Author Topic: What comes after the ACA?  (Read 775055 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #2700 on: June 15, 2017, 10:40:59 AM »


Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Since you bring up cost shifting - Am I correct that private pay insurance typically reimburses at a much higher rate than medicare/medicaid.  Given that, isn't anyone with private insurance indirectly supplementing lower reimbursement payor types?

Yes, as well as the non insured, and those who have insurance but don't pay their deductibles.
When I mentioned cost shifting I wasn't talking about insurance companies.  I was talking about tax payers and patients. All these healthcare laws (ACA and AHCA) do is describe who will take the brunt of the cost of healthcare.  The laws should instead activity work on decreasing how much healthcare costs and thereby requiring less money and less cost shifting to pay for it. Unfortunately our crooked republican and democrat politicians have no interest in real cost cutting measures that would affect the profits of insurance providers, pharmaceutical companies and large healthcare entities.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2701 on: June 15, 2017, 10:45:21 AM »
I may regret joining this discussion of people basically talking past eachother because politics = religion and basically shuts off your prefrontal cortex.... but, this info may add to the overall debate.

Warning -this is a LONG READ.

https://www.theatlantic.com/theplatinumpatients/

shenlong55

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Re: What comes after the ACA?
« Reply #2702 on: June 15, 2017, 10:46:09 AM »
Unfortunately you are correct NEsailor it is very difficult to understand who the law helped and by how much vs who it harmed.  I see the following groups of people
1) The poor who couldn't get medicaid but now can due to expansion and therefor have relatively free healthcare coverage. Definitely a good thing.
2) The working poor who can now get subsidized health insurance and subsidized deductibles. Definitely an improvement from no health coverage at all.
3) Those who get some subsidies, but the deductibles are so high that they still can't afford paying for healthcare.  This group is the biggest concern for health institutions who claim that the volume of patients with health insurance has increased over the last few years, but a large portion of them don't pay their deductibles and therefor it is no better than no insurance at all.  These people may have never had any coverage at all, or had a much lower cost coverage that fit their particular needs but now forced into the ACA.  Some where harmed and some were not affected at all
4) Those who get no subsidies and have huge deductibles.  Unless these people are Mustachian or making solid 6 figure incomes, they get hit with very expensive health insurance.  These people were definitely harmed by the law.
5) The wealthier Americans who now pay much more for healthcare but are able to absorb the costs due to their income.

So...  Are you saying that those in groups 3 & 4 actually had access to plans that were cheaper (after taking subsidies into account) and also had lower deductibles before the ACA was enacted?

Correct!
This is especially true for middle class American families whor are older, have multiple medical issues requiring chronic meds and physician visits but also have no dependents any more.  The crazy part comes when insurance alone is $10k/yr and their family deductibles are $12k as well but they are outside any chance for subsidies.  Subsidies come at an income of $64k/yr and increase as the income is lower.  You can easily see how a middle class American family can manage to not qualify for subsides and end up with such expensive costs.  I am sure most of these will most definitely want to dismantle or amend the ACA.

I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Ah, I see.  To be fair I wasn't really in the insurance market before ACA, but I think I was just confused because while $10k/year for a plan with a $12k deductible doesn't sound like good insurance it does sound like normal insurance.  In other words, I just thought it was normal for insurance to suck but I guess I just haven't seen an insurance market done well yet.

Midwest

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Re: What comes after the ACA?
« Reply #2703 on: June 15, 2017, 11:17:36 AM »


Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Since you bring up cost shifting - Am I correct that private pay insurance typically reimburses at a much higher rate than medicare/medicaid.  Given that, isn't anyone with private insurance indirectly supplementing lower reimbursement payor types?

Yes, as well as the non insured, and those who have insurance but don't pay their deductibles.
When I mentioned cost shifting I wasn't talking about insurance companies.  I was talking about tax payers and patients. All these healthcare laws (ACA and AHCA) do is describe who will take the brunt of the cost of healthcare.  The laws should instead activity work on decreasing how much healthcare costs and thereby requiring less money and less cost shifting to pay for it. Unfortunately our crooked republican and democrat politicians have no interest in real cost cutting measures that would affect the profits of insurance providers, pharmaceutical companies and large healthcare entities.

I understood you weren't talking about insurance companies.  However, the net effect of higher reimbursements by private pay insurance is a higher cost to the policy holder. 

With the current situation, people with private health insurance subsidize everyone else (medicare, medicaid, and uninsured) because private pay reimburses at a higher rate.  Due to this higher rate, the insureds pay higher premiums.

Your comment on cost cutting is dead on.  If that issue were addressed, maybe we could make some headway but both sides of the aisle have failed on that point.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2704 on: June 15, 2017, 11:26:25 AM »
I may regret joining this discussion of people basically talking past eachother because politics = religion and basically shuts off your prefrontal cortex.... but, this info may add to the overall debate.

Warning -this is a LONG READ.

https://www.theatlantic.com/theplatinumpatients/

Nice article.  It discusses one of the aspects of cost cutting I described in earlier posts. We need a way to tell patients and families "No" More treatment will not only be minimal affective, but will actually cause more harm than good.  For example:  Why place a feeding tube when they have no brain function and are bedridden?  Why subject them to more pain and suffering just to keep them alive a few more months or years? Why do that colon resection to improve life expectancy by 2 months? Why perform CPR and break every rib on someone who has little to no brain function and then must live on a respirator for a few more months?  I can go on and on.

End of life care is a huge financial burden.  I would love to see TV commercials that talk about hospice and decreasing pain and suffering.  It should be funded by the government since most of this care is paid for by Medicare that would be money well spent.

sol

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Re: What comes after the ACA?
« Reply #2705 on: June 15, 2017, 11:53:20 AM »

We need a way to tell patients and families "No" More treatment will not only be minimal affective, but will actually cause more harm than good. 

But, but, but DEATH PANELS (is what republicans started shouting when the democratic congress tried to institute such policies).  They said "Obama is going to kill your grandma!" and forever killed any chance at reasonable discussion about limiting end of life care for humanitarian reasons.
« Last Edit: June 15, 2017, 11:57:24 AM by sol »

NESailor

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Re: What comes after the ACA?
« Reply #2706 on: June 15, 2017, 11:56:50 AM »


I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.



I'm having a hard time making sense of this number.  Are you talking about your portion or the entire premium (since employers often cover a good portion (or all) of an employee's premium.  I.e.:  My family plan at work costs approximately 15K all in.  I pay 3K of this, the employer covers the other 12K.    If I said - "my premiums went up 300%" I would be signaling that my plan went from 15K to 45K/year.  I'd be pretty outraged, that's for sure. 

