Author Topic: ACA Sticker shock, give me an alternative  (Read 38970 times)

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #50 on: March 15, 2014, 10:39:11 AM »
jp why don't ask you Obama how you are going to pay for it?  According to him, his health care law makes health care "affordable" for everyone in America.  Maybe a magical fairy will come to your house each month and drop $900 from the sky.

If $900 is only 8% of your income, it is affordable. If it's more than 8% and you can't find a cheaper plan, you don't have to have insurance (i.e. there's no penalty for not having it). The fact you don't want to spend 7.9% of your income on health insurance doesn't make it unaffordable.
« Last Edit: March 15, 2014, 10:41:11 AM by Daleth »

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #51 on: March 15, 2014, 10:49:22 AM »
The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined.  I think you were misreading the out of pocket max as applying to each individually - it doesn't.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..

Is there not a plan available that would include the place you go that's currently out of network, as in network?

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #52 on: March 15, 2014, 02:48:08 PM »
The max out of pocket for a family plan that's ACA compliant is $12,700 for all family members combined.  I think you were misreading the out of pocket max as applying to each individually - it doesn't.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

No I wasn't misreading it. I have the chronic condition but based on my family's past few years we hit the OOP max for everyone. Not just me. I have to be prepared to hit all OOP maximums, including out of network,but thank you anyway. The out of network maximums are not reported on healthcare.gov but if you read the summary docs closely you should find it there..

Is there not a plan available that would include the place you go that's currently out of network, as in network?

The kicker for us in that the anesthesiologists aren't on anyone's network, so they are always out of network. I have regular, ongoing procedures requiring anesthesia each time. So, no. I can't.

Cassie

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Re: ACA Sticker shock, give me an alternative
« Reply #53 on: March 15, 2014, 04:33:24 PM »
Lexie, we are in the same boat-paying 730 for 2 of us & also hope we reach medicare age before we lose this insurance.  It has helped people who could not get insurance or young people that were in jobs without it. 

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #54 on: March 15, 2014, 06:22:11 PM »
For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.

For a family of 4 making more than $8000/mo and bitching, STFU.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #55 on: March 16, 2014, 08:16:15 AM »
For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.

For a family of 4 making more than $8000/mo and bitching, STFU.

Exactly.

kkbmustang

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Re: ACA Sticker shock, give me an alternative
« Reply #56 on: March 16, 2014, 12:10:09 PM »
For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.

For a family of 4 making more than $8000/mo and bitching, STFU.

Exactly.

And why is that, exactly? It's equivalent to saying people making over a certain dollar amount each month should be charged double for cell phone service than those making less than the threshold. Just because one is able to pay doesn't mean that there is a corresponding willingness to spend.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #57 on: March 16, 2014, 12:22:11 PM »
For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.

For a family of 4 making more than $8000/mo and bitching, STFU.

Exactly.

And why is that, exactly? It's equivalent to saying people making over a certain dollar amount each month should be charged double for cell phone service than those making less than the threshold. Just because one is able to pay doesn't mean that there is a corresponding willingness to spend.

No one is saying you HAVE TO spend 8% of your income or that people who earn $200k/yr have to spend twice as much as (or even 1% more than) people who earn $100k. Get the cheapest plan you can find, if you want, which may be 2%, who knows. All they're saying is that everyone's got to have insurance unless they can't find insurance that is affordable--and affordable is defined as 8% of your income (not gross income but MAGI, which for most people is about the same as their AGI).

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #58 on: March 16, 2014, 12:46:37 PM »

No one is saying you HAVE TO spend 8% of your income or that people who earn $200k/yr have to spend twice as much as (or even 1% more than) people who earn $100k. Get the cheapest plan you can find, if you want, which may be 2%, who knows. All they're saying is that everyone's got to have insurance unless they can't find insurance that is affordable--and affordable is defined as 8% of your income (not gross income but MAGI, which for most people is about the same as their AGI).

Maybe that's what you're saying but thats certainly not the point of socals
For a family of 4 making more than $8000/mo and bitching, STFU.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #59 on: March 16, 2014, 01:43:52 PM »
For a family of 4 making $8000/mo, the maximum premium for a silver ACA plan is $800/mo. Choose the bronze instead, the premium would be $100 or so less /mo.

