What comes after the ACA?

[protostache]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

Millions of people losing access to healthcare and a non-trivial number of them dying as a result is fun for you?

[Monkey Uncle]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

Yes, my state is among them.  Ten percent of the state's population would lose their health coverage, most of them poor, and many of them children.  And our AG, who claims on his web site to be defending the people of the state from injustice, thinks this is a good idea.

[boarder42]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

Millions of people losing access to healthcare and a non-trivial number of them dying as a result is fun for you?

do you have any statistics to back up this claim that non-trivial numbers were dying pre ACA b/c thats the situation we'd be back to.  is there data out there showing that the ACA has inherently saved a non-trivial number of lives since its incepetion - or just the data that we've covered extra people with shitty overpriced "insurance"

[protostache]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

Millions of people losing access to healthcare and a non-trivial number of them dying as a result is fun for you?

do you have any statistics to back up this claim that non-trivial numbers were dying pre ACA b/c thats the situation we'd be back to.  is there data out there showing that the ACA has inherently saved a non-trivial number of lives since its incepetion - or just the data that we've covered extra people with shitty overpriced "insurance"

http://www.nejm.org/doi/full/10.1056/NEJMsb1706645

I’m sure this has been linked at least once before in this monstrously long thread.

Also try to keep in mind that the number of people covered by individual market policies is dwarfed by those covered by Medicaid expansion, by about 4 to 1. Medicaid expansion policies are decidedly non-shitty and they are definitely not overpriced.

[use2betrix]

In most states you can’t even purchase PPO coverage anymore. I don’t have a “home” state, but Texas is as close as t gets. They only offer HMO plans, which means when I spend 3-4 months on the road traveling I have zero coverage aside from “life threatening emergencies.”

It’s beyond pathetic that these plans are no longer available to purchase for any amount of money.

[boarder42]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

Millions of people losing access to healthcare and a non-trivial number of them dying as a result is fun for you?

do you have any statistics to back up this claim that non-trivial numbers were dying pre ACA b/c thats the situation we'd be back to.  is there data out there showing that the ACA has inherently saved a non-trivial number of lives since its incepetion - or just the data that we've covered extra people with shitty overpriced "insurance"

http://www.nejm.org/doi/full/10.1056/NEJMsb1706645

I’m sure this has been linked at least once before in this monstrously long thread.

Also try to keep in mind that the number of people covered by individual market policies is dwarfed by those covered by Medicaid expansion, by about 4 to 1. Medicaid expansion policies are decidedly non-shitty and they are definitely not overpriced.

interesting - yes the medicaid expansion was done reasonably well.  the ACA i still think was destined to end in a dumpster fire regardless of who took office and while we may have some growing pains getting to a first world single payer system the destruction of the ACA is likely a first step. 

[protostache]

interesting - yes the medicaid expansion was done reasonably well.  the ACA i still think was destined to end in a dumpster fire regardless of who took office and while we may have some growing pains getting to a first world single payer system the destruction of the ACA is likely a first step.

If the Supreme Court picks up this case (very unlikely) and rules for the plaintiffs (even more unlikely) that would result in a complete rollback of the law including Medicaid expansion.

Moving toward fewer payers (for example, as detailed in the Medicare Extra thread) doesn't require destroying ACA as a first step. That should be the last step, after passing a law that's been fully debated and takes all stakeholders into account, and after the structures enabled by the new law are fully implemented. The ACA exchanges should only shut down once people are able to sign up for Medicare Extra (or whatever actually happens) in their workplaces or at the point of service.

The first step of moving to a new house is building the new house, not burning down the one you're currently living in.

[DavidAnnArbor]

IF one doesn't qualify for subsidies under the ACA, yes it feels like a raw deal, since the insurance costs are so high.
But if one qualifies for those subsidies, the ACA insurance plans are great.
Emergency care is available if you are out of your coverage area.

[swampwiz]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

Yes, my state is among them.  Ten percent of the state's population would lose their health coverage, most of them poor, and many of them children.  And our AG, who claims on his web site to be defending the people of the state from injustice, thinks this is a good idea.

My state has a real jacka33 AG too.

[Tyson]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

Yes, my state is among them.  Ten percent of the state's population would lose their health coverage, most of them poor, and many of them children.  And our AG, who claims on his web site to be defending the people of the state from injustice, thinks this is a good idea.

Freedumb at it's finest.

