Heeeeeeere's Obamacare!

[Unabogie]

Me, too.

Smallish premiums for minimal coverage has worked very well for my wife and I, allowing us to invest the savings so that if catastrophic illness ever hits, we could pay the deductibles from our savings/earnings. If we get lucky and stay well to very near the bitter end, our standard of living for our remaining years would be higher for the premiums not spent on unwanted insurance.

But the powers that be now know better than us what we really need.

So it goes...

I don't think this is as simple as you claim. Prior to the powers that be telling you what you need, lifetime and yearly caps were routine features of "minimal coverage". When my friend had a massive stroke (at age 40) he spent a month in ICU and then the next year in the hospital. His ICU bill alone was $800,000. I'm happy to hear you have that kind of money lying around, ready to spend on a health emergency, but my guess is you don't.

http://www.hhs.gov/healthcare/rights/limits/

This provision alone saved my friend from bankruptcy and losing his house when he couldn't work, and will never be able to hold a job again. Thanks to Obama, he didn't lose everything. Had this happened to you under your old plan, how would you have fared if not for the ACA?

 

[Kestrel]

You're not familiar with the age rating bands? Older people can only be charged 3x as much as young people, regardless of the relative risks. This requirement of Obamacare was implemented specifically to prevent insurers from using the actuarial age-based risks of insurees.

Of course, that's not the only restriction. In fact, there are very few factors that insurers are now allowed to use, and not all of them even to the full extent reflected by their actuarial risk. And again, this is intentionally and specifically designed to prevent insurers from using your actuarial risk to determine your premium.

The ACA forces insurers to use fewer factors in calculating premiums, but in the end they are still based on actuarial data. Otherwise how would an insurer comply with the requirement that 80% of all premiums collected be spent on medical services?

 

[Ziggurat]

The ACA forces insurers to use fewer factors in calculating premiums, but in the end they are still based on actuarial data.

Not the data of the insuree, though. Your claim was that low insurance rates were only possible if coverage was lousy, but that's not true. If your risk was low, then you could get a low rate even for good coverage. But since insurers can no longer charge you based on YOUR risk, rates can go up for people even when their coverage doesn't improve, if their individual risk was low. Remember, that's what we were talking about.

 

[Fast Eddie B]

I'm happy to hear you have that kind of money lying around, ready to spend on a health emergency, but my guess is you don't.

You can keep guessing.

But the overarching point is whose business is that one way or another?

As to that $800,000 bill, is anything being done to make that ICU stay more affordable? Is there no way to have good care without it costing $27,000 a day(!)?

And, until August Karen and I still have our high-deductible Aetna plan (the horror!). After August, that will be gone, as Aetna is pulling out of Georgia*, and I guess we'll have to get insurance for Karen that others deem acceptable.

It's the law. I just hope it's affordable!

* http://onlineathens.com/health/2013-07-31/two-insurers-pull-out-georgia-health-exchange

 

[Unabogie]

You can keep guessing.

But the overarching point is whose business is that one way or another?

As to that $800,000 bill, is anything being done to make that ICU stay more affordable? Is there no way to have good care without it costing $27,000 a day(!)?

And, until August Karen and I still have our high-deductible Aetna plan (the horror!). After August, that will be gone, as Aetna is pulling out of Georgia*, and I guess we'll have to get insurance for Karen that others deem acceptable.

It's the law. I just hope it's affordable!

* http://onlineathens.com/health/2013-07-31/two-insurers-pull-out-georgia-health-exchange

Considering that every day of that month, we didn't know if he'd be alive, that's probably what it has to cost. He had a bleed the size of an orange that just exploded in his head.

And the rest of the year was spent in a rehab hospital and included multiple surgeries and constant care.

 

[Grizzly Bear]

Considering that every day of that month, we didn't know if he'd be alive, that's probably what it has to cost. He had a bleed the size of an orange that just exploded in his head.

And the rest of the year was spent in a rehab hospital and included multiple surgeries and constant care.

I'm not going to guess much on your friend's case but one of my own friends had a 36 hour stay at the ER for observation and because he was uninsured he owes around $90,000 for that. That was for a few MRI's to make sure he didn't do any internal damage (his only injury was rug burn on his shoulder from the seat belt when his car got hit). I could sort of understand that more intensive care would justify higher costs, but I've never really understood how routine observation should be that ridiculously expensive.

I don't really question that if he had insurance he'd have minimized that debt, I just wonder the same thing about lowering any of the hidden costs that play into those exorbitant prices, as with anything dealing with insurance costs of premiums aren't only tied to individual or group risk factors, they're also dependent upon the costs they have to cover when coverage is rendered. So I tended to worry about premiums prior to the ACA being a debate.


