Let's talk health plans!

[disneysteve]

Back in the day 70's & 80's, we were allowed to deduct ALL our medical expenses from our taxes. It was wonderful. What insurance didn't cover, was a deduction. Now, at least for 2017, the medical decutions is based on a percentage of your income.

Medical deductions have been based on a percentage of income for a long time. I don't remember the exact figure but 7% sticks in my head. But I also think the new tax rules change that.

[TexasHusker]

Rather than just giving a snarky sarcastic response, is it even remotely possible that you could recognize the fact that just because the ACA plan didn't work well for you and your family, it has benefited tens of millions of Americans?

I think that ACA has benefited a lot of people, but on a very short term basis. In the scheme of things, it was a band aid on a fire hydrant. That isn't a political statement. It's a math statement.

Politicians inserted themselves into health care (this isn't the first time), and created a profoundly complicated bill that has proved completely untenable in even the medium term. The reasons for that are:

1. No medical underwriting and you can sign up or drop at any time. That right there is a death knell, because that's not the way insurance works. In the insurance world, a risk is analyzed by actuaries, and the risk is then monetized. If an insurance company consistently ends up paying out more than it takes in, it goes bankrupt. Politicians don't care about that.

No medical underwriting and you can sign up or drop at any time means there is no ability for the insurance company to evaluate the risk and price the product appropriately. Thus, while the politicians call it insurance, it's really just welfare.

That is why insurers are bailing on this and will continue to do so. Insurers are not charitable foundations; they are businesses owned by shareholders. If you own a 401K, you likely own some Aetna, Cigna, or United Health, and you probably want those companies to post a profit now and then. Politicians are only worried about getting re-elected. They have their own fat retirement plans, and their own customized health plans.

2. Essential benefits. Politicians decided what the average insured needs, and mandated these across the policies. Big troubles.

3. No funding. All of the subsidies for the insurance plans have to come from somewhere. Politicians only funded enough of the ACA plans to get them through their re-election cycles. Now that Obama is gone, there is no stable funding in place: The initial start-up funding was wholly inadequate and has run dry.

So yes, while ACA might have helped some folks (on the whole, not very many), it was a very short term fix. If I am bleeding to death, yes, a band aid applied will help me hang on for a couple extra minutes.

This patient was on life support from the beginning.

We have to decide if we want the gubmit in healthcare or not. If the gubmit is going to control healthcare, it needs to control all of it. Like the post office. Canada is the nearest example of this. If you like the Canada system, this is the ticket.

On the other hand, if healthcare is free market, then it needs to be free market. All of it. No gubmit price controls (like Medicare) that have cost shifted most of the real cost of healthcare over to the private sector through their absurdly now reimbursements for most things.

Pick your poison. If you want your healthcare plan designed by politicians, you need to keep voting Democrat. "Affordable Care Act" is the ultimate oxymoron. It isn't affordable, it isn't providing care, and it wasn't an Act. It was a Ponzi Scheme.

[disneysteve]

Thank you for a much more articulate response.

No medical underwriting and you can sign up or drop at any time means there is no ability for the insurance company to evaluate the risk and price the product appropriately.

This is actually a problem with health insurance in general, with or without the ACA. If you work for Company ABC, you are eligible to buy coverage with the health plans they offer regardless of your health status, and everyone pays the same rate. The insurer has to cover you. It doesn't matter if you're 21 and in perfect health or 55 and have diabetes and heart disease.

Plus, you might work for Company ABC for a year or two and then move to Company XYZ for a while and then Company PDQ, each time jumping to a new insurance plan.

One effect of this which we don't often talk about is that insurance companies have no need to think long term when deciding on what they will and won't cover. For example, they often refuse to cover the best diabetes drugs even though there is very good research showing the long term benefits of those drugs and how they decrease heart disease and other complications of diabetes. But they don't care because they know very well that it's highly unlikely that the patient will still be on their insurance 10 or 15 years from now when those complications arise. It will be on some other company's dime.

This is one solid argument for universal coverage. It creates much more of an incentive to not just look at what will make the most money this quarter but rather what will lower overall costs over years or decades.

[LivingAlmostLarge]

You have to be above 7.5% of income. Mostly nursing home and catastrophic hit that.

Texas, what do you propose if not obamacare? How do you allow insurance to be in the hands of the consumer if MOST consumers are covered by an employer provided coverage as described by DS. I mean all of our military is covered by tricare right?

So unless we completely hand it back there are two universal groups that are large. Military and seniors. I suspect we'll have trouble getting seniors off of medicare...

[TexasHusker]

Thank you for a much more articulate response.