For a family of 4 making more than $8000/mo and bitching, STFU.
Apparently asking for help on the forum is not allowed if you make a high income

You really don't seem to be getting it, do you? Plenty of people on this forum make good salaries. But you're the only one who insists that your entire lifestyle, complete with crashingly expensive house, private schools for the kids, a country club membership, landscaping and domestic staff, etc. is utterly non-negotiable while at the same time asking for advice and complaining that anyone who gives it to you isn't understanding you properly.
Are my lifestyle decisions the reason the OP was told to STFU?

It's your general whining, flounciness, bad behavior and generally bratty attitude over the forum I'm addressing, and you know full well your commentary was part of that. Plenty of people of high income have been posting on here, some for years, without being told to STFU, because they're aren't incredibly ugly personalities.
What does that have to do with the OP being attacked for making a high income?

No one's being attacked for making a high income. That's not our style on this board, at all. They're being criticized for whining about expenses they can easily afford, particularly when the expenses they're whining about are something most families need; self-insuring for your health care costs is not wise for people with merely upper middle class/lower upper class incomes--one serious car accident, premature baby or case of cancer needing chemo, and your retirement gets wiped out.

Whining is particularly annoying to some of us in the ACA context, since the way any kind of insurance works is that it's only economically viable (both for customers and for insurers) if many low to average risk people buy it to balance out the fewer higher risk people, so requiring the whiner and others in that demographic to buy health insurance is in fact what makes it possible for millions of their "working poor" fellow Americans to afford health insurance.
« Last Edit: March 16, 2014, 01:52:29 PM by Daleth »

swick

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Re: ACA Sticker shock, give me an alternative
« Reply #60 on: March 16, 2014, 01:46:11 PM »
MOD NOTE: Enough. This back and forth, derailing topics and generally acting like children is ridiculous. Clearly the forum rules are being violated by several people, over multiple threads. If you recall:

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Gin1984

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Re: ACA Sticker shock, give me an alternative
« Reply #61 on: March 16, 2014, 07:19:07 PM »
jp why don't ask you Obama how you are going to pay for it?  According to him, his health care law makes health care "affordable" for everyone in America.  Maybe a magical fairy will come to your house each month and drop $900 from the sky.

If $900 is only 8% of your income, it is affordable. If it's more than 8% and you can't find a cheaper plan, you don't have to have insurance (i.e. there's no penalty for not having it). The fact you don't want to spend 7.9% of your income on health insurance doesn't make it unaffordable.
I agree with this.  But then again I spent 25% of my income on COBRA when I aged out of my mom's insurance and could not be covered pre-ACA for ANY amount of money.

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #62 on: March 17, 2014, 04:27:27 PM »
It is beyond tacky for high-earning, genetic-lottery-winning people to complain about having to pay more for health insurance than the actuarial value of providing a risk-underwritten policy.  It is the equivalent of seeking advice on tax evasion. 

The young, healthy, and wealthy pay more for insurance so that the old, sick, and poor can pay less.  Some day, everyone will be old or sick or poor. 

The key benefit is guarantee-issue insurance where the 64 year-old can be charged no more than 3x the premium of an 18 year-old.  Even cold, put-upon rich people should realize the real value in having access to guarantee-issue price-constrained health insurance.   

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #63 on: March 17, 2014, 04:45:47 PM »
It is beyond tacky for high-earning, genetic-lottery-winning people to complain about having to pay more for health insurance than the actuarial value of providing a risk-underwritten policy.  It is the equivalent of seeking advice on tax evasion. 

Who in this thread is doing that? 

I see two people who have been asking for advice.  One is looking to continue their catastrophic-type health insurance.  This is widely accepted as the most efficient type of insurance, but the ACA prevents such plans from being issued to most people over the age of 30.  The other person to comment on their insurance premiums stated outright that their family is a high consumer of health care, to the point that the only sensible price comparison for them involves adding the premiums and total yearly out of pocket maxima (in and out of plan).

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #64 on: March 17, 2014, 05:09:58 PM »
Guarantee-issue catastrophic-only health insurance costs very nearly the same premium as bronze plans from the health insurance exchange.

The original poster is looking for what he had in 2013 which is very different. He had risk-underwritten catastrophic-only health insurance. Such a plan, for the young genetic-lottery winners, was indeed half the price or less than the current bronze plans. And rightly so, because the product you are buying now is different -- GUARANTEE ISSUE.


beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #65 on: March 17, 2014, 06:52:04 PM »
Guarantee-issue catastrophic-only health insurance costs very nearly the same premium as bronze plans from the health insurance exchange.

