6 ms·

Americans face biggest increase in health insurance costs in 15 years

62 points by cs702 1y ago

mitchbob 1y ago
https://archive.ph/x17re https://archive.ph/x17re
Tarsul 1y ago
If there's one "positive" in the labor stats the past few months it was an increase in employees in healthcare positions.
nodesocket 1y ago
I’m self employed and literally have the cheapest (non healthcare.gov) plan I could find at $396 a month. The plan is absolute garbage with carve outs, high deductibles, limits, and caps. I fully expected if I ever really need to use it (knock on wood), they will screw me and deny claims. My premiums have nearly doubled in the last 5 years. Seriously considering not having insurance and going cash. Any recommended plans for freelancers / solo self employed?
- tracerbulletx 1y ago
  This is a structural death blow to small business and something needs to be done about it if we think it's a good thing not to live under corporate feudalism.
  - deleted 1y ago
    [deleted]
- wonger_ 1y ago
  I've heard of co-op insurance, where self-employed people group together for better rates. No idea if it's good or not though. First google result was: https://opolis.co/insurance/ https://opolis.co/insurance/ Also interesting ideas in this reddit thread https://www.reddit.com/r/HealthInsurance/comments/1hgg2q4/self_employed_peeps_what_do_you_do_for_health/ https://www.reddit.com/r/HealthInsurance/comments/1hgg2q4/se..., probably skewed towards young/single people.
  - gentooflux 1y ago
    So the solution to healthcare for the self-employed is pansexual polygamy without the sex. Benefits without "benefits", if you will
    - jdlshore 1y ago
      Insurance has always been about groups of people banding together to soften emergencies. Prior to the ACA, the groups were people with the same employer, and getting insurance as an individual was prohibitively expensive and had ridiculous limits. The ACA added the ability to purchase through the marketplace and prevented the rampant denials that previously existed. I’m not sure how folks are grouped in the marketplace, but I believe it’s by zip code. I paid for my own insurance for decades and the ACA absolutely made things better, and cheaper, for individuals seeking insurance. Not even counting the subsidies for lower incomes.
- jdlshore 1y ago
  A better option than going cash is a HSA through the government marketplace. It will give you tax deductions on your savings, you’ll end up paying almost everything out of pocket (same as cash), but you’ll be protected against total ruin if you need emergency care. Don’t buy insurance outside of the marketplace. The ACA places limits on what insurers can deny, and those limits protect you from the rampant problems that existed before the ACA. I’m not sure if those protections apply to insurance purchased outside the marketplace.
  - A4ET8a8uTh0_v2 1y ago
    I was going to say. This is probably one of those few things that Bush got somewhat right.
  - nodesocket 1y ago
    HSA limit is $4,300 annual, how does that protect against total ruin? That's a hospital trip in a Uber and a few tylenol.
    - dragonwriter 1y ago
      They are probably using “HSA from the government marketplace” as shorthand for “a combination of an HSA with a HSA-eligible health plan from the state ACA marketplace”; the HSA doesn’t protect you from total ruin, thr linked high-deductible health plan should.
    - bfrog 1y ago
      One emergency visit is like 10k here now. Best of luck.
    - jdlshore 1y ago
      As @dragonwriter said, the HSA doesn't protect you against ruin, the linked high-deductible insurance does. You use the HSA for your ordinary medical expenses and get a nice tax discount from it. The HSA is also acts as a retirement investment account. So, if you're young with minimal healthcare needs, you can get multiple benefits: 1) High-deductible insurance that's (relatively) cheap but still protects you against financial ruin 2) After 10 years of maximum contributions, you'll have ~$10K in cash for emergencies and about $33K in retirement investment contributions.
- trashface 1y ago
