ACA at Risk if large insurers can't make it work?

[Telecaster]

I'm not complaining about government intervention, I'm complaining about Obamacare because, as the article you posted states, we have the most expensive health care system in the world, and Obamacare essentially just created an environment where if you were already paying for your insurance, you can keep paying for it and subsidize someone else via your tax money/deficit spending, yet it did practically nothing to make it so that our over priced healthcare system is less over priced.

It didn't help our health system achieve better outcomes.

It didn't improve access as even a lot of the lower earning people who got heavily subsidized plans still can't afford their deductibles.

Yours are demonstrably false statements.  One of my core principles is that you are not only welcome to your own opinion, I encourage to have your own opinion.  Groupthink is unhelpful, not to mention boring.   But you do not get your own set of facts.  If the facts don't support your (or mine) opinion, then time to rethink. 

Taking your statements in order:

1.  There are a large number areas designed to promote cost savings  in the ACA.  For one, the Cadillac insurance tax is designed to encourage insurers and employers to develop more efficient plans.   For large employers, insurance companies just act as administrators.  There's no incentive to maximize bang for your buck.  The Cadillac tax is attempt to do that.   Also, the penalty for excessive hospital re-admissions.  If patients are discharged, but then have to be readmitted with the same condition, it means the system isn't working properly.   Trying to curb readmissions is an attempt at cost savings.  Ideally, if hospitals fix the reason why patients are being readmitted, they would become more efficient overall.   Health care economists tell us those two items are low hanging fruit. 

2.  This is  false.  Outcomes have improved.  Hospital re-admissions are down, and by quite a bit.  That is a definite, measurable, non-trivial improvement in outcomes. 

http://blog.cms.gov/2013/12/06/new-data-shows-affordable-care-act-reforms-are-leading-to-lower-hospital-readmission-rates-for-medicare-beneficiaries/

There are a  number of other metrics which have improved as well.   

3. This is false.  The percent of uninsured people is the lowest in four decades.   Literally millions of people just from the Medicaid expansion alone now have improved access to health care. 

[SirFrugal]

1.  There are a large number areas designed to promote cost savings  in the ACA.  For one, the Cadillac insurance tax is designed to encourage insurers and employers to develop more efficient plans.   For large employers, insurance companies just act as administrators.  There's no incentive to maximize bang for your buck.  The Cadillac tax is attempt to do that.   Also, the penalty for excessive hospital re-admissions.  If patients are discharged, but then have to be readmitted with the same condition, it means the system isn't working properly.   Trying to curb readmissions is an attempt at cost savings.  Ideally, if hospitals fix the reason why patients are being readmitted, they would become more efficient overall.   Health care economists tell us those two items are low hanging fruit. 

Adding an extra tax on to people with good policies isn't making the cost of care itself cheaper, nice try though.  If I break my leg and go pay cash out of pocket the fact that the government taxed someone's cadillac policy isn't going to make my bill any cheaper.

2.  This is  false.  Outcomes have improved.  Hospital re-admissions are down, and by quite a bit.  That is a definite, measurable, non-trivial improvement in outcomes. 

http://blog.cms.gov/2013/12/06/new-data-shows-affordable-care-act-reforms-are-leading-to-lower-hospital-readmission-rates-for-medicare-beneficiaries/

There are a  number of other metrics which have improved as well.   

You gotta be kidding...you just claim yourself that Obamacare penalizes hospitals for readmissions, then act like care is getting better because readmissions are down lol.  I don't suppose medicare cuts and reduced payments have anything to do with it either.

3. This is false.  The percent of uninsured people is the lowest in four decades.   Literally millions of people just from the Medicaid expansion alone now have improved access to health care.

No, it is not false.  There are millions of people out there now who get subsidized plans with cheap premiums who have been getting sticker shock with unaffordable deductibles.  Go on and google it...you'll find plenty of sources to back it up.  There are people out there on the lower range of the income spectrum with 60-40 bronze plans and 5000+ deductibles.  You know what they say?  Yeah I have insurance but I still can't afford to go to the doctors.

[bigstack]

i think the other thing to look at is that many of us use to have great healthcare plans that went above and beyond what obamacare mandates.
obamacare passes and our employers start doing the obamacare minimum and pushing more and more of the burden to us along with higher copays and higher deductibles.

This is a problem with your employer, not the ACA. The last job I had offered better insurance than the ACA minimum. Now that I'm an employer, I offer health insurance that I would want as an employee, not the ACA minimum. Just because your employer is greedy doesn't mean that the ACA forced them to only offer the minimum. Want better insurance? Start demanding better or find a different job.

also it amuses me that this forum that is all about saving money and not wasting it on frivolous crap in order to make a better future for themselves has people that believe that we ought to be paying for someone elses stuff cause they didnt budget properly and make good life choices. instead of buying iphones these people should buy healthcare ... but since they bought an iphone we now have to buy them healthcare?

There are so many things wrong with that statement I don't know where to start. The ACA mandated that we all have insurance, that we all pay into the system, and that we all get a minimum of benefit. iPhones have nothing to do with it. Reading between the lines, I'm assuming you don't like the tax rebate for those that have lower income. Unless you're making more than $250,000 per year then you are not paying more because of this. The ACA did not shift the burden of poor people's health care onto the middle class, it added a tax to the top 15% of wage earners. If you're in that tax bracket, I have no sympathy for you.

the aca encouraged the corporate behavior ... just how it is.

as far as iphones that was just an example. if people didnt spend their money on junk and were not irresponsible they could have paid for their own insurance.... it was a choice they made. desnt matter if it is iphones or going out to eat or some car that is all flashy ...

[Tom Bri]

Maybe health insurers which don't own hospitals, specialist centers, and primary care centers will merge with the latter. Kaiser Permanente operates in this mode, and Sharp Hospital has a health plan which operates similar to Kaiser.
Both Kaiser and Sharp are non-profit. For-profit insurers and for-profit hospitals could be in trouble if the combined model takes off.

Are they noticeably less expensive than for-profit?

[Telecaster]

Adding an extra tax on to people with good policies isn't making the cost of care itself cheaper, nice try though.  If I break my leg and go pay cash out of pocket the fact that the government taxed someone's cadillac policy isn't going to make my bill any cheaper.

It might not make your bill cheaper.  But the large majority of Americans get insurance through their employer's health care plan.  Therefore making employers health plans more efficient is critical for cost control in the system itself.  I've never seen any scholarly opposition that the idea works (as opposed to tin foil hat opposition).   If you are interested, there is literally a stack of research supporting that idea just a quick Google search away.   

You may disagree with all those PhD actuaries, but the fact is the claim that the ACA did "practically nothing" to control costs isn't true.  It did, and does.  I've only pointed out some of the major ones. 

And proof is in the pudding. Since 2010 medical inflation has been the  lowest ever recorded.   Something happened in 2010, let me think what that was....

You gotta be kidding...you just claim yourself that Obamacare penalizes hospitals for readmissions, then act like care is getting better because readmissions are down lol.  I don't suppose medicare cuts and reduced payments have anything to do with it either.

You can laugh all you want, but if you had knee replacement and had to go back to the hospital, that's an worse than someone who had a knee replacement and didn't have to go back to the hospital.   Previously, hospitals had financial incentive to perform procedures.  Now they have financial incentives based on outcomes.   Accordingly doctors and hospitals have a financial inventive to review their procedures and find areas of improvement

You might think that's funny, but patients are getting demonstrably better care at measurably lower cost and as a taxpayer I'm elated.  And, it is worth pointing out, that re-admissions are down not only for Medicare patients for but everybody.   

No, it is not false.  There are millions of people out there now who get subsidized plans with cheap premiums who have been getting sticker shock with unaffordable deductibles.  Go on and google it...you'll find plenty of sources to back it up.  There are people out there on the lower range of the income spectrum with 60-40 bronze plans and 5000+ deductibles.  You know what they say?  Yeah I have insurance but I still can't afford to go to the doctors.