This is actually a problem with health insurance in general, with or without the ACA. If you work for Company ABC, you are eligible to buy coverage with the health plans they offer regardless of your health status, and everyone pays the same rate. The insurer has to cover you. It doesn't matter if you're 21 and in perfect health or 55 and have diabetes and heart disease.

This is incorrect. In group health plans, insurers do NOT blindly accept the group without extensive actuarial analysis and medical underwriting. If the there are major ongoing conditions (liver transplant, cancer) that have not resolved, the insurer might well no-bid the group. The insurer takes inventory of the entire group and assigns a premium based on that analysis. Of course, a new employee might bring a medical condition, etc., but insurers have such occurrences figured into their actuarial analysis.

That is entirely different than ACA, which allows folks to join before, during, or after a major medical event. Insurers have absolutely been creamed through the first few years of ACA, and it won’t survive unless Medicare takes the whole thing over. The insurers are OUT.

[disneysteve]

The insurer takes inventory of the entire group and assigns a premium based on that analysis. Of course, a new employee might bring a medical condition, etc., but insurers have such occurrences figured into their actuarial analysis.

That's what I meant. Our company has over 9,000 employees. There are new people coming on board on a nearly daily basis. Our health insurance rates are set annually. Someone hired today is eligible for the plan at the 2018 rates regardless of their age or health issues. There is no individual underwriting to my knowledge. If you meet the employment requirements to participate in the plan, you can do so.

[james.hendrickson]

That is entirely different than ACA, which allows folks to join before, during, or after a major medical event. Insurers have absolutely been creamed through the first few years of ACA, and it won’t survive unless Medicare takes the whole thing over. The insurers are OUT.

Here in Oregon the ACA exchange lost most of the major insurers about a year ago. This is a very real issue.

[TexasHusker]

That's what I meant. Our company has over 9,000 employees. There are new people coming on board on a nearly daily basis. Our health insurance rates are set annually. Someone hired today is eligible for the plan at the 2018 rates regardless of their age or health issues. There is no individual underwriting to my knowledge. If you meet the employment requirements to participate in the plan, you can do so.

If your company has over 9,000 employees, your company is its own insurance company: It is self insured. You likely have an insurance company administering the plan, and the plan likely has reinsurance. While folks come and go from the plan all of the time due to terminations/new employment, there is very likely a significant waiting period before insurance coverage begins. It is also likely your plan requires a certificate of credible coverage for any employee coming from another employer. Finally, employees very likely cannot jump on and off the plan based on their health status. They can only jump on and off at open enrollment, and if they jump off, there likely are significant limitations to their coverage the next year when they jump back on, especially if they cannot produce a letter of credible coverage for the year in which they were off.

Your self funded plan sets premiums based upon historic claims for the 9000 employees plus dependents, ongoing medical conditions, and trend analysis. That premium is recalculated each year.

The concept of insured risk includes actuarial analysis for a defined group, overall stability of the defined group for a set period of time, and assurance of earned premiums of group for a set period of time.

Crafted by politicians instead of insurance experts, “ACA” contains none of these key provisions, which has resulted in systemic failure of the bill after the artificial funding mechanisms depleted.

There are no insurers prepared to underwrite a welfare plan.

[TexasHusker]

Here in Oregon the ACA exchange lost most of the major insurers about a year ago. This is a very real issue.

https://www.cnbc.com/2017/06/13/map-shows-where-people-could-see-zero-few-obamacare-insurers-in-2018.html

Much of the country is already down to one insurer. Most is down to one or two insurers. And that one insurer “insures” that it doesn’t have new enrollees by raising the “premiums” to amounts that are untenable to all but those that are heavily subsidized.

In other words, much of the country has insurers IN NAME ONLY - the remaining insurers have quasi-withdrawn from the market by setting outrageous premiums.

[TexasHusker]

It's been a while since I looked at the exchanges, so I went and looked at Travis County (Austin) TX and surveyed the rates.

To buy the el-cheap, bargain-basement Bronze plan, it looks like this:

$1700 a month for a family of four. So that's $20,400 before you even use the insurance.

But before you can use the insurance, you have a $5600 per person deductible.

So if dad gets sick, the family will have to pay $26,000 before a dime of insurance pays.

After dad reaches is $5600 deductible, he now has a 50% coinsurance.

So let's say dad reached his deductible and after that, he had to have a 1-hour shoulder repair. The bill was $11,000, but the insurer got it down to $7000. Ol' dad has to pay half of that - $3500 - for his coinsurance.

Oh, don't forget the $600 Outpatient Surgical Center fee.

So dad gets his shoulder repaired, and has paid $30,100 for his insurance to pay half of a shoulder repair surgery - $3500.00

That's not insurance. That's insanity.