  $396 (if un-subsidized) probably means you are on a bronze tier plan. And yes many of those are hot garbage. However, if you are paying that for a crap plan and getting a subsidy too, you're probably getting ripped off. Most people on healthcare.gov or a state exchange who sign up for bronze tier are getting a subsidy, so the premium is reduced to near zero in some cases. Still often a bad plan, but a cheap bad plan. I pay ~$400 but the government kicks in ~$350 too due to my low income. Its a Silver PPO plan and not bad, though, I haven't used it for anything serious yet. The Silver plans have extra subsidies so are usually better quality than bronze. It also can be helpful to switch insurers if the plan is bad. My insurer up until last year was once decent but has gone downhill. They are also the dominant insurer in my area. The one I switched to this year is trying to gain market share in my area, so they seem to be a better deal, the plan is more generous and has less red tape.
  - toast0 1y ago
    When I was on the marketplace, I couldn't tell much difference between the metals. I'd pick a network, all the tiers covered only the mandatory stuff as best as I could see; really same deal with all the networks, but different providers. Higher tiers had higher premiums and lower deductables... for me, I just went with bronze because premiums + out of pocket max was lowest; I'm sure there's portions of the curve where care would cost less with a higher tier, but I figured lower cost with minimal use and lower cost with maximal use is pretty good. IMHO, health insurance makes it hard to do cost control of healthcare. Patients can't do it, because they won't know how much stuff costs until 6 months after service, so they can't really make decisions on cost. Providers can't do it either, they have even less idea of what things cost for patients, and they have an interest in providing more billable care. Insurance companies could do it, but denying care for economic reasons is hard, so they just go with denying care for beuracratic reasons; also, ACA insurers have revenue limits based on ratios to covered care, so covering more things allows them to get more revenue. Even government paid healthcare has trouble because everyone gets grumpy when they can't get all the care available.
  - nodesocket 1y ago
    The maximum you can make and receive any subsidy is absurdly low. I don't qualify for any government subsidies yet I'm the one actually paying real income tax.
- wrp 1y ago
  Would going with Direct Primary Care help? It is like concierge care in that you pay a monthly retainer to a doctor's office for unlimited access. You then supplement that with insurance with a very high deductible for major issues. DPC seems to be a growing trend among new primary care practices in the USA.
paulddraper 1y ago
> One of the insurance companies, UnitedHealth, has cited tariffs from President Donald Trump’s trade wars as a reason for the increases. My understanding was most of the cost of healthcare was human services.
- wetpaws 1y ago
  [dead]
ksec 1y ago
I just dont understand why health insurance and medical cost in US are so expensive.
- tryptophan 1y ago
  Because Obama rewrote the Healthcare laws to prioritize insurance companies above all else. Their stocks have been doing great!
  - sydbarrett74 1y ago
    ACA is largely based on Heritage Foundation policy papers. Project 2010, if you will.
  - gloryjulio 1y ago
    The ACA bill was originally a republican bill that Obama agreed and pushed. And then the republicans flipped around and started blaming Obama on their own bill.
  - conception 1y ago
    In what way were insurance companies limited before the ACA that “Obama” removed? Please be specific. I’ve never heard this take before.
    - ethbr1 1y ago
      Indeed. I'd like to hear too, seeing as the admin cost caps for insurers in ACA are a pretty big stick to counterbalance the mandate carrot. I know firsthand that a lot of insurers substantially increased internal efficiency as a result of no longer being able to pass excesses along to consumers in premiums.
- Ekaros 1y ago
  If you are allowed to skim only 10% on top. Obvious solution to increase amount is to increase underlying cost. This goes for insurance. But also for many other players like hospital owners. When you have oligopoly there is no reason to drive prices down.
westurner 1y ago
Is this the most predictable outcome in a for-profit competitive health insurance market? Was this the outcome of Romneycare in MA? Do other countries with single-payer health care have these types of sudden mass price increases by health insurers?