I can find an anecdote to support anything.  Your claim was that access to health care is decreased.  That means measurably fewer people have health care now than before the ACA.  You're making the claim.   Feel free to back it up. 

I'm willing to bet a steak dinner you can't.

[SirFrugal]

So just a question for some of you guys who plan on retiring early and getting subsidized healthcare...

When Obamacare was being debated, one of the big selling points behind it, and backed by the individual mandate was that it would get more healthy people paying into the system.  The idea was that as people with pre-existing conditions could no longer have that held against them, and rates for the elderly were capped, insurance costs would rise, but if we had more healthy people who were currently uninsured paying into the system, those rising premiums would be kept in check.  So in essence, if you are one of those healthy, able bodied people the core concept of Obamacare is that it depends on folks like you to pay into the system to keep it affordable for all.

How can you legitimately claim you support Obamacare while intentionally planning on becoming healthy able bodied person who will draw subsidies from the system instead of contributing to it?

I'm just at a loss how some of you can claim you support Obamacare because it is for the greater good of society, while you are literally planning on doing the most damaging thing you possible could to it.

[SirFrugal]

It might not make your bill cheaper.  But the large majority of Americans get insurance through their employer's health care plan.  Therefore making employers health plans more efficient is critical for cost control in the system itself.  I've never seen any scholarly opposition that the idea works (as opposed to tin foil hat opposition).   If you are interested, there is literally a stack of research supporting that idea just a quick Google search away.

You may disagree with all those PhD actuaries, but the fact is the claim that the ACA did "practically nothing" to control costs isn't true.  It did, and does.  I've only pointed out some of the major ones. 

And proof is in the pudding. Since 2010 medical inflation has been the  lowest ever recorded.   Something happened in 2010, let me think what that was....

If cadillac policies weren't efficient people wouldn't have paid for them.  All the tax on cadillac policies was, was an attack on the rich, because democrats tried to convince us that only the rich could support cadillac policies, but ironically it ended up hurting unions more than anything, which is why they sought special protection from these cadillac taxes in exchange for their support of Obamacare.  Don't tell me that isn't true, I spent 12 years in one of the unions that negotiated special terms to get its members out of that tax.

The simple fact is that if cadillac policies weren't worth the money people wouldn't have been buying them.  They were just expensive because they offered awesome coverage.

As far as Obamacare being passed in 2010...it was already discussed in this thread.  2008 and 2009 were sub 4% years, so what did 2010 mean, an ongoing trend continued...shocking.

You can laugh all you want, but if you had knee replacement and had to go back to the hospital, that's an worse than someone who had a knee replacement and didn't have to go back to the hospital.   Previously, hospitals had financial incentive to perform procedures.  Now they have financial incentives based on outcomes.   Accordingly doctors and hospitals have a financial inventive to review their procedures and find areas of improvement

You haven't even addressed the points I made.  The only thing you have managed to do is imply doctors were sabotaging their patients so they'd come back for readmission and they could milk medicare more.  Unless they like lawsuits I highly doubt they were doing that.

No, it is not false.  There are millions of people out there now who get subsidized plans with cheap premiums who have been getting sticker shock with unaffordable deductibles.  Go on and google it...you'll find plenty of sources to back it up.  There are people out there on the lower range of the income spectrum with 60-40 bronze plans and 5000+ deductibles.  You know what they say?  Yeah I have insurance but I still can't afford to go to the doctors.

I can find an anecdote to support anything.  Your claim was that access to health care is decreased.  That means measurably fewer people have health care now than before the ACA.  You're making the claim.   Feel free to back it up. 

I'm willing to bet a steak dinner you can't.

I didn't say it decreased access, I said it hasn't improved access, which it hasn't, because even prior to Obamacare if a sick person walked into a hospital it is law the hospital had to treat them.  Prior to Obamacare, poor people would have just walked into a hospital when they needed care, and they'd simply not pay the bill because they couldn't.  Post Obamacare, those same people get subsidized premiums but are stuck with deductibles and co-pays they can't afford.  If something happens to them, they walk in a hospital when they need care and are still leaving with a bill they can't pay.

http://www.democratandchronicle.com/story/money/business/2015/11/20/clausen-high-deductibles-can-make-insurance-unaffordable/76064798/
http://www.cbsnews.com/news/obamacare-deductibles-deliver-hefty-sticker-shock/
https://www.bostonglobe.com/news/politics/2015/11/16/high-deductible-health-plans-make-affordable-care-act-unaffordable-critics-say/eaWZZJNrFhm6vVPDBcdZ0I/story.html
http://freebeacon.com/issues/sticker-shock-high-obamacare-deductibles-make-insurance-unaffordable/
http://articles.chicagotribune.com/2013-10-13/business/ct-biz-1013-obamacare-deductibles-20131013_1_health-care-overhaul-health-insurance-health-coverage
http://petrieflom.law.harvard.edu/resources/article/sky-high-deductibles-make-health-care-unaffordable-for-some-insured
http://www.dailykos.com/story/2012/03/18/1075489/-Unaffordable-co-pays-and-deductibles-death-by-a-million-cuts-for-insured-Americans
http://news.investors.com/politics-obamacare/052214-701812-obamacare-bronze-plans-deductibles-unaffordable.htm
http://www.nationaljournal.com/s/71749/obamas-affordable-care-act-looking-bit-unaffordable
http://www.nytimes.com/2014/10/30/opinion/the-health-law-coping-with-high-deductibles.html?_r=0
http://www.tomtayloronline.org/sticker-shock-high-obamacare-deductibles-make-insurance-unaffordable/

I could go on...but I've made my point.  By the way, you can keep the steak dinner.

[msilenus]

So just a question for some of you guys who plan on retiring early and getting subsidized healthcare...

When Obamacare was being debated, one of the big selling points behind it, and backed by the individual mandate was that it would get more healthy people paying into the system.  The idea was that as people with pre-existing conditions could no longer have that held against them, and rates for the elderly were capped, insurance costs would rise, but if we had more healthy people who were currently uninsured paying into the system, those rising premiums would be kept in check.  So in essence, if you are one of those healthy, able bodied people the core concept of Obamacare is that it depends on folks like you to pay into the system to keep it affordable for all.

How can you legitimately claim you support Obamacare while intentionally planning on becoming healthy able bodied person who will draw subsidies from the system instead of contributing to it?

I'm just at a loss how some of you can claim you support Obamacare because it is for the greater good of society, while you are literally planning on doing the most damaging thing you possible could to it.

This is a poorly formed argument.  Did anyone here, on this thread, make this claim to you?  If so, I missed it.  They're resting their support on other claims.  Engage with them on those.  It is bogus to demand that they embrace some other defense that you were marginally sympathetic to in 2009.

But, to your argument: the early retirement movement/community is really small.  The argument can hold (more people pay in) in spite of a few folks retiring early.  The folks who do retire early will be weighted a bit toward people who paid the new taxes passed to fund Obamacare spending, because it's easier to retire early on more income.  They will also use less Medicare than generations before them due to some of Obamacare's reforms, and Medicare savings is one of the ways Obamacare is funded.

On the flips side: everyone's required to get coverage, and the non-Medicaid set will mostly wind up paying premiums, or else pay the fines.  Either way, that's millions paying in who were mostly insured by emergency room care and bankruptcy protection before. 

Also, note that no one who retires early is retiring early could possibly rely on ER care and bankruptcy protection.  Both before and after the law, they weren't really in the set who needed to be brought into the system.  After, most will still be paying premiums even if they're subsidized.  (Few people here seem enthusiastic to go on Medicaid.)

I wonder if the first generation who collected Social Security or Medicare (without paying into it at all!) faced objections like yours.  I was tempted to ask if you'd refuse those benefits, but reviewed some of your posts, and know you will collect SS just as you will collect Obamacare benefits like everyone else you're attacking here.  You are very cynical.

[Telecaster]

I can find an anecdote to support anything.  Your claim was that access to health care is decreased.  That means measurably fewer people have health care now than before the ACA.  You're making the claim.   Feel free to back it up. 