Or do you mean that only the part you pay is up 300%?  As in - the plan is now 21K and you pay 9K while your employer still pays 12K ?  This would still be a lot but it would actually only be a 40% increase since pre-ACA times (21/15) which is a pretty normal rate of increase when annualized (for the healthcare sector in general).

I know people are reporting ridiculous increases so I guess either scenario is possible.  Some of the increases are caused by going from a total garbage policy that wouldn't have covered a damn thing and cost 1500/year and going to a Bronze plan that has actual protections built in...but costs multiples of the 1500/year.  I'm not sorry about those - the catastrophic insurance pre-ACA was just as useless to non-mustachian people as the high deductible plans under the ACA - folks didn't plan right and still didn't have the resources to cover non-catastrophic (but high) costs of actual necessary care.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2707 on: June 15, 2017, 03:07:43 PM »

We need a way to tell patients and families "No" More treatment will not only be minimal affective, but will actually cause more harm than good. 

But, but, but DEATH PANELS (is what republicans started shouting when the democratic congress tried to institute such policies).  They said "Obama is going to kill your grandma!" and forever killed any chance at reasonable discussion about limiting end of life care for humanitarian reasons.

Sol,
I honestly do not remember democrats trying to introduce reasonable measures but would be thrilled to be pointed in the right direction. It just goes to show how self serving our politicians are. And yes, we need death panels. But maybe we should use a kinder word like death with dignity. I have a feeling that you may think I am a republican which I am not. Unfortunately our politicians will argue everything if it comes across party lines. It is a sad state of affairs.

NEsailor,
I pay my own health insurance since I am self employed.
« Last Edit: June 15, 2017, 03:19:08 PM by EnjoyIt »

protostache

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Re: What comes after the ACA?
« Reply #2708 on: June 15, 2017, 04:05:23 PM »
Origin of the term "death panels": https://en.m.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009#Reimbursement_for_counseling_about_living_wills

It's exactly what you described EnjoyIt. The GOP lost their shit about it when Sarah Palin interpreted it as mandatory end of life care. It was yet another obstructive move by the GOP minority.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2709 on: June 15, 2017, 07:47:15 PM »
Origin of the term "death panels": https://en.m.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009#Reimbursement_for_counseling_about_living_wills

It's exactly what you described EnjoyIt. The GOP lost their shit about it when Sarah Palin interpreted it as mandatory end of life care. It was yet another obstructive move by the GOP minority.

What a shame, this could have really helped curb some costs. A few months back I mentioned allowing physicians to decline providing services when those services were futile and I got a very stern chastising by a fellow mustachian. I can't remember who it was or all the details. I think most people don't realize that keeping their loved ones alive by any means necessary is not always the right thing to do.  In fact they are forcing their loved ones into more pain and suffering because they just can't let them go. I assume most people just don't understand the physiology and what such a request actually entails. There is no way to know if Sarah Palin and those that supported the term "death panels" actually believed that we should do everything possible despite the pain and suffering or they are truly just being obstructions dip shits.  As always I assume it is a little of both.  Some are simply clueless while others will be against anything that comes across party lines. It looks like this was attempted by a republican a few years back under George Bush and got shot down then as well by other republicans or better yet a health care lobbyist.
« Last Edit: June 15, 2017, 07:53:03 PM by EnjoyIt »

nereo

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Re: What comes after the ACA?
« Reply #2710 on: June 16, 2017, 06:28:34 AM »
Origin of the term "death panels": https://en.m.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009#Reimbursement_for_counseling_about_living_wills

It's exactly what you described EnjoyIt. The GOP lost their shit about it when Sarah Palin interpreted it as mandatory end of life care. It was yet another obstructive move by the GOP minority.

What a shame, this could have really helped curb some costs. A few months back I mentioned allowing physicians to decline providing services when those services were futile and I got a very stern chastising by a fellow mustachian. I can't remember who it was or all the details. I think most people don't realize that keeping their loved ones alive by any means necessary is not always the right thing to do.  In fact they are forcing their loved ones into more pain and suffering because they just can't let them go. I assume most people just don't understand the physiology and what such a request actually entails. There is no way to know if Sarah Palin and those that supported the term "death panels" actually believed that we should do everything possible despite the pain and suffering or they are truly just being obstructions dip shits.  As always I assume it is a little of both.  Some are simply clueless while others will be against anything that comes across party lines. It looks like this was attempted by a republican a few years back under George Bush and got shot down then as well by other republicans or better yet a health care lobbyist.
I put as much blame on our unrealistic society.  We aren't willing to discuss end-of-life care and I think most people genuinely believe that a miracle cure may be just around the corner for whatever 'terminal' disease ails a loved one. It certainly hasn't been helped by pop culture, with movies and tv shows following a familiar 'beat-the-odds, miracle cure' plot line.

I can't tell you how many times my father came home exhausted, saying "I've got a bedridden patient who's 85 and ready to die, but her children have convinced her to try one more invasive and expensive treatment which might give her a few more weeks with no real improvement in quality of life."  It got harder and harder on my dad as more of his patients reached their twilight years and so many of them had never discussed end-of-life with their spouses and children, nor had living wills.

tyort1

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Re: What comes after the ACA?
« Reply #2711 on: June 16, 2017, 12:30:57 PM »

I can't tell you how many times my father came home exhausted, saying "I've got a bedridden patient who's 85 and ready to die, but her children have convinced her to try one more invasive and expensive treatment which might give her a few more weeks with no real improvement in quality of life."  It got harder and harder on my dad as more of his patients reached their twilight years and so many of them had never discussed end-of-life with their spouses and children, nor had living wills.

Couldn't we make this one of the forms someone has to fill out when they get insurance?

TrudgingAlong

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Re: What comes after the ACA?
« Reply #2712 on: June 16, 2017, 01:25:23 PM »
I think assisted suicide should be considered as well. When you are terminal with something like cancer, I find it horrible your options are so limited to end the suffering. People freak out about this concept, too, but I have always wanted this to be an option if I were facing a horrible, painful end.

jim555

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Re: What comes after the ACA?
« Reply #2713 on: June 16, 2017, 01:32:04 PM »
End of life care is more of a >64 year old problem (Medicare) than a ACA problem (18-64).

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2714 on: June 16, 2017, 08:29:45 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2715 on: June 17, 2017, 10:12:17 AM »
End of life care is more of a >64 year old problem (Medicare) than a ACA problem (18-64).