The original poster is looking for what he had in 2013 which is very different. He had risk-underwritten catastrophic-only health insurance. Such a plan, for the young genetic-lottery winners, was indeed half the price or less than the current bronze plans. And rightly so, because the product you are buying now is different -- GUARANTEE ISSUE.

1)  The price depends on the state.  Where I am the cheapest bronze plans are about 25% more than the catastrophic coverage. 
2) Guarantee issue is not the only new feature.  The new catastrophic plans are required to cover at least 1 preventive care visit and 3 primary care visits.  There are other differences that necessarily raise the cost compared to old plans (some of which are good changes, in my view, but not all).
3) The maximum deductible of ACA compliant plans is 6350 for an individual and 12700 per family.  Before the ACA, and individual could purchase policies with higher deductibles for a smaller monthly premium.
4) Even then, the OP is not eligible to purchase catastrophic coverage for himself or his wife.  No one over the age of 30 is without a waiver.  (I will note that implementation of fines in the OP's case has been waived until 2016)

Yes, guarantee issue is a good and necessary addition to health care coverage in the United States, and yes, this will increase the price compared to old policies.  Few people are complaining about that, and I don't think anyone in this thread is.  However, the ACA has changed the insurance landscape in other ways, many of which reduce the freedom to choose the type of insurance best for you.

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #66 on: March 18, 2014, 12:46:12 AM »
Everything else besides guarantee-issue (w/ 3x pricing old vs. young) represents an immaterial cause of the original poster's higher 2014 premiums.   Complaints about the higher prices in 2014 is just a complaint that you want to keep getting risk underwritten policies that don't kick in a dime for care of sicker Americans. Don't hide the ugly side.  You don't want your premiums to help sick & poor get high quality care.
« Last Edit: March 18, 2014, 12:48:19 AM by SoCal »

nicknageli

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Re: ACA Sticker shock, give me an alternative
« Reply #67 on: March 18, 2014, 08:56:00 AM »
Sure it sucks to pay more in premiums than we want to, but it's tough when you get dealt a bad hand in the genetic lottery and have health issues from birth or chronic problems through life.  I also agree that we need to share the burden of health care costs.

Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?

rocksinmyhead

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Re: ACA Sticker shock, give me an alternative
« Reply #68 on: March 18, 2014, 08:57:38 AM »
Sure it sucks to pay more in premiums than we want to, but it's tough when you get dealt a bad hand in the genetic lottery and have health issues from birth or chronic problems through life.  I also agree that we need to share the burden of health care costs.

Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?

I thought there was something about smoking, but I haven't paid that close of attention since I have employer health insurance.

the weight one is so tricky because there is definitely a weight range that is healthy for some people, but not for others. it's not a straightforward relationship between weight and health/disease risk.

huadpe

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Re: ACA Sticker shock, give me an alternative
« Reply #69 on: March 18, 2014, 09:10:58 AM »
Sure it sucks to pay more in premiums than we want to, but it's tough when you get dealt a bad hand in the genetic lottery and have health issues from birth or chronic problems through life.  I also agree that we need to share the burden of health care costs.

Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?

I thought there was something about smoking, but I haven't paid that close of attention since I have employer health insurance.

the weight one is so tricky because there is definitely a weight range that is healthy for some people, but not for others. it's not a straightforward relationship between weight and health/disease risk.

The ACA allows the following variability on premiums:

up to a 50% surcharge for smokers

up to a 3:1 price ratio for age (that is, a 64.5 year old can pay no more than 3x an 18 year old).

There are no surcharges allowed for weight, no matter how high or caused by what.

Also, some states don't allow the smoking or age surcharges.  E.g. New York has pure community rating, so everyone pays the same rate for a given policy, period.

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #70 on: March 18, 2014, 10:28:27 AM »
Within a state, further limited pricing variability is permitted by location.  This is heavily restricted to prevent pricing shenanigans & racial/income discrimination.

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #71 on: March 18, 2014, 10:35:45 AM »
Everything else besides guarantee-issue (w/ 3x pricing old vs. young) represents an immaterial cause of the original poster's higher 2014 premiums.   Complaints about the higher prices in 2014 is just a complaint that you want to keep getting risk underwritten policies that don't kick in a dime for care of sicker Americans. Don't hide the ugly side.  You don't want your premiums to help sick & poor get high quality care.

