Obamacare 5 years later. Crow, anyone?

[ZirconBlue]

I still don't really understand how anyone had standing to sue in this case. Who was harmed by the Federal Governent subsidizing healthcare?

 

[Tony Stark]

I still don't really understand how anyone had standing to sue in this case. Who was harmed by the Federal Governent subsidizing healthcare?

You're right. But I'm glad SCOTUS decided to to take the case. It will make it much harder for Republican scumbags to challenge the law in the future.

 

[Spindrift]

You're right. But I'm glad SCOTUS decided to to take the case. It will make it much harder for Republican scumbags to challenge the law in the future.

And regular Republicans, too.

 

[Ampulla of Vater]

Marco Rubio was just laying out the same lazy talking point about people having low premiums but when they go to the hospital they are hit with a $4,000.00 deductible bill! Demonstrating that he either doesn't understand what a deductible is or he is deliberately lying.

How is it not true?

ETA: Never mind, I see that it was discussed further and Emily set the record straight.

 

[Tony Stark]

And regular Republicans, too.

Well most of them are scumbags.

 

[applecorped]

Well most of them are scumbags.

Excluding members here I take it?

 

[Tony Stark]

Excluding members here I take it?

No comment.

 

[Marcus]

I am very relieved to learn I will not be losing access to affordable health insurance as I am sure many self employed people across the country are today.

Me too. I've been self-employed for 37 years, I never had health insurance until Obamacare came along.

 

[Emily's Cat]

When I got Medicaid I qualified for and got my surgery. I also got the subsequent bill (paid for by insurance). Total hospital, anesthesiologist and hospital bill? $9,000. Kinda makes my $2,000 discount that I had "negotiated" look like a sucker's special.

So, I asked one of my clients (medical billing) why I was unable to negotiate a better deal. Simple, volume. It's like the difference between wholesale and retail. I could only offer a one time deal to a surgeon. An insurance company can offer a lifetime of income.

Also, Medicaid dictates the rates. There's no negotiation on the part of the hospitals and providers - they either take Medicaid rates (which are set by law), or they don't do Medicaid business. For a lot of doctors, they're quite content not to take any Medicaid patients. For hospitals, it's a lot more complicated, since even private hospitals usually have some degree of state or county funding. If they don't play ball with the state, they don't get the funds.

 

[Emily's Cat]

Oh, so you're to blame?

Sometimes, yes.

I *mostly* support our marketing and consumerism teams... but I do some pricing on occasion.

 

[Marcus]

I know you didn;t ask me, but I'm going to answer anyway. My opinion is that the legal question was baloney. Contextually, it was abundantly clear that subsidies were intended to apply at any exchange, and be administered at the state level. When you actually read the bill, where it says "state exchange", it is contextually clear that this is intended as "state level of exchange" as opposed to "state run exchange". It was a stupid case from the get-go.

My policy opinion is that ACA is just about the worst possible way to marginally improve a broken system. It's better than the morass we had before... but they gained that teensy improvement through about the most ridiculous approach they could have. Basically, ACA pretty much sucks, but it sucks slightly less than pre-ACA.

I will say, however, that several of the bits that were undefined in the bill itself have been implemented surprisingly well. Risk Adjustment, de minimus ranges around metallic levels, Reinsurance, and a few others have been developed in a pretty sound fashion.

If you are one of the previously uninsured, the suckage level appears quite low compared to before.

Why do you say so? I don't follow you here.

This is actually a concern of mine - some Bronze plans have $4000 or $5000 deductibles. Sure the premium is low, but if you end up in the ER or admitted to the hospital, you WILL get a massive bill. So I'm not really sure what you think a deductible is, and how it works...

I have a Silver plan, the deductible is $150. Perhaps someone can provide the stats on what percentage actually have those catastrophic plans.

 

[Giordano]

Did I miss something? Are the Republicans in Congress introducing bills to low the deductibles in the bronze/lower end plans, and thus make it more affordable to low income groups?

 

[Dread Pirate Roberts]

Does having a work option prevent you from getting a different plan on your own through the exchanges?

What is the monthly cost for those plans? Add a little more than $200/month to that payment for the lower deductible plan and you have your actual premium. Is it outrageous or not?

I'm not sure what you are complaining about, or am I misreading your post?

No complaints. Meadmaker had asked if there were non-HSA plans out there with higher deductibles, and I replied. Medical is $130/pay period (bi-weekly) for me and my kids. Now that you mention it, I'll check with HR on your first question.

Thanks

 

[Skeptic Ginger]

No complaints. Meadmaker had asked if there were non-HSA plans out there with higher deductibles, and I replied. Medical is $130/pay period (bi-weekly) for me and my kids. Now that you mention it, I'll check with HR on your first question.

Thanks

So you are paying less than $500/month for insurance for you and the kids. That's if you used your whole deductible. (or more if you have the 5K deductible)

Sounds like a good deal to me.


High deductibles are not a bad thing if the monthly rate is low enough. People in good health should choose high deductible plans.

I think mine is around 4K and it's an HMO I had before the ACA. My monthly rate went down and copays went up. But copays cut down on costs for everyone. When things are cheap, doctors order more tests. Now they think more carefully about them.