I respectfully disagree. There is only so much money in the pot. If 40% of it is used in end of life care, then that's 40% less that can be used in our society for preventative care, vaccines, emergency appendectomies, and medical research. Also, don't forget that 2/3's of Medicaid is spent on Nursing Home Care for seniors, many of which (End Stage Dementia) are being kept alive medically only because other people are paying for it.

JGS

AdrianC

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Re: What comes after the ACA?
« Reply #2716 on: June 18, 2017, 12:13:15 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

Adding more people with expensive pre-existing conditions to the pool must cause average rates to increase more than they would have, assuming no cost savings. The ACA has its winners and losers. Those of us who were buying private insurance before the ACA and don't qualify for subsidies, and couldn't keep our plan or our doctors, have been on the losing side, IMO.

We now pay $1200/mo with a $7k deductible per person for an HMO Silver plan with a shockingly narrow network. For example, we recently could not find an in network orthopedic doctor who would take a pediatric patient. That's just not right. Before the ACA we had a PPO plan with a national insurer, with a wide network. 

I think the ACA was a step in the right direction. It needs some fixes. It's not going to get fixed, obviously. I'm ready to move on. I'm concerned that if something is not done, and soon, we will not be able to buy health insurance at all. That will seriously screw up my FIRE.


Gin1984

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Re: What comes after the ACA?
« Reply #2717 on: June 18, 2017, 12:24:21 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

Adding more people with expensive pre-existing conditions to the pool must cause average rates to increase more than they would have, assuming no cost savings. The ACA has its winners and losers. Those of us who were buying private insurance before the ACA and don't qualify for subsidies, and couldn't keep our plan or our doctors, have been on the losing side, IMO.

We now pay $1200/mo with a $7k deductible per person for an HMO Silver plan with a shockingly narrow network. For example, we recently could not find an in network orthopedic doctor who would take a pediatric patient. That's just not right. Before the ACA we had a PPO plan with a national insurer, with a wide network. 

I think the ACA was a step in the right direction. It needs some fixes. It's not going to get fixed, obviously. I'm ready to move on. I'm concerned that if something is not done, and soon, we will not be able to buy health insurance at all. That will seriously screw up my FIRE.
But there was cost savings.  The insurance companies got caped on profit.  I remember multiple friends getting checks from their insurance companies.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2718 on: June 18, 2017, 12:28:42 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

Yes, 10-20% increases did occur before the ACA, but with the ACA those increases are 75% per year, every year. Ohh and the network of doctors is pathetic. I get much less for more money. Again, I can afford this increase, but many middle class Americans are having a hard time and want the ACA dismantled. At the end of the day healthcare is expensive and someone has to pay for it which is why I talk about cutting cost and not shifting the cost.

sol

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Re: What comes after the ACA?
« Reply #2719 on: June 18, 2017, 12:39:47 PM »
Yes, 10-20% increases did occur before the ACA, but with the ACA those increases are 75% per year, every year.

Why do you keep repeating this lie?  Health INSURANCE costs are way down (on the consumer side) since the ACA was passed, and health CARE costs are growing more slowly than they were before the ACA was passed.  It's at least not any worse, for the nation as a whole, and it's actually better for most people as measured by their out-of-pocket costs.

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Ohh and the network of doctors is pathetic.

Why do you keep repeating this lie?  Doctor networks are dictated by the insurers, not the government.  If anything, the ACA's regulations brought more customers into each network, strengthening the insurance network in (primarily rural) places were it was previously in bad shape.

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I get much less for more money.

This might be true for you personally, but it's certainly not true for the nation as a whole.  The ACA improved insurance coverage for everyone by mandating minimum coverage standards,  You can no longer buy "health insurance" that doesn't cover hospitalization or prescription drugs.  Can you believe that actually used to be a thing?

The ACA made insurance better, by mandating that it actually cover medical costs that were previously excluded.

But for you personally, especially if you are employed and very well paid, it is still possible that you are worse off.  The ACA made insurance better and cheaper for millions of people, and it accomplished that by raising taxes on few hundred thousands very wealthy individuals who already had great insurance, and who still have great insurance.  I'm okay with this trade, because it's better for the nation as a whole.

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Again, I can afford this increase, but many middle class Americans are having a hard time and want the ACA dismantled.

Middle class americans are not seeing the same cost increases that rich doctors are seeing.  Middle class americans saw their coverage quality increase, their premium growth rates slow, and tens of thousands of them were saved from medical bankruptcy because the ACA mandated their insurance plans cover costs that were previously excluded, or because they were offerred insurance in a marketplace where they were previoustly not allowed to buy insurance at all.  This was good for America.  I'm okay with taxing the rich to accomplish those goals.

The "ACA dismantle" you seem to think people want is NOT what I think they want.  People do NOT want to give up their subsidized health insurance so that the government can give a huge tax break to rich people like you (and me).  What kind of person actually supports that plan?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2720 on: June 18, 2017, 05:00:40 PM »

Why do you keep repeating this lie?  Health INSURANCE costs are way down (on the consumer side) since the ACA was passed, and health CARE costs are growing more slowly than they were before the ACA was passed.  It's at least not any worse, for the nation as a whole, and it's actually better for most people as measured by their out-of-pocket costs.


Why do you keep repeating the following lies? We all pay for insurance one way or another. Costs are not covered through thin air.  Someone must always pay the price. The cost of coverage has gone up substantially over the last few years despite a declining treat back in 2003 which has little to do with ACA passage.  Yes, some people have benefits and some people have suffered while many see little difference.


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Why do you keep repeating this lie?  Doctor networks are dictated by the insurers, not the government.  If anything, the ACA's regulations brought more customers into each network, strengthening the insurance network in (primarily rural) places were it was previously in bad shape.

Why do you keep repeating this lie?  ACA brought customers into sporadic networks of poor coverage.  It is the reason why people did not get to keep their doctors as promised. Because the market place is so unstable people are forced into changing coverage every year and therefor changing doctors every year.

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The ACA improved insurance coverage for everyone by mandating minimum coverage standards,  You can no longer buy "health insurance" that doesn't cover hospitalization or prescription drugs.  Can you believe that actually used to be a thing?

The ACA made insurance better, by mandating that it actually cover medical costs that were previously excluded.

Why do you keep repeating this lie?  Just because you have minimum coverage does not mean you can still afford it?  Just because you have insurance does not mean you can cover the $6k or $12k deductible every year.  Yes, having minimum standards has helped some, but not everyone wants prescription coverage or is willing to pay extra to have it.

