6 ms·

Yes, but in that time "double-digit" meant 1X%. Now it has been 3X% growth year-over-year.

by kobeya 10y ago

tptacek 10y ago
Based on a bit of casual research, my sense is that you are drastically overstating the post-ACA cost growth, and significantly understating the pre-ACA growth. And, putting that aside, when looking at pre-ACA coverage you have to factor in actuarial value (insurers could quietly reduce the value of their insurance while holding premiums constant; part of the post-ACA cost increase is that there's now a floor on actuarial value, so premiums most more closely reflect value).
- deleted 10y ago
  [deleted]
- tyingq 10y ago
  It's difficult to get good statistics, because the cost is rising primarily for those that don't get subsidies via the ACA. When you mix costs to those that get subsidies with costs for those that don't, you get mud. Similarly, they will show "employer costs" over time, when they know well that some employers are passing increased costs down to employees. In short, it's the usual situation for statistics. You can show pretty much any story you want. My story of $1200/month to $2200/month (over 6 years) is real, with apples-for-apples coverage. Of course, it's just one data point.
  - tptacek 10y ago
    Insurance in the small group market isn't subsidized; it's employer-provided. So subsidies can't be confounding those statistics, can they?† I'm not disputing that you experienced a barely-tenable increase in insurance premiums since 2011. But if your premiums had been increasing 30% YOY since Obamacare went into effect, you'd be paying something closer to $5000/mo, not $2200/mo. What you experienced instead looks closer to 13% YOY. The distinction is important because: * The California small-group market, which like most group markets was guaranteed-issue prior to ACA, was already experiencing increases at that scale before ACA. * Not only was that happening, but further cost increases were easily hidden by terms and conditions that reduced actuarial value for policies at the same premium. The ACA prohibits that practice; if the broader narrative about ACA was true, you'd expect even steeper price increases because insurers have fewer ways of hiding them. But we don't see that. So to me, you're telling a story about broad dysfunction in the health care marketplace that is orthogonal to ACA. I find that narrative very easy to believe! Either way, though: I might be wrong (and would love to hear about it if I am), but these issues aren't unknowable. † This is one of several reasons you know you're in trouble when you read an analysis of the ACA that insists on comparing the pre-ACA and post-ACA individual markets, or suggests that comparisons based on the small group market is somehow shenanigans: in addition to being the insurance market most of us startup founders actually participate in, the small group market is the closest we have to an apples/apples comparison: an unsubsidized guaranteed-issue marketplace for small numbers of people in both eras.
    - tyingq 10y ago
      That's the thing though... I don't have access to statistics that are solely for small group coverage. I don't happen to be in the California market either. Edit: I'm in the Texas market. And, if you're looking up statistics, be sure to watch out for: - Only the employer's costs being shown, versus also showing what's passed down to employees. We pay 100% of the premium. It's common for employers to pay around 40-60%, and of course, shift that percentage as costs go up...hiding actual cost hikes in the stats. - Mixing in employers that get the signficant ACA tax break if the average annual wages are below $50,000 per FTE. Not common in small developer centric companies. - Keeping in mind the average could look flatter than it actually is, as some companies raise deductibles or drop the percent of in/out patient covered specifically to keep costs flat. In short, it's very hard to see the actual cost for a specific policy over time in any kind of large scale.
      - tptacek 10y ago
        Ok, let's find out. What state are you in? --- The Texas small group marketplace saw double-digit increases in 36% of the 10 years prior to ACA (and a whopping 55% if your firm had between 25-99 employees) --- higher than that of California. Of the statistical concerns you expressed: 1. The percentage of premiums passed to employers is orthogonal to the comparison we're making and so doesn't impact the statistics. 2. Tax breaks on employers are also orthogonal to this comparison, but I'll add that they'd work against the overall argument about ACA driving costs, because those tax breaks are a feature of the ACA, not of the pre-ACA regime. 3. Deductibles and network sizes would affect statistics, and what we're looking at here is an overall average. So yes, keep that in mind.
        tyingq 10y ago
        The percentage isn't orthoganol when the employer can raise or lower it...assuming the stats show employer cost only. Which some stats I have seen do. Edit: some of the available statistics are employers reporting solely their costs, not the part of the premium they pass down. You haven't specified a source, so I have no idea where your numbers are coming from.
  - kobeya 10y ago
    > Of course, it's just one data point. And mine is another :\ FWIW it is really implausible to be a tech worker in the SF bay area and qualify for subsidies.
- tomohawk 10y ago
  At the very least, the ACA was billed as being the antidote to cost increases. Of course, they also said "if you like your doctor, you can keep your doctor" and many other untrue things. Everyone that I know is paying significantly more for significantly less coverage than before.
  - JamesBarney 10y ago
    Very healthy individuals who had could get access to insurance before the ACA are paying more.(because of the very popular pre-existing conditions part of the ACA) Are you sure they are paying for less coverage? Pretty much all individual health plans pre-ACA paid out more in the median case, and less in the average case, a whole lot less in the worst case. Basically they would pay for check ups, but totally skip town if you got cancer.
    - tomohawk 10y ago
      As one example, a neighbor works for the state gov't. The state gov't pushed all their employees onto the exchange. They now pay quite a bit more in premiums and their deductibles are way higher. They've had to go from a good PPO plan to an HMO plan with greatly diminished value. They're completely against the wall because of this.
      - tptacek 10y ago
        Which state is this, that kicked all its employees off group health insurance and into the (very expensive) individual coverage market?
        tomohawk 10y ago
        Maryland. The group plan prices aren't much different than the exchange. I see the full cost of my group plan with my employer. This year that price is better than the exchange and the plan is better, but not last year. My point would be that the ACA is a fail on this basis alone. They need to end the Depression era idea of employer provided health insurance (introduced to work around the wage controls imposed by FDR) and just let people buy it on their own. They need to move the tax writeoff from the employer to the employee. This whole notion that splitting up the single group that is the US market into smaller 'groups', and that this somehow increases buying power - it's ridiculous. We've been going down this path for 70 years - it's time to try something different.
nickff 10y ago
Is there a chart or other representation available which shows comparable insurance plan cost over time? I am not asking you to prove your point (as I disdain "citation needed" responses), but would be interested to take a look at a chart if someone has it handy.
inferiorhuman 10y ago
From the Covered California rate sheet[1]. Year over year increases in region 4 (SF) for the for-profit plans is anywhere from 8% to 25%. Kaiser (whom I despise, but is a not-for-profit org) raised their rates between 1% and 8%. 1: https://www.coveredca.com/news/PDFs/CoveredCA-2017-rate-booklet.pdf https://www.coveredca.com/news/PDFs/CoveredCA-2017-rate-book...

