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I'm "self-employed", ie employed by the company that I own, and so I have to shoulder the entirety of health insurance cost for my family of 4. Because I'm the

I'm "self-employed", ie employed by the company that I own, and so I have to shoulder the entirety of health insurance cost for my family of 4. Because I'm the only FT employee, we aren't eligible for "business/small group" health plans; which means we either have to buy private health insurance (often not meeting ACA Essential Coverage requirements) and/or purchase health insurance from the 'health exchange' marketplace administered by our state. The first year, we could actually purchase decent coverage and while it was expensive, it was a solid PPO plan. The past two years however, there isn't even a single PPO plan offered on the exchange in my state -- not one -- I don't even think there were any "Platinum" coverages offered. The end result is that we pay essentially a mortgage-size payment each month and in exchange we get relatively abysmal coverage. Worse yet? It seems they categorically deny ~75% of claims, which generally means we have to appeal & fight them on it (our success rate is high but it's time-consuming); if it's testing/labs that need done, we also have to front the cash out of pocket to avoid delaying diagnosis & any potentially needed treatment. Often that means $800+ out of pocket PLUS a 4-8 hour time investment over a 3-4 month span in order to try to recoup that money -- all the while, we're of course paying the absurd premiums each month. Insurance & the financial aspect of healthcare is so completely broken in the US that it's sickening. I believe the problem is so severe that it's really hurting our country's economy and is incredibly stifling for individuals & small businesses. I wish I knew how to fix it. :(

CuriouslyC 6y ago
Unfortunately not so much an option for a bit, but medical tourism is the best answer. You can take a vacation and get treatment for less than you're paying just for insurance.
- heavyset_go 6y ago
  Finding a good doctor is tough to do even domestically, how do you vet foreign doctors? Referrals from doctors you already trust?
throwaway31338 6y ago
I abandoned my business of 15 years last year because of worry about availability of health insurance. It looks like I was in a similar situation to you. My business was going well. I was making equivalent income of a bit more than a high-end salary for my skill set in my area. I was fine (grudgingly) paying the premiums. The problem was that there was absolutely no assurance insurance that would actually cover anything would be available in the future. We had "marketplace" plans for a number of years. Eventually there were no "silver" marketplace plans available in my locale (and "bronze", with 20% "co-insurance", means I'm going bankrupt if I have any significant events anyway, so I might as well just have no coverage). I gave up and took a job. I couldn't expose my family to the risk of not having any insurance available. It was crushing. I took the route of not having employees and was unable to qualify for "business" plans. I guess I wasn't "successful" after all, since I didn't aspire to grow the business beyond what would support my family.
- heavyset_go 6y ago
  Stories like these are reflective of the fact that there are higher rates of entrepreneurship in countries with universal healthcare.
- weaksauce 6y ago
  it's insane to me that the democrats haven't latched onto this as a talking point... it's a pro-small business move that would spark entrepreneurship that both sides love to talk about. the big businesses know that it will kneecap their ability to retain employees with the threat of losing their subsidized insurance.
- irlib 6y ago
  Does the "bronze" plan have "out of pocket maximum"? It supposed to be 20% up to the OOM and total coverage after, right?
WarOnPrivacy 6y ago
That is an excellent synopsis of the ACA.

CuriouslyC 6y ago

Unfortunately not so much an option for a bit, but medical tourism is the best answer. You can take a vacation and get treatment for less than you're paying just for insurance.

heavyset_go 6y ago
Finding a good doctor is tough to do even domestically, how do you vet foreign doctors? Referrals from doctors you already trust?

throwaway31338 6y ago

I abandoned my business of 15 years last year because of worry about availability of health insurance. It looks like I was in a similar situation to you. My business was going well. I was making equivalent income of a bit more than a high-end salary for my skill set in my area. I was fine (grudgingly) paying the premiums. The problem was that there was absolutely no assurance insurance that would actually cover anything would be available in the future. We had "marketplace" plans for a number of years. Eventually there were no "silver" marketplace plans available in my locale (and "bronze", with 20% "co-insurance", means I'm going bankrupt if I have any significant events anyway, so I might as well just have no coverage). I gave up and took a job. I couldn't expose my family to the risk of not having any insurance available. It was crushing. I took the route of not having employees and was unable to qualify for "business" plans. I guess I wasn't "successful" after all, since I didn't aspire to grow the business beyond what would support my family.

heavyset_go 6y ago
Stories like these are reflective of the fact that there are higher rates of entrepreneurship in countries with universal healthcare.
weaksauce 6y ago
it's insane to me that the democrats haven't latched onto this as a talking point... it's a pro-small business move that would spark entrepreneurship that both sides love to talk about. the big businesses know that it will kneecap their ability to retain employees with the threat of losing their subsidized insurance.
irlib 6y ago
Does the "bronze" plan have "out of pocket maximum"? It supposed to be 20% up to the OOM and total coverage after, right?

WarOnPrivacy 6y ago

That is an excellent synopsis of the ACA.