6 ms·

As I recall, Obamacare didn't do much, if anything, to decouple health plans from employment. If anything it made it more tightly coupled, by mandating employer

As I recall, Obamacare didn't do much, if anything, to decouple health plans from employment. If anything it made it more tightly coupled, by mandating employers with more than so many full-time employees provide health plans. The individual mandate didn't decouple health plans from employers, it just provided additional insult to injury by causing those whom were un- or under-employed and couldn't afford a now even more expensive full price health plan to be facing an even larger tax bill at the end of the year. Any other good or bad effects from Obamacare notwithstanding, if you want to decouple health plans from employment and specific employers, Obamacare is the wrong direction.

TheCoelacanth 9y ago
It did quite a bit to make it easier to buy insurance as an individual such as getting rid of pre-existing condition exclusions and adding subsidies for low income people.
40acres 9y ago
I mentioned Obamacare as more of a government solution to the problems mentioned in the parent post but I agree. However remember that Obamacare provides and individual insurance market at the state level (which is doing terribly..) along with medicaid expansion. These seem closer to the ideal of what American 'single payer' would look like.
prepend 9y ago
The creation of exchanges for purchases and removal of preexisting conditions as exclusions made it much more possible to buy insurance outside of group plans. I contracted for a few years and it was impossible to get insurance at a reasonable cost because of an extremely common health condition that’s never caused complication in my life. So I was only able to get insurance through employers.
- lostcolony 9y ago
  This. I had asthma as a child. Now? No meds, no issues, for two decades. I would not qualify for affordable healthcare because of that pre-existing condition without Obamacare. Even as is, with the fragility of our political system, I am very wary of contract work; the concern that I could lose healthcare at any time based on elected idiots stymies me.
  - Consultant32452 9y ago
    Did you ever actually shop for it? I bought health insurance before Obamacare and I have asthma.
    - lostcolony 9y ago
      My mom did for me between my turning 18 and going to college, since the cutoff to be on a parent's insurance hadn't been raised. She was outright refused by a number of providers, and finally managed to get me on a plan with Kaiser Permanente, which was still pricey, and which required us driving 40 miles to see a primary care physician (we were not in the sticks, either, but in the suburbs. On prior insurances I'd been able to see a doctor just a few miles from us, but that was the closest office a KP approved doctor worked from)
    - crankylinuxuser 9y ago
      Sure, you found some company willing to take your money claiming you had "insurance". In reality, had you actually try to use it, would have been in "pre-existing condition" hell. Because the asthma could have cause $ailment, and they don't cover preexisting. Tood bad, so sad. Glad you paid the premiums!
      - dragonwriter 9y ago
        The other part of precondition hell was recisions, where if you had an expensive condition, the insurance company would look for evidence of a (potentially unrelated) pre-existing condition that had not been disclosed, cancel your insurance based on that (perhaps refunding all the premiums you had paid, for all the good that did you) and call it a day; as part of ending preexisting condition exclusions, the ACA ended recision.
        crankylinuxuser 9y ago
        As someone who was diagnosed with T2 diabetes thanks to Obamacare, I greatly appreciate the work the ACA did. It's not great, but it's a hell of a lot better than what I had prior - nothing.
maxerickson 9y ago
People are talking about guaranteed issue, because for the most part they don't want a system that screws over people with preexisting issues (which is what a market based system without guaranteed issue will tend to do).
sedachv 9y ago
> As I recall, Obamacare didn't do much Do you have any actual experience purchasing health insurance before ACA, and later through an ACA exchange? I am not sure what exactly you are "recalling." I purchased health insurance for me and my wife through Covered California last year and found the process quick, the comparisons easy to make, and the pricing clear and reasonable. I have not purchased health insurance myself before the ACA, but from what I was told the options for independent contractors were few and expensive, and were difficult to find.
- korethr 9y ago
  I was laid off in late 2013, shortly before the ACA took effect. When I was laid off, I had the opportunity to keep my existing plan on an individual basis through COBRA. My savings and cash flow would not permit such. Some web searching lead me to believe that I'd be facing similar rates if I went shopping myself, so I opted to go without, and see what happened when the ACA took effect. In the beginning of 2014, I looked at my state's exchange. The plans were now even more expensive, and per the questionnaire on the exchange's site, I was ineligible for the subsidy to make it less-unaffordable because of how much I'd made in the previous year. So I said "fuck it", and opted to eat the tax penalty when I filed my taxes in the following year. So, no, in my experience, the ACA did not decouple the affordability of a health plan from one's employer -- it made it worse.
  - sedachv 9y ago
    > So, no, in my experience, the ACA did not decouple the affordability of a health plan from one's employer -- it made it worse. I still don't follow your reasoning. You seem to be saying that any health insurance is too expensive for you to afford, so the ACA doesn't work? As you saw from COBRA, health insurance is expensive, and your compensation package from full-time employment obscures that expense, because typically your employer asks you to pay only part of the expense from your salary. You have to figure the real cost of health insurance into your rates as an independent contractor. The ACA made it easier to shop for health insurance as an independent. I was in a similar situation to yours - when I was laid off last year, I ended up picking a plan from Covered California that was $80 less expensive per month than the offered COBRA plan, with significantly lower out of pocket costs ($0 vs $9,000 deductible, for starters), in a much more highly rated provider network. So the plan that I was getting from my employer was a lot worse than what I chose to buy through ACA. This would be more apparent if your employer paid out the cost of all of your benefits in your salary and then had you pay the full cost of insurance (which is essentially what happens when you are an independent contractor).
yardie 9y ago
Maybe it is different in your state. In mine, FL every September I get a notice asking if I want to continue to use employer provided healthcare or would I prefer to find something on the exchange. Employers of a certain size are compelled to offer health insurance and employees are free to choose something different. That doesn't sound like it's tightly coupled to me. Finally, according to our healthcare rep, no one has been penalized for not taking a healthcare plan. The IRS sends out scary notices every year that they swear to god are going to assess penalties this year. And they haven't so far.

