The real life impact of reversing the ACA

[disneysteve]

As the current administration continues their efforts to dismantle the ACA, real people are seeing their lives turned upside down.

just one example. My cousin, who is being treated for metastatic cancer, has to now deal with his monthly premium skyrocketing from $350/month to $950/month as of January 1. He has more than enough to deal with. He doesn’t need this too.

At at least he is fortunate to still have coverage as about 17 million people will lose coverage entirely.

[Smallsteps]

I am sorry your cousin is faced with that. Many others have had this happen over and over again since the ACA was enacted.

The issue is the inability of either party to craft a compromise that could help more people then it hurts. These premiums were going up and up and up before this administration was even elected.
None of the funny math that promised so much savings and keep your plan or doctor worked out.

NO one has put up any ideas except socialized single payer that is NOT affordable or sustainable look at the British system.
From the Start, the ACA has been a burden for some and maybe a blessing for others.

Quite frankly some were ok until it hit their own personal wallets or altered their plans/ doctor choice or had insanely high deductibles.

The Career politicians just want to play the blame game and kick ANY resolution or progress on ANY issue to the curb.
Honestly as your point shows the attitude of "wait until we have x amount of majority and we can do this"...... then the other party says the same thing. The Congress and Senate are at fault for NOT addressing any options to either improve or change the ACA.

In your equation does the 17 million include those who chose to not buy insurance?
That is not losing coverage but CHOOSING to forgo it.

None of the signups/ or the number of people who transitioned to private or employer coverage were ever accounted for accurately. The signups ( on exchange) this year are reported as down from previous years is that because they now have JOBS that have benefits or they joined a medi-share program or maybe on someone else plan??
Or is it just more dramatic to say they LOST coverage because they are not going through that exchange system.

Even if some people disagree that people should have a CHOICE on their coverage, there are some who are not on meds and may only see a doctor once a year but the lowest premium they could get was 569 a month (seriously the one visit was about $100).
In the world of ACA they were expected to pay close to $6900 for a single visit ( no seriously the other $6800 should have been tax deductible charity since it only paid for others).

[disneysteve]

Even if some people disagree that people should have a CHOICE on their coverage, there are some who are not on meds and may only see a doctor once a year but the lowest premium they could get was 569 a month (seriously the one visit was about $100).
In the world of ACA they were expected to pay close to $6900 for a single visit

But here's where the discussion breaks down typically. You aren't getting insurance for what you already use. You're getting insurance for what you might use. I can't decide to drive without auto insurance just because I haven't had an accident in nearly 40 years. I'm legally required to have coverage. Medical should be the same way. You can't wait until you get sick to decide you want health insurance. It's too late then. The problem is when an uninsured person lands in the hospital, the hospital and tax payers end up paying that bill. I'd much rather pay it through a system that provides insurance for all.

I do agree, however, that the cost of the coverage needs to be affordable. As I said, with the ACA, my cousin paid $350/month. Now, without that support, he's going to be paying $600 more. He would kill to have his ACA plan back. Getting coverage without it is nearly unaffordable. Fortunately, he has the means to pay the higher premium but many people don't. He'd be screwed without it.

Millions of people got coverage, sometimes for the first time ever, thanks to the ACA. Our family practice was overwhelmed with new patients and returning patients we hadn't seen for years when the ACA went into effect. I hate the thought of many of those people now losing coverage again because their premiums skyrocket beyond what they can possibly afford. Repealing the ACA is a huge step backwards.

[Joan.of.the.Arch]

DS, will their coverage come to a screeching halt? For example, if someone had an ACA covered appointment next week, might they either be turned away or told to pay upfront for all services? If they had a treatment, therapy, or surgery scheduled, is being turned away likely? Do you think a lot of practices and hospitals will eat the costs for things that are already scheduled?

I hope the legal appeals are treated as a national emergency.

[disneysteve]

The signups ( on exchange) this year are reported as down from previous years is that because they now have JOBS that have benefits or they joined a medi-share program or maybe on someone else plan??

Sign ups are down. Some of that is probably because people got jobs with coverage, but a lot of it is likely due to the administration cutting the advertising budget by 90%. People didn't get the message that it was time to sign up, what they needed to do, or when the deadline was. Some states picked up the slack and ran their own ads and outreach programs and guess what - sign ups in those states are just fine.

[disneysteve]

DS, will their coverage come to a screeching halt? For example, if someone had an ACA covered appointment next week, might they either be turned away or told to pay upfront for all services? If they had a treatment, therapy, or surgery scheduled, is being turned away likely? Do you think a lot of practices and hospitals will eat the costs for things that are already scheduled?

