5 ms·

Didn't the ACA take care of that? Most of the startups I know were pushing people into the state exchanges for their healthcare needs to try and limit their ov

Didn't the ACA take care of that? Most of the startups I know were pushing people into the state exchanges for their healthcare needs to try and limit their overhead for providing health insurance.

aksss 8y ago
Snort! The individual market in my state is comprised of three types of people - those so disabled they _can't_ work, who consume extraordinary sums of cash, the subsidized, and (less each year) the small business owners/independent contractors. The last category is expected to pay more than the price of their mortgage to support the first two categories, which is completely unsustainable. After two years of trying to be a good little mousekateer, I shut it off and feel like a rube for waiting that long. I spend less on healthcare each year than my cat's vet costs, but am expected to pay the cost of another mortgage, with high deductible to boot? GTFO. I self-insure, and am happy the tax penalty bit the dust.
- s73v3r_ 8y ago
  "those so disabled they _can't_ work" Why wouldn't they be on Medicare, unless you're in a state that declined to expand it. "I self-insure, and am happy the tax penalty bit the dust." Good for you, but realize you're not always going to be healthy. Once you're not, you're going to hope and pray that there is still a way to distribute costs like we have today.
  - aksss 8y ago
    The insurance companies report to our state board about what drives y/y premium increases in our market. This (the quote) is one of them (the 20% driving 80% of costs, if I may loosely invoke Pareto). Maybe I'm flying loose characterizing them as such, but if you're sucking up $1m-2m annually(!!) in subsidized health care services, I'm assuming you have some serious concerns preventing you from living up to your full employment potential (and God bless 'em, by the way). On the individual market, you're in a very high-risk pool, and the only people substantially contributing (e.g. zero subsidies) are in the minority and, IME, increasingly disenfranchised, either leaving the system or going back to working for the man. BTW, my state did expand medicaid and that system has plenty of its own issues. How they intersect, I neither know nor care at this point. >>"realize you're not always going to be healthy" Do you honestly think people don't realize that? I mean really? Do you honestly think I wouldn't prefer to have an out-of-pocket maximum that comes with insurance? I mean, stop assuming people are idiots and look at the problem: the premiums on the individual market are often too expensive for new business owners if they're in this doldrum-zone of being too profitable for subsidies but not large enough to build a new lower-cost risk pool out of their own employees or wealthy enough to afford a premium that costs as much as a house with no asset to show for it (when, btw, their consumption of services is less than $1k/year). This is just the reality, and a major contributing factor to why many who think about trying to start a business simply don't. It's _literally_ prohibitively expensive. Being a veteran of going two years unsubsidized on the individual market in one of the highest-cost states probably means I've done more to help distribute costs than most (i.e. "you"). That the system is unsustainable (and predictably so, btw) is not my guilt to bear. That some aren't familiar with the nature of the burden and simply think people make bad decisions doesn't bode well for a fix anytime soon. The day there's an affordable plan, I'll sign up again, rest assured. In the meantime, enjoy your employer-sponsored plan, my friend. You have less to worry about than I do while I fly solo.
    - deleted 8y ago
      [deleted]
- dv_dt 8y ago
  So the rest of us get to pay your expensive emergency room rates if you get "unlucky". I note that most of us will be unlucky in that way at some point in our lives. It may work out accounting wise in the short term, individual sense, but that we can't work out a much less expensive, socially carried method like other developed nations is a crying shame.
  - aksss 8y ago
    You can proselytize all you want about policy theory and ideals, but the reality of starting a business (not just a side-hustle) comes with more risk to the owner than you probably realize. Trust me, I'd love to have insurance, but it's unobtainium where I live if you don't qualify for subsidies. Considering the benefits from profitable new businesses, including the employment numbers we drive, the taxes we generate, the office leases we pay, the administrative services we buy, etc., etc., I think the "rest of you" will probably get the better end of the deal relative to the risk a business owner directly bears, crap emergency treatment for the uninsured aside (if even needed during the start up years, which I'm gambling won't be). I'm just telling you the reality of being a small business owner.
dv_dt 8y ago
When the ACA was working well, it was helpful, but not amazingly so. With Trump and GOP policy changes, all of those costs are going to increase, and coverage guarantees (like for pre-existing conditions) are getting rolled back. So if one might be forced to shop the private small business health market which has always been more expensive in my area.
pnathan 8y ago
ACA helps. It needs an overhaul, along with a medicaid expansion everywhere to manage the risk pools. If we had done ACA 1.1 with appropriate adjustments, it might not be a concern. but the actual inflight plans are to reverse the ACA and, depending on the plan and who's been adjusting it most recently, it might even make us worse off than before the ACA.