[sherr]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

I've seen one or two things about the ACA that were "poorly executed", but the vast vast vast vast majority of the problems seem to revolve around one party doing everything they can to sabotage it. It would be hard for any legislation to be successful under those circumstances.

[boarder42]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

I've seen one or two things about the ACA that were "poorly executed", but the vast vast vast vast majority of the problems seem to revolve around one party doing everything they can to sabotage it. It would be hard for any legislation to be successful under those circumstances.

even prior to this administration most of the plans did not work if i decided i wanted to go spend the summer in national parks and needed some non emergency medical treatment.  THIS alone is a huge problem - the need for supplemental insurance to travel within one's country.  Many here approach this from their own personal side of pre exisiting conditions and how it fixed that for them but to approach it from a different side(selfish as we all are) you're evil saying we should be working b/c we have pre-existing conditions - well the system wasnt perfect before but it was better for me than this new one so i'm sorry if i dont take to everyone else's personal selfish reasons for supporting something that does, in a way, hurt others regardless of if you'd like to admit it or not. 

[sherr]

even prior to this administration most of the plans did not work if i decided i wanted to go spend the summer in national parks and needed some non emergency medical treatment.  THIS alone is a huge problem - the need for supplemental insurance to travel within one's country.  Many here approach this from their own personal side of pre exisiting conditions and how it fixed that for them but to approach it from a different side(selfish as we all are) you're evil saying we should be working b/c we have pre-existing conditions - well the system wasnt perfect before but it was better for me than this new one so i'm sorry if i dont take to everyone else's personal selfish reasons for supporting something that does, in a way, hurt others regardless of if you'd like to admit it or not.

Um, what? Where do you get the idea that you need supplemental insurance in case you get injured at a National Park? I've literally never heard of that before, and Google isn't turning up much.

And for the record no one in my family has any pre-existing conditions, but I would certainly rather we have a system that covers them. There was no guarantee you could get insurance the old way if you had pre-existing conditions even if you were working.

For someone who supposedly wants single-payer you have a strange definition of "hurting others." "I have to pay a little more for insurance" is not really comparable to "oh, you got cancer and got laid off and couldn't find a new job before COBRA expired, oh well it's a pre-existing condition now and I guess it's just time for you to die." The whole idea of health insurance is supposed to be to solve that problem in the first place; the healthy people pay more than they use in order to ensure that the unlucky ones can live. If your problem with the ACA is that you'll be paying for those people's treatment then you'll be paying for them with single-payer too.

[mm1970]

even prior to this administration most of the plans did not work if i decided i wanted to go spend the summer in national parks and needed some non emergency medical treatment.  THIS alone is a huge problem - the need for supplemental insurance to travel within one's country.  Many here approach this from their own personal side of pre exisiting conditions and how it fixed that for them but to approach it from a different side(selfish as we all are) you're evil saying we should be working b/c we have pre-existing conditions - well the system wasnt perfect before but it was better for me than this new one so i'm sorry if i dont take to everyone else's personal selfish reasons for supporting something that does, in a way, hurt others regardless of if you'd like to admit it or not.

Um, what? Where do you get the idea that you need supplemental insurance in case you get injured at a National Park? I've literally never heard of that before, and Google isn't turning up much.

And for the record no one in my family has any pre-existing conditions, but I would certainly rather we have a system that covers them. There was no guarantee you could get insurance the old way if you had pre-existing conditions even if you were working.

For someone who supposedly wants single-payer you have a strange definition of "hurting others." "I have to pay a little more for insurance" is not really comparable to "oh, you got cancer and got laid off and couldn't find a new job before COBRA expired, oh well it's a pre-existing condition now and I guess it's just time for you to die." The whole idea of health insurance is supposed to be to solve that problem in the first place; the healthy people pay more than they use in order to ensure that the unlucky ones can live. If your problem with the ACA is that you'll be paying for those people's treatment then you'll be paying for them with single-payer too.

The whole national park thing - I don't get that, but I have private employer insurance - and I have an HMO.  So I don't have out of state coverage.

[boarder42]

even prior to this administration most of the plans did not work if i decided i wanted to go spend the summer in national parks and needed some non emergency medical treatment.  THIS alone is a huge problem - the need for supplemental insurance to travel within one's country.  Many here approach this from their own personal side of pre exisiting conditions and how it fixed that for them but to approach it from a different side(selfish as we all are) you're evil saying we should be working b/c we have pre-existing conditions - well the system wasnt perfect before but it was better for me than this new one so i'm sorry if i dont take to everyone else's personal selfish reasons for supporting something that does, in a way, hurt others regardless of if you'd like to admit it or not.