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Middle class americans are not seeing the same cost increases that rich doctors are seeing.  Middle class americans saw their coverage quality increase, their premium growth rates slow, and tens of thousands of them were saved from medical bankruptcy because the ACA mandated their insurance plans cover costs that were previously excluded, or because they were offerred insurance in a marketplace where they were previoustly not allowed to buy insurance at all.  This was good for America.  I'm okay with taxing the rich to accomplish those goals.

You seam to be confused a little.  I never said all middle class Americans.  Middle class America has a huge range of income.  For many with pre-existing conditions the ACA was a benefit.  For others is was a detriment. Also, having more costly provisions in your insurance does not necessarily make it better.  For example, I do not need prenatal care, nor does my 62 year old mother.  Ohh, and anyone buying health insurance from the market place has had price increases in the 100-300% range.


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The "ACA dismantle" you seem to think people want is NOT what I think they want.  People do NOT want to give up their subsidized health insurance so that the government can give a huge tax break to rich people like you (and me).  What kind of person actually supports that plan?

I think you may have misread me.  I never said everyone wants the ACA dismantled, only those that have been harmed by it. I think you read what I write, but only choose to take in the pieces you disagree with and then throw out an argument to combat that piece which was taken out of context.

Sol, please read this and if you can answer my questions

I can clearly point out the benefits of the ACA and also the harms. Why can't you?  Are you so stuck in thinking it is the best thing since sliced bread that you ignore some of its detriments? I believe there is a psychological effect that comes into play here and it is called consistency. When someone openly takes a stand on a subject, they will consistently continue to take that stand without waver despite facts that may prove them wrong. In your case not wrong, but also not 100% accurate. There are without a doubt some excellent things the ACA did, but it came at a cost. Let me repeat this so that you don't ignore it. "There are without a doubt some excellent things the ACA did, but it came at a cost." For some middle class taxpayers it made healthcare which was once affordable all of a sudden unaffordable.

Try answering these questions:
1) Can you agree that just because someone has health insurance does not mean that they can still afford their deductible, and having health insurance vs having no insurance changes nothing regarding their ability to afford healthcare? No benefit or harm of ACA

2) Can you agree that some people who had no health insurance can get partial subsidies, but still can't afford their deductibles and now are mandated to pay for an insurance that provides no benefit, but still can't afford the care because their subsidies are so high? Minor detriment with potential benefit of ACA

3) Can you agree that many Americans had to change their doctors because their new mandated health plan is not taken by their physician? Minor detriment

4) Can you agree that some physicians refuse to accept healthcare.gov insurances because they are concerned they will not get paid because of the high deductible? Medium detriment

5) Can you agree that a family of 3 making $110k/yr is now paying significantly more for healthcare compared to pre ACA passage? Can you agree the cost may have increased significantly considering the increased deductibles? Very major detriment for that family.

6) Can you agree that a man or a women over 45 does not require prenatal care covered through their health insurance and having it does not make their insurance better? Very minor detriment.

7) Big question for you now which I asked earlier in this thread.  This is a hypothetical straw man question but the concept is really important.  Should we induce 1 tax payer to have unaffordable healthcare so that 1 non taxpayer can have affordable healthcare?  What about 1 tax payer suffer to benefit 10 non tax payers?  What 10 tax payers suffer to help one non tax payer?  Obviously life is not so black and white, but the concept is very important.

Sol, why is it that you simply can't come to terms that the ACA is not perfect, has harmed a percentage of taxpayers and the law needs improvement on.  The best way to help the ACA perform better is not through arguing who will pay more, but working on solutions to decrease cost. 

BTW, I can fully agree with you that expanding medicaid has helped a significant amount of people. I will agree that the pre-existing condition mandate allowed many get healthcare coverage which was once completely unaffordable or unavailable. I can also agree with you that there is a solid subset of the population that is better off thanks to the ACA. Now lets see if you can agree with me at all.  Lets see if you even respond.
« Last Edit: June 18, 2017, 05:02:29 PM by EnjoyIt »

protostache

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Re: What comes after the ACA?
« Reply #2721 on: June 18, 2017, 07:32:30 PM »
Of course ACA has problems. All of those things you list are arguably true, although lots of people qualify for CSRs that are designed to make copays and deductibles affordable.

But why do these flaws mean we have to tear the whole thing down? Why can't we work together to fix the problems and move forward? Someone earlier said they're "ready to move on" but I'm not. I want to fix ACA and make it work for more people and more providers and more markets.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2722 on: June 18, 2017, 08:44:15 PM »

ACA brought customers into sporadic networks of poor coverage.  It is the reason why people did not get to keep their doctors as promised. Because the market place is so unstable people are forced into changing coverage every year and therefor changing doctors every year.

This is totally false. The networks of coverage are not sporadic but are great in my area of Michigan.
Pre-ACA, if you actually needed medical care, then you had a pre-existing condition, and you were then going to be paying huge for health insurance, if you could even get health insurance.


Just because you have insurance does not mean you can cover the $6k or $12k deductible every year.  Yes, having minimum standards has helped some, but not everyone wants prescription coverage or is willing to pay extra to have it.

This is so self-contradictory, it doesn't make sense. How can you be concerned about people not being able to cover their deductible while at the same time you're fine with an insurance product that lacks prescription coverage?  What?  If you can't afford the deductible (which by the way is optional, get the gold plan and your deductible goes away), then how are you going to afford expensive prescriptions ? 



I do not need prenatal care, nor does my 62 year old mother. 

Well insurance is a pooling of risks. So your point is people should just pay when they get sick, which becomes the unlucky lottery that bankrupts some people because healthcare is so expensive.

Try answering these questions:
1) Can you agree that just because someone has health insurance does not mean that they can still afford their deductible?

Get the gold plan, there's no deductible.

2) Can you agree that some people who had no health insurance can get partial subsidies, but still can't afford their deductibles?

You don't understand the ACA. Not only are there subsidies, but there are cost-sharing reductions that lower deductibles and costs. If someone is poorer, they get all of that.


3) Can you agree that many Americans had to change their doctors because their new mandated health plan is not taken by their physician? Minor detriment

You can have a physician who leaves the practice that you were going to, and then therefore you don't get your same doctor. This happens regardless of health insurance plans.


5) Can you agree that a family of 3 making $110k/yr is now paying significantly more for healthcare compared to pre ACA passage?

No I don't agree. I would say the amount of income is higher than that before a family of 3 wouldn't qualify for subsidies.

The best way to help the ACA perform better is not through arguing who will pay more, but working on solutions to decrease cost. 

No I don't agree with you on that either. Revenues to pay for subsidies have to come from somewhere.

