Let's talk health plans!

[disneysteve]

So they don't have that kind of money, but they do have $2000 a month for Obummercare? Hmm.

You've made it very clear that you don't like the ACA. That's fine. You're entitled to your opinion. I disagree, obviously, as working in health care, I've seen how the ACA has tremendously benefited millions of people and greatly improved access to care. But you can't pretend that your personal situation is typical. I have no idea how much you earn but I can assure you that very, very few people are paying $24,000/year for their health insurance. Seeing as the median income is only a bit over $50,000 (before taxes), that would mean that people would be paying 50% or more of their income and that just isn't reality. Personally, we were paying about $700/month for a plan with a $4,600 deductible. That's a long way from the $2,000 number you mentioned.

So no, most people DO NOT have the money to enter a plan with a 50K deductible. Remember, the majority of Americans live paycheck to paycheck. They're lucky if they can come up with a few hundred dollars when the car breaks down or the washing machine dies. How do you propose they come up with 10K or 20K or more when one of them needs surgery? Oh yeah, a home equity loan. Perfect. Except how are they then supposed to make the payments on that loan if they're already tapped out, especially if their medical condition is such that they're unable to work for a period of time.

[Joan.of.the.Arch]

You might be talking about a small slice of Americans who would even be able to participate in a plan like that with the kinds of deductibles and savings you are suggesting. Two thirds of adults 18 to 35 would not have access to home equity loans because they are renters, not owners. Even between 35 and 44, forty percent of householders are renting.

Does the type plan you are suggesting even accept any age 58-65?

[disneysteve]

Does the type plan you are suggesting even accept any age 58-65?

I'm guessing not since he wants to reinstate the pre-existing conditions clause. Heck, doing so would rule out plenty of people younger than 58 - diabetes, high blood pressure, cancer, etc.

[Smallsteps]

I think the largest thing missing in this discussion of healthcare is the patient! I do not see how anyone thinks the ACA was a good plan, but to each their own.
I am totally on board with common sense limitations to make things work
I worked for a long time in health insurance.... I have seen the insanity..

People should be able to chose what coverage they need not forced to buy a one size fits all policy........... MANY did this prior to the ACA. Others did not Why?? There are probably a million reasons my favorite ( true answer a friend gave me) is " we never even priced a policy because the media/ politicians told us that we could not afford it"
Mandates always have a loophole Not sure if in all locations but no insurance as far as auto has nothing but a slap on the wrist take away a drivers license ??? I don't know about other cars I have seen tons not one STARTS by inserting a license. so now we have a ton of uninsured and unlicensed drivers ... do you feel safe??
ACA compliance PLEASE , look at ALL tax forms only a box to check yes or no if you had coverage ...... and since private policies do not require a SSN how would IRS ever verify great to have huge law suppose to share costs relying on the HONOR system for compliance.
so go without if something bad happens you sign up at hospital and let others pay for you.

a few years ago I and a "friend" both had a close loved one diagnosed with cancer.
my friend at the time was offered a promotion/ raise and overtime also had insurance which they turned down why ... the reason I was told by their own mouth was to "stay under an amount so they could get Medicaid to pay" they had a home and assets they hid......so others will pay...
I on the other hand just took my family member to all appointments and surgeries etc thinking all the time getting the insurance letter "reviewing " to see if they would pay. I would have paid in payments sold my home, started over whatever it took I love this child enough to do what it takes... not just expect or pay games to make sure others pay my bills
The whole ACA is full of lies ... why does every policy require birth control/ maternity not just those whom may use it I can tell you outright the elderly are all subsidizing the young with many "Essential" items .... not the young subsidizing the old as we were told.
Some who never had coverage like (my first example) also went hog wild wanted every test / every possible treatment especially if they were heavily subsidized.
While some of you working in health care may see it as a plus I only see people who want something for nothing and damn the people who end up paying. I spoke to a friend from a country with socialized medicine and she said it was about the people who would not think of taking advantage of their fellow citizens.

[LivingAlmostLarge]

Because that's how insurance work. People who are healthy have to subsidize the pool of people who aren't. That's also why there is coverage that not everyone uses. Like property taxes or car insurance. And maternity riders weren't even feasible really before. You couldn't be pregnant or get pregnant for 18 months before the rider kicked in.

And trust me you don't want to go back to pre-existing conditions being allowed. Everyone will have something eventually and it'll kick them off or be so expensive as to be unaffordable.

And Obamacare is the 1990s Republican plan in opposition to socialized government run healthcare. But what it's done is starting to change the conversation about healthcare being a right.

[disneysteve]

I do not see how anyone thinks the ACA was a good plan

Try speaking to any of the 20 million people who now have health insurance who didn't have it before.
Try speaking to a woman whose breast cancer was diagnosed early and cured thanks to mandated preventive care coverage like mammograms.
Try speaking to someone who thought he'd have to work until he was 65 and got Medicare but thanks to affordable coverage under the ACA was able to retire years before turning 65.