This is offensive and inaccurate.  I provided a list of reasons why price went up, and guarantee issue is only one of them.

If you want to respond to my points, I'm happy to continue this discussion.  If you're going to make offensive and inaccurate ad hominem comments, then I see no point in continuing.

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #72 on: March 18, 2014, 11:57:52 AM »
You providing a list of reasons is sort of like the Republican "and replace" alternative to the ACA.  A list of seemingly-valid talking points that muddy up the discussion to give the appearance of a 50/50 argument. 

The comparison at issue here is the insurance policy for a young & healthy family in 2013 that is based upon risk-underwriting where the premium is based upon the actuarial expectations of healthcare expenses for this young & healthy family vs. a 2014 ACA policy that is guarantee-issue where the premium is based upon the actuarial expectations of healthcare expenses for the entire pool of covered people.  The key driver for the higher costs in the latter vs. former is the removal of underwriting in 2014.

Your attempt to argue that the 2014 policy really has higher premiums because the insurer has to pay an internist $100/yr for a physical and the insurer has to kick-in 100% coverage at a $6K out--of-pocket annual cap rather than a $10K cap is unpersuasive & illogical.  An extra $10/mo in preventative care benefits will raise premiums in the competitive ACA marketplaces an immaterial $10/mo.  The lower annual out-of-pocket cap is wholly irrelevant to the young & healthy family as they are getting no where near the cap. 

The lower out-of-pocket cap is an intentional feature of the guarantee-issue-3x structure of 2014 health insurance ACA marketplaces.  Everyone pays the pro-rata costs for an insurer to pay benefits and make a profit in a system that limits the maximum individual downside for people who get sick.  Bitching about the lower cap is the same complaint as the original poster -- you don't want to have to pay for insurance benefits that won't benefit you in 2014 (fingers crossed) and instead want sick people to have higher healthcare expenses with a higher cap.

Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness.
« Last Edit: March 18, 2014, 12:00:30 PM by SoCal »

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #73 on: March 18, 2014, 12:15:49 PM »
The comparison at issue here is the insurance policy for a young & healthy family in 2013 that is based upon risk-underwriting where the premium is based upon the actuarial expectations of healthcare expenses for this young & healthy family vs. a 2014 ACA policy that is guarantee-issue where the premium is based upon the actuarial expectations of healthcare expenses for the entire pool of covered people.  The key driver for the higher costs in the latter vs. former is the removal of underwriting in 2014.

The OP is not eligible for any ACA-compliant plan anything remotely resembles their old plan plus guaranteed issue.  Your continued insistence on this suggests that you're completely missing the point.

And, just out of morbid curiosity, are you calling me all of those names, the OP, or anyone who expresses an opinion contrary to yours?

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #74 on: March 18, 2014, 12:27:54 PM »
The fact that one-third of the price increase the OP is facing for ACA-compliant policies can be found at https://www.coveredca.com/  Compare for yourself the price difference between minimum coverage and the bronze level plan, then realize the OP is not eligible for a catastrophic coverage plan because of age.

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #75 on: March 18, 2014, 01:50:08 PM »
The original poster is definitely eligible for a 2014 bronze plan that is substantially similar to the same as his 2013 catastrophic, with the exception of the added costs for guarantee-issue 3x community-rating pricing and other features designed to more broadly spread the cost of covering sick people (i.e. a low $6K out-of-pocket cap, everyone pays for maternity - even men, stupid liberals, don't know men can't get pregnant). 

As a Californian, I am very familiar with CoveredCA.  A high-earning 20 y/o will pay the same ~$100/mo for either bronze or catastrophic, 29 y/o will pay the same ~$175/mo for either bronze or catastrophic, 30 y/o will pay ~$180/mo for bronze.  Proof that bronze coverage costs an insurance company about the same as catastrophic in 2014.  The original poster's lack of access to catastrophic coverage that twenty-somethings have access to in 2014 is a meaningless semantic distinction, worthy of the world's smallest violin.

Glad you have abandoned defense of the obscurity that a $100 preventative annual physical is the cause of the premium increase.  It gets old having to keep swatting down such nonsense and of course the opposing side never apologizing for making such a stupid argument in the first place. 

Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness are apt descriptions of anyone complaining about the ACA because they don't believe they should be forced to pay one dime more for insurance that benefits someone else.  Wanting to go back to your 2013 policy that was priced low based upon your lottery-winning-genes and good health luck is insanely immoral. 
« Last Edit: March 18, 2014, 02:09:20 PM by SoCal »

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #76 on: March 18, 2014, 02:48:45 PM »
The original poster is definitely eligible for a 2014 bronze plan that is substantially similar to the same as his 2013 catastrophic, with the exception of the added costs for guarantee-issue 3x community-rating pricing and other features designed to more broadly spread the cost of covering sick people (i.e. a low $6K out-of-pocket cap, everyone pays for maternity - even men, stupid liberals, don't know men can't get pregnant). 

As a Californian, I am very familiar with CoveredCA.  A high-earning 20 y/o will pay the same ~$100/mo for either bronze or catastrophic, 29 y/o will pay the same ~$175/mo for either bronze or catastrophic, 30 y/o will pay ~$180/mo for bronze.  Proof that bronze coverage costs an insurance company about the same as catastrophic in 2014.  The original poster's lack of access to catastrophic coverage that twenty-somethings have access to in 2014 is a meaningless semantic distinction, worthy of the world's smallest violin.

This is a good start.  However, instead of cherry picking the numbers, I suggest putting in the OP's situation - family of 4, 2 kids.  You'll find that bronze coverage no longer equals catastrophic.

Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness are apt descriptions of anyone complaining about the ACA because they don't believe they should be forced to pay one dime more for insurance that benefits someone else.  Wanting to go back to your 2013 policy that was priced low based upon your lottery-winning-genes and good health luck is insanely immoral.
Good, so none of those things apply to me.  Continue tilting at windmills.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #77 on: March 18, 2014, 04:21:44 PM »
the added costs for guarantee-issue 3x community-rating pricing and other features designed to more broadly spread the cost of covering sick people (i.e. a low $6K out-of-pocket cap, everyone pays for maternity - even men, stupid liberals, don't know men can't get pregnant). 

Last I heard it was men who get women pregnant. I certainly hope no one here is so short-sighted as to argue that women should be charged more for insurance (i.e., women should bear the entire cost of pregnancy instead of splitting the extra premiums 50-50 with men) because they're the ones who get pregnant. In response to such an argument I would be forced to say something like, "Man up! Grow a pair! It takes two to make a baby, so both those two should pay."

Heck, if any gender should pay the entire cost, it's men, since pregnancy and childbirth costs you exactly nothing physically or medically--women shoulder that burden 100%.

Cpa Cat

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Re: ACA Sticker shock, give me an alternative
« Reply #78 on: March 19, 2014, 06:27:21 AM »
If you're self-employed in any way - with a Sch C or S-corp/partnership, make sure you're getting your self-employed health insurance deduction on the front page (line 29) of your tax return. This is far superior to trying to make the 10% threshold for the itemized deduction on medical expenses. You can do this as long as you have a profit.

In fact, if you're self-employed and can pick up a plan that allows an HSA, you essentially ensure all of your medical costs are deductible.

If you have a partnership and S-corp, the entity needs to reimburse you for you health insurance premiums.

randymarsh

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Re: ACA Sticker shock, give me an alternative
« Reply #79 on: March 19, 2014, 06:50:54 AM »
Heck, if any gender should pay the entire cost, it's men, since pregnancy and childbirth costs you exactly nothing physically or medically--women shoulder that burden 100%.

Huh? Because women carry the baby, that means they shouldn't have to pay any of the financial costs?

That type of viewpoint just reinforces the belief that women are caregivers, men a paycheck.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #80 on: March 20, 2014, 07:13:03 PM »
Heck, if any gender should pay the entire cost, it's men, since pregnancy and childbirth costs you exactly nothing physically or medically--women shoulder that burden 100%.

Huh? Because women carry the baby, that means they shouldn't have to pay any of the financial costs?

That type of viewpoint just reinforces the belief that women are caregivers, men a paycheck.

My point was that it should be shared 50-50. I added that last remark as an aside because while making one gender pay 100% for the costs of childbirth is totally unfair--I think we both agree on that--if the system is going to be set up to put 100% of the financial costs on only one gender, then it would actually be MORE unfair to choose women as that gender because women are already "paying" the 100% of the physical and medical "costs" by virtue of the fact that pregnancy and childbirth happens exclusively in women's bodies.