On the cost side, the ACA was yielding research on making medicine more cost-effective by
  • Changing incentives toward patient outcomes rather than merely reimbursing for procedures
  • Determining why medical procedures in one geographic region were much cheaper than in other areas

EnjoyIt

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Re: What comes after the ACA?
« Reply #2723 on: June 18, 2017, 10:09:32 PM »
Protostache,
I never said to scrap the ACA. I think there are some huge benefits to it. The ACA needs a little help.

DavidAnnArbor,
You have to realize that the ACA exists in not just Michigan but in the entire US. Some parts of the US have good insurance options while others are sporadic. You are missing my point completely. Again, there are great parts to the ACA and many people have been helped immensely. But also a good number of people have been screwed. The only thing I disagree with you is that we can not spend an infinite amount on healthcare and we need to cut cost. You want to tax more to cover more people while I want to cut costs and make it more affordable for everybody.

Regarding the deductible comment. It is my fault for not being clearer. Allow me to elaborate. Some people don't want prescription coverage though must pay for it thereby increasing their cost. A completely other subgroup of people don't get subsidies and therefor end up spending a large amount on healthcare insurance. A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing. The rich can afford to pay more but a large percentage of the middle class very well may not. They are the ones who are upset and likely a subset of people who want the law scrapes.

The outcomes research and provisions have potential promise, but the way they are being administered is actually increasing the cost due to the regulatory burdens providers must jump through to comply with the outcome research. MACRA reimbursement is a behemoth mess which they still can't figure out how to track. Bundled payments for outcomes does seam to be the future and may very well decrease costs in the long run, but it is a tiny fraction of the healthcare dollar. Much of it is wasted on unnecessary treatment of the almost deceased or practically brain dead, Add in the money  wasted on regulatory compliance. There are more examples I don't want to get into again in this post.





I will reiterate one more time. the ACA has some very good aspects of the law. But is has also made healthcare unaffordable to a subset of middle class tax payers and did very little to making healthcare any more affordable for a subset of people who aren't fully subsidized.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2724 on: June 18, 2017, 10:19:04 PM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.

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Re: What comes after the ACA?
« Reply #2725 on: June 18, 2017, 10:39:18 PM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."

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Re: What comes after the ACA?
« Reply #2726 on: June 19, 2017, 01:31:33 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.

obstinate

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Re: What comes after the ACA?
« Reply #2727 on: June 19, 2017, 04:31:47 AM »
Also, that little family could be paying arbitrarily more after the Rs remove the ban on lifetime limits.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2728 on: June 19, 2017, 06:47:57 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?

nereo

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Re: What comes after the ACA?
« Reply #2729 on: June 19, 2017, 07:03:18 AM »

I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?

I guess I just don't see where your outrage is coming from, EnjoyIt - perhaps this is an example of the consumers being completely disassociated from the true costs.  An $8k premium works out to $666/mo. Many (perhaps most) 'middle class' families spend at least that much on dual car payments.  Mortgages are often triple this amount. Hitting your OOP max is a rare event, but so is replacing a roof or needing major engine work.

It doesn't strike me as overly burdensome that someone would pay about as much for their healthcare as they would for their vehicles.
The problem has become that so many Americans (~2/3rds) get their health care through their employer with incredibly low monthly premiums; $200/mo for a family seems about normal.  Ergo, these 'middle class' Americans have come to believe that $200/mo is an appropriate amount to spend on health care, never realizing that their employer is chipping in 2-3x as much.

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Re: What comes after the ACA?
« Reply #2730 on: June 19, 2017, 07:04:40 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?
What makes you think us taxpayers in the UK who pay higher taxes in return for the NHS aren't having decent lives?  Health insurance in the USA is the equivalent of a tax payment in any country which has universal health care.

And frankly, the idea that a middle class family can't have a decent life on an income of $100,000 less $20,000 in a "bad" health year (less only $8,000 in a "good" health year) is 1) preposterous in itself, 2) an insult to the majority of USA residents, let alone the residents of other advanced economies who have "decent" lives on much less, and 3) completely in contradiction to mustachian principles.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2731 on: June 19, 2017, 07:19:33 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

I also think that a family can have an excellent life in the US on $100k/yr income. This forum proves it. But, if you built your life on X and some law comes around and makes that life sudenly unsustainable, you will be pissed and vote to get it repealed.  Don't forget now that these high deductibles exist your medication costs more. Where at one time your prescriptions were covered, you are paying full price to control that blood pressure and elevated cholesterol. Someone will always have to cover the cost of healthcare and right now the middle class is being squeezed the most. The rich can afford it, the poor get subsidies and the middle class must now pay more.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

protostache

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Re: What comes after the ACA?
« Reply #2732 on: June 19, 2017, 07:45:54 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?

This is my family. We pay $12,000 per year in premiums and have a $9,000 out of pocket max which we just met this morning. We have a 2x mortgage and 2 paid for cars. I do not feel different. I am in fact very grateful for the ACA, even with it's many flaws, even though we have to pay $21,000 out of pocket for our health care. I gladly pay higher taxes so people who can't can receive Medicaid.

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Re: What comes after the ACA?
« Reply #2733 on: June 19, 2017, 07:59:33 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.


EnjoyIt

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Re: What comes after the ACA?
« Reply #2734 on: June 19, 2017, 08:46:54 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

Nereo, you are correct, my tone can be toned down.  At first, a few years ago, I was angered about the higher premiums I now have to pay, but eventually I realize that I can afford the increase and content with it since it benefits many people.  I would still rather have the entire healthcare system cost less.  Just a 20% cut would solve all our healthcare problems today without the need to raising taxes even more. 

My biggest issue with the 100% proponents of the ACA is the one sided view saying only the good things it has done and ignoring the bad. Simply saying we have more people insured does not necessarily mean they have affordable healthcare.  A family of 3 making $60k/yr may have had very inexpensive health insurance at one time that covered what they needed.  Now they have to pay 3x as much for coverage, get subsidies that cover half and now have higher deductibles making their new insurance practically useless.  Just because you have health insurance does not mean you can still afford healthcare.  I see these people every day who are unhappy with how this bill has turned out for them.  Sure it helped a significant portion of Americans, but it harmed a significant portion as well and we can't simply ignore them.

Are we that blinded by our desire to do good that we are willing to ignore the bad?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2735 on: June 19, 2017, 08:57:43 AM »
This is my family. We pay $12,000 per year in premiums and have a $9,000 out of pocket max which we just met this morning. We have a 2x mortgage and 2 paid for cars. I do not feel different. I am in fact very grateful for the ACA, even with it's many flaws, even though we have to pay $21,000 out of pocket for our health care. I gladly pay higher taxes so people who can't can receive Medicaid.

