4 ms·

I took much bigger risks (changed industries, started a company, did freelance work) once Obamacare was passed. I never went without health insurance, and it wa

I took much bigger risks (changed industries, started a company, did freelance work) once Obamacare was passed. I never went without health insurance, and it was subsidized during those periods when I could least afford it. It's insane to me that conservatives somehow landed on the side of opposing a system that encourages professional independence and risk taking. They talk a big game about "small business owners" but make it as dangerous as possible to try and become one.

csdreamer7 8y ago
Don't know why you are being downvoted. ACA plans are limited and pricey, but health insurance before Obamacare was a joke. Lifetime caps and pregnancy being a preexisting condition, and then trying to get health care by yourself. We really need an option to buy into medicaid. No deductibles, no co-pays, dental included, network is limited, but so are ACA plans.
- dragonwriter 8y ago
  > We really need an option to buy into medicaid. No deductibles, no co-pays State Medicaid plans can and do require deductibles, copays, and similar charges (cost sharing). https://www.medicaid.gov/medicaid/cost-sharing/index.html https://www.medicaid.gov/medicaid/cost-sharing/index.html
  - csdreamer7 8y ago
    Are you sure that link is up to date? The latest referenced was published in 2010. Also the groups mentioned that medicaid can charge are mothers and the disabled. No mention of able working adults. That seems really strange. Update: just clicked on the summary of one of them. Doesn't even mention the ACA, but other acts: American Recovery and Reinvestment Act of 2009 (the Recovery Act)
    - dragonwriter 8y ago
      > Are you sure that link is up to date? Since I work directly on IT systems used in payment processing for a state Medicaid agency, I can assure you that to the extent such agencies can and do impose cost sharing it is correct, though there may have been some tweaks to the parameters (though I don't recall hearing of any changes to the basic rules.) > Also the groups mentioned that medicaid can charge are mothers and the disabled. No, it mentions that there are limits on the cost premiums and enrollment fees that can be assigned to pregnant mothers, the disabled, and the medically needy, and that “States have the option to impose higher, alternative premiums on other groups of enrollees, if their family incomes exceed 150% of the federal poverty level.” With regard to cost sharing more generally, it notes that “Certain vulnerable groups, such as children and pregnant women, are exempt from most out of pocket costs”.
- osrec 8y ago
  Can I ask, would a system like the NHS in the UK ever be viable in the US? It's not perfect, but it certainly gives us UK residents surety that we are always fairly protected if we were to become unhealthy. Also, they literally don't stop providing care until you're either better or pass away. In that sense, the NHS is really quite amazing.
  - specialist 8y ago
    Not yet. (I support friends who work on this policy reform.) Meanwhile... I now advocate "buy-in". Incrementally extend eligibility of existing large plans (eg local govt, self insured corps). One side effect will be to increase customer bargaining power (vis-a-vis insurers). Rock, paper, scissors.
specialist 8y ago
Me too. Medicare for All and universal childcare would lead to small business creation. Since that's not in the cards... Any jurisdiction wanting to vitalize their local economy should create a "buy-in" option to their health insurance pool. Eligibility extended to anyone who is self-employed, just started a business (with some minimum amount of capital / cash on hand / accounts receivable), or similar "sincerity" test.

csdreamer7 8y ago

Don't know why you are being downvoted. ACA plans are limited and pricey, but health insurance before Obamacare was a joke. Lifetime caps and pregnancy being a preexisting condition, and then trying to get health care by yourself. We really need an option to buy into medicaid. No deductibles, no co-pays, dental included, network is limited, but so are ACA plans.

dragonwriter 8y ago
> We really need an option to buy into medicaid. No deductibles, no co-pays State Medicaid plans can and do require deductibles, copays, and similar charges (cost sharing). https://www.medicaid.gov/medicaid/cost-sharing/index.html https://www.medicaid.gov/medicaid/cost-sharing/index.html
- csdreamer7 8y ago
  Are you sure that link is up to date? The latest referenced was published in 2010. Also the groups mentioned that medicaid can charge are mothers and the disabled. No mention of able working adults. That seems really strange. Update: just clicked on the summary of one of them. Doesn't even mention the ACA, but other acts: American Recovery and Reinvestment Act of 2009 (the Recovery Act)
  - dragonwriter 8y ago
    > Are you sure that link is up to date? Since I work directly on IT systems used in payment processing for a state Medicaid agency, I can assure you that to the extent such agencies can and do impose cost sharing it is correct, though there may have been some tweaks to the parameters (though I don't recall hearing of any changes to the basic rules.) > Also the groups mentioned that medicaid can charge are mothers and the disabled. No, it mentions that there are limits on the cost premiums and enrollment fees that can be assigned to pregnant mothers, the disabled, and the medically needy, and that “States have the option to impose higher, alternative premiums on other groups of enrollees, if their family incomes exceed 150% of the federal poverty level.” With regard to cost sharing more generally, it notes that “Certain vulnerable groups, such as children and pregnant women, are exempt from most out of pocket costs”.
osrec 8y ago
Can I ask, would a system like the NHS in the UK ever be viable in the US? It's not perfect, but it certainly gives us UK residents surety that we are always fairly protected if we were to become unhealthy. Also, they literally don't stop providing care until you're either better or pass away. In that sense, the NHS is really quite amazing.
- specialist 8y ago
  Not yet. (I support friends who work on this policy reform.) Meanwhile... I now advocate "buy-in". Incrementally extend eligibility of existing large plans (eg local govt, self insured corps). One side effect will be to increase customer bargaining power (vis-a-vis insurers). Rock, paper, scissors.

specialist 8y ago

Me too. Medicare for All and universal childcare would lead to small business creation. Since that's not in the cards... Any jurisdiction wanting to vitalize their local economy should create a "buy-in" option to their health insurance pool. Eligibility extended to anyone who is self-employed, just started a business (with some minimum amount of capital / cash on hand / accounts receivable), or similar "sincerity" test.