Questions For Americans About New Health Insurance Exchanges

[GGT]

Will you enroll in an Insurance Exchange created under the Patient Protection and Affordable Care Act (aka Obamacare)...for your health insurance coverage?

Has your State agreed to participate and create their own Exchange...or has it refused and defaulted to the federal government instead?

If you already have employer-subsidized health insurance would you:
(A) Encourage your employer to use the Exchange...if it meant you had the same coverage, with less OOP premium or deductible costs?
(B) Negotiate for an 'exemption' from employer-subsidized policies...if that translates to a higher salary/wage or take-home pay, and choose your own insurance plan on an Exchange?


That's the short list of questions, obviously there are many more. Terms like "provide" or "offer" sound too vague from an employer perspective. And the Tax implications are clear as mud.

[Loki]

http://www.forbes.com/sites/theapoth...-62-for-women/

[GGT]

Damn, fastest reply ever!

It'll take me some time to evaluate that Forbes article....but at first blush it's got some inconsistencies, perhaps even fallacies, regarding premium costs. For the longest time people have been complaining that young and/or healthy folks aren't participating in our insurance-based system, with "skin-in-the-game"....until they show up in the ER with expensive injuries or illness.

[GGT]

If you shop for coverage on your own, you’re likely to see your rates go up, even after accounting for the impact of pre-existing conditions, even after accounting for the impact of subsidies.

That's misleading, if not patently false. I've been buying my own health insurance for over ten years, and premiums (for catastrophic coverage ONLY) were increasing 10-20% every time the Insurance Commission allowed rate hikes. Those are different from "open enrollment" periods, btw.

My personal premiums will likely go down, because the Exchanges will 'allow' me to participate in discounted Group Rates that were previously blocked-out for large employers. But it only works if more people participate, and expand the pool.

[Dreadnaught]

I've convinced 1.5 friends to opt-out of Obamacare and not bother with this crap (one is almost there) and pay the fee, while getting catastrophic health insurance. It's a better deal than what they will pay with the Obamacare plan.

The grass-roots war against this nonsense reform will take time.

[GGT]

I've convinced 1.5 friends to opt-out of Obamacare and not bother with this crap (one is almost there) and pay the fee, while getting catastrophic health insurance. It's a better deal than what they will pay with the Obamacare plan.

The grass-roots war against this nonsense reform will take time.

Yes, it will take time to explain why it's "nonsense" to give more people access to Health Insurance, when our system of Health Care is designed around Health Insurance.

The "grass roots" efforts began as repeal-and-replace. But there's never been a plausible replacement offered, or what to do about 40 million Americans without health care via health insurance. It's adding insult to injury when those same politicians defund Medicaid, public health clinics, and SNAP.

PS, If you're advising friends on whether it's a "better deal" to pay a fine for not having insurance, or buying catastrophic insurance....I hope you're an expert on medical bankruptcy law.

[Loki]

http://online.wsj.com/article/SB1000...139251304.html

Another source showing that the main effect of the Healthcare Reform is that young people (who tend to have much lower wages than their older counterparts) will now be subsidizing older people (who are far more likely to be sick). At least we know why GGT supports this.

[GGT]

Another source showing that the main effect of the Healthcare Reform is that young people (who tend to have much lower wages than their older counterparts) will now be subsidizing older people (who are far more likely to be sick). At least we know why GGT supports this.

I didn't expect to repeat previous debates about whether our current system is fubar, or the merits or flaws of ACA law itself....let alone reiterate that I didn't "support" Obamacare as it was written. One good part of the law was requiring insurance companies to allow children to remain on family policies until age 27. That helps those still in school or earning low wages.

Besides, younger people already "subsidize" elders and retirees in many ways, just like every other developed nation with aging populations. And older people "subsidize" youth from the day they're born, from maternal to pediatric healthcare....to university student health plans and campus clinics. Can we get past the strawmen?

[Ominous Gamer]

its almost as if that's how insurance works. rates from the profit makers cover the losses from the expensive ones.

else no teen ever would be able to drive.

[GGT]

Has anyone actually looked at the website healthcare.gov and looked at their options?

[Hazir]

One really has to wonder why the Americans are so hysterical about health care and paying for it. It's not like they get the best care for the best price that way. Not even if you look at it while not giving a damn about all the people with no insurance or insurance so crappy they might as well not have insurance.