Explain to me why you don't get the health insurance on the marketplace that has a much lower out of pocket maximum?

Isn't that what the different metals intend to reveal, that a Gold or Platinum plan has a much lower out of pocket maximum?

A family of 3 that ends up in a negative health situation going forward would choose a plan that would have much lower deductibles.

You'll pay more for that insurance per month, but you'll probably come out ahead because you won't be paying these maximums anymore.

Gin1984

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Re: What comes after the ACA?
« Reply #2736 on: June 19, 2017, 09:10:40 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

Nereo, you are correct, my tone can be toned down.  At first, a few years ago, I was angered about the higher premiums I now have to pay, but eventually I realize that I can afford the increase and content with it since it benefits many people.  I would still rather have the entire healthcare system cost less.  Just a 20% cut would solve all our healthcare problems today without the need to raising taxes even more. 

My biggest issue with the 100% proponents of the ACA is the one sided view saying only the good things it has done and ignoring the bad. Simply saying we have more people insured does not necessarily mean they have affordable healthcare.  A family of 3 making $60k/yr may have had very inexpensive health insurance at one time that covered what they needed.  Now they have to pay 3x as much for coverage, get subsidies that cover half and now have higher deductibles making their new insurance practically useless.  Just because you have health insurance does not mean you can still afford healthcare.  I see these people every day who are unhappy with how this bill has turned out for them.  Sure it helped a significant portion of Americans, but it harmed a significant portion as well and we can't simply ignore them.

Are we that blinded by our desire to do good that we are willing to ignore the bad?
I think what you are not understanding is that people are not ignoring the bad.  ACA is just the best option we have now.  I know of no person who does not see improvements that can be made, but scraping it with harm many, many people and that is not worth it.  Because overall, it has improved things for those who needed it.  I'm middle class and I could NEVER retire early prior because I had medical conditions and could not get health insurance for ANY amount of money.  The small time I was going to be uninsured I COBRAed which cost me $575/month for one person.  Just premiums and that was over eight years ago.  So the numbers you keep throwing out, seem reasonable for actual insurance, if it is not subsidized by someone (employer, government).  And my husband feels safer, even though he does not have a medical condition because he saw me not be able to get anything.  And knowing that if he does get sick, the insurance won't drop him is worth a significant amount of money.   

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2737 on: June 19, 2017, 09:15:24 AM »
And my husband feels safer, even though he does not have a medical condition because he saw me not be able to get anything.  And knowing that if he does get sick, the insurance won't drop him is worth a significant amount of money.   

Yes this can't be underestimated. Insurance companies used to drop the insured clients when they got sick. This was well revealed in the documentary, "Sicko" by Michael Moore.

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Re: What comes after the ACA?
« Reply #2738 on: June 19, 2017, 09:19:08 AM »
But why do these flaws mean we have to tear the whole thing down? Why can't we work together to fix the problems and move forward? Someone earlier said they're "ready to move on" but I'm not. I want to fix ACA and make it work for more people and more providers and more markets.
The ACA isn't going to get fixed.


protostache

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Re: What comes after the ACA?
« Reply #2739 on: June 19, 2017, 09:31:18 AM »
This is my family. We pay $12,000 per year in premiums and have a $9,000 out of pocket max which we just met this morning. We have a 2x mortgage and 2 paid for cars. I do not feel different. I am in fact very grateful for the ACA, even with it's many flaws, even though we have to pay $21,000 out of pocket for our health care. I gladly pay higher taxes so people who can't can receive Medicaid.

Explain to me why you don't get the health insurance on the marketplace that has a much lower out of pocket maximum?

Isn't that what the different metals intend to reveal, that a Gold or Platinum plan has a much lower out of pocket maximum?

A family of 3 that ends up in a negative health situation going forward would choose a plan that would have much lower deductibles.

You'll pay more for that insurance per month, but you'll probably come out ahead because you won't be paying these maximums anymore.

First, we don't qualify for any subsidies. Second, I made a massive spreadsheet that compared several on and off exchange HSA-compatible plans in all of the metal tiers, along with at least one non-HSA-compatible plan. This plan was the cheapest of those I evaluated assuming 1) max HSA contributions, b) full deduction of premiums on taxes and c) hitting our family out of pocket max.

It's actually a somewhat unconventional setup that, as far as I can tell from BCBSM's filings, isn't being offered again next year. We have a $4k individual / $8k family deductible and $4.5k individual / $9k family out of pocket max silver HSA plan. Next year our deductible will be a bit lower and our out of pocket max will be a little higher. We will likely have a 30-40% increase in premiums, based again on BCBSM's filings, 2/3 of which is due to the lack of enforcement for the individual mandate and the continued uncertainty of the CSR payments. Here is an overview of the data. I looked up BCBSM's filings on this website.

The ACA isn't going to get fixed.

But why not? ACA has over 50% approval and the repeal effort has less than 10%. The vast majority of the people that the ACA serves are better off with the law than without and a few small changes would make it work better for the rest. But no, of course we can't do that, because the people in Congress are beholden to interests that want it gone and not their actual constituents that benefit from the law.

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Re: What comes after the ACA?
« Reply #2740 on: June 19, 2017, 09:39:34 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

Nereo, you are correct, my tone can be toned down.  At first, a few years ago, I was angered about the higher premiums I now have to pay, but eventually I realize that I can afford the increase and content with it since it benefits many people.  I would still rather have the entire healthcare system cost less.  Just a 20% cut would solve all our healthcare problems today without the need to raising taxes even more. 

My biggest issue with the 100% proponents of the ACA is the one sided view saying only the good things it has done and ignoring the bad. Simply saying we have more people insured does not necessarily mean they have affordable healthcare.  A family of 3 making $60k/yr may have had very inexpensive health insurance at one time that covered what they needed.  Now they have to pay 3x as much for coverage, get subsidies that cover half and now have higher deductibles making their new insurance practically useless.  Just because you have health insurance does not mean you can still afford healthcare.  I see these people every day who are unhappy with how this bill has turned out for them.  Sure it helped a significant portion of Americans, but it harmed a significant portion as well and we can't simply ignore them.

Are we that blinded by our desire to do good that we are willing to ignore the bad?
I think what you are not understanding is that people are not ignoring the bad.  ACA is just the best option we have now.  I know of no person who does not see improvements that can be made, but scraping it with harm many, many people and that is not worth it.  Because overall, it has improved things for those who needed it. 