In other words, the financial costs should be shared 50-50, but if you consider more than the financial costs, women are already bearing 100% of the physical burden of pregnancy and childbirth so if you're going to stick one gender with 100% of the financial costs, it should be men so that they can at least carry SOME of the burden.

randymarsh

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Re: ACA Sticker shock, give me an alternative
« Reply #81 on: March 20, 2014, 07:51:25 PM »
In other words, the financial costs should be shared 50-50, but if you consider more than the financial costs, women are already bearing 100% of the physical burden of pregnancy and childbirth so if you're going to stick one gender with 100% of the financial costs, it should be men so that they can at least carry SOME of the burden.

Biology isn't fair/equal so we should make the financial aspect unfair too?

brewer12345

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Re: ACA Sticker shock, give me an alternative
« Reply #82 on: March 20, 2014, 08:00:37 PM »
Have we gotten to single payor yet?

Abe

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Re: ACA Sticker shock, give me an alternative
« Reply #83 on: March 22, 2014, 02:12:47 PM »
Cost control won't happen until our society acknowledges the rising use of extremely expensive, marginally more effective treatments. At an oncology conference I attended, a presenter noted that adding a fourth chemotherapy agent (bevacizumab, if anyone's interested) increased the cost for treatment of colorectal cancer from $10k to $30-40k. Improvement in survival is on the order of a few months. There are many examples of this, since research in medicine has matured enough that the low-hanging fruits have been picked. In addition, many of the other diseases afflicting us are in part self-induced. It's cheaper to prevent them, but as anyone who exercises regularly knows, quite hard. If we value that cutting-edge, fix-problems-later, no-holds-barred treatment strategy as a society (which clearly we do!), we will have to accept that healthcare will be an ever-larger part of our spending. The ACA is great for individuals who didn't have insurance, and to some extent hospitals/physicians. But it will definitely not help decrease costs significantly.

rusty

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Re: ACA Sticker shock, give me an alternative
« Reply #84 on: March 23, 2014, 07:29:03 AM »

Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
 
there are a couple factors:
where you live, age, smoker/non, family size (who is on your tax return), household income.

jp

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Re: ACA Sticker shock, give me an alternative
« Reply #85 on: March 24, 2014, 10:36:10 AM »
Immoral, Ayn Randian, Paul Ryanism, Charles Trevelyanian, short-sighted selfishness are apt descriptions of anyone complaining about the ACA because they don't believe they should be forced to pay one dime more for insurance that benefits someone else.  Wanting to go back to your 2013 policy that was priced low based upon your lottery-winning-genes and good health luck is insanely immoral.

I left the thread after I got my solution.  I didn't want to turn this into an ideological debate about whether the ACA is good or bad.  But now that my moral character has been attacked for wanting to save money...

I disagree with your assessment.  I don't want to pay more than I have to.  I am not complaining or whining about the law.  I just don't want to pay more than is necessary.  Yes, there is a price at which I would put my kids on a catastrophic plan and the wife and I would opt out.  That is just me not thinking the product is worth the price.  I have the money, what does that have to do with anything?  I have the money to other things that are overpriced too.

As for not wanting to pay for someone else's health problems.  I am sorry that the charity you think is the most important is not the same as the charity I think is the most important.  I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it?  After all, I do have finite resources, so every dollar that goes to healthcare...

MissPeach

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Re: ACA Sticker shock, give me an alternative
« Reply #86 on: March 24, 2014, 02:09:18 PM »
I had sticker shock the first time I looked the plans up too. I don't qualify for subsidies but was curious what they were. The good news is in retirement when my income is more inline with my expenses it will be very affordable.

randymarsh

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Re: ACA Sticker shock, give me an alternative
« Reply #87 on: March 24, 2014, 07:05:22 PM »
As for not wanting to pay for someone else's health problems.  I am sorry that the charity you think is the most important is not the same as the charity I think is the most important.  I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it?  After all, I do have finite resources, so every dollar that goes to healthcare...

By design, insurance has you paying for other people's health problems. That's how insurance works.

Daleth

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Re: ACA Sticker shock, give me an alternative
« Reply #88 on: March 25, 2014, 10:17:35 AM »
As for not wanting to pay for someone else's health problems.  I am sorry that the charity you think is the most important is not the same as the charity I think is the most important.  I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it?  After all, I do have finite resources, so every dollar that goes to healthcare...