ETA: In other news... I think at one point I posted some info on how much I'd be likely to spend on my coverage through this law. Here's my little update: so far it's about $117/month + $34'ish on dental with a partial subsidy incorporated into it. I'd have to check my plan options to say much about the coverage I have but it's a silver plan. It was in the lower cost bracket of what I sought out because I'm on a budget with this requirement to have the insurance hovering over my head. Will have to see about later but for now while I hate shelling out the extra money every month with my other bills in play as long as the premium remains stable and doesn't change radically I'll treat it like another normal bill.

 

[thaiboxerken]

I'm not sure why liberals are arguing with conservatives in this thread. The ACA passed and people are coming around to liking it because it is better than the "system" it replaced.

 

[Fast Eddie B]

Considering that every day of that month, we didn't know if he'd be alive, that's probably what it has to cost.

I guess, and I'm glad the care was available, at any cost.

But it still cost $800,000, which somebody has to pay, one way or another.

Unless we can somehow drive down costs, doesn't it seem a little like rearranging the deck chairs on the Titanic?

 

[Kestrel]

Not the data of the insuree, though. Your claim was that low insurance rates were only possible if coverage was lousy, but that's not true. If your risk was low, then you could get a low rate even for good coverage. But since insurers can no longer charge you based on YOUR risk, rates can go up for people even when their coverage doesn't improve, if their individual risk was low. Remember, that's what we were talking about.

In other words, you want all insurance policies to be based on a personal health evaluation so you can save a few bucks. And to hell with anyone with a pre existing condition.

The individual market for health insurance used to operate that way. The result was that only the people who could give the right answers to 50 or more health questions got insurance for a reasonable price. The same problem made it hard for small businesses to purchase insurance if any of the employees had a history of health problems. The large employer market worked better because the larger pool of policyholders made the risks more like the general population.

The ACA makes the individual market function more like the large employer market. With risks spread across a larger pool of policyholders.

So how do the new rules work in practice? Men pay a bit more, women a bit less. The 3 to 1 limit on age based premiums raises premiums a bit on young people and lowers premiums for those approaching Medicare age. Premiums for those without any existing health problems go up a bit and those with serious health problems can now buy insurance.

In my own case, I lost my discount for being male. Got a slight subsidy for being close to retirement age, and lost my heathy person discount. My old health insurance policy had the same deductible as my new exchange policy, but no cap on my out of pocket expenses. The old policy didn't cover prescription drugs, physical therapy or include any free preventive care. The new policy is only $15 a month more and I don't qualify for subsidies.

Several of my former co workers took a buyout offer and retired early. Every one of them had trouble finding insurance due to pre existing conditions.

 

[eeyore1954]

I don't think this is as simple as you claim. Prior to the powers that be telling you what you need, lifetime and yearly caps were routine features of "minimal coverage". When my friend had a massive stroke (at age 40) he spent a month in ICU and then the next year in the hospital. His ICU bill alone was $800,000. I'm happy to hear you have that kind of money lying around, ready to spend on a health emergency, but my guess is you don't.

http://www.hhs.gov/healthcare/rights/limits/

This provision alone saved my friend from bankruptcy and losing his house when he couldn't work, and will never be able to hold a job again. Thanks to Obama, he didn't lose everything. Had this happened to you under your old plan, how would you have fared if not for the ACA?

Maybe I misunderstood but I thought he was referring to a high deductible with catastrophic coverage . Then he would use savings for the deductible but the insurance would pay for the major bill above the deductibles.

 

[johnny karate]

That's always the excuse, isn't it? Disinformation only comes from one side, and that's the only reason people would ever dislike the law.

The law itself was passed because of a campaign of disinformation by Obama and the Democrats. To complain about that now is more than a touch ironic, and to blame that as the primary source of public discontent is more than a little delusional.

I'm not complaining. I'm making a statement of fact.

Enjoy whatever short-term gains you think the GOP can yield from this.

But I'm afraid the game is already over.

 

[Grizzly Bear]

I'm not complaining. I'm making a statement of fact.

Non-partisan fact checking groups would humbly disagree with your assessment. While it would be silly to suggest that all of the criticisms against the ACA are grounded in reality, it remains very clear that the law was also made out to be far more idealistic than it will be in practice for political reasons. And the inability to acknowledge such things is in my opinion a shame because there's always room for substantive improvement if indeed the law proves to be a long term success at the end of the day in it's basic premise. Since the ACA is likely to stay for the foreseeable future for better or worse, I'm sure some debate on ironing out the flaws should be plenty realistic if no viable replacement is found.

 

[Unabogie]

Maybe I misunderstood but I thought he was referring to a high deductible with catastrophic coverage . Then he would use savings for the deductible but the insurance would pay for the major bill above the deductibles.

Those kinds of plans went hand in hand. The lower the premium, the higher the deductible and the lower the yearly limits. Note this passage in the link I provided.

http://www.hhs.gov/healthcare/rights/limits/

The law restricts and phases out the annual dollar limits that all job-related plans, and individual health insurance plans issued after March 23, 2010, can put on most covered health benefits. Specifically, the law says that none of these plans can set an annual dollar limit lower than: $750,000: for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.
$1.25 million: for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.
$2 million: for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.
No annual dollar limits are allowed on most covered benefits beginning January 1, 2014.