Look up above.  Whenever I bring up a bad item about the bill I get criticism with a list of the good the bill has done.  No one is debating the positives, and no one is debating getting rid of it. I am debating the negatives and the reality of healthcare in this country which so many like to ignore.  Healthcare in the US is expensive.  We have cost shifted its price tag from the people who can't afford it to the rich who can while squeezing a subset of the middle class even further.  I am not saying it is the worst thing, but a much better solution would be to make healthcare less expensive and more affordable to everyone.  Stick with the pre-existing conditions clause and eliminate the waste cutting the cost to everyone by 20-40%

BTW, I see a subset of the lower middle class who have seen no benefit at all.  Their cost of healthcare has stayed the same despite the partial subsidies and now the higher deductibles.  I would much prefer their out of pocket expenses be lower because the delivery of healthcare is less expensive.

I see physicians not accepting healthcare.gov insurance because the patients don't always pay their deductibles and the reimbursement is too low to make it worthwhile.  I see hospital systems profit margins drop or even lose money over the last few years because the newly insured are just not paying their deductibles.  This is the current reality which we must accept in addition to all the positives the law has to offer.

The law needs to be revamped significantly by adding provisions that decrease cost substantially.  I do not see the republicans doing it. They seam to be discussing more cost shifting instead of cost cutting. The democrats are equally talking about more cost shifting but in the other direction and are also to blame.

OurTown

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Re: What comes after the ACA?
« Reply #2741 on: June 19, 2017, 09:54:17 AM »
My best hope is that the ACA "replacement" is so bad . . .

How bad is it?

. . . thanks.  It's so bad that the voting public in the near future will support truly universal healthcare, as in a single payer system. 

Right now, the public is about to get what they deserve because they voted for these ass-hats.

NESailor

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Re: What comes after the ACA?
« Reply #2742 on: June 19, 2017, 10:36:41 AM »




First, we don't qualify for any subsidies. Second, I made a massive spreadsheet that compared several on and off exchange HSA-compatible plans in all of the metal tiers, along with at least one non-HSA-compatible plan. This plan was the cheapest of those I evaluated assuming 1) max HSA contributions, b) full deduction of premiums on taxes and c) hitting our family out of pocket max.

It's actually a somewhat unconventional setup that, as far as I can tell from BCBSM's filings, isn't being offered again next year. We have a $4k individual / $8k family deductible and $4.5k individual / $9k family out of pocket max silver HSA plan. Next year our deductible will be a bit lower and our out of pocket max will be a little higher. We will likely have a 30-40% increase in premiums, based again on BCBSM's filings, 2/3 of which is due to the lack of enforcement for the individual mandate and the continued uncertainty of the CSR payments. Here is an overview of the data. I looked up BCBSM's filings on this website.

The ACA isn't going to get fixed.

But why not? ACA has over 50% approval and the repeal effort has less than 10%. The vast majority of the people that the ACA serves are better off with the law than without and a few small changes would make it work better for the rest. But no, of course we can't do that, because the people in Congress are beholden to interests that want it gone and not their actual constituents that benefit from the law.

And this is why I constantly return to my original song titled: "People are stupid" :D... Not you guys, that is.  Let me explain.  See what protostache did there when "shopping for insurance"?  A neat little ROI analysis with some additional risk/reward calculations.  That's what effectively shopping for insurance is.  Now, the free marketeers hail this as some sort of a cure-all approach that will get everyone better care for less money.  In fact, it will get everyone what they deserve - and not in the "this is t-ball and everyone gets a participatory medal because we're nice" kind of way either.  The free market judges stupidity much more harshly than society (or the big bad government).  Study after study is telling us that the average American cannot come up with a few hundred bucks in an emergency.  We expect these average Americans to go out and perform complicated actuarial analyses?  Hahahaha, that's cruel. 

We need someone to look after those who cannot do it themselves.  The market won't do that because it's programmed to do the opposite - take advantage of them.  Who would this be?  I know approximately half of the country hates the answer but it's right there.

So what comes after the ACA?  What we deserve.

Oh...and why won't it get fixed?  Because approximately half of the country does not understand that no ACA does not mean better care for less money.  Note - I'm not calling half of the country stupid in the previous statement.  I'm saying that those who oppose the ACA without at the same time supporting a viable alternative that improves the system - do not understand what's coming.   Fine by me either way.   But a lot of harm is getting done for short term political gain and that makes me sad.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2743 on: June 19, 2017, 10:42:38 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

I would gladly pay 20% extra if it meant that 50 million Americans would not have to suffer from chronic anxiety/fear that their next illness would leave them bankrupt. I would gladly pay 20% to ensure that people don't die unnecessarily because they can't afford the ED visit for chest Pain or because they hope their strange looking mole will "just go away." I would gladly pay 20% more if that led to less families having to decide between food money and prescription money. Go Single Payer and be done with it. Take my extra 20%, and let everyone get on with their lives/use their mental energy on more productive aspects of their existence.

JGS

EnjoyIt

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Re: What comes after the ACA?
« Reply #2744 on: June 19, 2017, 11:47:39 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

I would gladly pay 20% extra if it meant that 50 million Americans would not have to suffer from chronic anxiety/fear that their next illness would leave them bankrupt. I would gladly pay 20% to ensure that people don't die unnecessarily because they can't afford the ED visit for chest Pain or because they hope their strange looking mole will "just go away." I would gladly pay 20% more if that led to less families having to decide between food money and prescription money. Go Single Payer and be done with it. Take my extra 20%, and let everyone get on with their lives/use their mental energy on more productive aspects of their existence.

JGS

It sounds so easy when it is hypothetical money and 50 million are helped.  It is very different when you, yourself can't have the nice house and FIRE like you have been dreaming and your 20% at best helped helped 1 person.

AdrianC

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Re: What comes after the ACA?
« Reply #2745 on: June 19, 2017, 02:45:59 PM »
The ACA isn't going to get fixed.

But why not? ACA has over 50% approval and the repeal effort has less than 10%. The vast majority of the people that the ACA serves are better off with the law than without and a few small changes would make it work better for the rest. But no, of course we can't do that, because the people in Congress are beholden to interests that want it gone and not their actual constituents that benefit from the law.

There you go.

The Republicans are not going to save "Obamacare". They will gladly encourage a death-spiral, and are doing so.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2746 on: June 19, 2017, 06:11:06 PM »
BTW, I see a subset of the lower middle class who have seen no benefit at all.  Their cost of healthcare has stayed the same despite the partial subsidies and now the higher deductibles.   