 

[Emily's Cat]

I have a Silver plan, the deductible is $150. Perhaps someone can provide the stats on what percentage actually have those catastrophic plans.

Average Ded for Silver plans in WA state is around $2500. If, however, you qualify for a Cost-Share Reduced Silver plan, your cost shares (including deductible and out of pocket max) could be significantly reduced. Over 50% of my Book of Business have Bronze plans - all of which have deductibles that are $5250 and above.

In 2014, the lowest Bronze plan deductible in my area had a $5000 deductible for individuals, $10000 for families. Our state exchange reported a little over 50% of the people who enrolled through the exchange selected Bronze plans.

So... I'd say "A Lot" is the answer to your question

 

[Marcus]

Average Ded for Silver plans in WA state is around $2500. If, however, you qualify for a Cost-Share Reduced Silver plan, your cost shares (including deductible and out of pocket max) could be significantly reduced. Over 50% of my Book of Business have Bronze plans - all of which have deductibles that are $5250 and above.

In 2014, the lowest Bronze plan deductible in my area had a $5000 deductible for individuals, $10000 for families. Our state exchange reported a little over 50% of the people who enrolled through the exchange selected Bronze plans.

So... I'd say "A Lot" is the answer to your question

I'm surprised half the people using your state exchange opted for a Bronze plan. I believe a large percentage of ACA users are getting premium subsidies, so why not spring for the Silver? Do you know if this a nation wide trend or just an anomaly in your state?

ETA: I just noticed you said the average deductible for Silver plans (not Bronze plans) is $2500. So I guess i have a really good plan, I have no idea why, I just looked for the most attractive one when I signed up.

 

[Kestrel]

Average Ded for Silver plans in WA state is around $2500. If, however, you qualify for a Cost-Share Reduced Silver plan, your cost shares (including deductible and out of pocket max) could be significantly reduced. Over 50% of my Book of Business have Bronze plans - all of which have deductibles that are $5250 and above.

In 2014, the lowest Bronze plan deductible in my area had a $5000 deductible for individuals, $10000 for families. Our state exchange reported a little over 50% of the people who enrolled through the exchange selected Bronze plans.

So... I'd say "A Lot" is the answer to your question

I fear that many of those Bronze plans were sold to families that qualified for a cost sharing on a Silver plan.

 

[Meadmaker]

The only plan provided by my company has a $2,500 individual and $5,000 family deductible, and it's not an HSA. It's been at that level for at least the past 4 years.

Interesting. I think those are high enough to offer an HSA. Can you start your own if you are in one of those plans? I've never had a high deductible plan that didn't have an HSA attached, but I always read the tax forms, and it doesn't seem like they are inherently linked.


At any rate, high deductibles aren't necessarily bad. Low premiums and high deductibles is a good combination for a lot of people. To hear Republicans talk about the horrors of having high deductibles is really weird. Even without the HSA portion, those are pretty Republican plans.

ETA: Looked up IRS regs. If your deductible is as high as the congresscritters were whining about, you are eligible to start your own HSA. It doesn't have to be affiliated with an employer. And if you can possibly afford it, you should. So, it seems that the republicans are, indeed, whining about a scheme they created.

 

[Emily's Cat]

I'm surprised half the people using your state exchange opted for a Bronze plan. I believe a large percentage of ACA users are getting premium subsidies, so why not spring for the Silver? Do you know if this a nation wide trend or just an anomaly in your state?

I believe it's true in *most* states. It's true of all but one state in which we operate.

Yes, a fair number (about 40% or so, varies significantly by state) get premium subsidies. But that subsidy is a "bucket of money". So they can get, say, $500 off on a $700 Silver plan, or they can get $500 off on a $450 Bronze. If they're healthy, and don't have much medical need, there are many people who can get a Bronze plan for $0 premium.

Silver has a really large number of policyholders too, of course - much more than we would expect without subsidies and cost-share reductions. When I compare the membership distribution On Exchange to Off Exchange, there's a really dramatic difference, even though the plans offered are substanitally the same. There's no difference in pricing, and for all the biggest carriers, they offer the same plans On and Off. On Exchange, is't something like 40% Bronze, 45% Silver, and 15% Gold. Off Exchange it's more like 60% Bronze, 35% Silver, and 5% Gold. The subsidies really affect what level of coverage people choose. In aggregate though, it ends up being about half in Bronze.

 

[Emily's Cat]

I fear that many of those Bronze plans were sold to families that qualified for a cost sharing on a Silver plan.

Well, yes, some of the people who selected a Bronze plan qualified for a Silver with a Cost-Share reduction (CSR). I'm not sure why you say "fear" and "sold" though. It's not like the Bronze has been "pushed" or anything.

I believe it's really more an effect of the subsidy being a "bucket of money" than anything else. Sure, you might qualify for a $150 deductible and $10 Office visits on a CSR Silver Plan... But if you're healthy enough, that might not really matter much. Let's say the Silver plan costs $400 per month, and the Bronze costs $275. If your subsidy is $300, then you end up with a choice:

• Pay $100 per month for a Silver plan, and get lower cost sharing or...
• Pay $0 per month for a Bronze plan, with higher cost sharing

If you believe that you're unlikely to use the services, then the Bronze is a better deal. The lower cost sharing only has value if you expect to use those services.