Um, what? Where do you get the idea that you need supplemental insurance in case you get injured at a National Park? I've literally never heard of that before, and Google isn't turning up much.

And for the record no one in my family has any pre-existing conditions, but I would certainly rather we have a system that covers them. There was no guarantee you could get insurance the old way if you had pre-existing conditions even if you were working.

For someone who supposedly wants single-payer you have a strange definition of "hurting others." "I have to pay a little more for insurance" is not really comparable to "oh, you got cancer and got laid off and couldn't find a new job before COBRA expired, oh well it's a pre-existing condition now and I guess it's just time for you to die." The whole idea of health insurance is supposed to be to solve that problem in the first place; the healthy people pay more than they use in order to ensure that the unlucky ones can live. If your problem with the ACA is that you'll be paying for those people's treatment then you'll be paying for them with single-payer too.

if you're traveling out of state you're not covered under most ACA plans for anything other than ER visits. last i checked all the national parks werent in a single state but i could be wrong. 

[MrGreen]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

I've seen one or two things about the ACA that were "poorly executed", but the vast vast vast vast majority of the problems seem to revolve around one party doing everything they can to sabotage it. It would be hard for any legislation to be successful under those circumstances.

even prior to this administration most of the plans did not work if i decided i wanted to go spend the summer in national parks and needed some non emergency medical treatment.  THIS alone is a huge problem - the need for supplemental insurance to travel within one's country.  Many here approach this from their own personal side of pre exisiting conditions and how it fixed that for them but to approach it from a different side(selfish as we all are) you're evil saying we should be working b/c we have pre-existing conditions - well the system wasnt perfect before but it was better for me than this new one so i'm sorry if i dont take to everyone else's personal selfish reasons for supporting something that does, in a way, hurt others regardless of if you'd like to admit it or not.

I imagine this depends on what you're used to seeing from employer healthcare. If you work somewhere that doesn't offer insurance or doesn't offer anything more than a HDHP to begin with, then what might be available to you via the ACA is no worse that what you have access to already. I suspect the percentage of the population that only has access to a HDHP through work is significant.

[boarder42]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

this is fun!  i like the drama around poorly executed legislation.

I've seen one or two things about the ACA that were "poorly executed", but the vast vast vast vast majority of the problems seem to revolve around one party doing everything they can to sabotage it. It would be hard for any legislation to be successful under those circumstances.

even prior to this administration most of the plans did not work if i decided i wanted to go spend the summer in national parks and needed some non emergency medical treatment.  THIS alone is a huge problem - the need for supplemental insurance to travel within one's country.  Many here approach this from their own personal side of pre exisiting conditions and how it fixed that for them but to approach it from a different side(selfish as we all are) you're evil saying we should be working b/c we have pre-existing conditions - well the system wasnt perfect before but it was better for me than this new one so i'm sorry if i dont take to everyone else's personal selfish reasons for supporting something that does, in a way, hurt others regardless of if you'd like to admit it or not.

I imagine this depends on what you're used to seeing from employer healthcare. If you work somewhere that doesn't offer insurance or doesn't offer anything more than a HDHP to begin with, then what might be available to you via the ACA is no worse that what you have access to already. I suspect the percentage of the population that only has access to a HDHP through work is significant.

i have an HDHP and i can go to the hospital or doctor or urgent care in other locations the network isnt confined to a very restricted set of locations as the ACA HMO plans are.

Actually just did a search in 4 different states and found multiple in network places within 20 miles of the random state zip codes i entered.  you dont get this with an ACA plan and i pay way more than even myself and my employer pay for less coverage - but hey at least we are all covered right.

[geekette]

I have an ACA BCBS plan and am covered across the country.  ACA plan coverage just depends on what's offered in your home area.

I can't think of a time, though, when I've wanted non-emergency care away from home.

[Exflyboy]

I have an ACA BCBS plan and am covered across the country.  ACA plan coverage just depends on what's offered in your home area.

I can't think of a time, though, when I've wanted non-emergency care away from home.