I'm willing to bet a steak dinner you can't.

I didn't say it decreased access, I said it hasn't improved access, which it hasn't, because even prior to Obamacare if a sick person walked into a hospital it is law the hospital had to treat them.  Prior to Obamacare, poor people would have just walked into a hospital when they needed care, and they'd simply not pay the bill because they couldn't.  Post Obamacare, those same people get subsidized premiums but are stuck with deductibles and co-pays they can't afford.  If something happens to them, they walk in a hospital when they need care and are still leaving with a bill they can't pay.

http://www.democratandchronicle.com/story/money/business/2015/11/20/clausen-high-deductibles-can-make-insurance-unaffordable/76064798/
http://www.cbsnews.com/news/obamacare-deductibles-deliver-hefty-sticker-shock/
https://www.bostonglobe.com/news/politics/2015/11/16/high-deductible-health-plans-make-affordable-care-act-unaffordable-critics-say/eaWZZJNrFhm6vVPDBcdZ0I/story.html
http://freebeacon.com/issues/sticker-shock-high-obamacare-deductibles-make-insurance-unaffordable/
http://articles.chicagotribune.com/2013-10-13/business/ct-biz-1013-obamacare-deductibles-20131013_1_health-care-overhaul-health-insurance-health-coverage
http://petrieflom.law.harvard.edu/resources/article/sky-high-deductibles-make-health-care-unaffordable-for-some-insured
http://www.dailykos.com/story/2012/03/18/1075489/-Unaffordable-co-pays-and-deductibles-death-by-a-million-cuts-for-insured-Americans
http://news.investors.com/politics-obamacare/052214-701812-obamacare-bronze-plans-deductibles-unaffordable.htm
http://www.nationaljournal.com/s/71749/obamas-affordable-care-act-looking-bit-unaffordable
http://www.nytimes.com/2014/10/30/opinion/the-health-law-coping-with-high-deductibles.html?_r=0
http://www.tomtayloronline.org/sticker-shock-high-obamacare-deductibles-make-insurance-unaffordable/

I could go on...but I've made my point.  By the way, you can keep the steak dinner.

Letters to the editor?  Really?  That's your data?  Your claim is that access to health care has not been improved.  (I stand corrected, you didn't say "decreased.").

Okay, if that's true there should some data somewhere that says no more people have access to health care now than there were in 2010.   

But it isn't true.  And letters to the editor don't count as data.  You're smart enough to know that. 

[msilenus]

I didn't say it decreased access, I said it hasn't improved access, which it hasn't, because even prior to Obamacare if a sick person walked into a hospital it is law the hospital had to treat them.  Prior to Obamacare, poor people would have just walked into a hospital when they needed care, and they'd simply not pay the bill because they couldn't.  Post Obamacare, those same people get subsidized premiums but are stuck with deductibles and co-pays they can't afford.  If something happens to them, they walk in a hospital when they need care and are still leaving with a bill they can't pay.

You need to have a life-threatening symptom for that to work. 

If you don't have insurance but are having bad headaches, you don't have a path to diagnosis.  Your symptom is not life-threatening.  If it's migraines, maybe that's okay.  If it's an operable tumor, not having insurance probably kills you.

[Tom Bri]

I work in insurance. I talk with people every working day and I feel for their dilemma. They can't afford the ACA plans, but they have preX conditions that prevent them from using other types of insurance. You all can talk about cadillac plans and how only the rich pay more taxes. I don't care. Whatever you think of the goals of the ACA, it has not solved the basic problem that lots of people just can not afford major medical insurance. The figure bandied about pre-ACA was 45 million uninsured. Now we have 30-35 million uninsured. This is success?

[msilenus]

I work in insurance. I talk with people every working day and I feel for their dilemma. They can't afford the ACA plans, but they have preX conditions that prevent them from using other types of insurance. You all can talk about cadillac plans and how only the rich pay more taxes. I don't care. Whatever you think of the goals of the ACA, it has not solved the basic problem that lots of people just can not afford major medical insurance. The figure bandied about pre-ACA was 45 million uninsured. Now we have 30-35 million uninsured. This is success?

I think some of your numbers have to be wrong or non-comparable, but there is no "success" without something like single payer which covers illegal aliens.  This is serious progress, however:


I personally know one family that's struggling to pay for an ACA plan... but they don't manage their finances very well.  Are you talking to people in Medicaid gap states, by any chance?

[brooklynguy]

How can you legitimately claim you support Obamacare while intentionally planning on becoming healthy able bodied person who will draw subsidies from the system instead of contributing to it?

What msilenus said.  To respond to this question directly, I support the ACA because I believe it is better for society than the system that preceded it (though I believe a universal coverage system would be better still), and I also plan on becoming a frugal early retiree who will likely be receiving large ACA subsidies.  The latter fact does not render the former belief hypocritical.  I also support tax reform that would do away with the unfair and regressive aspect of our existing tax system that taxes investment income at lower rates than earned income, because I believe it is worse for society, even though I stand to personally benefit from it as an early retiree living off my investments.  There's a distinction to be made between what system is best for society's interests and what system is best for one's own interests, and there are varying degrees of alignment between the two as you shift your perspective from individual to individual.

[nereo]

How can you legitimately claim you support Obamacare while intentionally planning on becoming healthy able bodied person who will draw subsidies from the system instead of contributing to it?

What msilenus said.  To respond to this question directly, I support the ACA because I believe it is better for society than the system that preceded it (though I believe a universal coverage system would be better still), and I also plan on becoming a frugal early retiree who will likely be receiving large ACA subsidies.  The latter fact does not render the former belief hypocritical.  I also support tax reform that would do away with the unfair and regressive aspect of our existing tax system that taxes investment income at lower rates than earned income, because I believe it is worse for society, even though I stand to personally benefit from it as an early retiree living off my investments.  There's a distinction to be made between what system is best for society's interests and what system is best for one's own interests, and there are varying degrees of alignment between the two as you shift your perspective from individual to individual.

well said.   

[Tom Bri]

I work in insurance. I talk with people every working day and I feel for their dilemma. They can't afford the ACA plans, but they have preX conditions that prevent them from using other types of insurance. You all can talk about cadillac plans and how only the rich pay more taxes. I don't care. Whatever you think of the goals of the ACA, it has not solved the basic problem that lots of people just can not afford major medical insurance. The figure bandied about pre-ACA was 45 million uninsured. Now we have 30-35 million uninsured. This is success?

I think some of your numbers have to be wrong or non-comparable, but there is no "success" without something like single payer which covers illegal aliens.  This is serious progress, however:

Well, 11% of 300,000,000 is roughly 30,000,000 people. I have no idea where the democrats got their 45,000,000 uninsured figure. So at least my number of 30mil is accurate, if this graph is accurate. I talk to people from all states, we are a national company.

[Cathy]

... there is no "success" without something like single payer which covers illegal aliens.

Incidentally, no province in Canada offers public healthcare to persons who are not lawfully present in the country. Here's the authority for that claim for every province:

Province	Authority denying public healthcare to unauthorised aliens
Ontario	Health Insurance Act, RSO 1990, c H.6, § 1 (definition of "resident"); General, RRO 1990, Reg 552, § 1.4
Quebec	Health Insurance Act, CQLR c A-29 § 5; Regulation respecting eligibility and registration of persons in respect of the Régie de l'assurance maladie du Québec, CQLR c A-29, r 1, §§ 2-3
Nova Scotia	Health Services and Insurance Act, RSNS 1989, c 197, § 2(l); Hospital Insurance Regulations, NS Reg 11/58, § 1(m)(i)
New Brunswick	Medical Services Payment Act, RSNB 1973, c M-7 § 1 (definition of "resident")
Manitoba	Health Services Insurance Act, CCSM c H35, § 2(1) (definition of "resident")
British Columbia	Medicare Protection Act, RSBC 1996, c 286, § 1 (definition of "resident"); Medical and Health Care Services Regulation, BC Reg 426/97, § 2
Prince Edward Island	Health Services Payment Act, RSPEI 1988, c H-2, § 1(h); General Regulations, PEI Reg EC499/13, § 1(s)
Saskatchewan	Saskatchewan Medical Care Insurance Act, RSS 1978, c S-29, § 2(q); Medical Care Insurance Beneficiary and Administration Regulations, RRS c S-29 Reg 13, § 3(q)
Alberta	Alberta Health Care Insurance Act, RSA 2000, c A-20, § 1(x); Alberta Health Care Insurance Regulation, Alta Reg 76/2006, § 5(2)
Newfoundland and Labrador	Medical Care Insurance Act, 1999, SNL 1999, c M-5.1, § 2(h)

I constructed this table specifically for this post in order to ensure that I was posting accurate information. It took 30 minutes, but it was worth it to ensure I didn't post an inaccurate claim.

