4 ms·

Perhaps because of the sticker shock and because, if you can get them, pre ACA plans are cheaper and offer more value. For example if you go to ehealthinsuranc

by pmorici 13y ago

Perhaps because of the sticker shock and because, if you can get them, pre ACA plans are cheaper and offer more value. For example if you go to ehealthinsurance.com and compare the lowest cost pre-ACA 2013 plans with ACA-compliant 2014 plans for a healthy individual in their late 20's early thirties you get the following very affordable options pre-ACA... BlueCross BlueShield; Deductible: $5,000, Co-Insurance: 0%, Doctor Visit: 1-2 $30 co-pay deductible waved, Cost: $98 /month BlueCross BlueShield; Deductible: $5,000, Co-Insurance: 0%, Doctor Visit: 1-2 $30 co-pay deductible waved, Cost: $66 /month, The closest ACA compliant option to the above... BlueCross BlueShield; Deductible: $6,000, Co-Insurance: 0%, Doctor Visit: no charge after deductible, Cost: $130 /month So in summary you are looking at paying somewhere between 32% and 97% more money, and don't get the benefit of 1-2 low cost doctors visits per year.

tptacek 13y ago
Aren't you comparing conditionally-issued insurance with guaranteed-issue health insurance? The big problem I had with sites like ehealthinsurance.com is that a family using it to find insurance had a coinflip chance of actually getting one of those rates after completing an application.
- atwebb 13y ago
  I've also found it's like viewing interest rates on Zillow, it will be the lowest possible number that almost no one could qualify for but, it looks nice when shopping and gets people thinking they can afford it so the small increases later are accepted.
- pmorici 13y ago
  Yes, but how many people is that actually an issue for? Most of the preexisting condition demagoguery you hear about seems to stem from people who were going w/o insurance until they found out they had a medical condition. There were already limits on preexisting condition exclusions in a number of states. You also have to wonder if that in and of itself is worth a doubling in costs? http://en.wikipedia.org/wiki/Pre-existing_condition#Current_pre-existing_condition_exclusion_regulation http://en.wikipedia.org/wiki/Pre-existing_condition#Current_...
  - tptacek 13y ago
    Horse. Shit. I have a perfectly healthy family, a family in which I am notably the least actuarially sound bet. When we started Matasano, we found my wife and (at the time) 7 year old daughter both uninsurable, full stop, at any price, due not to preexisting conditions but instead previous medical examinations that led insurers to believe that at some point in the future the two (coincidentally? female) members of my family might develop a condition. I've talked to dozens of people since then and come to the conclusion that "functioning human female reproductive system" is, in essence, a coverage-denying preexisting condition in many US states.
    - pmorici 13y ago
      You're in IL right? For some reason the insurance situation in IL seems to be really crappy. They allow(ed) for looking back further in people's medical history than a lot of other states according to wikipedia. That doesn't explain why the new plans are so much more expensive though even in states that previously had restrictions on preexisting conditions and medical history use in underwriting.
      - tptacek 13y ago
        Let's again be clear about what I said. "They" (meaning every insurer in IL) did not "look at our medical history". They looked at visits to doctors and (in one case) the emergency room that did not result in diagnoses, and decided to hedge their bets by presuming a preexisting condition that was not indicated in the record. Another thing that happens --- particularly in California, lest you think this is an IL problem --- is that comparatively minor medical conditions were used as proxies for rare but expensive conditions. For instance, if you were a woman with abnormal cramping, you might be default-denied based on a simple blacklist of uninsurable conditions because insurers were scared that might presage something expensive down the road. The preexisting condition and recission policies of insurers prior to Obamacare were a national disgrace.
        pmorici 13y ago
- tanzam75 13y ago
  > Aren't you comparing conditionally-issued insurance with guaranteed-issue health insurance? In addition to guaranteed issue, the Obamacare plans have (1) an annual out-of-pocket limit (2) no annual or lifetime limit on benefits (3) an absolute right to renewal. These features raise the cost substantially compared to previous plans on the individual market. The classic example is if you get cancer and need $2 million in treatment. If your plan had 20% coinsurance, or a $1 million lifetime limit, then you'd be in rough shape. And if the insurance company dropped you when you got sick, on the grounds that you forgot to disclose some trivial and unrelated illness on your application, then you'd be in really rough shape. The things that make Obamacare expensive are the features that don't show up on the sticker -- because they are now required of all plans. Guaranteed issue is the major one, because they prevent sick people from being washed out of the actuarial pool. All of these features are things that you hope you will never need to "take advantage" of. If you waste your money buying them, that's actually not a bad outcome.