[LittleFuzzy]

Has anyone actually looked at the website healthcare.gov and looked at their options?

No. I've been using catastrophic coverage only for years.

[Dreadnaught]

Besides, younger people already "subsidize" elders and retirees in many ways, just like every other developed nation with aging populations. And older people "subsidize" youth from the day they're born, from maternal to pediatric healthcare....to university student health plans and campus clinics. Can we get past the strawmen?

And it's doing a shitty job, so let's double-down on this strategy!

[GGT]

No. I've been using catastrophic coverage only for years.

Same here. That means OOP expenses for doctor visits, screening/testing, prescriptions, glasses, dental, and anything out-patient like physical therapy or counseling...plus 20% of any in-patient hospital costs incurred, after a $5,000 deductible. I have a type of health-savings account to cover most of that, but it adds up pretty fast with just 'routine' things.

I'm curious how those OOP costs effect a young guy like you, or if you have some coverage (dental or vision maybe) through your parents?

[EyeKhan]

Another source showing that the main effect of the Healthcare Reform is that young people (who tend to have much lower wages than their older counterparts) will now be subsidizing older people (who are far more likely to be sick).

Isn't this how health insurance is supposed to work??? Healthy (generally young) subsidize care for the sick (generally old)? There's no other way to care for sick people, is there?

Also, I've read that the actual exchange premiums are coming out generally lower than the government originally estimated... Shouldn't the direct competition generated by the exchange system work that way to drive premiums down? Sort of like a market-based solution?

@ Dread -- really? You are counseling people to pay money to stay uninsured (except catastrophic, noted) rather than even buying the cheapest insurance plan and getting things like annual physicals and what not? Shouldn't they at least compare the cost of an exchange plan vs. their catastrophic plan + fine and take the best deal?

[LittleFuzzy]

Same here. That means OOP expenses for doctor visits, screening/testing, prescriptions, glasses, dental, and anything out-patient like physical therapy or counseling...plus 20% of any in-patient hospital costs incurred, after a $5,000 deductible. I have a type of health-savings account to cover most of that, but it adds up pretty fast with just 'routine' things.

I'm curious how those OOP costs effect a young guy like you, or if you have some coverage (dental or vision maybe) through your parents?

I actually do have a separate dental (I never think of dental as part of health insurance for some reason, probably because it's a distinct plan of its own). I don't have vision, I pay for eye exams and new glasses out of pocket. The way the lack of vision affects me is that I only go in about half as often as they always tell me I should. They say an exam every nine months to a year and when I had vision coverage it went for a new pair of glasses every two. I go in for an exam every two years (and a good deal of that is that I HATE the examination and am an awful, uncooperative patient when I'm in there) and I end up buying new lenses every four years or so. My vision isn't changing much these days so it hasn't been a problem. The OOP costs for straight health haven't had much affect on me because I haven't needed any. I get a physical and check-up every eighteen months or so and that's it. I haven't had any health problems beyond the occasional cold or flu in some time.

[GGT]

Fuzzy, at what age do you think you'll need to upgrade your coverage? (I can't remember how old you are.)

One thing that's confounding about "health insurance" coverage is the difference between medical - dental - ophthalmic. Wisdom tooth extractions, broken jaws with wired teeth, and periodontics are medical/surgical. Conjunctivitis can be treated by a family doctor, but herpes near the eye, or eye trauma needs a specialist. And opticians aren't ophthalmologists. You can get a vision test at any Walmart, and buy glasses....but that doesn't mean they screen for glaucoma or macular degeneration.

[Loki]

Isn't this how health insurance is supposed to work??? Healthy (generally young) subsidize care for the sick (generally old)? There's no other way to care for sick people, is there?

Also, I've read that the actual exchange premiums are coming out generally lower than the government originally estimated... Shouldn't the direct competition generated by the exchange system work that way to drive premiums down? Sort of like a market-based solution?

@ Dread -- really? You are counseling people to pay money to stay uninsured (except catastrophic, noted) rather than even buying the cheapest insurance plan and getting things like annual physicals and what not? Shouldn't they at least compare the cost of an exchange plan vs. their catastrophic plan + fine and take the best deal?

Because in our society, what we need is to take money away from young people and give them to older people.

[EyeKhan]

Because in our society, what we need is to take money away from young people and give them to older people.