It's not just subsidies, there are cost sharing reductions. It converts what is a silver plan into gold-plated plan with almost all the costs paid for except for small amounts.

One more time now:

There are Premium Subsidies
and there are Cost Sharing Reductions, most especially for the lower middle class, if not outright Medicaid.

sol

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Re: What comes after the ACA?
« Reply #2747 on: June 20, 2017, 12:31:16 AM »
EnjoyIt, you deserve a longer response than I can muster before bed tonight.  Rest assured that I'm not ignoring you.

We all pay for insurance one way or another. Costs are not covered through thin air.  Someone must always pay the price.

Of course we do.  And the ACA had a whole list of cost control provisions that we've previously addressed in this thread.  Should I go back and find the list for you?  They worked hard to address your concerns.

But health care costs paid to the providers aren't the only problem here, there's also the problem of making healthcare available to more people, including people who cannot afford it.  That's why we have medicaid (for the disabled and the indigent) and medicare (for the elderly) for people for whom the costs of care typically exceed their ability to pay.  Managing the ability to pay is absolutely part of the solution here, because without it lowering the costs paid to providers doesn't really help anything.  If you make $20k/year, lowering the cost of your life-saving heart surgery from $400k to $200k doesn't mean squat to you, because you're still not going to get it.  Insurance (and the ACA's associated subsidies) are the mechanism to get more people access to care.

I understand the concern of wealthy white Americans, who can already afford care and do not like seeing their costs go up.  I understand why those folks are unhappy, and I recognize their concerns.  I just don't think they are as important as the concerns of tens of millions of Americans for whom basic medical care was previously unavailable.  Health insurance subsidies are absolutely a necessary part of the solution.

Quote
ACA brought customers into sporadic networks of poor coverage.

Yes, sporadic networks that already existed and were offered more customers by the ACA, in attempt to shore them up.  It didn't work in all places, because the ACA wasn't sufficient to make it profitable for anyone to provide comprehensive healthcare in places where there are almost no people  There's a clear reason why populous states have functioning markets and low population states (like Alaska) do not, and it doesn't have anything to do with the ACA.

Quote
 
It is the reason why people did not get to keep their doctors as promised.

No, the ACA is in no way related to which doctors left which provider networks.  That process has always happened.  The ACA did not make it better or worse.  I consider it a PR disaster that Obama said "You can keep your doctor" instead of "The ACA will not change your doctor" because NOBODY has been able to keep their doctor, ever.  That has never been a guarantee of any health insurance plan.  That quote made it sound like the ACA was going to somehow bind doctors to health plans, which was never going to happen.   The only way to "guarantee" that is to nationalize healthcare and have a single nationwide health plan.  And even the, some doctors will retire or die on the job, and those patients will lose their doctor.

Quote
Because the market place is so unstable people are forced into changing coverage every year and therefor changing doctors every year.

The individual market has always been unstable.  The ACA didn't make it any worse, anyway, unless you consider establishing health exchanges so that it was easier for people to find cheaper insurance to be "making it worse".

Quote
Yes, having minimum standards has helped some, but not everyone wants prescription coverage or is willing to pay extra to have it.

Sure, and not everyone wants cancer coverage or pregnancy coverage or ambulance coverage.  But the nature of health insurance is that it covers costs you cannot forsee, and if you get cancer or pregnant or need prescription drugs, and you didn't have insurance, then you're going to get treated and the rest of us are going to pay for you costs because you're a freeloader.  The minimum coverage requirements were specifically targeted at freeloaders who wanted full coverage treatment at tiny coverage prices.  They forced everyone to pay for the care they were going to get anyway.

Quote
For example, I do not need prenatal care, nor does my 62 year old mother.

You also don't need cancer coverage, until you do.  The nature of health insurance is to pool risk.  You don't get to pick which features you want to pay for.  If you did, we would all just pay for exactly what care we actually needed, which is the same as nobody having insurance at all.  That's just fee for service.

Quote
Ohh, and anyone buying health insurance from the market place has had price increases in the 100-300% range.

Technically, nationwide health insurance costs were rising more slowly than before the ACA passed, until Congress started fucking with it by yanking the funding and encouraging people to bail.  Yes, costs have gone up for health insurance.  Also food, energy, houses, and cars.  Welcome to economics!

Quote
I think you may have misread me.  I never said everyone wants the ACA dismantled, only those that have been harmed by it.

That's fair enough.  Some people live in states where the individual health insurance market was previously a disaster, and it has not gotten notably better with the ACA, and so I understand why they want to try something different. 

Quote
Sol, please read this and if you can answer my questions

more tomorrow.   must sleep.


DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2748 on: June 20, 2017, 06:35:40 AM »
First, we don't qualify for any subsidies. Second, I made a massive spreadsheet that compared several on and off exchange HSA-compatible plans in all of the metal tiers, along with at least one non-HSA-compatible plan. This plan was the cheapest of those I evaluated assuming 1) max HSA contributions, b) full deduction of premiums on taxes and c) hitting our family out of pocket max.

It's actually a somewhat unconventional setup that, as far as I can tell from BCBSM's filings, isn't being offered again next year. We have a $4k individual / $8k family deductible and $4.5k individual / $9k family out of pocket max silver HSA plan. Next year our deductible will be a bit lower and our out of pocket max will be a little higher. We will likely have a 30-40% increase in premiums, based again on BCBSM's filings, 2/3 of which is due to the lack of enforcement for the individual mandate and the continued uncertainty of the CSR payments. Here is an overview of the data. I looked up BCBSM's filings on this website.



Ok thank you for sharing your thinking on this. I wish the premium subsidies were expanded, that would be a fix that a rational Congress could do.

When I first thought about getting insurance through the marketplace back in late 2014 I also found the insurance rates were double what I was already paying on my individual health insurance I got on my own. My insurance plan was grandfathered in for 2015. But then in early 2016 after sleuthing around MMM forums, the Gocurrycracker blog, and the internet I discovered how to lower my AGI on my self-employed income through the solo 401k. Moreover in 2016 my health insurance provider wanted to increase my premiums by 30%, so this spurred me to look again at the ACA marketplace and I realized I could now qualify for subsidies. Additionally, I recharacterized a Roth contribution as a traditional IRA contribution and between this and the solo 401k, the HSA, and the 457 that really lowered my AGI, suddenly my premiums after subsidies were very very affordable.
« Last Edit: June 20, 2017, 06:58:35 AM by DavidAnnArbor »

Bateaux

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Re: What comes after the ACA?
« Reply #2749 on: June 20, 2017, 06:46:05 AM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.