[SirFrugal]

I work in insurance. I talk with people every working day and I feel for their dilemma. They can't afford the ACA plans, but they have preX conditions that prevent them from using other types of insurance. You all can talk about cadillac plans and how only the rich pay more taxes. I don't care. Whatever you think of the goals of the ACA, it has not solved the basic problem that lots of people just can not afford major medical insurance. The figure bandied about pre-ACA was 45 million uninsured. Now we have 30-35 million uninsured. This is success?

You can't talk common sense to some people, even though articles pop up on various news outlets dealing with these very issue.  Here's one that popped up just yesterday...

http://news.investors.com/112115-782025-obamacare-deductibles-more-shocking-2017.htm?ven=yahoocp&src=aurlled&ven=yahoo

Some of the lowest-cost bronze plans for 2016 are setting deductibles and out-of-pocket limits at the $6,850 ceiling to hold down premiums, which still rose by about 12% over 2015, on average.

That means that landing in the hospital could wreck the finances of many modest-income bronze plan enrollees.

Great, we have more people insured, but they are still one trip to the hospital away from financial ruin.

[SirFrugal]

What msilenus said.  To respond to this question directly, I support the ACA because I believe it is better for society than the system that preceded it (though I believe a universal coverage system would be better still), and I also plan on becoming a frugal early retiree who will likely be receiving large ACA subsidies.

You get to push additional cost on to the balance of society rather than just work a few more years and be self sufficient in early retirement, and you think that it is good for society?

Its good for you, bad for society.  Rationalize it with whatever flawed logic you like, that is the simple fact of the matter.

@Cathy - Nice post.  I was unaware that Canada's universal healthcare system did more to cut off leeches than our own system does.

[Sparafusile]

I work in insurance. I talk with people every working day and I feel for their dilemma. They can't afford the ACA plans, but they have preX conditions that prevent them from using other types of insurance. You all can talk about cadillac plans and how only the rich pay more taxes. I don't care. Whatever you think of the goals of the ACA, it has not solved the basic problem that lots of people just can not afford major medical insurance. The figure bandied about pre-ACA was 45 million uninsured. Now we have 30-35 million uninsured. This is success?

You can't talk common sense to some people, even though articles pop up on various news outlets dealing with these very issue.  Here's one that popped up just yesterday...

http://news.investors.com/112115-782025-obamacare-deductibles-more-shocking-2017.htm?ven=yahoocp&src=aurlled&ven=yahoo

Some of the lowest-cost bronze plans for 2016 are setting deductibles and out-of-pocket limits at the $6,850 ceiling to hold down premiums, which still rose by about 12% over 2015, on average.

That means that landing in the hospital could wreck the finances of many modest-income bronze plan enrollees.

Great, we have more people insured, but they are still one trip to the hospital away from financial ruin.

This isn't an argument against the ACA, it's an argument against the insurance company's greed. As we've discussed, the per-capita cost of health care has only gone up about 3% in the past 4-5 years yet the premium is going up 12%? If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

[BTDretire]

Aww...poor you, you can't leech healthcare off the system while you retire early.  I'm all for retiring early...but one of the major downfalls of Obamacare is the very thing a lot of people on here like it for...the less you work the more "free" handouts you get!

Full disclaimer...I will abuse the system as much as possible when I retire early if the government sets it up that way, ...

Yep, financially the ACA is forcing me to make the decision to an ACA policy.
 I'm 60 yrs old and have been accumulating dividend stocks, however the last few days, I've been pondering selling $200,000 of dividends stocks to lower my income by $12,000 and hiring an employee to knock my income down even more, then the hardworking taxpayers will give me $12,792 to subsidize my families $15,828 policy. That will save me $5412, no I expect at least a 9% increase in my existing non ACA policy, so $6,172. Hard to walk away from saving $6,172. Even without any income changes the hardworking taxpayer subsidy would save me near $4,000.

The taxes associated with the ACA really only affected a few groups of people in the US:

• The top 15% of wage earners - those making over $200,000 a year.
• The corporations that earned over $250,000 in a year.
• Those people that didn't have health insurance previously.

Tax or fees, you forgot to include the increased insurance policy fees I had to pay, 2102-18.4%, 2013-19.2% and 2014-22%!!

The ACA is not a "free" handout any more than social security, food stamps, public education, unemployment, etc are "free". We all pay into them and we all benefit. If we all are healthy, well educated, and well fed citizens, we can continue to be a great country.

  Hmm, just be aware on any given year almost 1/2 of the taxpayers pay $0 in federal income taxes. And some of those get money back they never paid in.
 If you want to argue, 'they' pay payroll taxes also known as Social Security taxes, my counter would be, that's a payment into a retirement and disability insurance program.

[Eric]

What msilenus said.  To respond to this question directly, I support the ACA because I believe it is better for society than the system that preceded it (though I believe a universal coverage system would be better still), and I also plan on becoming a frugal early retiree who will likely be receiving large ACA subsidies.

You get to push additional cost on to the balance of society rather than just work a few more years and be self sufficient in early retirement, and you think that it is good for society?

Its good for you, bad for society.  Rationalize it with whatever flawed logic you like, that is the simple fact of the matter.

So I take it that you're not going to file for Social Security when you're eligible.  After all, you could just work a few more years and be self sufficient.  Same with Medicare.  No sense in damaging society by accepting Medicare when you're 65 when you could've just worked a few more years to be self sufficient.  That's your plan, right?  Because if not, then you're not really in a position to be claiming someone else has flawed logic.

[jorjor]

This isn't an argument against the ACA, it's an argument against the insurance company's greed. As we've discussed, the per-capita cost of health care has only gone up about 3% in the past 4-5 years yet the premium is going up 12%?

There are a couple big reasons that premiums in the individual market are increasing faster than the per capita cost:

1. The transitional reinsurance program effectively depressed rates. It placed a fee that is charged to all markets and funneled that money into the individual market. Insurers then price for this money that they know is coming to pay a portion of claims. The amount covered by that program decreases from 2014 to 2016. It goes away in 2017. Rates will be higher than per capita trend again in 2017 when that program goes away.

2. I'm not asking you to shed a tear for insurers with this next one. Insurers lost a lot of money overall in the individual market in 2014. They were setting 2015 rates in March and April of 2014 so they did not yet know that they were about to lose a lot of money in 2014. Rate setting for 2016 was the first time that actual claims experience for that block of business was available, and less enrollment meant higher morbidity and higher overall cost. Now, they're adjusting to the cost because that enrollment is still low and morbidity is still high

If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

It did quite a bit to control what insurance companies can charge. MLR requirements, increased rate review, somewhat standardized benefits so plans are easier to compare, etc. It did almost nothing to control what a provider can charge, and that's been a constant and major portion of increased costs (and subsequent rate increases) in the past couple decades.

[msilenus]

Its good for you, bad for society.  Rationalize it with whatever flawed logic you like, that is the simple fact of the matter.

So I take it that you're not going to file for Social Security when you're eligible.  After all, you could just work a few more years and be self sufficient.  Same with Medicare.  No sense in damaging society by accepting Medicare when you're 65 when you could've just worked a few more years to be self sufficient.  That's your plan, right?  Because if not, then you're not really in a position to be claiming someone else has flawed logic.