jevinskie 13y ago
I thought the law was supposed to encourage preventative care. Not offering at least one low cost doctor visit seems to betray that goal.
- tptacek 13y ago
  Health insurance is supposed to keep you from going bankrupt when your appendix bursts.
  - twoodfin 13y ago
    Well, sure, but most Americans and policymakers haven't thought about "health insurance" in those terms for a long time. PPACA makes plans that only protect against that kind of thing illegal.
  - pbz 13y ago
    Health insurance "yes", health care "no".
    - gwright 13y ago
      So much of the public debate regarding these issues is terribly confusing and misleading simply due to the wanton disregard for the difference between "health insurance" and "health care". I realize that some of the erroneous usage is just sloppiness, but these two things really aren't interchangeable from a public policy standpoint. Prime example: the "Affordable Care Act" isn't about health care, it is about health insurance.
- twoodfin 13y ago
  Preventative visits are required to be no-deductible, so I assume you only get hit with the cost if it's an irregular visit for an illness of some kind.
- pmorici 13y ago
  According to the details of each plan they all offer free preventive doctor visits. the 1-2 low cost visits per year are for if you got a cold or something and went to the doctor.
twoodfin 13y ago
The case the administration is making is that these old plans had invidious characteristics such as lifetime spending limits and missing "essential" no-deductible coverage for preventative services and birth control. Not sure whether that's an accurate claim for the pre-ACA plans you listed. Presumably ACA's no-deductible requirement applies to the new plan, so while you might pay for irregular doctor's visits, your scheduled preventative checkups should have no out of pocket costs. But I think that's small potatoes (the number of patients likely to exceed any reasonable lifetime coverage limitations has got to be tiny, and cheaply re-insurable by BCBS if needed). The real cost is likely coming from BCBS' estimate of the change in the risk pool characteristics of this new plan. Namely, it doesn't matter how healthy you are to sign up for the new one, so presumably on average it will be made up of less healthy people. There's also the cost-shifting that has to happen: Plans for older people can only be a set multiple (3x?) more expensive than for younger people, so the younger person's plan must be made more expensive. This is called cost-sharing if you're being polite, and a redistribution scheme if not.
- hga 13y ago
  "The case the administration is making is that these old plans had invidious characteristics such as lifetime spending limits and missing "essential" no-deductible coverage for preventative services and birth control." Coupled with the claim that plans based on the new floor for coverage would be at least affordable. Which many are finding invidious because they can't afford the replacement policies that are initially offered by their existing insurers. With all subsidy calculations tied to the Federal site, those who might get a subsidy aren't able to find out for sure without generally extreme levels of effort, although subsidy calculators are available, like the Kaiser Foundation's: http://kff.org/interactive/subsidy-calculator/ http://kff.org/interactive/subsidy-calculator/
  - twoodfin 13y ago
    That Kaiser calculator is great. I get the sense that this would have all worked so much better if the law had been structured such that HHS approved plans, insurers sold those plans on their own sites (or through private clearinghouses), while the IRS provided a quick calculator like this and a longer process to get a certification of your last year's income you could present to an insurer to get a subsidized rate.
bluedino 13y ago
$5,000 deductible? My PPO had a $2,500 deductible and I thought that was insanity.
- twoodfin 13y ago
  It's not that crazy. Most young people, most years will never spend $5,000 on health care, particularly when preventative services are free. So if you're responsible enough and financially capable to save for a rainy day, it makes sense to pay less out of pocket every month. Those savings may still be tax-deductible; I'm not sure how ACA changed HSA availability in that regard.
- pmorici 13y ago
  Assuming you have savings high deductible plans are the smartest financial decision. Insurance is to keep you from going broke in the unlikely event that something serious happens not to pay for every runny nose you might get.