TheCoelacanth 9y ago

It did quite a bit to make it easier to buy insurance as an individual such as getting rid of pre-existing condition exclusions and adding subsidies for low income people.

40acres 9y ago

I mentioned Obamacare as more of a government solution to the problems mentioned in the parent post but I agree. However remember that Obamacare provides and individual insurance market at the state level (which is doing terribly..) along with medicaid expansion. These seem closer to the ideal of what American 'single payer' would look like.

prepend 9y ago

The creation of exchanges for purchases and removal of preexisting conditions as exclusions made it much more possible to buy insurance outside of group plans. I contracted for a few years and it was impossible to get insurance at a reasonable cost because of an extremely common health condition that’s never caused complication in my life. So I was only able to get insurance through employers.

lostcolony 9y ago
This. I had asthma as a child. Now? No meds, no issues, for two decades. I would not qualify for affordable healthcare because of that pre-existing condition without Obamacare. Even as is, with the fragility of our political system, I am very wary of contract work; the concern that I could lose healthcare at any time based on elected idiots stymies me.
- Consultant32452 9y ago
  Did you ever actually shop for it? I bought health insurance before Obamacare and I have asthma.
  - lostcolony 9y ago
    My mom did for me between my turning 18 and going to college, since the cutoff to be on a parent's insurance hadn't been raised. She was outright refused by a number of providers, and finally managed to get me on a plan with Kaiser Permanente, which was still pricey, and which required us driving 40 miles to see a primary care physician (we were not in the sticks, either, but in the suburbs. On prior insurances I'd been able to see a doctor just a few miles from us, but that was the closest office a KP approved doctor worked from)
  - crankylinuxuser 9y ago
    Sure, you found some company willing to take your money claiming you had "insurance". In reality, had you actually try to use it, would have been in "pre-existing condition" hell. Because the asthma could have cause $ailment, and they don't cover preexisting. Tood bad, so sad. Glad you paid the premiums!
    - dragonwriter 9y ago
      The other part of precondition hell was recisions, where if you had an expensive condition, the insurance company would look for evidence of a (potentially unrelated) pre-existing condition that had not been disclosed, cancel your insurance based on that (perhaps refunding all the premiums you had paid, for all the good that did you) and call it a day; as part of ending preexisting condition exclusions, the ACA ended recision.
      - crankylinuxuser 9y ago
        As someone who was diagnosed with T2 diabetes thanks to Obamacare, I greatly appreciate the work the ACA did. It's not great, but it's a hell of a lot better than what I had prior - nothing.

maxerickson 9y ago

People are talking about guaranteed issue, because for the most part they don't want a system that screws over people with preexisting issues (which is what a market based system without guaranteed issue will tend to do).

sedachv 9y ago

> As I recall, Obamacare didn't do much Do you have any actual experience purchasing health insurance before ACA, and later through an ACA exchange? I am not sure what exactly you are "recalling." I purchased health insurance for me and my wife through Covered California last year and found the process quick, the comparisons easy to make, and the pricing clear and reasonable. I have not purchased health insurance myself before the ACA, but from what I was told the options for independent contractors were few and expensive, and were difficult to find.

korethr 9y ago
I was laid off in late 2013, shortly before the ACA took effect. When I was laid off, I had the opportunity to keep my existing plan on an individual basis through COBRA. My savings and cash flow would not permit such. Some web searching lead me to believe that I'd be facing similar rates if I went shopping myself, so I opted to go without, and see what happened when the ACA took effect. In the beginning of 2014, I looked at my state's exchange. The plans were now even more expensive, and per the questionnaire on the exchange's site, I was ineligible for the subsidy to make it less-unaffordable because of how much I'd made in the previous year. So I said "fuck it", and opted to eat the tax penalty when I filed my taxes in the following year. So, no, in my experience, the ACA did not decouple the affordability of a health plan from one's employer -- it made it worse.
- sedachv 9y ago
  > So, no, in my experience, the ACA did not decouple the affordability of a health plan from one's employer -- it made it worse. I still don't follow your reasoning. You seem to be saying that any health insurance is too expensive for you to afford, so the ACA doesn't work? As you saw from COBRA, health insurance is expensive, and your compensation package from full-time employment obscures that expense, because typically your employer asks you to pay only part of the expense from your salary. You have to figure the real cost of health insurance into your rates as an independent contractor. The ACA made it easier to shop for health insurance as an independent. I was in a similar situation to yours - when I was laid off last year, I ended up picking a plan from Covered California that was $80 less expensive per month than the offered COBRA plan, with significantly lower out of pocket costs ($0 vs $9,000 deductible, for starters), in a much more highly rated provider network. So the plan that I was getting from my employer was a lot worse than what I chose to buy through ACA. This would be more apparent if your employer paid out the cost of all of your benefits in your salary and then had you pay the full cost of insurance (which is essentially what happens when you are an independent contractor).

yardie 9y ago

Maybe it is different in your state. In mine, FL every September I get a notice asking if I want to continue to use employer provided healthcare or would I prefer to find something on the exchange. Employers of a certain size are compelled to offer health insurance and employees are free to choose something different. That doesn't sound like it's tightly coupled to me. Finally, according to our healthcare rep, no one has been penalized for not taking a healthcare plan. The IRS sends out scary notices every year that they swear to god are going to assess penalties this year. And they haven't so far.