I'm not sure your argument makes any sense Loki. You understand how insurance in general works. You recognize there is no way to pay for the health care of the minority sick unless the majority healthy also pay into the insurance system. In health, it tends to line up with age. In auto insurance, it's the opposite. While the majority pays into the system to cover the accidents of the minority, the highest risk minority tends to be the young over the old. Age isn't really the point, its where the risk is highest. Maybe you are suggesting the higher risk people in the health insurance pool should pay more (substantially more?) in premiums? But to dismantle the whole thing, let the healthy majority opt out for example, makes the system unworkable. What other option is there, besides letting the un-wealthy unhealthy go without healthcare?

[Loki]

The difference being that the young pay substantially more for car insurance, while the effect of this policy is to increase the cost of health insurance for the young while decreasing the cost for the old.

And you're missing the point that this is ultimately benefiting the wealthy (on average) at the expense of the poor.

Who makes more money, your average 25-year-old or your average 50-year-old? Who benefits from Obamacare and who gets hurt by it?

[GGT]

Because in our society, what we need is to take money away from young people and give them to older people.

A wealthy, developed, first world, civilized society like ours used degrees of "wealth redistribution" for the Common Good for generations. That's a good reason for taxes (even if people hate paying taxes) and made the country what it is today...with public utilities, infrastructure, education, free libraries, healthcare etc. available to everyone, not just the wealthy or privileged.

The difference being that the young pay substantially more for car insurance, while the effect of this policy is to increase the cost of health insurance for the young while decreasing the cost for the old.

And many young drivers' premiums are paid by their parents, because it's cheaper (and less risk) when pooled with a family of drivers. But people don't have to drive a car to get around. They can walk, ride a bike, bum a ride, call a taxi, take the bus/train/subway. No such options exist for health care -- not the elderly with age-related diseases, the parents with a premature baby in NICU, the young folks who get cancer, or anyone with multiple trauma. Comparing health insurance to car insurance is absurd.

And you're missing the point that this is ultimately benefiting the wealthy (on average) at the expense of the poor.

Who makes more money, your average 25-year-old or your average 50-year-old? Who benefits from Obamacare and who gets hurt by it?

Are all your arguments going to be money-based, as if medical care is a zero sum game? The ACA is complex, and people have tons of questions....but your posts don't make much sense. I think you're under the false impression that Obamacare is a "government entitlement" program, like SS Medicaid, or Medicare. It's not. It's a government regulatory initiative, aimed at the Insurance Industry. That's why the first roll-outs were ending life-time caps, family policy age limits, and pre-existing disease exclusions/denials...along with the 80/20 rule that gave consumers millions of dollars in premium rebates. In exchange, the Insurance Industry wanted compulsory mandates, to increase their pools and offset profit changes. They lobbied hard for that, as did Hospitals.

[Loki]

Yeah, we definitely need a redistributionist program that favors the elderly at the expense of the young. It's not like we have social security, supplemental security income, or medicare.

I'll make this as simple as possible for you. Here are undisputable facts:

The average young person makes significantly less money than the average old person.
Obamacare will make health insurance more expensive for the average young person.
Obamacare will make health insurance cheaper for the average old person.

Do you not see the problem here? A vast majority of our entitlement spending is already getting spent on the old, who make substantially more money than the young. Why should we add to that?

[GGT]

Yeah, we definitely need a redistributionist program that favors the elderly at the expense of the young. It's not like we have social security, supplemental security income, or medicare.

Bastardizing terms like "redistribution" and "expense" doesn't give your argument strength or validity. The only reason you had access to public transportation, public education, or public health benefits (or even your family's desire and ability to immigrate).....is because others invested in your future well before you were born. Rather late to have second thoughts that look more like biting the hands that helped you get where you are today, or stingy sour grapes you don't want to extend to others.

I'll make this as simple as possible for you. Here are undisputable facts:

The average young person makes significantly less money than the average old person.
Obamacare will make health insurance more expensive for the average young person.
Obamacare will make health insurance cheaper for the average old person.

Do you not see the problem here? A vast majority of our entitlement spending is already getting spent on the old, who make substantially more money than the young. Why should we add to that?