Yes we can't get BCBS plans here.. But our HD plan says we are covered for emergency services out of network. Of course what this really means is the plan will simply pay the OON providers the same as what they pay the in network providers.. As this won't be close to what the provider will charge, they will simply balance bill you for the rest of it.

Its close to having almost no coverage at all really.

[geekette]

From healthcare.gov:

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can't charge you more for getting emergency room services at an out-of-network hospital.

[DavidAnnArbor]

From healthcare.gov:

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can't charge you more for getting emergency room services at an out-of-network hospital.

These are one of the many safeguards under the ACA that actually make it an awesome legislation. It needs some tweaking, and the subsidies should clearly be expanded.

[Monkey Uncle]

I have an ACA BCBS plan and am covered across the country.  ACA plan coverage just depends on what's offered in your home area.

I can't think of a time, though, when I've wanted non-emergency care away from home.

Same here.

[Paul der Krake]

The shitty part is if you have a semi-emergency away from home, like a broken bone that could be fixed at an urgent care clinic, but now you're stuck either:
1) going to the ER, and paying in-network outrageous ER fees
2) going to the urgent care clinic and paying outrageous out of network fees

[use2betrix]

I have an ACA BCBS plan and am covered across the country.  ACA plan coverage just depends on what's offered in your home area.

I can't think of a time, though, when I've wanted non-emergency care away from home.

Yes we can't get BCBS plans here.. But our HD plan says we are covered for emergency services out of network. Of course what this really means is the plan will simply pay the OON providers the same as what they pay the in network providers.. As this won't be close to what the provider will charge, they will simply balance bill you for the rest of it.

Its close to having almost no coverage at all really.

This - exactly as I mentioned above. I do contract work all over the country. I’ve lived in about 15-20 cities and around 8 states over the last 9 years. In the last 14 months I’ve lived 2 months Phoenix, 4 months SC, 3 months Ohio, 3 months Louisiana, and spent 2 months on an 8000 mile road trip from SC to Canada and everywhere throughout the Rockies.

My shithole HMO plan in TX literally only covers emergencies. Like everyone else, I rarely see a doctor. I haven’t had a sick day from work in 8 years. That being said, in the black hills on vacation I became insanely sick and saw a doctor and got a script for about 4 prescriptions. Fortunately I was still on my employers PPO at the time (right before I got my HMO plan). The HMO plans also don’t cover prescriptions outside of network.

I am speaking all of this from vast personal experience for the several times I’ve purchased ACA garbage plans.

The plans are great for poor people/low income. I don’t knowoif a single working middle class person that has benefited this and countless people got screwed (I’m sure they exist, just don’t personally know them). Yes - we needed help for pre existing conditions. However for every 1 person that got helped there’s probably 100 people paying for it. Not to mention everyone else that’s supporting all the obese, non-exercising, non-healthy eating, smokers, etc. that are raising the rates. Not sure how rates can change for smokers though not the obese, as it’s the leading cause of preventable death in this country. Granted, it’s genetics and should probably be classified as a Pre existing condition with the direction our country is heading, with our complete lack of accountability.

[DreamFIRE]

The plans are great for poor people/low income.

It will be great for me when I FIRE if ACA is still around along with its subsidies.  I have 7 figures so not exactly poor.  Thank goodness boarder will be subsidizing my premiums along with CSR's.  :)

I've known plenty of people who have benefited from ACA.  It hasn't benefited me personally since I'm still on my company plan, but it sure could help when I FIRE.

Not to mention everyone else that’s supporting all the obese, non-exercising, non-healthy eating, smokers, etc. that are raising the rates. Not sure how rates can change for smokers though not the obese, as it’s the leading cause of preventable death in this country.

 Did you see this post?  Studies show that healthy people end up costing the most in the long run.
https://forum.mrmoneymustache.com/welcome-to-the-forum/'medicare-extra-for-all'-would-mean-even-more-motivation-to-rothize/msg1911572/#msg1911572

[Exflyboy]

From healthcare.gov:

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can't charge you more for getting emergency room services at an out-of-network hospital.

These are one of the many safeguards under the ACA that actually make it an awesome legislation. It needs some tweaking, and the subsidies should clearly be expanded.

Umm what safeguard is that? You go to an OON ER and all that means is your insurance co will pay them the IN-network rate... As this will be way less than the BS headline rate the hospital (and everyone in it) will charge.. you dear patient will be simply billed the balance... Probably thousands of $$ in the even of a heart attack or god forbid a stay in the ICU!