blitzar 1y ago
I struggle to have sympathy for the people of a country that has collectively chosen, time and time again, to have a thing they now have. Congratulations you have what you wanted.
- rzazueta 1y ago
  Very cool take. So, how have you fought off similar oppression in your utopic part of the world, wherever that may be? Please, enlighten the rest of us.
  - wetpaws 1y ago
    [dead]
  - conception 1y ago
    Usually you tax the ultra wealthy to reign in their influence and limit corruption/lobbying/political spending. That’s how it’s been done non-violently in the past.
- estimator7292 1y ago
  I suppose you want to personally take responsibility for the EU's current anti-encryption crusaide? After all, you chose this path! Clearly you think that we must all summit our private conversations and thoughts to your government for approval? Grow up already.
  - watwut 1y ago
    But, voters indeed punished politicians that wanted reforms like price transparency or single payer. Voters consider it bad socialism.
- gedy 1y ago
  It's too bad most Americans came to get away from Europe and it's 500 years of bullshit problems.
  - 1y ago
fzeroracer 1y ago
At this point the only tenable option is going to be some sort of single-payer healthcare. Small businesses can't afford the healthcare costs to employ people and your average worker can't afford the costs either. When I was looking for a plan earlier since I got laid off about a month ago, the cheapest plans were in the $500 or so a month range which is insane for someone that's had zero health issues so far and doesn't smoke or drink. I fully expect the west coast states to implement single payer before the government ever catches on.
- deleted 1y ago
  [deleted]
- gonzalohm 1y ago
  Or regulate prices. How can a hospital charge $250 for an IV bag while in Europe the same bag is 10€ Or an ambulance ride in the US STARTS at $500. An ambulance ride in the EU is 260€/hour (obviously is free in case of emergency) I think the problem is that the US is in this weird dynamic in which hospitals charge more because "the patient is not paying for it, the insurance is" but in the end insurance are going to raise premiums to pay for that
ManuelKiessling 1y ago
It’s interesting how it’s the same in Germany — a country which in many regards, but especially in this one, is on the opposite side of the spectrum in terms of how the underlying system works.
r2b2 1y ago
Patients and providers should have the ability to shop and negotiate price directly with each other. No 3rd party will ever be in a better position to negotiate individualized care and prices for 350,000,000 people better than we (or our family) can for ourselves. Currently, patients cannot price compare anything, not even for the exact same drug from two different pharmacies on the same street! To make it worse, most providers can't even make sense enough of the provider-insurer prices to shop on behalf of the patients. To improve prices in healthcare, all care must have a price visible to all, paid by patients. Insurance should be required by law to publicly publish their reimbursement rates and immediately (48 hours) reimburse their insured patients for care at approved (in-network) providers. This would end the current: impossible to self advocate, impossible for providers to advocate on behalf of patients, intractable insurer-provider price web. Insurers and providers should never negotiate price. Providers should only be concerned with providing good care, how to classify/code it, and the amount they need to charge for that care to be financially viable. Insurers should only be concerned with how much they will pay out for each classification/code, and which providers they authorize as in-network. Last, since there is a long tail of medical care that doesn't fit nicely into a code box, each plan should have a mandatory minimum coverage of something like 50% all unknown-care costs at in-network providers and pharmacies above $5,000 annually, with some annual cap. As a society, if we want to further subsidize healthcare for those with lower economic means, and/or those who end up with catastrophic expenses, then that should be done on it's own, as two distinct standalone welfare programs.