If you can't make your January premium payment because your rate doubled or tripled, your coverage will get terminated. If you have appointments or surgery scheduled after the termination date, oh well. You're out of luck. And no, I doubt that practices and hospitals will pick up those costs. If you were coming to see me in my office, you either need to pay your copay if you have insurance or you need to pay the cash price if you don't have insurance. We don't provide free care. There is a system in place (charity care) for hospital services but that doesn't mean that everyone will qualify, and that only covers hospital charges, not doctor charges, meds, outpatient care, etc.

[Smallsteps]

[QUOTE=disneysteve;n699757]

But here's where the discussion breaks down typically. You aren't getting insurance for what you already use. You're getting insurance for what you might use. I can't decide to drive without auto insurance just because I haven't had an accident in nearly 40 years. I'm legally required to have coverage. Medical should be the same way.


I do not think the discussion breaks down at that point...…. for me it is the continued comparison to auto coverage.

Auto coverage is a joke depending on where you are... example being some states withhold car tags since it is the CAR that is insured ...and then it some states ( mine) still use the honor system. they assume people comply. The only way they find out is after the accident or if pulled over. So they get a ticket and threatened with losing their license.
I can hardly type because of laughter because now we have a bunch of people without a license and no insurance. still on the road everyday ……………... NO CAR I have ever encountered start with the inserting of a valid drivers license from ANY state. SO my uninsured motorist is twice the price as it was before the mandatory law to require auto insurance ( even when adjusting for average rates now vs then).

The whole SELLING point of the shared burden with BOTH types of insurance is that law will SAVE those who play by the rules money. NEITHER examples saved anyone any money.

We are told that we have to have same costs for health insurance based on income...…. not lifestyle or health. Discussion broke down when we started labeling others whom have different views instead of trying to change a persons perspective.
While I support pre existing conditions … where is the line...……. when defending this many use items that can not be helped or controlled by patient (like cancer or hereditary diseases) ...........but what about items that have some responsibility of the patient ??? …..examples chain smokers with lung issues and 400lb patients that need knee replacements or many other issues facing morbid obesity.

Health coverage is similar even with the ACA, many did not comply and do not even start with the FINE. Most did not pay it ...how some ask?? .……simple look at the tax forms since the passing of this ZERO accountability. The honor system again.
Just check a box yes ……... no policy # required or carrier no documentation at all. UNLESS you signed over your whole financial world to the health plan websites.
PRIVATE insurance not bought through the exchange ….the SSN is OPTIONAL on application.
To me this is as ineffective as saying STOP or I will yell stop again.
I still resent that every ACA compliant policy required many extras that many would NEVER use. Every policy was tagged with a pediatric dental cost / birth control cost ( regardless if you would NEVER need BC) and maternity even if you are a man. This is not in case you need it...……. this is strictly forced to subsidize.

I understand those who support the idea of I guess shared cost all around.

Would you would gladly pay more for Auto coverage so people with bad records with tickets and

DUI can pay the same as you or any other responsible driver ?
Surprise that, yes, years without an accident or tickets saves you MONEY on you car insurance. Being healthy or responsible consumer of healthcare saved ZERO in continuing rising of insurance.

The reality of prescheduled appointments is that insurance companies had to wait up to three months before droppings an ACA enrolled person even if they did not pay their co-insurance premium.
Most appointments will go through with clinics and doctors finding out after billing that the coverage is not valid.
The computer systems are not fail proof and I was told I did not have coverage when I did and clinic said yeah it is covered when it was not happens thousands of times everyday.

My favorite line was a person I worked with that was excited by the ACA they said her husband could not afford a plan before I asked her how much was an estimate of coverage??
she said " oh we NEVER priced it out the media told us we could not afford it before the ACA"

[disneysteve]

Smallsteps, I agree with many of your points. I think it is ridiculous that auto rates are based on your driving record, life insurance is based on your health condition and habits, but health insurance rates are the same for everyone. If you smoke, use drugs, are overweight, or have high cholesterol, you should pay more for your coverage.

I also agree that there needs to be an enforcement system for the mandate or else it's worthless.

As for coverage including things you won't ever use, that's a little harder. You can't go totally a la carte but maybe they could have 3 levels of coverage and you could pick the one that best meets your needs.

[Smallsteps]

Sign ups are down. Some of that is probably because people got jobs with coverage, but a lot of it is likely due to the administration cutting the advertising budget by 90%. People didn't get the message that it was time to sign up, what they needed to do, or when the deadline was. Some states picked up the slack and ran their own ads and outreach programs and guess what - sign ups in those states are just fine.

I am a bit confused by the idea there is a huge need for advertising to remind people to take care of their OWN responsibilities.
You said you had new patients and returning patients they must have been happy to get care, so why assume that they either can't or don't understand the way insurance works that you must renew your policy yearly... auto/ home and HEALTH.

I understood the first year to promote and some yearly to promote for NEW customers. Why do we need millions of dollars in ads every year?