Oh but it's stupid to buy such a trashy policy, why not upgrade to the SILVER plan for more benefits?

That policy for a family of four comes in at $2548 per month. $30,576 just in premiums.

But with the SILVER plan, dad's deductible is only $1450!

So dad meets his deductible of $1450, whew!

But dad still has 50% coinsurance for an MRI and a shoulder repair - the price of those for the insurance co was $6500 - so dad is out $3250.

And dad still has his outpatient surgery facility fee of $600.

So this time, the family paid out almost $36,000 in premiums, deductibles, coinsurances, and admissions fees, all for the insurance co. to pay $3250.



ACA - what a well-crafted, sensible solution to healthcare finance. AFFORDABLE. CARE. ACT. Hahahaha!

[Thrif-t]

^TH that's scary!! I'm thanking God for my DH's benefits. I can't imagine, Yikes!

[msomnipotent]

It's been a while since I looked at the exchanges, so I went and looked at Travis County (Austin) TX and surveyed the rates.

To buy the el-cheap, bargain-basement Bronze plan, it looks like this:

$1700 a month for a family of four. So that's $20,400 before you even use the insurance.

But before you can use the insurance, you have a $5600 per person deductible.

So if dad gets sick, the family will have to pay $26,000 before a dime of insurance pays.

After dad reaches is $5600 deductible, he now has a 50% coinsurance.

So let's say dad reached his deductible and after that, he had to have a 1-hour shoulder repair. The bill was $11,000, but the insurer got it down to $7000. Ol' dad has to pay half of that - $3500 - for his coinsurance.

Oh, don't forget the $600 Outpatient Surgical Center fee.

So dad gets his shoulder repaired, and has paid $30,100 for his insurance to pay half of a shoulder repair surgery - $3500.00

That's not insurance. That's insanity.


Oh but it's stupid to buy such a trashy policy, why not upgrade to the SILVER plan for more benefits?

That policy for a family of four comes in at $2548 per month. $30,576 just in premiums.

But with the SILVER plan, dad's deductible is only $1450!

So dad meets his deductible of $1450, whew!

But dad still has 50% coinsurance for an MRI and a shoulder repair - the price of those for the insurance co was $6500 - so dad is out $3250.

And dad still has his outpatient surgery facility fee of $600.

So this time, the family paid out almost $36,000 in premiums, deductibles, coinsurances, and admissions fees, all for the insurance co. to pay $3250.



ACA - what a well-crafted, sensible solution to healthcare finance. AFFORDABLE. CARE. ACT. Hahahaha!

This sounds exactly like the insurance I had through the state years ago. It was called the high risk pool because it was basically the insurance of last resort for people that couldn't get health insurance anywhere else.

[disneysteve]

It's been a while since I looked at the exchanges, so I went and looked at Travis County (Austin) TX and surveyed the rates.

To buy the el-cheap, bargain-basement Bronze plan, it looks like this:

$1700 a month for a family of four.

I'm not exactly sure how to find the family rates here in NJ but I did find the individual rates. The Bronze plan is about $250/month which I think is pretty reasonable.

There is also a plan below the Bronze plan called the Catastrophic plan which I'm guessing only covers really major stuff. That runs about $180/month.

[TexasHusker]

I'm not exactly sure how to find the family rates here in NJ but I did find the individual rates. The Bronze plan is about $250/month which I think is pretty reasonable.

There is also a plan below the Bronze plan called the Catastrophic plan which I'm guessing only covers really major stuff. That runs about $180/month.

I haven't found an ACA plan that covers much of anything until you're out many $ thousands.

Curious, what age group are you looking at for a $250 per month plan?

Cheapest I found in NJ was the "Classic Bronze Plan"

Age Premium

21 267.39
30 303.48
40 341.72
50 477.55
60 725.69


That gets you a $3000 deductible, 50% coinsurance plan, $7350 max out of pocket. You pay 50% of all name brand drugs. You have no benefit if you go out of network.

And if you're say a 40 year old individual, you are going to pay well over $7,000 a year before your "insurance" pays a nickel.

[TexasHusker]

This sounds exactly like the insurance I had through the state years ago. It was called the high risk pool because it was basically the insurance of last resort for people that couldn't get health insurance anywhere else.

Most states had high risk pools before Obamacare. If the goal of Obama and friends was to guarantee the opportunity to buy health insurance to all Americans, they could have simply mandated that ALL states maintain a high risk pool. That wouldn’t have cost the US Tax payer a cent. Of course, the intentions of Obama and friends had little to do with providing more insurance opportunities, and everything to do with a takeover of an industry. These folks aren’t THAT stupid to suppose ACA would actually work long term.

They knew better then, but it was an end to justify the means.