By design, insurance has you paying for other people's health problems. That's how insurance works.

Yes, exactly (and vice versa--others pay for yours, when you need it).

If you don't want to pay for other people's medical care, don't get health insurance. If you don't want to pay for other peoples house fires, dog bites, lawsuits over falls on icy sidewalks, etc., don't get homeowner's insurance. If you don't want to pay for other people's car accidents, don't get car insurance. Paying for other people's problems is what insurance IS.


MDM

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Re: ACA Sticker shock, give me an alternative
« Reply #89 on: March 25, 2014, 10:39:09 AM »
As for not wanting to pay for someone else's health problems.  I am sorry that the charity you think is the most important is not the same as the charity I think is the most important.  I like helping others, but being called selfish because I don't want to subsidize health care... well that is a bit of an oversimplification isn't it?  After all, I do have finite resources, so every dollar that goes to healthcare...

By design, insurance has you paying for other people's health problems. That's how insurance works.

Yes, exactly (and vice versa--others pay for yours, when you need it).

If you don't want to pay for other people's medical care, don't get health insurance. If you don't want to pay for other peoples house fires, dog bites, lawsuits over falls on icy sidewalks, etc., don't get homeowner's insurance. If you don't want to pay for other people's car accidents, don't get car insurance. Paying for other people's problems is what insurance IS.

jp seems to have it right (see line highlighted above).  Insurance is not charity.  Insurance is something you buy (or not, as you choose) from a company who is looking to make a profit on your purchase.  Of course they profit by paying less on average than they take in, but that is how any business profits.

A homeowner may well be liable to pay when his dog bites someone, but that is independent of whether he writes a check, or the insurance company writes a check, to the one bitten.

Related but separate is the concept of a right to healthcare.  If I have a right to it, that implies some doctor has an obligation to provide it - and that just doesn't seem fair to the doctor.

Heywood57

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Re: ACA Sticker shock, give me an alternative
« Reply #90 on: March 25, 2014, 10:57:07 AM »
The ACA equivalent to our current employer sponsored health plan is
a silver plan for over $1300/month. That's for parents + 4 kids.
There is no way we could afford that.

SoCal

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Re: ACA Sticker shock, give me an alternative
« Reply #91 on: March 25, 2014, 11:23:29 AM »
The ACA equivalent to our current employer sponsored health plan is
a silver plan for over $1300/month. That's for parents + 4 kids.
There is no way we could afford that.

The maximum silver-plan premium for a family of 4 making up to ~$8000/mo is ~$750/mo.
http://obamacarefacts.com/obamacare-subsidies.php

The Affordable Care Act gives every American access to affordable, quality health care.  Millions of Americans previously had no such access.  You will pay more than $750/mo if and only if you make more than $8000/mo, in which case your appeal for internet sympathy for your unaffordable plight is easily dismissed when weighed against the real, life-saving good being delivered to millions of Americans. 


 

MPAVictoria

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Re: ACA Sticker shock, give me an alternative
« Reply #92 on: March 25, 2014, 01:36:23 PM »
"Related but separate is the concept of a right to healthcare.  If I have a right to it, that implies some doctor has an obligation to provide it - and that just doesn't seem fair to the doctor."

I will never understand Americans. Of course people have a right to healthcare but that obligation falls on society as a whole not any individual doctor.

Also I urge you to read this:
The U.S.: We Are Number 27 in Health!
http://delong.typepad.com/sdj/2013/07/the-us-we-are-number-27-in-health.html#more

BlueHouse

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Re: ACA Sticker shock, give me an alternative
« Reply #93 on: March 25, 2014, 02:55:37 PM »
Anyone know if there provisions in the ACA for people to be charged more if they're overweight, obese or smoke, etc?
In DC the ACA premium is based only on age.  When I first tried to apply, there was a question on smoking, but it was permanently toggled to "smoker" with no way to change it.  Within a week, the DC Exchange updated its site and that question was removed completely.  It was never meant to show up, but the Exchange modified an existing web form and it carried over into the new application.

MDM

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Re: ACA Sticker shock, give me an alternative
« Reply #94 on: March 25, 2014, 03:07:15 PM »
"Related but separate is the concept of a right to healthcare.  If I have a right to it, that implies some doctor has an obligation to provide it - and that just doesn't seem fair to the doctor."