I have seen/ heard PRIVATE companies that manage these plans, advertise to have them handle your plan or change plans, that really should be enough to remind people it does for MEDICARE.

Perhaps that is why we have such dismal retirement savings we have not massively funded a big Madison avenue ad campaign to remind people that they get older every year and will need to retire.

{quote}

As for coverage including things you won't ever use, that's a little harder. You can't go totally a la carte but maybe they could have 3 levels of coverage and you could pick the one that best meets your needs.

[/QUOTE]

The idea of levels of coverage may help, but if that was offered instead of the ONE size for all plan, it would have hastened the demise of the ACA.
The add on charges for items people can't use were needed to pay for this law.

It is really telling when politicians knew they could not TELL the truth so instead hid little charges on anything they could hoping no one would figure it out or just ACCEPT it.
I for one would have been a lot more understanding if we were not lied to about the ACA and told things like " we need to pass it to find out what is in it"

Disneysteve I appreciate that as a doctor you have seen some good out of this law … many of the rest of us have NOT.

[disneysteve]

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Perhaps that is why we have such dismal retirement savings we have not massively funded a big Madison avenue ad campaign to remind people that they get older every year and will need to retire.

I never really thought about it but you're absolutely right. If the government would stop spending millions (or billions) on programs to encourage people to spend more and borrow more and shift those funds to programs to encourage people to save more, the nation would be in far better shape. Stop forcing home ownership down everyone's throat. Get rid of programs that allow people to buy a house with little to nothing down. Instead, do more to promote savings. Increase IRA contribution limits. Instead of tax breaks for the wealthy, give more opportunities to save for retirement tax-free.

The idea of levels of coverage may help, but if that was offered instead of the ONE size for all plan, it would have hastened the demise of the ACA.
The add on charges for items people can't use were needed to pay for this law.

At the core, though, isn't that how most insurance works. You spread the risk as broadly as you can. Many, probably most, will never need or use the coverage but that's how they are able to provide it to those who do.

Disneysteve I appreciate that as a doctor you have seen some good out of this law … many of the rest of us have NOT.

I've seen almost nothing but good from the ACA. It has quite literally saved lives. People were finally able to get care for health problems that they had been neglecting for years due to lack of affordable coverage. We had many patients come back to our practice who hadn't had any medical care for a long time despite having serious health problems like high blood pressure and diabetes. Once the ACA happened, they were able to get back into treatment and get their conditions under control.

The one big negative I've seen has been over the past 2 years as people are now in constant fear of reinstating pre-existing clauses and becoming uninsurable again. Or losing ACA coverage all together and having to go back to buying insurance privately, which is out of the realm of possibility for many people, so that means going back to no coverage.

[Smallsteps]

I just realized this has become a discussion between 2 people. It is a issue that frustrates me greatly.

The Nanny state attitude will never solve this problem. It is impossible to legislate PERSONAL responsibility.
They will never charge extra for bad habits like smoking /drug abuse/ obesity because we classified these as PRE_EXISITING conditions.
No longer is an addict responsible but instead a victim.

In the middle of treatment for cancer / or other health conditions no one wants their plan or coverage to change.As you can attest that STRESS does not help with healing.

With that said, where is accountability....
Pre ACA I knew many who went without insurance some faced big bills but also WHAT they DID or DID NOT do said a lot about who is responsible.
I had jobs that offered $x amount per hour with benefits and $2 per hour more without...…. guess which one was more often then not?
This is a calculated RISK but if things went bad it was the EMPLOYERS fault? Does Vegas give your money back if you make a bad bet?

I had a retail job not high paying but had great insurance I worked the whole time while I had kids to have good dependable insurance. Stressful job with bad schedules.
A good friend had no coverage complained constantly but would not simply apply and work this job. Instead she wanted Prestige of a real career ( m-f / 8-5 job) and put her child who was born with a condition in jeopardy. AGAIN a personal choice of RISK.
So along comes the ACA , the governments ANSWER is a one size fits all idea that lowered my coverage, upped my prices and in their mind LEVELED some playing field.

My personal responsibility and sacrifice to do the right thing was equated as I was just LUCKY. Total BS.

Since this has passed I again have SEEN a much different reality then you have seen.
I have seen people turn down promotions or better job because and I quote " if I make more I will have to pay more for my coverage"
Seriously, one lady I talked to was completely clueless that her attitude was why her parents were on the verge of losing their coverage because they did not qualify for subsidies and basically were in a way, PAYING for her "good deal".

I have a friend whose husband has a skill in great demand but can't be hired because he has no drivers license. He lost it because he has many tickets and refuses to pay his fines.
So he works under the table for a mom and pop HVAC place driving their truck each day and Thanks to the ACA we the taxpayers are paying for insurance for his family with 6 kids.
If he would clean up his driving mess he could get on with a union job with many benefits, Health and Retirement, but instead he thinks he is screwing over "the man" not seeing that "the man" is his family, friends and neighbors.