by pmorici 13y ago

tptacek 13y ago

Aren't you comparing conditionally-issued insurance with guaranteed-issue health insurance? The big problem I had with sites like ehealthinsurance.com is that a family using it to find insurance had a coinflip chance of actually getting one of those rates after completing an application.

atwebb 13y ago
I've also found it's like viewing interest rates on Zillow, it will be the lowest possible number that almost no one could qualify for but, it looks nice when shopping and gets people thinking they can afford it so the small increases later are accepted.
pmorici 13y ago
Yes, but how many people is that actually an issue for? Most of the preexisting condition demagoguery you hear about seems to stem from people who were going w/o insurance until they found out they had a medical condition. There were already limits on preexisting condition exclusions in a number of states. You also have to wonder if that in and of itself is worth a doubling in costs? http://en.wikipedia.org/wiki/Pre-existing_condition#Current_pre-existing_condition_exclusion_regulation http://en.wikipedia.org/wiki/Pre-existing_condition#Current_...
- tptacek 13y ago
  Horse. Shit. I have a perfectly healthy family, a family in which I am notably the least actuarially sound bet. When we started Matasano, we found my wife and (at the time) 7 year old daughter both uninsurable, full stop, at any price, due not to preexisting conditions but instead previous medical examinations that led insurers to believe that at some point in the future the two (coincidentally? female) members of my family might develop a condition. I've talked to dozens of people since then and come to the conclusion that "functioning human female reproductive system" is, in essence, a coverage-denying preexisting condition in many US states.
  - pmorici 13y ago
    You're in IL right? For some reason the insurance situation in IL seems to be really crappy. They allow(ed) for looking back further in people's medical history than a lot of other states according to wikipedia. That doesn't explain why the new plans are so much more expensive though even in states that previously had restrictions on preexisting conditions and medical history use in underwriting.
    - tptacek 13y ago
      Let's again be clear about what I said. "They" (meaning every insurer in IL) did not "look at our medical history". They looked at visits to doctors and (in one case) the emergency room that did not result in diagnoses, and decided to hedge their bets by presuming a preexisting condition that was not indicated in the record. Another thing that happens --- particularly in California, lest you think this is an IL problem --- is that comparatively minor medical conditions were used as proxies for rare but expensive conditions. For instance, if you were a woman with abnormal cramping, you might be default-denied based on a simple blacklist of uninsurable conditions because insurers were scared that might presage something expensive down the road. The preexisting condition and recission policies of insurers prior to Obamacare were a national disgrace.
      - pmorici 13y ago
tanzam75 13y ago
> Aren't you comparing conditionally-issued insurance with guaranteed-issue health insurance? In addition to guaranteed issue, the Obamacare plans have (1) an annual out-of-pocket limit (2) no annual or lifetime limit on benefits (3) an absolute right to renewal. These features raise the cost substantially compared to previous plans on the individual market. The classic example is if you get cancer and need $2 million in treatment. If your plan had 20% coinsurance, or a $1 million lifetime limit, then you'd be in rough shape. And if the insurance company dropped you when you got sick, on the grounds that you forgot to disclose some trivial and unrelated illness on your application, then you'd be in really rough shape. The things that make Obamacare expensive are the features that don't show up on the sticker -- because they are now required of all plans. Guaranteed issue is the major one, because they prevent sick people from being washed out of the actuarial pool. All of these features are things that you hope you will never need to "take advantage" of. If you waste your money buying them, that's actually not a bad outcome.