Nothing in your post addresses the problems inherent in our healthcare system. Well, except for the fact that health insurance doesn't necessarily mean health care (which is why I didn't support the Bill as written). I'll add some additional, undisputed facts to make this "simpler" for you:

The majority of 'young people' have a longer life expectancy than their parents or grandparents, thanks to previous generations.
The bulk of modern scientific, medical, and technological R & D, innovations and advancements, were funded by your elders.
Personal medical bankruptcy currently outpaces every other type.
15% of today's Americans have NO health care coverage.

That's ~ 45 million people who don't qualify for Medicaid or Medicare programs, have no employer-subsidized insurance, and haven't been able to access or afford private insurance to help off-set the real costs of their healthcare needs. They end up delaying preventive care, and land in Emergency Rooms -- where costs are multiplied and redistributed to everyone, hiking premiums for those with Private Insurance, and cost-shifting to those with public-subsidized coverage and the tax base. Everyone "pays" to some extent.

Should an "Exceptional Nation" like the US treat healthcare like a privilege, and expect "certain" people to pay with their lives?

[Loki]

Remind me how making insurance twice as expensive for young people, a demographic the program is meant to encourage to get insurance, will lead to more young people getting insured?

[GGT]

Remind me how making insurance twice as expensive for young people, a demographic the program is meant to encourage to get insurance, will lead to more young people getting insured?

I'd remind you that conservatives and Republicans have been trying to "incentivize" (or demonize) the uninsured by labeling them dead-beats, leaches, moochers, regardless of age. Young people are the reckless, impulsive, selfish, "invincibles" that are the bane of actuarials and insurers. But without that youth participating, the whole model of insurance and risk pools, projected into the future, falls apart fast.


btw, that same principle is used when setting age requirements for marriage, driving, buying booze or tobacco, or enlisting in the military....even when the contradictions don't make sense.

[EyeKhan]

The difference being that the young pay substantially more for car insurance, while the effect of this policy is to increase the cost of health insurance for the young while decreasing the cost for the old.

Ok. So one thing you would change in the ACA is to increase the premiums for higher risk people?

And you're missing the point that this is ultimately benefiting the wealthy (on average) at the expense of the poor.

I don't see how you draw this conclusion. With the expansion of Medicaid and the means-tested premium subsidies I see literally hundreds of thousands of working-poor in Michigan gaining access to health care who never had it before. Working poor families are getting access for premiums around 50-100 bucks a month when before the ACA a reasonable family insurance plan would cost thousands a year.

Who makes more money, your average 25-year-old or your average 50-year-old? Who benefits from Obamacare and who gets hurt by it?

I'm all for progressive taxation and means-tested premiums, so you're preaching to the choir here. The problem is that policy would never have gotten past a Republican filibuster when the act was passed. The ACA is unfortunately what would pass the congress at the time.

As for hurt, as above a HUGE number of people left out of health-care pre-ACA are now able to participate. I see the old tricks of denial by pre-existing condition gone. I see 25-year-olds still covered on their parent's family plans. I see a very straight forward market-based system that by all early indications appears to be controlling premiums. If the price of that is that all healthy people have to pay into the system with some certain means-tested minimum premium, I fail to see tragedy.

[Dreadnaught]

Isn't this how health insurance is supposed to work??? Healthy (generally young) subsidize care for the sick (generally old)? There's no other way to care for sick people, is there?

Also, I've read that the actual exchange premiums are coming out generally lower than the government originally estimated... Shouldn't the direct competition generated by the exchange system work that way to drive premiums down? Sort of like a market-based solution?

@ Dread -- really? You are counseling people to pay money to stay uninsured (except catastrophic, noted) rather than even buying the cheapest insurance plan and getting things like annual physicals and what not? Shouldn't they at least compare the cost of an exchange plan vs. their catastrophic plan + fine and take the best deal?

Risk pooling =! subsidizing. And I think that's a key differentiator between the core concept of insurance and what we've actually got in our system these days.

I'm counseling my friends with these basic views-

1) They need to look at the plans being offered in detail. They will probably find that these plans don't really offer them too much they can actually use, especially for the money. Remember, these are people who have never bought insurance (ironically thanks to Obamanomics) and are reasonably used to not having it.

2) They should consider that they are being used as pawns in a desperate political numbers game.

3) They should consider either paying the fine and see how things develop (at least this year while the fine is relatively low) or just buy catastrophic insurance because they are more likely to experience a physical catastrophe than a heart attack. At least for the foreseeable future.