Yes, but in that time "double-digit" meant 1X%. Now it has been 3X% growth year-over-year.

by kobeya 10y ago

Yes, but in that time "double-digit" meant 1X%. Now it has been 3X% growth year-over-year.

Based on a bit of casual research, my sense is that you are drastically overstating the post-ACA cost growth, and significantly understating the pre-ACA growth. And, putting that aside, when looking at pre-ACA coverage you have to factor in actuarial value (insurers could quietly reduce the value of their insurance while holding premiums constant; part of the post-ACA cost increase is that there's now a floor on actuarial value, so premiums most more closely reflect value).

deleted 10y ago
[deleted]
tyingq 10y ago
It's difficult to get good statistics, because the cost is rising primarily for those that don't get subsidies via the ACA. When you mix costs to those that get subsidies with costs for those that don't, you get mud. Similarly, they will show "employer costs" over time, when they know well that some employers are passing increased costs down to employees. In short, it's the usual situation for statistics. You can show pretty much any story you want. My story of $1200/month to $2200/month (over 6 years) is real, with apples-for-apples coverage. Of course, it's just one data point.
- tptacek 10y ago
  Insurance in the small group market isn't subsidized; it's employer-provided. So subsidies can't be confounding those statistics, can they?† I'm not disputing that you experienced a barely-tenable increase in insurance premiums since 2011. But if your premiums had been increasing 30% YOY since Obamacare went into effect, you'd be paying something closer to $5000/mo, not $2200/mo. What you experienced instead looks closer to 13% YOY. The distinction is important because: * The California small-group market, which like most group markets was guaranteed-issue prior to ACA, was already experiencing increases at that scale before ACA. * Not only was that happening, but further cost increases were easily hidden by terms and conditions that reduced actuarial value for policies at the same premium. The ACA prohibits that practice; if the broader narrative about ACA was true, you'd expect even steeper price increases because insurers have fewer ways of hiding them. But we don't see that. So to me, you're telling a story about broad dysfunction in the health care marketplace that is orthogonal to ACA. I find that narrative very easy to believe! Either way, though: I might be wrong (and would love to hear about it if I am), but these issues aren't unknowable. † This is one of several reasons you know you're in trouble when you read an analysis of the ACA that insists on comparing the pre-ACA and post-ACA individual markets, or suggests that comparisons based on the small group market is somehow shenanigans: in addition to being the insurance market most of us startup founders actually participate in, the small group market is the closest we have to an apples/apples comparison: an unsubsidized guaranteed-issue marketplace for small numbers of people in both eras.
  - tyingq 10y ago
    That's the thing though... I don't have access to statistics that are solely for small group coverage. I don't happen to be in the California market either. Edit: I'm in the Texas market. And, if you're looking up statistics, be sure to watch out for: - Only the employer's costs being shown, versus also showing what's passed down to employees. We pay 100% of the premium. It's common for employers to pay around 40-60%, and of course, shift that percentage as costs go up...hiding actual cost hikes in the stats. - Mixing in employers that get the signficant ACA tax break if the average annual wages are below $50,000 per FTE. Not common in small developer centric companies. - Keeping in mind the average could look flatter than it actually is, as some companies raise deductibles or drop the percent of in/out patient covered specifically to keep costs flat. In short, it's very hard to see the actual cost for a specific policy over time in any kind of large scale.
    - tptacek 10y ago