I'm sure every plan was different before, but do you really think dirt cheap plans weren't sporting low yearly/lifetime caps?

Note the highlighted. That limit was lower than my friend Mike's stay in the ICU. It didn't even touch the yearlong stay in the hospital with a section of his skull sitting in a freezer.

 

[johnny karate]

Non-partisan fact checking groups would humbly disagree with your assessment.

You're saying non-partisan fact-checking groups disagree with my assessment that the GOP has used disinformation to discredit Obamacare?

I call shenanigans.

While it would be silly to suggest that all of the criticisms against the ACA are grounded in reality, it remains very clear that the law was also made out to be far more idealistic than it will be in practice for political reasons. And the inability to acknowledge such things is in my opinion a shame because there's always room for substantive improvement if indeed the law proves to be a long term success at the end of the day in it's basic premise. Since the ACA is likely to stay for the foreseeable future for better or worse, I'm sure some debate on ironing out the flaws should be plenty realistic if no viable replacement is found.

I agree.

Let me know when the Republicans get onboard.

 

[Ziggurat]

In other words, you want all insurance policies to be based on a personal health evaluation so you can save a few bucks. And to hell with anyone with a pre existing condition.

We were having a discussion about facts. I made a factual assertion, you asked me to support that assertion with a source, and I did. And now your response is to make a personal attack. That is not a recipe for a logical debate, or even for that matter a civil one.

Do not assign to me motives I have never expressed. Do not assign to me positions I have not expressed either. My factual assertions regarding actuarial risk and Obamacare's removal of much of that risk from premium calculations have been correct. If you read carefully, you will note that I have not yet, in this discussion, voiced ANY opinion on whether or not this is the right thing to do, I have only stated that this is, in fact, what Obamacare does. You are not challenging me on these facts. Your hostile response is unwarranted.

I know perfectly well the reasons why Obamacare removes these actuarial risks from premium prices. I am not ignorant of them, I did not deny their existence, I do not attribute them to malign motives, and I haven't even argued that they are wrong. All I have done is (correctly) describe what some of those changes are. If you want to argue for why these changes are the right thing to do, that's fine. I might continue the discussion on that topic, I might not, but regardless, what I have discussed so far has been facts, facts which you do not challenge. So again, a hostile personal attack in response to a correct assertion of facts is unjustified. Do you want to have an acrimonious personal fight? Or would you rather have a calm and deliberate discussion?

 

[Kestrel]

I'm sure every plan was different before, but do you really think dirt cheap plans weren't sporting low yearly/lifetime caps?

I keep running into people who don't understand basic insurance terminology. All too many equate the out of pocket cap in exchange policies to the yearly cap in their old policy.

 

[Unabogie]

I keep running into people who don't understand basic insurance terminology. All too many equate the out of pocket cap in exchange policies to the yearly cap in their old policy.

Exactly. Eddie B. is in his 60s. And unless Georgia's insurers are wildly exaggerating their costs, it's a state with high premiums. So how does a person in his 60s find a plan that only costs a fraction of what a comprehensive, no-limit plan costs? They place limits on how much they have to pay out.

Consider my friend's case. If he'd had a plan like this and incurred $800k in an ICU charge, then the high deductible would kick in for the first $25k. After that, the insurance would pay the rest, up to the annual limit. Let's say the limit was $500k. That means that he'd have been on the hook for a total of $325k. And this is at a time when his income was decimated. So he spent the next year in the hospital, which probably came out to around $2M. Of that, he would have been on the hook for $1.5M.

The ban on annual and lifetime caps is arguably the most important piece of Obamacare.

 

[Emily's Cat]

A really low premium is only possible if the insurance policy will not pay for expensive proceedures.

Not necessarily. When it's a completely risk-underwritten pool and doesn't cover maternity or drugs... it's not so hard to maintain a low premium with a low to moderate deductible and OOP Max.

Guys, there are a LOT of variables in this equation. I mean a LOT like you'll have trouble keeping all of them in your brain at the same time LOT. Like I can't even fit them all in the pricing model LOT. Not quite "stars in the sky" but most definitely bigger than the breadbox you keep imagining

 

[Emily's Cat]

Not anymore. That method of operation is, in fact, now prohibited by law.

This is false.

I believe that you are conflating underwriting with actuarially sound rate setting. They are two entirely different things, performed by people with entirely different backgrounds.

 

[Emily's Cat]

Not anymore. That method of operation is, in fact, now prohibited by law.

This is false.

I believe that you are conflating underwriting with actuarially sound rate setting. They are two entirely different things, performed by people with entirely different credentials. Sort of like conflating an RN and an MD, simply because you've seen them both in hospitals...