No, he's already said that he will even use Obamacare, and the same logic would surely apply to Social Security.  It's even a sort of twisted funhouse mirror of brooklynguy's logic on Obamacare.  They're both separating out personal good from the general good, and doing what's right for themselves while advocating for what they think is right for society.  SirFrugal just comes off very different because he's being nasty and cynical about it.  But ultimately that's just spin and presentation.

Full disclaimer...I will abuse the system as much as possible when I retire early if the government sets it up that way, as either you will end up one of the ones screwing the system, or one of the ones supporting the screwed up system.  Knowing that its just stupid to opt to let other people screw you when any other option is available, but my god is our system messed up beyond all belief when these are our choices.  You must really hate your kids and grand kids if you think a system that essentially will force them to pay your medical bills for a 40-50 year retirement is somehow a well designed system.

[jorjor]

Maybe health insurers which don't own hospitals, specialist centers, and primary care centers will merge with the latter. Kaiser Permanente operates in this mode, and Sharp Hospital has a health plan which operates similar to Kaiser.
Both Kaiser and Sharp are non-profit. For-profit insurers and for-profit hospitals could be in trouble if the combined model takes off.

Provider payment reform is certainly a hot topic, and that model is one possibility. The Kaiser model has worked well where it exists, but whether it becomes the preferred structure remains to be seen. It's really tough effectively delivering that model across different states with different market rules and different cultures (that itself could be argued is a flaw in our health system), and accomplishing that is absolutely essential if you're going to make it the preferred structure that really big nationwide companies will heavily buy into. As an anecdote, it also seems to have a real love-hate relationship among consumers. For every person I know who loves Kaiser (we actually have a Kaiser option) I know one who didn't like it at all.

[msilenus]

Well, 11% of 300,000,000 is roughly 30,000,000 people. I have no idea where the democrats got their 45,000,000 uninsured figure. So at least my number of 30mil is accurate, if this graph is accurate. I talk to people from all states, we are a national company.

Yeah, 30-35m sounds right to me.  Note that estimates for illegal aliens in the country are around 11m, and the act excludes them.  State governments in mostly the South have cut another 3m people out that the Act funds coverage for, and it's not the ACA's fault that they're doing that to their citizens.  People in those states are paying the new Obamacare taxes, and are subject to the same rules that are pushing down Medicare costs like everyone else, but their working poor below the Exchange subsidy level who aren't on Medicaid are just completely and senselessly fucked over.  Since you're talking to people from all over, I bet a lot of the people who can't afford coverage are in that situation.  But again, the ACA funding for them is there, it's just being left on the table at the state level.

Anyway, even if the law reached everyone it could possibly reach it would probably be leaving ~14m uninsured behind.

Note that no one has gotten a fine for not being insured yet.  It will be a few more years yet before we can really see where things land.

[MDM]

Incidentally, no province in Canada offers public healthcare to persons who are not lawfully present in the country.

Thanks for the legwork (fingerwork?) on this. 

[Tom Bri]

Well, 11% of 300,000,000 is roughly 30,000,000 people. I have no idea where the democrats got their 45,000,000 uninsured figure. So at least my number of 30mil is accurate, if this graph is accurate. I talk to people from all states, we are a national company.

.........
Anyway, even if the law reached everyone it could possibly reach it would probably be leaving ~14m uninsured behind.

Note that no one has gotten a fine for not being insured yet.  It will be a few more years yet before we can really see where things land.

The fine is coming in to force this year. I expect a lot of wailing and gnashing of teeth. Every day I tell people, yes we can sell you insurance a lot cheaper than ACA. No, it won't save you from that fine.
From my viewpoint, the ACA solved one big problem, PreX conditions, and caused a whole bunch of new problems. Seems to me the ACA represents a major lack of forethought and imagination on the part of its advocates. I don't look to the Repubs for new ideas, that isn't their role in our political system. New ideas and programs are for the Dems to figure out. Then we get Repubs in and correct the oversights, repeal crap that just doesn't work. Well, that's the ideal, sad that it rarely works out so well in practice.

[msilenus]

The fine is coming in to force this year. I expect a lot of wailing and gnashing of teeth. Every day I tell people, yes we can sell you insurance a lot cheaper than ACA. No, it won't save you from that fine.
From my viewpoint, the ACA solved one big problem, PreX conditions, and caused a whole bunch of new problems. Seems to me the ACA represents a major lack of forethought and imagination on the part of its advocates. I don't look to the Repubs for new ideas, that isn't their role in our political system. New ideas and programs are for the Dems to figure out. Then we get Repubs in and correct the oversights, repeal crap that just doesn't work. Well, that's the ideal, sad that it rarely works out so well in practice.

PreX is huge.  I would go so far as to say that before the ACA, there was no way to get meaningful insurance in this country outside of group plans and government care.  One minor omission or error on your enormous application, and all you're doing is paying premiums and maybe getting a little bit of it back for minor health issues.  But once you get cancer and really need it --only then can you find out if you have insurance, because only then do they start reading your application closely.  That's not insurance.  Insurance doesn't come with fundamental epistemological issues about whether you have it or not.

All the ACA plans solve that.  They all also (and this has nothing to do with PreX) have no lifetime maximums.  So whether or not you're covered isn't dependent on how sick you get or how many times, or whether it's a lifelong issue that you catch.

It is a problem that real insurance like this is more expensive than lotto-ticket maybe-you're-okay insurance, but it's a cold hard actuarial reality.  And I personally think the ACA deals with it pretty well.  I've gone through the income cutoffs and subsidy phase-outs, and they all look very reasonable to me.  The only people I feel really bad for on the expense side are the working poor that are getting fucked over by their state legislators and governors because their state refused federal dollars for the Medicaid expansion.  But again: that's not a policy defect in the ACA.  The ACA is there for them.  The defect is elsewhere.

Actually, that's not entirely true.  I think there are a few regions that have very few options on the exchanges because of regional monopoly issues.  (Am I thinking of west Georgia?  I can't remember.)  Anyway, the ACA exempts those folks from the individual mandate if the costs get too high, but it doesn't do anything to expand competition in those areas.  That's by and large not the national story, but those folks are also left behind.

[Sparafusile]

If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

It did quite a bit to control what insurance companies can charge. MLR requirements, increased rate review, somewhat standardized benefits so plans are easier to compare, etc. It did almost nothing to control what a provider can charge, and that's been a constant and major portion of increased costs (and subsequent rate increases) in the past couple decades.

That's a good distinction, thanks for the clarification. From the few conversations I've had with a couple providers, it sounds like the insurance company policies are rather draconian. For example, they don't pay out claims until 12 months after they are filed. I can't help but wonder if that and other things have something to do with the increase in price charged. This is just anecdotal so I may be wrong.

[jorjor]

If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

It did quite a bit to control what insurance companies can charge. MLR requirements, increased rate review, somewhat standardized benefits so plans are easier to compare, etc. It did almost nothing to control what a provider can charge, and that's been a constant and major portion of increased costs (and subsequent rate increases) in the past couple decades.

That's a good distinction, thanks for the clarification. From the few conversations I've had with a couple providers, it sounds like the insurance company policies are rather draconian. For example, they don't pay out claims until 12 months after they are filed. I can't help but wonder if that and other things have something to do with the increase in price charged. This is just anecdotal so I may be wrong.

Most (all?) state have rules that require insurance companies to pay within a certain time period of receiving a cleanly filed claim. I've even seen real life interest/penalty charges in claims data in instances where that didn't happen. From what I've seen, most but certainly not all claims are paid within several months of the service date. I've seen claims paid 12+ months after incurral, but that claim might not have been flied immediately (or cleanly) or might have been in some legal battle over who holds responsibility. Liability claims, workers compensation, or car accidents would be instances where that would commonly happen because some other insurer might be responsible for the bill. One could argue that insurance companies are making up reasons that the claim isn't clean in order to delay paying.