jevinskie 13y ago

I thought the law was supposed to encourage preventative care. Not offering at least one low cost doctor visit seems to betray that goal.

tptacek 13y ago
Health insurance is supposed to keep you from going bankrupt when your appendix bursts.
- twoodfin 13y ago
  Well, sure, but most Americans and policymakers haven't thought about "health insurance" in those terms for a long time. PPACA makes plans that only protect against that kind of thing illegal.
- pbz 13y ago
  Health insurance "yes", health care "no".
  - gwright 13y ago
    So much of the public debate regarding these issues is terribly confusing and misleading simply due to the wanton disregard for the difference between "health insurance" and "health care". I realize that some of the erroneous usage is just sloppiness, but these two things really aren't interchangeable from a public policy standpoint. Prime example: the "Affordable Care Act" isn't about health care, it is about health insurance.
twoodfin 13y ago
Preventative visits are required to be no-deductible, so I assume you only get hit with the cost if it's an irregular visit for an illness of some kind.
pmorici 13y ago
According to the details of each plan they all offer free preventive doctor visits. the 1-2 low cost visits per year are for if you got a cold or something and went to the doctor.

twoodfin 13y ago

The case the administration is making is that these old plans had invidious characteristics such as lifetime spending limits and missing "essential" no-deductible coverage for preventative services and birth control. Not sure whether that's an accurate claim for the pre-ACA plans you listed. Presumably ACA's no-deductible requirement applies to the new plan, so while you might pay for irregular doctor's visits, your scheduled preventative checkups should have no out of pocket costs. But I think that's small potatoes (the number of patients likely to exceed any reasonable lifetime coverage limitations has got to be tiny, and cheaply re-insurable by BCBS if needed). The real cost is likely coming from BCBS' estimate of the change in the risk pool characteristics of this new plan. Namely, it doesn't matter how healthy you are to sign up for the new one, so presumably on average it will be made up of less healthy people. There's also the cost-shifting that has to happen: Plans for older people can only be a set multiple (3x?) more expensive than for younger people, so the younger person's plan must be made more expensive. This is called cost-sharing if you're being polite, and a redistribution scheme if not.

hga 13y ago
"The case the administration is making is that these old plans had invidious characteristics such as lifetime spending limits and missing "essential" no-deductible coverage for preventative services and birth control." Coupled with the claim that plans based on the new floor for coverage would be at least affordable. Which many are finding invidious because they can't afford the replacement policies that are initially offered by their existing insurers. With all subsidy calculations tied to the Federal site, those who might get a subsidy aren't able to find out for sure without generally extreme levels of effort, although subsidy calculators are available, like the Kaiser Foundation's: http://kff.org/interactive/subsidy-calculator/ http://kff.org/interactive/subsidy-calculator/
- twoodfin 13y ago
  That Kaiser calculator is great. I get the sense that this would have all worked so much better if the law had been structured such that HHS approved plans, insurers sold those plans on their own sites (or through private clearinghouses), while the IRS provided a quick calculator like this and a longer process to get a certification of your last year's income you could present to an insurer to get a subsidized rate.

bluedino 13y ago

$5,000 deductible? My PPO had a $2,500 deductible and I thought that was insanity.

twoodfin 13y ago
It's not that crazy. Most young people, most years will never spend $5,000 on health care, particularly when preventative services are free. So if you're responsible enough and financially capable to save for a rainy day, it makes sense to pay less out of pocket every month. Those savings may still be tax-deductible; I'm not sure how ACA changed HSA availability in that regard.
pmorici 13y ago
Assuming you have savings high deductible plans are the smartest financial decision. Insurance is to keep you from going broke in the unlikely event that something serious happens not to pay for every runny nose you might get.