62 points by cs702 1y ago

https://archive.ph/x17re https://archive.ph/x17re

If there's one "positive" in the labor stats the past few months it was an increase in employees in healthcare positions.

nodesocket 1y ago

I’m self employed and literally have the cheapest (non healthcare.gov) plan I could find at $396 a month. The plan is absolute garbage with carve outs, high deductibles, limits, and caps. I fully expected if I ever really need to use it (knock on wood), they will screw me and deny claims. My premiums have nearly doubled in the last 5 years. Seriously considering not having insurance and going cash. Any recommended plans for freelancers / solo self employed?

tracerbulletx 1y ago
This is a structural death blow to small business and something needs to be done about it if we think it's a good thing not to live under corporate feudalism.
- deleted 1y ago
  [deleted]
wonger_ 1y ago
I've heard of co-op insurance, where self-employed people group together for better rates. No idea if it's good or not though. First google result was: https://opolis.co/insurance/ https://opolis.co/insurance/ Also interesting ideas in this reddit thread https://www.reddit.com/r/HealthInsurance/comments/1hgg2q4/self_employed_peeps_what_do_you_do_for_health/ https://www.reddit.com/r/HealthInsurance/comments/1hgg2q4/se..., probably skewed towards young/single people.
- gentooflux 1y ago
  So the solution to healthcare for the self-employed is pansexual polygamy without the sex. Benefits without "benefits", if you will
  - jdlshore 1y ago
    Insurance has always been about groups of people banding together to soften emergencies. Prior to the ACA, the groups were people with the same employer, and getting insurance as an individual was prohibitively expensive and had ridiculous limits. The ACA added the ability to purchase through the marketplace and prevented the rampant denials that previously existed. I’m not sure how folks are grouped in the marketplace, but I believe it’s by zip code. I paid for my own insurance for decades and the ACA absolutely made things better, and cheaper, for individuals seeking insurance. Not even counting the subsidies for lower incomes.
jdlshore 1y ago
A better option than going cash is a HSA through the government marketplace. It will give you tax deductions on your savings, you’ll end up paying almost everything out of pocket (same as cash), but you’ll be protected against total ruin if you need emergency care. Don’t buy insurance outside of the marketplace. The ACA places limits on what insurers can deny, and those limits protect you from the rampant problems that existed before the ACA. I’m not sure if those protections apply to insurance purchased outside the marketplace.
- A4ET8a8uTh0_v2 1y ago
  I was going to say. This is probably one of those few things that Bush got somewhat right.
- nodesocket 1y ago
  HSA limit is $4,300 annual, how does that protect against total ruin? That's a hospital trip in a Uber and a few tylenol.
  - dragonwriter 1y ago
    They are probably using “HSA from the government marketplace” as shorthand for “a combination of an HSA with a HSA-eligible health plan from the state ACA marketplace”; the HSA doesn’t protect you from total ruin, thr linked high-deductible health plan should.
  - bfrog 1y ago
    One emergency visit is like 10k here now. Best of luck.
  - jdlshore 1y ago
    As @dragonwriter said, the HSA doesn't protect you against ruin, the linked high-deductible insurance does. You use the HSA for your ordinary medical expenses and get a nice tax discount from it. The HSA is also acts as a retirement investment account. So, if you're young with minimal healthcare needs, you can get multiple benefits: 1) High-deductible insurance that's (relatively) cheap but still protects you against financial ruin 2) After 10 years of maximum contributions, you'll have ~$10K in cash for emergencies and about $33K in retirement investment contributions.
trashface 1y ago
$396 (if un-subsidized) probably means you are on a bronze tier plan. And yes many of those are hot garbage. However, if you are paying that for a crap plan and getting a subsidy too, you're probably getting ripped off. Most people on healthcare.gov or a state exchange who sign up for bronze tier are getting a subsidy, so the premium is reduced to near zero in some cases. Still often a bad plan, but a cheap bad plan. I pay ~$400 but the government kicks in ~$350 too due to my low income. Its a Silver PPO plan and not bad, though, I haven't used it for anything serious yet. The Silver plans have extra subsidies so are usually better quality than bronze. It also can be helpful to switch insurers if the plan is bad. My insurer up until last year was once decent but has gone downhill. They are also the dominant insurer in my area. The one I switched to this year is trying to gain market share in my area, so they seem to be a better deal, the plan is more generous and has less red tape.
- toast0 1y ago
  When I was on the marketplace, I couldn't tell much difference between the metals. I'd pick a network, all the tiers covered only the mandatory stuff as best as I could see; really same deal with all the networks, but different providers. Higher tiers had higher premiums and lower deductables... for me, I just went with bronze because premiums + out of pocket max was lowest; I'm sure there's portions of the curve where care would cost less with a higher tier, but I figured lower cost with minimal use and lower cost with maximal use is pretty good. IMHO, health insurance makes it hard to do cost control of healthcare. Patients can't do it, because they won't know how much stuff costs until 6 months after service, so they can't really make decisions on cost. Providers can't do it either, they have even less idea of what things cost for patients, and they have an interest in providing more billable care. Insurance companies could do it, but denying care for economic reasons is hard, so they just go with denying care for beuracratic reasons; also, ACA insurers have revenue limits based on ratios to covered care, so covering more things allows them to get more revenue. Even government paid healthcare has trouble because everyone gets grumpy when they can't get all the care available.
- nodesocket 1y ago
  The maximum you can make and receive any subsidy is absurdly low. I don't qualify for any government subsidies yet I'm the one actually paying real income tax.
wrp 1y ago
Would going with Direct Primary Care help? It is like concierge care in that you pay a monthly retainer to a doctor's office for unlimited access. You then supplement that with insurance with a very high deductible for major issues. DPC seems to be a growing trend among new primary care practices in the USA.

paulddraper 1y ago

> One of the insurance companies, UnitedHealth, has cited tariffs from President Donald Trump’s trade wars as a reason for the increases. My understanding was most of the cost of healthcare was human services.

wetpaws 1y ago
[dead]

ksec 1y ago

I just dont understand why health insurance and medical cost in US are so expensive.