What YOUR insurance company charges you is irrelevant.. Your still on the hook for OON services you use no matter what the ACA says.

Am I missing something?

[DreamFIRE]

A new attack on the ACA...

Twenty states sue federal government, seeking end to Obamacare

(Reuters) - A coalition of 20 U.S. states sued the federal government on Monday over Obamacare, claiming the law was no longer constitutional after the repeal last year of its requirement that people have health insurance or pay a fine. ...

https://www.reuters.com/article/us-usa-healthcare/twenty-states-sue-federal-government-seeking-end-to-obamacare-idUSKCN1GB06R

It seems that since the existing ACA law was already in place and ruled constitutional, that the repeal itself would be unconstitutional prior to it being implemented as to prevent the existing law from possibly being ruled unconstitutional, there-by eliminating the repeal.

These are one of the many safeguards under the ACA that actually make it an awesome legislation. It needs some tweaking, and the subsidies should clearly be expanded.

You know it.  Some tweaking and shoring things up vs. sabotage would go a long way.   No need to scrap the whole thing when it can be fixed if there were the political will to do so.

[Monkey Uncle]

From healthcare.gov:

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can't charge you more for getting emergency room services at an out-of-network hospital.

These are one of the many safeguards under the ACA that actually make it an awesome legislation. It needs some tweaking, and the subsidies should clearly be expanded.

Umm what safeguard is that? You go to an OON ER and all that means is your insurance co will pay them the IN-network rate... As this will be way less than the BS headline rate the hospital (and everyone in it) will charge.. you dear patient will be simply billed the balance... Probably thousands of $$ in the even of a heart attack or god forbid a stay in the ICU!

What YOUR insurance company charges you is irrelevant.. Your still on the hook for OON services you use no matter what the ACA says.

Am I missing something?

I can't speak to the situation everywhere across the country, but I can tell you that for my ACA exchange plan, this is not true.  ER visits are treated as if they are in-network, regardless of whether the facility actually is or isn't in-network.  Once you are stable, of course, they will force you to transfer to an in-network facility.  But you will not be balance-billed for going to an out-of-network ER in an emergency.

[MrGreen]

From healthcare.gov:

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can't charge you more for getting emergency room services at an out-of-network hospital.

These are one of the many safeguards under the ACA that actually make it an awesome legislation. It needs some tweaking, and the subsidies should clearly be expanded.

Umm what safeguard is that? You go to an OON ER and all that means is your insurance co will pay them the IN-network rate... As this will be way less than the BS headline rate the hospital (and everyone in it) will charge.. you dear patient will be simply billed the balance... Probably thousands of $$ in the even of a heart attack or god forbid a stay in the ICU!

What YOUR insurance company charges you is irrelevant.. Your still on the hook for OON services you use no matter what the ACA says.

Am I missing something?

I can't speak to the situation everywhere across the country, but I can tell you that for my ACA exchange plan, this is not true.  ER visits are treated as if they are in-network, regardless of whether the facility actually is or isn't in-network.  Once you are stable, of course, they will force you to transfer to an in-network facility.  But you will not be balance-billed for going to an out-of-network ER in an emergency.

This was the explanation in my Summary of Benefits as well, when I was using an ACA plan.

[Exflyboy]

According to what I've read the ACA specifically does not exclude balance billing for OON emergency care, They are required to pay a reasonable amount based on the greater of 3 standards (don't ask me what they are).. But if there is a shortfall then the OON ER/ICU can easily balance bill you for the rest.

The only thing the ACA requires is that emergency services are "covered" for OON and that your insurance cartel cannot charge you any extra fees..

Here is an article.. I have found 3 similar ones.

http://www.dinsmore.com/publications/aca-patient-protections-provisions-for-out-of-network-emergency-department-services/

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs.html

http://www.modernhealthcare.com/article/20160521/MAGAZINE/305219913

[boarder42]

According to what I've read the ACA specifically does not exclude balance billing for OON emergency care, They are required to pay a reasonable amount based on the greater of 3 standards (don't ask me what they are).. But if there is a shortfall then the OON ER/ICU can easily balance bill you for the rest.

The only thing the ACA requires is that emergency services are "covered" for OON and that your insurance cartel cannot charge you any extra fees..