[msilenus]

If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

It did quite a bit to control what insurance companies can charge. MLR requirements, increased rate review, somewhat standardized benefits so plans are easier to compare, etc. It did almost nothing to control what a provider can charge, and that's been a constant and major portion of increased costs (and subsequent rate increases) in the past couple decades.

That's a good distinction, thanks for the clarification. From the few conversations I've had with a couple providers, it sounds like the insurance company policies are rather draconian. For example, they don't pay out claims until 12 months after they are filed. I can't help but wonder if that and other things have something to do with the increase in price charged. This is just anecdotal so I may be wrong.

I think it's worth noting that there's a useful dynamic between the exchanges, insurers, and providers:

The individual market is dominated by the exchanges, and consumer choice is dominated by premium sensitivity.  Premiums are very transparent on the exchanges, customer experience is pretty uniform, and it's easy to see which plans are cheapest.  It's hard for insurers to compete on anything other than price and maybe selection.  It's pretty cut-throat.  So how do they win on price?

They bargain more aggressively with providers, and they shrink their networks to squeeze out higher-cost providers.  This is bad if you want to keep your favorite doctor on your cheapo plan.  It's also bad if you're the favorite doctor.  (But it's good for everyone else.)

My suspicion is that these lower small-network rates can't stay in the small networks forever.  Insurers know what they can get, and will put pressure on providers in plans upmarket to get closer to that.  Eventually maybe you get to see your favorite doctor again... once he's facing being kicked out of a group network.

[jorjor]

I think it's worth noting that there's a useful dynamic between the exchanges, insurers, and providers:

The individual market is dominated by the exchanges, and consumer choice is dominated by premium sensitivity.  Premiums are very transparent on the exchanges, customer experience is pretty uniform, and it's easy to see which plans are cheapest.  It's hard for insurers to compete on anything other than price and maybe selection.  It's pretty cut-throat.  So how do they win on price?

They bargain more aggressively with providers, and they shrink their networks to squeeze out higher-cost providers.  This is bad if you want to keep your favorite doctor on your cheapo plan.  It's also bad if you're the favorite doctor.  (But it's good for everyone else.)

My suspicion is that these lower small-network rates can't stay in the small networks forever.  Insurers know what they can get, and will put pressure on providers in plans upmarket to get closer to that.  Eventually maybe you get to see your favorite doctor again... once he's facing being kicked out of a group network.

This is a good post and pretty on point. Individual consumers are very price sensitive, and don't exhibit much loyalty to their insurer. That isn't a bad thing, it's just a thing. It leads to narrow networks as a way to cut price and show up on the top of the price list on the Exchange.

It's tougher to push that narrow network up as far as the really big employers. There is much more vetting of network adequacy from the purchaser, and larger employers care quite a bit about providing access to employees covering multiple locations with some willingness to trade price to achieve that. That market is also quite large, so threatening to cut out a provider has less teeth if the provider knows the insurer needs them in-network to attract larger employers and all the membership they bring. I suspect that's a big reason why you see so many large insurer mergers: to gain more negotiation power when you threaten to cut someone out of your network. Of course, that leads to provider consolidation as a means to combat that. Sooner or later, maybe the system will just turn itself into single payer. (Okay, that last part is a joke.)

[Tom Bri]

That's a good distinction, thanks for the clarification. From the few conversations I've had with a couple providers, it sounds like the insurance company policies are rather draconian. For example, they don't pay out claims until 12 months after they are filed. I can't help but wonder if that and other things have something to do with the increase in price charged. This is just anecdotal so I may be wrong.

30 days is the standard in most states, after receipt of a clean claim. We often have to order records or get clarification, so they do often run longer.

[BTDretire]

Every single thread that even mentions the ACA gets derailed by similar whining.  Why?  Why does this have to be?  Can we not just discuss the fucking program based on its merits?  Does every single thread have to suffer the incessant whining of some "rugged individualist" who tries to claim some bullshit moral high ground while simultaneously proving themselves to be a massive hypocrite?  Christ!

 The merits from my chair. Since 2012 I have had a 115% in my BCBS premium.
It's said healthcare costs are only up 3% a year since the ACA. Why have my insurance cost went up 21%? Could it be because of the ACA.

I'm paying $8448 for a family of 3, the premium for a Bronze ACA plan is $17,184.
Free market BCBS plan $8448, ACA plan $17,184.
See it here.
https://www.healthcare.gov/see-plans/#/plan/results
Free Market Plan, $10,000 deductible and OOP,
ACA Plan, $13,700 deductible and OOP.

"As of June 30 2015 9.9 million were still enrolled and had paid for a Marketplace plan. This is on par with HHS’s original projection of 9.1 million."
http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/
 So we have 3% of the population covered by Obamacare. 9.9M/321M=.03
 This includes those that had a policy but were kicked off, those that saw the subsidy
and took it to save money, those that lost it because their employer dropped insurance because of Obamacare. I don't know how many people that leaves as truly getting insurance because of the ACA, but less than 3%.

 I'm comfortable with my BCBS free market policy except for the part of the increases caused by the ACA. However, I can save at least $4,400 by accepting the hardworking taxpayer subsidy of at least $12,782.

[GuitarStv]

I'm not sure why there's so much hate for universal health care, when pretty much every country who has it has superior care at half the cost per capita.

It's because of the Death Panels, obviously.

Not really, do a little research.  Americans who want universal coverage usually point at the Canadian system as an example.  75% of Canadians have private health insurance.  How great is their universal coverage when 75% of their citizens are willing to pay more for better care?  It was literally fought all the way to the Canadian supreme court to give citizens the right to pay cash for health care beyond the government supplied care.

Hey, Canadian here.  Most Canadians have private health insurance because our health care doesn't go far enough.  We don't get coverage for dental, optometry, and drugs.  It's one of the areas that we do really lag behind, and there's a lot of support for adding these services to our health care system.

For stuff that's actually covered though we don't have a two tiered system like you're insinuating.  If you go in to a hospital with a heart attack, you're going to get the exact same quality treatment regardless of your health insurance.  It will cost you the same regardless of your insurance.  Health insurance just pays for perks, like a private room or cable in your room.

[Axecleaver]

Apologies for un-de-railing the post to address the OP's point, but...

United Healthcare's announcement was that they were THINKING about MAYBE pulling out of the Exchanges in 2017 (not 2016). And the reason they gave is not because they "can't make it work" but rather because the profits they were making on the individual market were not as huge as the group market.

Translation: Our marketing to corporate America's decision makers is more effective than our marketing to individuals, so we're thinking about focusing our business on what we do well.

[cpa cat]

Not really, do a little research.  Americans who want universal coverage usually point at the Canadian system as an example.  75% of Canadians have private health insurance.  How great is their universal coverage when 75% of their citizens are willing to pay more for better care?

This comment indicates a lack of understanding of what private health insurance in Canada entails.

1. It's generally a benefit provided by employers. This is why 75% of Canadians have it. It's a perk.

2. It provides supplemental insurance for chiropractic, acupuncture, massage, vision, dental, prescriptions, and other "extras" not covered by Health Canada. It is not for medical care, strictly speaking.

3. The most important supplement is for prescription medication, because while Health Canada will cover medications in a hospital setting, it won't cover regular prescriptions. Prescription coverage is available as a provincial benefit to some individuals, but not all. Despite the fact that the Canadian healthcare system does not cover prescription medications, the government does negotiate and regulate rates, lowering the overall cost of drugs in Canada (which is why people order cheap prescription drugs from Canada).

So it's not that the Canadian health system is bad. Canadians don't seek out supplemental health insurance because they're unhappy with their healthcare. They rarely seek it out at all. It's like Aflac or dental insurance in the United States. Your employer doesn't necessarily get a big benefit out of offering it, except that employees appreciate it and have come to expect it to be available.

[big_slacker]

Maybe health insurers which don't own hospitals, specialist centers, and primary care centers will merge with the latter. Kaiser Permanente operates in this mode, and Sharp Hospital has a health plan which operates similar to Kaiser.
Both Kaiser and Sharp are non-profit. For-profit insurers and for-profit hospitals could be in trouble if the combined model takes off.