tryptophan 1y ago
Because Obama rewrote the Healthcare laws to prioritize insurance companies above all else. Their stocks have been doing great!
- sydbarrett74 1y ago
  ACA is largely based on Heritage Foundation policy papers. Project 2010, if you will.
- gloryjulio 1y ago
  The ACA bill was originally a republican bill that Obama agreed and pushed. And then the republicans flipped around and started blaming Obama on their own bill.
- conception 1y ago
  In what way were insurance companies limited before the ACA that “Obama” removed? Please be specific. I’ve never heard this take before.
  - ethbr1 1y ago
    Indeed. I'd like to hear too, seeing as the admin cost caps for insurers in ACA are a pretty big stick to counterbalance the mandate carrot. I know firsthand that a lot of insurers substantially increased internal efficiency as a result of no longer being able to pass excesses along to consumers in premiums.
Ekaros 1y ago
If you are allowed to skim only 10% on top. Obvious solution to increase amount is to increase underlying cost. This goes for insurance. But also for many other players like hospital owners. When you have oligopoly there is no reason to drive prices down.

westurner 1y ago

Is this the most predictable outcome in a for-profit competitive health insurance market? Was this the outcome of Romneycare in MA? Do other countries with single-payer health care have these types of sudden mass price increases by health insurers?

blitzar 1y ago

I struggle to have sympathy for the people of a country that has collectively chosen, time and time again, to have a thing they now have. Congratulations you have what you wanted.

rzazueta 1y ago
Very cool take. So, how have you fought off similar oppression in your utopic part of the world, wherever that may be? Please, enlighten the rest of us.
- wetpaws 1y ago
  [dead]
- conception 1y ago
  Usually you tax the ultra wealthy to reign in their influence and limit corruption/lobbying/political spending. That’s how it’s been done non-violently in the past.
estimator7292 1y ago
I suppose you want to personally take responsibility for the EU's current anti-encryption crusaide? After all, you chose this path! Clearly you think that we must all summit our private conversations and thoughts to your government for approval? Grow up already.
- watwut 1y ago
  But, voters indeed punished politicians that wanted reforms like price transparency or single payer. Voters consider it bad socialism.
gedy 1y ago
It's too bad most Americans came to get away from Europe and it's 500 years of bullshit problems.
- 1y ago

fzeroracer 1y ago

At this point the only tenable option is going to be some sort of single-payer healthcare. Small businesses can't afford the healthcare costs to employ people and your average worker can't afford the costs either. When I was looking for a plan earlier since I got laid off about a month ago, the cheapest plans were in the $500 or so a month range which is insane for someone that's had zero health issues so far and doesn't smoke or drink. I fully expect the west coast states to implement single payer before the government ever catches on.

deleted 1y ago
[deleted]
gonzalohm 1y ago
Or regulate prices. How can a hospital charge $250 for an IV bag while in Europe the same bag is 10€ Or an ambulance ride in the US STARTS at $500. An ambulance ride in the EU is 260€/hour (obviously is free in case of emergency) I think the problem is that the US is in this weird dynamic in which hospitals charge more because "the patient is not paying for it, the insurance is" but in the end insurance are going to raise premiums to pay for that

ManuelKiessling 1y ago

It’s interesting how it’s the same in Germany — a country which in many regards, but especially in this one, is on the opposite side of the spectrum in terms of how the underlying system works.

r2b2 1y ago

Patients and providers should have the ability to shop and negotiate price directly with each other. No 3rd party will ever be in a better position to negotiate individualized care and prices for 350,000,000 people better than we (or our family) can for ourselves. Currently, patients cannot price compare anything, not even for the exact same drug from two different pharmacies on the same street! To make it worse, most providers can't even make sense enough of the provider-insurer prices to shop on behalf of the patients. To improve prices in healthcare, all care must have a price visible to all, paid by patients. Insurance should be required by law to publicly publish their reimbursement rates and immediately (48 hours) reimburse their insured patients for care at approved (in-network) providers. This would end the current: impossible to self advocate, impossible for providers to advocate on behalf of patients, intractable insurer-provider price web. Insurers and providers should never negotiate price. Providers should only be concerned with providing good care, how to classify/code it, and the amount they need to charge for that care to be financially viable. Insurers should only be concerned with how much they will pay out for each classification/code, and which providers they authorize as in-network. Last, since there is a long tail of medical care that doesn't fit nicely into a code box, each plan should have a mandatory minimum coverage of something like 50% all unknown-care costs at in-network providers and pharmacies above $5,000 annually, with some annual cap. As a society, if we want to further subsidize healthcare for those with lower economic means, and/or those who end up with catastrophic expenses, then that should be done on it's own, as two distinct standalone welfare programs.