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A lot of complaints about the ACA seem related to monthly premiums going up compared to pre-ACA plans. It goes something like this: prior to the ACA I was payin

A lot of complaints about the ACA seem related to monthly premiums going up compared to pre-ACA plans. It goes something like this: prior to the ACA I was paying $X, now I'm paying more, therefore the ACA is bad. But here's the thing, pre-ACA and post-ACA plans are not remotely directly comparable. Pre-ACA plans could reject you for pre-existing conditions, drop your coverage if you got sick and became too expensive to insure (recission), or had maximum lifetime limits that would leave you bankrupt if you got a serious chronic illness (think expensive cancer treatments). All of these practices are now banned under the ACA. Does anyone remember applying for individual health insurance prior to the ACA? It was a nightmare. You had to fill out a 30-page questionnaire regarding your health history, and if you made any mistakes, the insurance company would have cause to deny your claims if you ever got sick. You weren't sure if your insurance would actually pay out when you needed it. And that's assuming they even approved you in the first place. So yes, health insurance costs more now, but you have to ask yourself, was that $50-100/month plan you were paying for really health insurance if they could drop your coverage just because you were getting too expensive for them? Besides, in exchange for paying more, a lot of people less fortunate than myself can now get coverage, and I know my coverage will actually pay out in the event that I become seriously ill. So overall, despite the additional cost, I think it's a net improvement. It's not perfect, however. It still leaves too much power in the hands of the insurance companies, who are essentially middlemen squeezing the health care industry from both ends: charging higher premiums to patients and paying less to doctors, so they can extract a profit in the middle. Ultimately we need to transition to a single-payer system where insurance is administered by a government entity instead of profit-seeking corporations. This is how every other modern country in the world does it, and the result is better health outcomes than the US. It's absurd how behind the times we are on this front.

dragonwriter 10y ago
> drop your coverage if you got sick and became too expensive to insure (recission) Yeah, the significance of rescission and the ACA's prohibition is often overlooked. Prior to the ACA, if you got sick enough and expensive enough, insurance companies could -- while you had outstanding claims, and this happened while people were in the hospital -- retroactively cancel your insurance, refund your premiums, and walk away leaving you fully liable not only for any future healthcare, but for anything they hadn't paid for yet from the time when you had coverage. Now, this could generally only be done based on an omission or inaccuracy in initial disclosures, usually related to a preexisting condition, but there was no requirement (federally, some states had controls) that the be intentional or significant, and insurance companies would hunt out errors once care got expensive. The ACA elimination of exclusion for preexisting conditions itself elominated most of the basis for rescission and the onerous disclosure requirements that it was based on errors in, but the ACA also explicitly prohibited it except for fraud or intentional misrepresentation of material facts.
curun1r 10y ago
Here's my complaint with the ACA, and it has nothing to do with insurance premiums. My job ended in January '16. I got a large severance and left the US for 7 months. I sold some stock in July, but other than that, my income was $0 each month. Looking forward, my income was likely to be just as erratic, with most months being $0. After spending way too much time talking with the folks at CoveredCA trying to figure out just how to fill out the forms for such an uncertain income level, I finally got all the information on my application and got denied. I couldn't even buy an unsubsidized plan. The exchange failed hard for my scenario and I ended up having to buy insurance directly from the health insurance company I was with when I was employed. It was quick and easy and cheaper than it would have been on the exchanges. And now, to add insult to injury, I'm probably going to have to pay a penalty for not having US health insurance for all those months that I wasn't living in the US, since I'm pretty sure I didn't pass the threshold for being a non-resident. As a programmer, I'm all to familiar with code that handles the 90% case and just assumes those other edge cases don't exist. It's lazy and error prone and a sign of an amateur programmer. The ACA feels like the legislative equivalent of that sort of code. In their hurry to create a system where the majority of those without health coverage could get it, they created a system that's truly terrible for edge cases like me.
- nodamage 10y ago
  Interesting, I haven't heard of someone getting denied coverage for applying to an ACA plan before. What was the reason for the denial?
  - curun1r 10y ago
    The denial letter looked like it was making two separate, independent eligibility determinations. One, for CoveredCA insurance and one for MediCal. I was denied by CoveredCA because my monthly income was $0, which would normally push me towards MediCal. But I was denied by MediCal because I made six figures in both months that I reported taxable income. The MediCal denial makes sense. I don't see why I should have the state pay the entirety of my medical insurance costs when I'm making that much money. I also would like more choice when it comes to my doctor and treatment than MediCal allows and I'm willing to pay for it. The CoveredCA part is baffling to me. Why I'm not allowed to purchase health insurance with no premium assistance because I don't have a steady income leads me to believe that the ACA is poorly-written legislation.

dragonwriter 10y ago

> drop your coverage if you got sick and became too expensive to insure (recission) Yeah, the significance of rescission and the ACA's prohibition is often overlooked. Prior to the ACA, if you got sick enough and expensive enough, insurance companies could -- while you had outstanding claims, and this happened while people were in the hospital -- retroactively cancel your insurance, refund your premiums, and walk away leaving you fully liable not only for any future healthcare, but for anything they hadn't paid for yet from the time when you had coverage. Now, this could generally only be done based on an omission or inaccuracy in initial disclosures, usually related to a preexisting condition, but there was no requirement (federally, some states had controls) that the be intentional or significant, and insurance companies would hunt out errors once care got expensive. The ACA elimination of exclusion for preexisting conditions itself elominated most of the basis for rescission and the onerous disclosure requirements that it was based on errors in, but the ACA also explicitly prohibited it except for fraud or intentional misrepresentation of material facts.

curun1r 10y ago

Here's my complaint with the ACA, and it has nothing to do with insurance premiums. My job ended in January '16. I got a large severance and left the US for 7 months. I sold some stock in July, but other than that, my income was $0 each month. Looking forward, my income was likely to be just as erratic, with most months being $0. After spending way too much time talking with the folks at CoveredCA trying to figure out just how to fill out the forms for such an uncertain income level, I finally got all the information on my application and got denied. I couldn't even buy an unsubsidized plan. The exchange failed hard for my scenario and I ended up having to buy insurance directly from the health insurance company I was with when I was employed. It was quick and easy and cheaper than it would have been on the exchanges. And now, to add insult to injury, I'm probably going to have to pay a penalty for not having US health insurance for all those months that I wasn't living in the US, since I'm pretty sure I didn't pass the threshold for being a non-resident. As a programmer, I'm all to familiar with code that handles the 90% case and just assumes those other edge cases don't exist. It's lazy and error prone and a sign of an amateur programmer. The ACA feels like the legislative equivalent of that sort of code. In their hurry to create a system where the majority of those without health coverage could get it, they created a system that's truly terrible for edge cases like me.

nodamage 10y ago
Interesting, I haven't heard of someone getting denied coverage for applying to an ACA plan before. What was the reason for the denial?
- curun1r 10y ago
  The denial letter looked like it was making two separate, independent eligibility determinations. One, for CoveredCA insurance and one for MediCal. I was denied by CoveredCA because my monthly income was $0, which would normally push me towards MediCal. But I was denied by MediCal because I made six figures in both months that I reported taxable income. The MediCal denial makes sense. I don't see why I should have the state pay the entirety of my medical insurance costs when I'm making that much money. I also would like more choice when it comes to my doctor and treatment than MediCal allows and I'm willing to pay for it. The CoveredCA part is baffling to me. Why I'm not allowed to purchase health insurance with no premium assistance because I don't have a steady income leads me to believe that the ACA is poorly-written legislation.