Didn't the ACA take care of that? Most of the startups I know were pushing people into the state exchanges for their healthcare needs to try and limit their overhead for providing health insurance.

aksss 8y ago

Snort! The individual market in my state is comprised of three types of people - those so disabled they _can't_ work, who consume extraordinary sums of cash, the subsidized, and (less each year) the small business owners/independent contractors. The last category is expected to pay more than the price of their mortgage to support the first two categories, which is completely unsustainable. After two years of trying to be a good little mousekateer, I shut it off and feel like a rube for waiting that long. I spend less on healthcare each year than my cat's vet costs, but am expected to pay the cost of another mortgage, with high deductible to boot? GTFO. I self-insure, and am happy the tax penalty bit the dust.

s73v3r_ 8y ago
"those so disabled they _can't_ work" Why wouldn't they be on Medicare, unless you're in a state that declined to expand it. "I self-insure, and am happy the tax penalty bit the dust." Good for you, but realize you're not always going to be healthy. Once you're not, you're going to hope and pray that there is still a way to distribute costs like we have today.
- aksss 8y ago
  The insurance companies report to our state board about what drives y/y premium increases in our market. This (the quote) is one of them (the 20% driving 80% of costs, if I may loosely invoke Pareto). Maybe I'm flying loose characterizing them as such, but if you're sucking up $1m-2m annually(!!) in subsidized health care services, I'm assuming you have some serious concerns preventing you from living up to your full employment potential (and God bless 'em, by the way). On the individual market, you're in a very high-risk pool, and the only people substantially contributing (e.g. zero subsidies) are in the minority and, IME, increasingly disenfranchised, either leaving the system or going back to working for the man. BTW, my state did expand medicaid and that system has plenty of its own issues. How they intersect, I neither know nor care at this point. >>"realize you're not always going to be healthy" Do you honestly think people don't realize that? I mean really? Do you honestly think I wouldn't prefer to have an out-of-pocket maximum that comes with insurance? I mean, stop assuming people are idiots and look at the problem: the premiums on the individual market are often too expensive for new business owners if they're in this doldrum-zone of being too profitable for subsidies but not large enough to build a new lower-cost risk pool out of their own employees or wealthy enough to afford a premium that costs as much as a house with no asset to show for it (when, btw, their consumption of services is less than $1k/year). This is just the reality, and a major contributing factor to why many who think about trying to start a business simply don't. It's _literally_ prohibitively expensive. Being a veteran of going two years unsubsidized on the individual market in one of the highest-cost states probably means I've done more to help distribute costs than most (i.e. "you"). That the system is unsustainable (and predictably so, btw) is not my guilt to bear. That some aren't familiar with the nature of the burden and simply think people make bad decisions doesn't bode well for a fix anytime soon. The day there's an affordable plan, I'll sign up again, rest assured. In the meantime, enjoy your employer-sponsored plan, my friend. You have less to worry about than I do while I fly solo.
  - deleted 8y ago
    [deleted]
dv_dt 8y ago
So the rest of us get to pay your expensive emergency room rates if you get "unlucky". I note that most of us will be unlucky in that way at some point in our lives. It may work out accounting wise in the short term, individual sense, but that we can't work out a much less expensive, socially carried method like other developed nations is a crying shame.
- aksss 8y ago
  You can proselytize all you want about policy theory and ideals, but the reality of starting a business (not just a side-hustle) comes with more risk to the owner than you probably realize. Trust me, I'd love to have insurance, but it's unobtainium where I live if you don't qualify for subsidies. Considering the benefits from profitable new businesses, including the employment numbers we drive, the taxes we generate, the office leases we pay, the administrative services we buy, etc., etc., I think the "rest of you" will probably get the better end of the deal relative to the risk a business owner directly bears, crap emergency treatment for the uninsured aside (if even needed during the start up years, which I'm gambling won't be). I'm just telling you the reality of being a small business owner.

dv_dt 8y ago

When the ACA was working well, it was helpful, but not amazingly so. With Trump and GOP policy changes, all of those costs are going to increase, and coverage guarantees (like for pre-existing conditions) are getting rolled back. So if one might be forced to shop the private small business health market which has always been more expensive in my area.

pnathan 8y ago

ACA helps. It needs an overhaul, along with a medicaid expansion everywhere to manage the risk pools. If we had done ACA 1.1 with appropriate adjustments, it might not be a concern. but the actual inflight plans are to reverse the ACA and, depending on the plan and who's been adjusting it most recently, it might even make us worse off than before the ACA.