We have Group Health here in the PacNW which is very similar. I liked the idea of this model but man did it suck when I actually had to deal with it. My wife grew up in the eastern bloc and she compares it to the old communist model of service. They're all about getting you in and out as quickly and cheaply as possible and collecting the co-pay. They have a very limited amount of specialists and they love to referral bounce you around if the doc doesn't want to deal with your problem. I spent $100 in co-pays just trying to get them to transfer over my long term prescription/therapy from my previous provider. Gave 'em diagnosis, lab results and everything. Nope, they wanted me to go off it (which greatly affects my quality of life) so they could further bounce me around and co-pay me to death trying to figure out the 'real' problem with me which had already been solved. I was more informed about my condition through google than any of the docs I saw, it was truly scary.

They eventually just said they refused to offer me the same prescription/therapy and I have now gone with a cash plan through my old doc. He laughed and said he's had the same issue with other patients, he is giving me a small amount above his cost which is reasonable and fair. Luckily we're at open enrollment and can go to a different plan in a couple months.

I don't know if Kaiser operates in the same way but my experience with group health was bad enough that I'd be very wary of this being the solution to healthcare costs in the US.

Also, I don't want to internet stat debate about the ACA but this thread got me curious so I went on the exchange here and did the best I could to get close to the plan I have starting next year through my employer. There actually wasn't one as good (that isn't confidence inspiring) and I do believe someone has a different definition of affordable than I do. :(

[Tom Bri]

Can anyone give me a good idea of how many new insured people are in ACA plans? Non-propagandistic numbers are hard to come by. How many people who did not have insurance before are now insured?
Also, related to the original post and question, how many insurance companies got out of the major medical market? I know my employer did, but we were never a big player. I was told we dumped about 12,000 people when we left that business. I was pretty bummed.

[geekette]

While we've never been without insurance, if not for the ACA we'd either have none, or one of us would have to get a job with benefits (DH was laid off 2 years ago at age 51.  Thanks to this site and the ACA, he realized he could retire).  How would people like us be counted?

I guess UHC is doing okay in NC. They're having to refund almost 5 million since they didn't spend a high enough percentage of premiums on health care.

[FenderBender]

Huge thank you to SriFrugal.  The information you have provided is truly enlightening. 


 

[beltim]

Can anyone give me a good idea of how many new insured people are in ACA plans? Non-propagandistic numbers are hard to come by. How many people who did not have insurance before are now insured?

This study estimated ~17 million more Americans had health insurance in February 2015 compared to September 2013:
http://www.rand.org/news/press/2015/05/06.html

A different approach by Goldman Sachs used a different method to estimate a net gain of 17-18 million insured:
http://www.forbes.com/sites/scottgottlieb/2015/05/14/how-many-people-has-obamacare-really-insured/

The number of previously uninsured people who enrolled in Medicaid is about 6 million according the the RAND study.

[FenderBender]

How can you legitimately claim you support Obamacare while intentionally planning on becoming healthy able bodied person who will draw subsidies from the system instead of contributing to it?

What msilenus said.  To respond to this question directly, I support the ACA because I believe it is better for society than the system that preceded it (though I believe a universal coverage system would be better still), and I also plan on becoming a frugal early retiree who will likely be receiving large ACA subsidies.  The latter fact does not render the former belief hypocritical.  I also support tax reform that would do away with the unfair and regressive aspect of our existing tax system that taxes investment income at lower rates than earned income, because I believe it is worse for society, even though I stand to personally benefit from it as an early retiree living off my investments.  There's a distinction to be made between what system is best for society's interests and what system is best for one's own interests, and there are varying degrees of alignment between the two as you shift your perspective from individual to individual.

just love that word - unfair.  is 90% fair? 50% fair?  how about you decide what is fair above the current rate and just add that to the check you send to the IRS.  there is nothing stopping you from being fair starting now.

[SirFrugal]

So I take it that you're not going to file for Social Security when you're eligible.  After all, you could just work a few more years and be self sufficient.  Same with Medicare.  No sense in damaging society by accepting Medicare when you're 65 when you could've just worked a few more years to be self sufficient.  That's your plan, right?  Because if not, then you're not really in a position to be claiming someone else has flawed logic.

Social security - The more you pay into it, the more you get out of it when you retire.

Medicare - Its optional, it has an age requirement, and a price tag.

Obamacare - The less you put into it the more you get out of it.

Yeah...clearly those 3 programs have so much in common.  Early retirement isn't a drain on SS because you don't get as much as you would if you worked longer/paid more into it(although it is skewed a bit to help low wage earners out), and its not a drain on Medicare because you still have to meet the minimum age and you have to eventually pay the same to participate whether you retired at 18 or 65.

For what its worth though if I could have opted out of SS and medicare when I was 16 I would have gladly done so.  If I had what I paid into SS plus what my employer pays on my behalf, and the money I've paid into Medicare I'd probably already have an extra 250k socked away...easily 1mil+ by the time I retire.  In other words, I'd have retired with an amount(not counting what I save anyhow) that the interest on it alone would crush what I'm going to get from SS/medicare benefits...and somehow, the government can't even keep these programs solvent lol.

But you know...since opting out isn't an option you better believe it I'll be collecting benefits I actually earned and paid for, unlike the people who just want to jump on the early retirement Obamacare subsidy bandwagon and dig their hands deep into their neighbors pocket.

[Cathy]

This comment indicates a lack of understanding of what ... health insurance in Canada entails. ...
... [Private insurance] provides supplemental insurance for chiropractic, acupuncture, massage, vision, dental, prescriptions, and other "extras" not covered by Health Canada ...
... Health Canada will cover medications in a hospital setting ...
... So it's not that the Canadian health system is bad ...

"Health Canada" is the popular name for the agency that is legally called the "Department of Health". Department of Health Act, SC 1996, c 8, § 2(1). This agency is tasked with administering "all matters over which Parliament has jurisdiction relating to the promotion and preservation of the health of the people of Canada". Id, § 4(1) (emphasis added).

Under the Constitution of Canada, provincial legislatures (and not the federal Parliament) have exclusive jurisdiction over "Property and Civil Rights in the Province". Constitution Act, 1867, 30 & 31 Vict, c 3, § 92(13). This provision has been held to give the provinces exclusive jurisdiction over public welfare insurance programs, unless another provision of the Constitution says otherwise. Canada (Attorney General) v. Ontario (Attorney General), [1937] UKPC 7, at *2 ("There can be no doubt that ... insurance of this kind ... would be within the exclusive competence of the Provincial Legislature."). For example, the only reason that the Canada Pension Plan ("CPP") is constitutional is that it is specifically authorised by the Constitution. See Constitution Act, 1867, § 94A ("The Parliament of Canada may make laws in relation to old age pensions and supplementary benefits..."); Hislop v. Canada (Attorney General), 2009 ONCA 354, at ¶ 63 ("the CPP qualifies as a law 'in relation to old age pensions and supplementary benefits'"), leave denied 2009 CanLII 59424 (SCC). The Constitution does grant the federal Parliament jurisdiction over "Quarantine" and "Marine Hospitals", but that is obviously not enough of a jurisdictional grant to build a national healthcare system. See Constitution Act, 1867, § 91(11).

Because the federal Parliament does not have jurisdiction to enact or administer a general public healthcare system, Health Canada also has no role in the administration of such a thing, because, as mentioned above, Health Canada's role is limited to matters over which Parliament has jurisdiction.

As a result, Canada does not actually have a national healthcare system. Every province has its own healthcare system, authorised by provincial law. "There is no single model[.]" Chaoulli v. Quebec (Attorney General), [2005] 1 SCR 791, 2005 SCC 35, ¶ 77. It is not possible to make generalised statements about public healthcare in Canada without consulting at least 10 sets of laws, as I did in an earlier post in this thread.

I am aware that most Canadians think of their healthcare system as being a national program and this post is not intended to criticise them for thinking that. I simply enjoy constitutional theory and maybe some other readers do too.