Here is an article.. I have found 3 similar ones.

http://www.dinsmore.com/publications/aca-patient-protections-provisions-for-out-of-network-emergency-department-services/

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs.html

http://www.modernhealthcare.com/article/20160521/MAGAZINE/305219913

so basically if you have a medical emergency out of network risk your life driving back to your coverage area or risk going broke.  not much different than the way people with pre existing conditions were treated under previous plans.  what a great piece of legislation this was!

[Exflyboy]

EXACTLY!.. According to the rules at least you are wide open for $$$ costs for emergency care OON.. Despite the fact you are "covered".

How this is administered in real life is dependent solely on how generous the OON provider is.

[boarder42]

EXACTLY!.. According to the rules at least you are wide open for $$$ costs for emergency care OON.. Despite the fact you are "covered".

How this is administered in real life is dependent solely on how generous the OON provider is.

would almost be better to be uninsured so you could negotiate the cost yourself rather than some 3rd party saying here you go this is what we'll pay you collect the rest from that guy over there.

[geekette]

I don’t equate the off chance of an individual having a major emergency while traveling and potentially being subject to large oop costs as “not much different” than the inability of many individuals to get insurance at all.

[boarder42]

I don’t equate the off chance of an individual having a major emergency while traveling and potentially being subject to large oop costs as “not much different” than the inability of many individuals to get insurance at all.

i would consider that to be the same thing since the individual traveling essentially has no insurance at all.  it doesnt have to be a major incident they have no insurance outside of the bubble around their county - however far that radius is based on the plan they have.

[Exflyboy]

Well there are rules as to what they have to pay.. so they will pay accordingly.. The thing you don't know of course is the difference between what they pay and the amount of the balance bill.

You can be pretty sure the balance bill will come directly from the providers BS "chargemaster" book so I suspect its open to negotiation.

That would be fun right after open heart surgery!

[NoStacheOhio]

I suspect some of the disparities come in how hard your plan fights for you. Depending on the insurer, they may be able to exclude balance billing as a condition of the provider accepting their payment.

I could see this being a huge problem for college students and young adults who live outside their (parent's) plan's area. This is a fixable problem, and doesn't require blowing up the entire system though.

[use2betrix]

I signed up for Cobra last year, which I’m entitled to, by law. After FOUR WEEKS of them taking my $1200 for two months of coverage, it still had not been activated. I eventually cancelled and went with the garbage ACA plan.

Also, my hernia surgery last year was about $28,000. I was in and out in about 3 hours. That was nearly twice as expensive as my previous hernia surgery several years earlier. It’s well documented that medical costs are rising to offset things as well.

[Monkey Uncle]

According to what I've read the ACA specifically does not exclude balance billing for OON emergency care, They are required to pay a reasonable amount based on the greater of 3 standards (don't ask me what they are).. But if there is a shortfall then the OON ER/ICU can easily balance bill you for the rest.

The only thing the ACA requires is that emergency services are "covered" for OON and that your insurance cartel cannot charge you any extra fees..

Here is an article.. I have found 3 similar ones.

http://www.dinsmore.com/publications/aca-patient-protections-provisions-for-out-of-network-emergency-department-services/

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs.html

http://www.modernhealthcare.com/article/20160521/MAGAZINE/305219913

Thanks for posting those links.  I wasn't aware of all those nuances.

I went back and re-read my insurance plan booklet.  In typical disorganized insurance booklet fashion, it addresses out of network emergency care in four widely separated places.  In three of those places, the wording leads me to believe that it is covered exactly the same as in-network emergency care.  However, one place does mention that the insured can be held responsible for "the excess of the amount the out-of-network provider charges over the amount [insurer] is required to pay."  Nowhere does it explain who determines what the insurer is required to pay, or how that determination is made.  Presumably the insurer gets to decide whatever it wants.  So I stand corrected on the potential for being balance-billed for out of network emergencies.

But please go back and re-read the links you posted -- this situation is not unique to ACA plans.  The language in those articles indicates to me that such balance billing is allowed under all insurance plans.  So in this respect, the ACA plans are no shittier than employer-provided plans (with the possible exception that you might get a narrower network under an ACA plan, and thus be more likely to encounter a balance-billing situation).  And the current situation is not as shitty as the pre-ACA situation, in which insurers were allowed to apply higher deductibles and co-pays for out-of-network emergency care. 

Ain't American health care grand.  It's pretty shitty, but not as bad as it used to be!