      Ok, let's find out. What state are you in? --- The Texas small group marketplace saw double-digit increases in 36% of the 10 years prior to ACA (and a whopping 55% if your firm had between 25-99 employees) --- higher than that of California. Of the statistical concerns you expressed: 1. The percentage of premiums passed to employers is orthogonal to the comparison we're making and so doesn't impact the statistics. 2. Tax breaks on employers are also orthogonal to this comparison, but I'll add that they'd work against the overall argument about ACA driving costs, because those tax breaks are a feature of the ACA, not of the pre-ACA regime. 3. Deductibles and network sizes would affect statistics, and what we're looking at here is an overall average. So yes, keep that in mind.
      - tyingq 10y ago
        The percentage isn't orthoganol when the employer can raise or lower it...assuming the stats show employer cost only. Which some stats I have seen do. Edit: some of the available statistics are employers reporting solely their costs, not the part of the premium they pass down. You haven't specified a source, so I have no idea where your numbers are coming from.
- kobeya 10y ago
  > Of course, it's just one data point. And mine is another :\ FWIW it is really implausible to be a tech worker in the SF bay area and qualify for subsidies.
tomohawk 10y ago
At the very least, the ACA was billed as being the antidote to cost increases. Of course, they also said "if you like your doctor, you can keep your doctor" and many other untrue things. Everyone that I know is paying significantly more for significantly less coverage than before.
- JamesBarney 10y ago
  Very healthy individuals who had could get access to insurance before the ACA are paying more.(because of the very popular pre-existing conditions part of the ACA) Are you sure they are paying for less coverage? Pretty much all individual health plans pre-ACA paid out more in the median case, and less in the average case, a whole lot less in the worst case. Basically they would pay for check ups, but totally skip town if you got cancer.
  - tomohawk 10y ago
    As one example, a neighbor works for the state gov't. The state gov't pushed all their employees onto the exchange. They now pay quite a bit more in premiums and their deductibles are way higher. They've had to go from a good PPO plan to an HMO plan with greatly diminished value. They're completely against the wall because of this.
    - tptacek 10y ago
      Which state is this, that kicked all its employees off group health insurance and into the (very expensive) individual coverage market?
      - tomohawk 10y ago
        Maryland. The group plan prices aren't much different than the exchange. I see the full cost of my group plan with my employer. This year that price is better than the exchange and the plan is better, but not last year. My point would be that the ACA is a fail on this basis alone. They need to end the Depression era idea of employer provided health insurance (introduced to work around the wage controls imposed by FDR) and just let people buy it on their own. They need to move the tax writeoff from the employer to the employee. This whole notion that splitting up the single group that is the US market into smaller 'groups', and that this somehow increases buying power - it's ridiculous. We've been going down this path for 70 years - it's time to try something different.

nickff 10y ago

Is there a chart or other representation available which shows comparable insurance plan cost over time? I am not asking you to prove your point (as I disdain "citation needed" responses), but would be interested to take a look at a chart if someone has it handy.

inferiorhuman 10y ago

From the Covered California rate sheet[1]. Year over year increases in region 4 (SF) for the for-profit plans is anywhere from 8% to 25%. Kaiser (whom I despise, but is a not-for-profit org) raised their rates between 1% and 8%. 1: https://www.coveredca.com/news/PDFs/CoveredCA-2017-rate-booklet.pdf https://www.coveredca.com/news/PDFs/CoveredCA-2017-rate-book...