[SirFrugal]

This isn't an argument against the ACA, it's an argument against the insurance company's greed. As we've discussed, the per-capita cost of health care has only gone up about 3% in the past 4-5 years yet the premium is going up 12%? If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

Do a little research for a change...health insurance companies run profit margins a little over 3% on average.

You want to know why rates have gone up 12%?  Because less able bodied healthy people signed up then they were estimating and they had a larger % of elderly and preX condition people sign up...it turns out many of their plans were sold at a loss.  You know...a loss that the ACA put taxpayers on the hook to reimburse.  But hey...some of you guys think it is "good for society" that you can retire early and leech subsidies contributing to this problem!  Who cares if everyone else has to pay more as long as you get a good deal!

Do you realize there are non-profit co-ops on the exchanges as well?  0% profit, and you know what happened to them?  Almost half of them have closed already, and their rates aren't any better then those super greedy for profit guys with their 3% profit margin, otherwise there wouldn't be any profit companies even bothering trying to compete on the exchanges.

[GuitarStv]

This comment indicates a lack of understanding of what ... health insurance in Canada entails. ...
... [Private insurance] provides supplemental insurance for chiropractic, acupuncture, massage, vision, dental, prescriptions, and other "extras" not covered by Health Canada ...
... Health Canada will cover medications in a hospital setting ...
... So it's not that the Canadian health system is bad ...

"Health Canada" is the popular name for the agency that is legally called the "Department of Health". Department of Health Act, SC 1996, c 8, § 2(1). This agency is tasked with administering "all matters over which Parliament has jurisdiction relating to the promotion and preservation of the health of the people of Canada". Id, § 4(1) (emphasis added).

Under the Constitution of Canada, provincial legislatures (and not the federal Parliament) have exclusive jurisdiction over "Property and Civil Rights in the Province". Constitution Act, 1867, 30 & 31 Vict, c 3, § 92(13). This provision has been held to give the provinces exclusive jurisdiction over public welfare insurance programs, unless another provision of the Constitution says otherwise. Canada (Attorney General) v. Ontario (Attorney General), [1937] UKPC 7, at *2 ("There can be no doubt that ... insurance of this kind ... would be within the exclusive competence of the Provincial Legislature."). For example, the only reason that the Canada Pension Plan ("CPP") is constitutional is that it is specifically authorised by the Constitution. See Constitution Act, 1867, § 94A ("The Parliament of Canada may make laws in relation to old age pensions and supplementary benefits..."); Hislop v. Canada (Attorney General), 2009 ONCA 354, at ¶ 63 ("the CPP qualifies as a law 'in relation to old age pensions and supplementary benefits'"), leave denied 2009 CanLII 59424 (SCC). The Constitution does grant the federal Parliament jurisdiction over "Quarantine" and "Marine Hospitals", but that is obviously not enough of a jurisdictional grant to build a national healthcare system. See Constitution Act, 1867, § 91(11).

Because the federal Parliament does not have jurisdiction to enact or administer a general public healthcare system, Health Canada also has no role in the administration of such a thing, because, as mentioned above, Health Canada's role is limited to matters over which Parliament has jurisdiction.

As a result, Canada does not actually have a national healthcare system. Every province has its own healthcare system, authorised by provincial law. "There is no single model[.]" Chaoulli v. Quebec (Attorney General), [2005] 1 SCR 791, 2005 SCC 35, ¶ 77. It is not possible to make generalised statements about public healthcare in Canada without consulting at least 10 sets of laws, as I did in an earlier post in this thread.

I am aware that most Canadians think of their healthcare system as being a national program and this post is not intended to criticise them for thinking that. I simply enjoy constitutional theory and maybe some other readers do too.

Standards for health care that the provinces must meet are set federally, and a lot of money that goes into health care is federal.  The provinces administer the care in most cases, but the care that you get across the country is usually pretty comparable.

[Sparafusile]

This isn't an argument against the ACA, it's an argument against the insurance company's greed. As we've discussed, the per-capita cost of health care has only gone up about 3% in the past 4-5 years yet the premium is going up 12%? If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

Do a little research for a change...health insurance companies run profit margins a little over 3% on average.

United reported that it made $10.3 billion in profits on $103 billion revenue in 2014. As far as I can tell, that's more than 3%. In fact, they were doing so well that they reached an all-time high in stock prices January. Anthem also beat profit expectations in 2014. This is all public information and published by the companies themselves. How many of your statements have been shown to be factually incorrect now?

[nereo]

...
As a result, Canada does not actually have a national healthcare system. Every province has its own healthcare system, authorised by provincial law. "There is no single model[.]" Chaoulli v. Quebec (Attorney General), [2005] 1 SCR 791, 2005 SCC 35, ¶ 77. It is not possible to make generalised statements about public healthcare in Canada without consulting at least 10 sets of laws, as I did in an earlier post in this thread.

I am aware that most Canadians think of their healthcare system as being a national program and this post is not intended to criticise them for thinking that. I simply enjoy constitutional theory and maybe some other readers do too.

THanks for this post Cathy.  It was a shock to me to learn that there were differences among the various provinces when I moved from Newfoundland to Quebec.

Standards for health care that the provinces must meet are set federally, and a lot of money that goes into health care is federal.  The provinces administer the care in most cases, but the care that you get across the country is usually pretty comparable.

I'd agree that the plans can appear very similar to the end-user, primarily because in all provinces if you go to the doctor or hospital in your province you leave (typically) without having to pay any fees.    However, differences 'upstream' make health care in Canada diffferent from province to province.  For example, wait times for both primary care physicians and specialists vary wildly from province to province - here in Quebec this problem has been complicated by strict hiring and licensing requirements for doctors and nurses; even board certified doctors and RNs from other parts of Canada can find it difficult to work in Quebec because of these restrictions. 
Coverage outside your province also varies.  Quebec residents are urged to get private insurance if traveling outside of Quebec, even if they remain inside Canada.  The QUebec healthcare system will only reimburse other provinces up to the Quebec rates (which are often less than in other provinces), so an ER visit while in Alberta could leave me owing money even though I have what's commonly referred to as "free" Canadian health care.  If traveling in the US the province will only reimburse a portion of costs and only for emergency procedures. 

What's really become apparent to me during the last 3 years is how "Canadian" health care (really provincially-administered health care) can be altered based on the budgets of your particular province.  A recent change in the RAMQ (Quebec health care) has severely reduced the amount of time that you can spend outside Québec and receive any health care services or reimbursements.  They also no longer pay for services provided by a non-physician (for example, care administered by a nurse or clinic aide).  These increased restrictions have come under the 'austerity' measures and are deeply unpopular with snowbirders and those of us that do extensive travel or work outside our Province of residence.  Personally, I live in Quebec (~300 days/year) but do summer field work in Nunavut and spend a few weeks/year visiting family in the US.  I have three health insurance plans.
http://www.ramq.gouv.qc.ca/en/citizens/temporary-stays-outside-quebec/health-insurance/Pages/services-covered.aspx

[tooqk4u22]

This isn't an argument against the ACA, it's an argument against the insurance company's greed. As we've discussed, the per-capita cost of health care has only gone up about 3% in the past 4-5 years yet the premium is going up 12%? If anyhting, the ACA didn't go far enough to control the price that the insurance companies can charge. The only reason you're hearing about it more is because there are more people on the plan. Nobody ever claimed the ACA was perfect, but it's a step in the right direction to fix the real issue.

Do a little research for a change...health insurance companies run profit margins a little over 3% on average.

United reported that it made $10.3 billion in profits on $103 billion revenue in 2014. As far as I can tell, that's more than 3%. In fact, they were doing so well that they reached an all-time high in stock prices January. Anthem also beat profit expectations in 2014. This is all public information and published by the companies themselves. How many of your statements have been shown to be factually incorrect now?

Not sure where you got your figures but for FYE 2014 per the 10K, UnitedHealth reported $130.5M of revenue and $5.6M of Net Income - equates to 4.3% net margin.  Not trying to get into the debate but the facts should be correct.