[Monkey Uncle]

I don’t equate the off chance of an individual having a major emergency while traveling and potentially being subject to large oop costs as “not much different” than the inability of many individuals to get insurance at all.

i would consider that to be the same thing since the individual traveling essentially has no insurance at all.  it doesnt have to be a major incident they have no insurance outside of the bubble around their county - however far that radius is based on the plan they have.

That is not the case across the board.  It depends on the plan you have.  My BCBS ACA plan provides coverage away from home through partnerships with other BCBS affiliates.  Your costs are determined by whatever the local BCBS has negotiated with the local providers.  So there is some uncertainty, to be sure, but it's not the same thing as having no coverage.

Edit: I should also add that ACA plans aren't categorically different from non-ACA plans in this respect.  IIRC, the plans I encountered through employer-sponsored insurance were also based on local, state, or regional networks, and it was up to me to pay attention to how they handled out-of-area claims.

[katsiki]

But please go back and re-read the links you posted -- this situation is not unique to ACA plans.  The language in those articles indicates to me that such balance billing is allowed under all insurance plans.  So in this respect, the ACA plans are no shittier than employer-provided plans (with the possible exception that you might get a narrower network under an ACA plan, and thus be more likely to encounter a balance-billing situation).  And the current situation is not as shitty as the pre-ACA situation, in which insurers were allowed to apply higher deductibles and co-pays for out-of-network emergency care. 

Ain't American health care grand.  It's pretty shitty, but not as bad as it used to be!

I believe you are right.  We just had our annual insurance meeting.  The insurance agent (employer plan) was discussing several scenarios.  He recommended that people wait or drive back if injured "mildly" while on vacation or out of the area.  In a "real" emergency, he said go to the ER anywhere.  If it is less serious, wait or drive home.  I almost laughed out loud.

[Exflyboy]

Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!

[Bateaux]

Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

[Gin1984]

Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!

That depends on the state.  In California, at least last I checked, balance billing was not legal.   

[boarder42]

Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

i still scoff b/c the current system isnt sustainable so do what you want you are not only way over saving to a 3% SWR your post acutally said you were saving another 1.5MM for those 2 specific things.  thats fine you'll likely die with multiple millions of dollars. and you're a year or so away from FIRE so you've already worked much longer than is likely necessary.  in your situation i'd have FIREd probably 5 or so years ago b/c thats got to be close to the minimum extra time you've worked to amass all that.  and i'd be on a healthshare plan.

[BFGirl]

Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

If you are able to save those kinds of sums for healthcare, that is great.  I'd love to have that kind of cushion and would likely plan for it if I was a high earner.   However, those types of sums are out of my reach unless I want to give up on FIRE before 65 or 70, so I'll have to take some risk of a medical catastrophe if I want to enjoy some years of freedom.

[Monkey Uncle]

Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!

That depends on the state.  In California, at least last I checked, balance billing was not legal.

California is one of six states that outright ban balance billing.  Fifteen other states place at least some restrictions on the practice.  My state (WV) prohibits emergency departments from balance-billing HMO members, but it does not protect members in any other setting, and it provides no protection at all for PPO patients.

http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/balance-billing-consumer-protections-states

[Monkey Uncle]

All of this reading on balance billing suggests to me that it is an evolving situation, and that providers and insurers are probably sensitive to giving the appearance of sticking it to the patient.  If I were to get a big balance bill, I sure as hell wouldn't just suck it up and pay.  I suspect a savvy consumer stands a decent chance of getting the provider and the insurer to work out a discounted solution so they can avoid entanglements with the state insurance commission.

[sol]

All of this reading on balance billing suggests to me that it is an evolving situation, and that providers and insurers are probably sensitive to giving the appearance of sticking it to the patient.  If I were to get a big balance bill, I sure as hell wouldn't just suck it up and pay.  I suspect a savvy consumer stands a decent chance of getting the provider and the insurer to work out a discounted solution so they can avoid entanglements with the state insurance commission.

My experience with that situation is that hospital will take the tax write-off by discharging the remainder of the unpaid debt to a collection agency.  That gives them a partial financial benefit without having to hound people for money, but it certainly does not free the patient from the burden of the debt.

[MrGreen]

Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!

I have trouble accepting this because balance billing is a practice specific to out of network. Balance billing for in network doesn't exist by the very definition of in network so how can they claim it's treated as in network but still balance bill?