My fear is that retirement will be the same way sooner or later.....The nanny state of everyone needs the SAME and will take what I sacrificed and saved for (it will be classified as just being LUCKY) and give it to someone who CHOSE to screw off.

[LivingAlmostLarge]

Yeah but smallsteps let's talk about the elephant in the room with health insurance! Employer provided coverage tax free. I mean that tax free benefits disproportionately favors the rich. It also makes it a free way to give benefits. Now if we wanted a true free market economic health market we would have to kill all employer provided coverage then allow the free market to take over. That means that EVERYONE is on level playing field of buying insurance.

That being said what do you think would happen? Your points are good but we aren't really on a free market healthcare and we really aren't on socialized. We have a hybrid. Subsidized health insurance, then socialized medicine with medicare/medicaid/tricare, then everyone else. If socialized medicine was so terrible then why are people "don't take away my medicare?"

Because it's truthfully UNAFFORDABLE for people above 65 to buy premiums. A very small sliver. Of course if we were on a free market health insurance market without a subsidizied employer insurance and other plans it might be a different case. We might have to not go after all treatments. We might have to make decisions about care based on cost.

Perhaps single payer seems expensive, but it has been proven fact that every other westernized country has it and it's cheaper than what we have now with higher stats for health and quality of life.

As for retirement Disneysteve says he grew up without pensions and he didn't know people with pensions. But the majority of private companies used to have pensions do not anymore. It has gone something like 90% to less than 15%. And so we haven't seen an en masse retirement yet of people who didn't have the social safety net. It started in the 1980s and 1990s that pensions started dropping. What age of people will not have it? I would say it will hit really in another 20 years. Because I started "working in 2000 and I'm generation X tail end, and most of generation X don't have pensions. But their parents pretty much most did. Many of my "middle"class friends whose parents were teachers, worked in government federal, city, state jobs all had pensions. But people in their 40s? Wait and see.

[disneysteve]

They will never charge extra for bad habits like smoking /drug abuse/ obesity because we classified these as PRE_EXISITING conditions.

And I agree that makes no sense. High blood pressure, sure. Diabetes, of course. Cancer, obviously. But smoking is a personal choice. Obesity is a personal choice. Those things aren't "pre-existing conditions".

I have seen people turn down promotions or better job because and I quote " if I make more I will have to pay more for my coverage"

But that was also a problem before. I've seen plenty of people who feel stuck in dead end jobs because the job has health insurance. They couldn't leave the job because they couldn't risk being uninsured. Even if they went to a new job that offered coverage, there was often a 90-day probation period before you were eligible. Yes, you could pay COBRA, but many couldn't afford that. This is a big part of the problem with insurance being tied to employment.

I have a friend whose husband has a skill in great demand but can't be hired because he has no drivers license. He lost it because he has many tickets and refuses to pay his fines.
So he works under the table for a mom and pop HVAC place driving their truck each day and Thanks to the ACA we the taxpayers are paying for insurance for his family with 6 kids.

And if not for the ACA, he and his family would be on Medicaid and taxpayers would be paying for it anyway. What's the difference? What really changed in this scenario with the introduction of the ACA?

[disneysteve]

As for retirement Disneysteve says he grew up without pensions and he didn't know people with pensions

I am currently in south Florida visiting a relative. He retired at 55 and is now 63. He has a very small pension ($400/month) but is otherwise on his own. His income is about $5,000/month. So $400 comes from the pension, $1,400 comes from SS which he just started collecting a few months ago, and the $3,200 comes from the investing he did during his working years. The pension is just pocket change, only 8% of his income.

So there are lots of people out there, including many already retired, for whom pensions were just never a big thing if they existed at all.

[LivingAlmostLarge]

DS my aunt and uncle were two school teachers who didn't save for retirement. Free medical for life, retired at 55, and now make around $8k/month from $2k SS each, $2k pension each. My mom makes like $4k/month for life from pension for social worker She never broke $60k. Free medical for life. And many many more. The statistics show at one time 88% of private sector workers had pensions. It's down to 33%. Starting in the 1980s. https://protectpensions.org/2016/08/...ctor-pensions/ So we haven't seen the impact yet. Assume it's 50% public and 50% private workers. And half of private workers lost pensions but only starting in 1980s. How long until 25% of the population start to see what happens when they try to retire without? And the workers covered by pensions have become a lot less.

But i agree that i've seen people look at jobs but not like the employer provided health insurance so they decide not to switch because they fear a less generous plan than they are used to? Or worried their doctors will not longer be covered going from BCBS to Aetna? How is this efficient? How is this free market?