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Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while als

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for our next child, still far cheaper than paying for a $15,000/yr policy + 15,000/yr deductible. In my decade of buying family insurance, I watched my family policy increase by nearly $1000/mo combined with a staggering decrease in value provided via super high deductible... oh, and no legal way out. I know ACA is good for some, but goodness did it remove my interest in remaining insured. I’m sure you can cite data that tells a different story, but my experience, as well as that of my peers, says ACA has been very bad for those actually paying the bill unsubsidized. I fully blame ACA for this.

tptacek 9y ago
You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense. Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of rising insurance premiums and (I think) pretty much failed. But it didn't create that problem; 5-digit annual premiums for a family of four were a reality prior to the ACA --- or, at least, they were in Chicago on the small group market. The subtext to these discussions though is whether we'd be better off without the ACA. No, we would not be. We would lose guaranteed-issue insurance, so a sizable fraction of families wouldn't be able to get insurance at all, and, from the available evidence, we would at least have the same rate problems we have now, and (according to some studies) have worse rates. Obviously, this subtext is about the GOP's health care rhetoric, and I'm not wild about opening up a political salient in this thread, but let's at least be clear: the idea that you can repeal the ACA, do nothing else, and get lower health insurance premiums for real coverage is sleight of hand.
- x0x0 9y ago
  For another example: my broken ankle: tib+fib fracture, 2 severed ligaments, partially torn syndesmotic ligament, gave myself plantar fasciitis during recovery. Two surgeries, a bunch of ortho visits, a bunch more PT, 10 months on crutches. The net bill was over $110k if I hadn't had insurance and wanted to go to one of two ankle specialists in the city I live in. With insurance, $5k-ish.
- whatshisface 9y ago
  If enough people didn't have access to insurance, then there would be pressure on hospitals to find ways to reduce prices (so that their volume could go up). As it stands the medical industry is allowed to hold the poor for ransom ("accept our increased costs or they won't get treated") against the US's deep but finite pockets. Before, we had the (very poor) demand elasticity of people paying everything they had and then maxing out every credit source, and predictably prices rose to around that point. Now, we have no demand elasticity at all, and prices can be expected to rise well above the average person's net worth + credit access. If you look at any microeconomic equilibrium chart, you'll see that the price is held in a balance between people buying and people holding off due to price. When the good is healthcare, the human cost of "holding off" is very high, and usually involves inability to pay. Unfortunately our economic system tends to fly off the rails if this balance is disrupted, no matter how noble or urgent the cause.
  - komali2 9y ago
    >pressure on hospitals to reduce prices Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company. The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you want to get economic about it though you'll lose because as it turns out a healthy educated populace is more productive than one that loses productive families here and there to lances of bankruptcy from the unpredictable nest of human disease.
    - deleted 9y ago
mhdhn 9y ago
You are taking a huge, basically unlimited risk with your now healthy family. And note that you will probably save at least as much by the discounts you get through the insurance company's networks as by how much insurance pays vs. patient. Example, had a covered but elective heart procedure. Insurance was billed around $220,000. But they got the hospital and doctors to accept less than $20,000. Yes, I paid some of that - but you see it's all in the under 10% part of the bill. Good luck negotiating your bill down 90% on your own.
- ethagknight 9y ago
  I do have a catestrophic policy, I wasn’t clear above. Agree it is a risk, but it’s not unlimited. However, The list prices are sham values. Why do you think the doctors would be willing to accept $20k from one payor but not another? Medical billing ultimately becomes a game of persistence, and you can wear down the billing office and reach a settlement that ultimately. Been there, Done that!
bwb 9y ago
The ACA is not at fault there, that problem was there before.
- ethagknight 9y ago
  Absolutely false to say ACA is not at fault. It’s not solely ACA’s fault, but it is complicit. dramatic annual increases occurred every year after ACA. I’m not looking at statistics but my family insurance premiums over time.

tptacek 9y ago

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense. Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of rising insurance premiums and (I think) pretty much failed. But it didn't create that problem; 5-digit annual premiums for a family of four were a reality prior to the ACA --- or, at least, they were in Chicago on the small group market. The subtext to these discussions though is whether we'd be better off without the ACA. No, we would not be. We would lose guaranteed-issue insurance, so a sizable fraction of families wouldn't be able to get insurance at all, and, from the available evidence, we would at least have the same rate problems we have now, and (according to some studies) have worse rates. Obviously, this subtext is about the GOP's health care rhetoric, and I'm not wild about opening up a political salient in this thread, but let's at least be clear: the idea that you can repeal the ACA, do nothing else, and get lower health insurance premiums for real coverage is sleight of hand.

x0x0 9y ago
For another example: my broken ankle: tib+fib fracture, 2 severed ligaments, partially torn syndesmotic ligament, gave myself plantar fasciitis during recovery. Two surgeries, a bunch of ortho visits, a bunch more PT, 10 months on crutches. The net bill was over $110k if I hadn't had insurance and wanted to go to one of two ankle specialists in the city I live in. With insurance, $5k-ish.
whatshisface 9y ago
If enough people didn't have access to insurance, then there would be pressure on hospitals to find ways to reduce prices (so that their volume could go up). As it stands the medical industry is allowed to hold the poor for ransom ("accept our increased costs or they won't get treated") against the US's deep but finite pockets. Before, we had the (very poor) demand elasticity of people paying everything they had and then maxing out every credit source, and predictably prices rose to around that point. Now, we have no demand elasticity at all, and prices can be expected to rise well above the average person's net worth + credit access. If you look at any microeconomic equilibrium chart, you'll see that the price is held in a balance between people buying and people holding off due to price. When the good is healthcare, the human cost of "holding off" is very high, and usually involves inability to pay. Unfortunately our economic system tends to fly off the rails if this balance is disrupted, no matter how noble or urgent the cause.
- komali2 9y ago
  >pressure on hospitals to reduce prices Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company. The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you want to get economic about it though you'll lose because as it turns out a healthy educated populace is more productive than one that loses productive families here and there to lances of bankruptcy from the unpredictable nest of human disease.
  - deleted 9y ago

mhdhn 9y ago

You are taking a huge, basically unlimited risk with your now healthy family. And note that you will probably save at least as much by the discounts you get through the insurance company's networks as by how much insurance pays vs. patient. Example, had a covered but elective heart procedure. Insurance was billed around $220,000. But they got the hospital and doctors to accept less than $20,000. Yes, I paid some of that - but you see it's all in the under 10% part of the bill. Good luck negotiating your bill down 90% on your own.

ethagknight 9y ago
I do have a catestrophic policy, I wasn’t clear above. Agree it is a risk, but it’s not unlimited. However, The list prices are sham values. Why do you think the doctors would be willing to accept $20k from one payor but not another? Medical billing ultimately becomes a game of persistence, and you can wear down the billing office and reach a settlement that ultimately. Been there, Done that!

bwb 9y ago

The ACA is not at fault there, that problem was there before.

ethagknight 9y ago
Absolutely false to say ACA is not at fault. It’s not solely ACA’s fault, but it is complicit. dramatic annual increases occurred every year after ACA. I’m not looking at statistics but my family insurance premiums over time.