing to its collapse as if it was always fundamentally flawed On the inverse, I see many people on the left pointing to the number of people who have signed up as the primary indication of it's success as well. Which contains it's own notes of ignorance. Was the government not handing out fines to people who didn't sign-up? So they were basically forcing people onto the program? How could the numbers of sign-ups be meaningful then? Also, I couldn't imagine going without health care. You have to take what you can get otherwise the risks are significant. So considering it's an essential service, saying "look at the number of people using it" as an success indicator is like saying "plenty of people are calling the firemen, clearly they are doing a good job". There is a serious human cost here when people have their health plans doubling in cost... while the rest of the world has worked out far more functional systems. So those cost calculations should be relative to this high level reality, not some internal benchmarks between stages of mediocrity. It seems by not deciding to be free market nor socialized that the US is getting the worst of both worlds. It's easy to blame the republicans for this but the half baked socialized system that the democrats put forward was hardly a good solution. > Far too few people realize that much of the ACA plans' cost increases is due to Congress reneging on a government promise Have you considered that maybe the entire Democrat plan of getting to a socialized system via cuts and slivers in one direction, knowing full well that cuts and slivers will be done in the other direction is a terrible idea? Stop pretending that private companies can function efficiently in an ever more legislated environment, as if only more thousand page bills get passed that it will finally start working well... history has continued to indicate otherwise. Either a) embrace markets or b) go hard on selling the public on the idea of single payer public insurance. (I should note I'm in favour of public health insurance after living with it in Canada, despite typically being in favour of markets elsewhere)

JohnTHaller 10y ago

First, the Republican-lead senate already voted to throw out the good parts like insurers not being able to exclude pre-existing conditions. This causes rates to up (basic economics). So now, me donating a kidney can be used to refuse me insurance. Second, I can't figure out what your insurance was that was only $250 before the ACA. The only people I know who pay that little were on catastrophic plans. Insurance for me in NY state as a healthy (I was never without insurance so the kidney donation didn't count against me) single male in my 30s on a private insurer was creeping up to nearly $10,000 a year for complete coverage under an HMO like I used to get when I worked for a Fortune 500. Under the ACA, I pay half that for similar coverage.

imagist 10y ago

> The government doubled the price of the plan or more, and is paying with our tax dollars the difference between my $270 and $780. Do you have evidence that the government is the main cause of the increase of the price of the plan? It could have merely been the companies using the ACA as an excuse to raise prices.

drodgers 10y ago

"the private plan without subsidies... was $250" But that plan was only available to healthy people without any pre-existing conditions. Now, the $780 version of that plan is available to everyone. You are a healthy person who could get healthcare before and still can for roughly the same price. The ACA wasn't meant to change things much for you: it was meant to increase coverage. Now people who are older or who have a chronic condition or a bad family history can get the same health insurance as you. That's what your tax dollars are paying-for.

losvedir 10y ago
> But that plan was only available to healthy people without any pre-existing conditions. > Now, the $780 version of that plan is available to everyone But you're making a political statement that the government should ensure sick people should have access to health care (which is fine, e.g., I support welfare). It's just odd that you think this program should be paid for primarily by middle class Americans, unlike most other government safety nets which come from taxes which mostly target higher income individuals.

speaktruth 10y ago

>Sure it had more bells and whistles > [...] >this same plan today is $780 a month without subsidies The problem with your comment is that your prices are very exact but the consumed goods (insurances) are described only vaguely. The country I live in, introduced obligatory health insurance 1996. The first proposition by our Democratic Party goes back to 1960. After 30 years of intense political fight we now have a system that is supported by all of the parties. So I think our system is as balanced as it gets. Plus we have a highly competitive system between insurence companies, and you are allowed to switch the insurance company every year, which then is done by lot of people. The absolute most important thing is a rock-solid legal description of the minimun that every insurance company has to deliver. Here are the + and - after 10 years of practical experience with obligatory healthcare: + High competition, disciplines insurance companies to work efficiently, and allows new, small and innovative companies to enter the market. + It's a pretty fair non-discriminatory system, nationwide and across all insurance companies + Simple system once it is established + Vulnerable persons are well protected. + The common health of the people is rising. - The costs are rising every year because the is no direct interest in keeping the costs down - The insurance companies get more powerful every year due intense lobbying, this not in our interest. - There is explosion of special health services, very expensive treatments, rising salaries in the health economy TLDR: Obligatory healthcare is good and you live longer. But it comes with a price.

god_bless_texas 10y ago

> the government is picking up the lion's share of the tab Oh yeah? Where do they get their money from?

xtiansimon 10y ago

@virmundi, In what state do you live? To my understanding each state has the option to set up it's own State Healthcare Marketplace or use the Federal Marketplace. Different states have more or fewer healthcare providers to choose from, so the state you live in makes a big difference.

enobrev 10y ago

I went about eight years without health insurance because I was freelance and in NYC it was somewhere around $550 per month for the worst of plans for a perfectly healthy twentysomething with no medical conditions whatsoever (besides being a smoker at the time) I ended up taking a job at a start-up when I turned 30 because I figured at 30 I should probably start going to the doctor more often and it was the only way I could afford health insurance. I was finally able to go back to freelance a little over a year ago because a decent plan only cost about $700 total per month for both me AND my wife, and She has pre-existing conditions, which is to say she had gone even longer without insurance before we'd met. I was merely hedging bets according to my age. She actually needs it. Of course, BCBS-IL keep cancelling our plans as is their apparent loophole to raise rates. Because even though the non-profit had a surplus of 14B in early 2016, the absolutely perfect plan we were on wasn't making enough money for them, so they killed it. That's twice in a row, so we switched to Cigna this year, which I don't assume will be much better. It's expensive,. They're all expensive, whether I use the marketplace or not. But they're nowhere near as expensive as they were four years ago. Especially for my wife who literally could not be insured before the ACA.

emcq 10y ago

The average spending per individual in the US per year is $10000 [0]. For an all inclusive insurance plan, if you have say a $5000 deductible and are spending less than $416/month per person you are contributing less to the pool than is being spent on average per individual. You're doing good, and are de-risked for potential health costs. A healthcare plan where you get dumped the second you have a preexisting condition removes the de-risking benefit of insurance. The only benefit then left is the negotiating leverage of an insurance company able to pay $50k for a surgery that would out of pocket be $100k, lower ambulance bills, etc. [0] http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/ http://www.pbs.org/newshour/rundown/new-peak-us-health-care-...

jfnixon 10y ago
Heh, negotiated leverage. Providers aren't stupid, and they jack up the "rack rate" so they can offer the demanded discounts to insurers. The main result of this is cash patients pay through the nose. If you really want to fix this, have ACA:NG prohibit any cash price exceeding the lowest 'negotiated' rate. Similarly, if you want to avoid the problem of expensive drugs that sell for significantly less in Canada, legally require Big Pharma to sell in the US for the lowest 'negotiated' price among all the national healthcare systems.