[Hazir]

Risk pooling =! subsidizing. And I think that's a key differentiator between the core concept of insurance and what we've actually got in our system these days.

I'm counseling my friends with these basic views-

1) They need to look at the plans being offered in detail. They will probably find that these plans don't really offer them too much they can actually use, especially for the money. Remember, these are people who have never bought insurance (ironically thanks to Obamanomics) and are reasonably used to not having it.

2) They should consider that they are being used as pawns in a desperate political numbers game.

3) They should consider either paying the fine and see how things develop (at least this year while the fine is relatively low) or just buy catastrophic insurance because they are more likely to experience a physical catastrophe than a heart attack. At least for the foreseeable future.

Now look who's near ready to vote for a Tea Party candidate. Your myopia is breath taking.

[EyeKhan]

Risk pooling =! subsidizing. And I think that's a key differentiator between the core concept of insurance and what we've actually got in our system these days.

The cheaper majority pays for the expensive minority with the understanding some of them will at some point join that minority. Better?

1) They need to look at the plans being offered in detail.

Oh, good. It sounded like you were bragging you talked them out of consulting the ACA insurance exchanges at all, out of some idealistic principle, which is stupid advice.

2) They should consider that they are being used as pawns in a desperate political numbers game.

3) They should consider either paying the fine and see how things develop (at least this year while the fine is relatively low) or just buy catastrophic insurance because they are more likely to experience a physical catastrophe than a heart attack. At least for the foreseeable future.

Or buy an insurance plan, after they look at the plans in detail, if they find one that gives them benefits they could use for a reasonable price. Right???

[GGT]

Risk pooling =! subsidizing. And I think that's a key differentiator between the core concept of insurance and what we've actually got in our system these days.

What is it you think we've actually got in our system these days? A functional, efficient, private, insurance-based healthcare system that delivers quality, affordable care to every citizen ?

*Pooling people with different risk factors evens out premium costs -- that's why group plans cost less for large employers. In exchange for higher numbers of enrollees (and total premium dollars), insurers give them special group discount prices, and negotiate with providers/hospital for reduced rates. <No small group or individual can do those things.> Those employers help "subsidize" the employee's premiums, giving them a false perception of costs, with coverage tied to employment (not transferrable or portable).

*This 'concept of insurance' has distorted the entire system of healthcare, from pricing to cost-shifting, to access/delivery and affordability....and even our tax structures. It's also done harm to job markets and local economies. Those large employers got huge tax credits for bringing jobs to town, and people desperate for employer-healthcare traded wages for health insurance.

*Millions of people got trapped in jobs they hate, under-employed or underpaid, reluctant to change careers or transfer/move -- because that health insurance was too important and valuable to risk losing, and COBRA has time limits. Millions more were working without any coverage but didn't qualify for Medicaid. Others had catastrophic plans, but outrageous bills still forced them into Medical Bankruptcy.

I'm counseling my friends with these basic views-

1) They need to look at the plans being offered in detail. They will probably find that these plans don't really offer them too much they can actually use, especially for the money. Remember, these are people who have never bought insurance (ironically thanks to Obamanomics) and are reasonably used to not having it.

How is "Obamanomics" the reason your friends have never bought insurance, and are used to not being insured? If it's because they're part-time or contract workers....that trend started in the 80's when large corporations restructured and/or downsized, escalated during the 90's with small business start-ups, and exploded during The Great Recession.

2) They should consider that they are being used as pawns in a desperate political numbers game.

This is nothing new. Both parties *and the Insurance Industry* have been using people as pawns in numbers games. I'd say our healthcare system is on life support, and it's real people who are desperate.

3) They should consider either paying the fine and see how things develop (at least this year while the fine is relatively low) or just buy catastrophic insurance because they are more likely to experience a physical catastrophe than a heart attack. At least for the foreseeable future.

But if they buy a policy on an Exchange, their preventive care (annual physical, vaccinations, flu shots, PAPs, mammograms, birth control, prostate and rectal exams, etc. are free of charge. (That may only apply to "Silver" level plans, not sure about that.) I hope you're also "counseling" them on financial liabilities not covered by all CAT plans....and an unfortunate accident/trauma can rack up a million dollar bill pretty quick. After they pay a deductible + 20%, they're still responsible for what their insurance doesn't cover.