I will never understand Americans. Of course people have a right to healthcare but that obligation falls on society as a whole not any individual doctor.

Also I urge you to read this:
The U.S.: We Are Number 27 in Health!
http://delong.typepad.com/sdj/2013/07/the-us-we-are-number-27-in-health.html#more
If you ever do understand Americans, please let us know - there are 300 million of us and I can't figure us out either.

But to the main points of your note:
 -  I appreciate the perspective on societal obligation.  In the end, however, it becomes not the undefined "they" who provide healthcare, but individuals.  At least I don't understand how one can be given a right to the work output of others without simultaneously imposing an obligation on those others to produce that work output.
 -  Thanks for the link.  It and the study published in JAMA on which the article is based do make interesting reads. 
A couple more articles on the issue of US health care, one presumably liberal: http://libecon.wordpress.com/2013/03/15/time-magazine-on-the-cost-of-health-care/, and the other presumably conservative: http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-health-costs-part-1/, go into more details (and say things better) than I can here.

I suspect that most of the 300 million Americans would agree that "something" should be done to improve at least some facet of healthcare here.  Where we find large differences is defining what that "something" should be.

Mega

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Re: ACA Sticker shock, give me an alternative
« Reply #95 on: March 25, 2014, 05:08:42 PM »
Hi folks,

All I want to say is you should really consider moving to Canada.

I make ~$100k a year, and pay about $30k in income tax. But that income tax provides me, and my wife, and my future daughter with $0 deductable health coverage. And even if I lose my job, I still have coverage.

If your plans are seriously ~$1500 a month, with $6k deductables you are potentially paying nearly as much as me for healtcare as I pay in income taxes for the year.

Canada is always looking for highly motivated, educated, wealthy individuals! You could even try it out for a year by using the NAFTA exemption.

Good luck.

MPAVictoria

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Re: ACA Sticker shock, give me an alternative
« Reply #96 on: March 26, 2014, 10:12:29 AM »
" I appreciate the perspective on societal obligation.  In the end, however, it becomes not the undefined "they" who provide healthcare, but individuals.  At least I don't understand how one can be given a right to the work output of others without simultaneously imposing an obligation on those others to produce that work output."

This is a strawman my friend. I am not suggesting enslaving medical professionals and forcing them to work 23 hours a day in underground health care mines. I am suggesting that society has a responsibility to the health of its members. Doctors, nurses and so on will individually provide services because the wish to do so for the money or the personal satisfaction. There will be no need to impose an obligation on any individual but I suspect you know that already.

"A couple more articles on the issue of US health care, one presumably liberal: http://libecon.wordpress.com/2013/03/15/time-magazine-on-the-cost-of-health-care/, and the other presumably conservative: http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-health-costs-part-1/, go into more details (and say things better) than I can here."

Sorry articles in the popular press don't carry much weight with me.

"I suspect that most of the 300 million Americans would agree that "something" should be done to improve at least some facet of healthcare here.  Where we find large differences is defining what that "something" should be."

That "something" should be the exact same something that works in every other developed country in the world. Socialized medical care.

MDM

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Re: ACA Sticker shock, give me an alternative
« Reply #97 on: March 26, 2014, 10:53:11 AM »
Actually it's not a strawman and no I don't know that already - but you are welcome to your beliefs.

Two Churchill quotes seem apt, the first more favorable to my position and the second more favorable to yours (in other words, you may be right but so far I'm not sure):
 -  "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries."
 -  "You can always count on Americans to do the right thing—after they’ve tried everything else."

beltim

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Re: ACA Sticker shock, give me an alternative
« Reply #98 on: March 26, 2014, 10:57:24 AM »
That "something" should be the exact same something that works in every other developed country in the world. Socialized medical care.

Either you mean something different by socialized medical care, or this is wrong.  I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized.

MPAVictoria

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Re: ACA Sticker shock, give me an alternative
« Reply #99 on: March 26, 2014, 11:54:39 AM »
"Either you mean something different by socialized medical care, or this is wrong.  I thought it was pretty well established that Switzerland has the world's best healthcare, and that is most definitely not socialized. "

That all depends on what you mean by socialized but I am happy to use another term if you like. Let us just say that access to healthcare is guaranteed by the government.