People should be able to chose what coverage they need not forced to buy a one size fits all policy

The problem with this approach is that given that choice, far too many people choose the cheapest option. They focus on the cost, not the coverage. Then they're screwed when something happens and they discover that the bare bones policy they chose to get the cheap premium is useless.

why does every policy require birth control/ maternity not just those whom may use it I can tell you outright the elderly are all subsidizing the young with many "Essential" items

You sound like all of the empty nesters and seniors who argue that their property taxes are too high. "Why should we have to pay so much to support the schools when our kids are grown?" That's how civil society works. We all contribute to the greater good. And that's certainly how insurance works - spreading risk over a large pool of customers. If only the people who wanted certain coverage had to buy it, the cost would be prohibitive.

While some of you working in health care may see it as a plus I only see people who want something for nothing

In any system, there will be abuse and people who try to skirt the rules, but I can tell you that after the ACA started, my practice saw a few hundred patients who were either totally new to us or had been patients years ago and hadn't been in for a long time because they had lost their coverage. They weren't looking to get something for nothing. They were looking to get much-needed medical care that they had been forced to forgo for a long time because they couldn't afford it. They had sky high blood pressure. They had uncontrolled diabetes. They were frequent flyers at the ER for asthma attacks. Now, with insurance, they were able to get the treatment they needed, stay out of the hospital, stop missing work, and start feeling better. If you think that's a bad thing, I'm not really sure what else to say.

[TexasHusker]

Because that's how insurance work. People who are healthy have to subsidize the pool of people who aren't. That's also why there is coverage that not everyone uses. Like property taxes or car insurance. And maternity riders weren't even feasible really before. You couldn't be pregnant or get pregnant for 18 months before the rider kicked in.

And trust me you don't want to go back to pre-existing conditions being allowed. Everyone will have something eventually and it'll kick them off or be so expensive as to be unaffordable.

And Obamacare is the 1990s Republican plan in opposition to socialized government run healthcare. But what it's done is starting to change the conversation about healthcare being a right.

I hope so because Obummercare is going bankrupt and has been headed that way since inception. You can't let people randomly jump on and off the plan based on whether or not they are ill at the moment, and about a hundred other such cockamie.

[disneysteve]

You can't let people randomly jump on and off the plan based on whether or not they are ill at the moment

So TH, what's the answer? I totally agree that people shouldn't be insured sometimes and not insured other times because you never know when you are going to get sick or injured. Everyone needs to be insured all the time. If we continue to have a system where insurance is primarily tied to one's employment as opposed to universal coverage for all, what other option is there?

[TexasHusker]

So TH, what's the answer? I totally agree that people shouldn't be insured sometimes and not insured other times because you never know when you are going to get sick or injured. Everyone needs to be insured all the time. If we continue to have a system where insurance is primarily tied to one's employment as opposed to universal coverage for all, what other option is there?

I can give you my answer but it would be a dissertation.

The structure of healthcare finance needs to be torn down and rebuilt. There would be a lot of pain with that exercise, but long term it is the only option other than a Euro-style government takeover of the system.

[disneysteve]

The structure of healthcare finance needs to be torn down and rebuilt.

I don't disagree, but realistically we aren't likely to see that happen in our lifetimes. There are too many hands in the pot and too much money involved.

So where does that leave us? The ACA isn't perfect for sure but it improved a number of things - insuring millions of previously uninsured people, eliminating pre-existing condition clauses, extending coverage to age 26 for students, covering preventative care testing, etc. Now that we have all of that stuff, we can't just take it all away again. I mean, we could, and Trump has tried repeatedly without success, but nobody wants to be the one to tell 20 million people they're losing their insurance again.

So what's the answer at this point starting from where we are today?

[LivingAlmostLarge]

I still like the idea of decoupling insurance with employment. That would be very interesting. But how many medicare and military people would start screaming? I mean what would happen if we didn't have medicare and tricare? What would be the benefits for those who have socialized programs but now are going to be forced into a real pool?

Decoupling insurance and forcing everyone onto the individual insurance pool would be very fair and I think it would show how health care can't be free market. But Republicans don't have the guts to do it. Because everyone on employer provided insurance would panic.

Plus it would show how harsh pre-exisiting conditions and what insurance companies really think about insuring medical expenses.

[disneysteve]

I still like the idea of decoupling insurance with employment. That would be very interesting. But how many medicare and military people would start screaming?

I don't see why you couldn't keep medicare and tricare and still uncouple insurance from employment for everyone else.

[scfr]

I hope this info might be useful for those contemplating early retirement who wonder how much health insurance would cost. With so much talk about FIRE, I feel concern for younger people who might be choosing early retirement unaware of what they are looking at down the road in terms of health care costs.

If you have employer-sponsored health care and have no idea what it's worth, when you get your W-2 look at the figure next to DD in box 12.

DH & I are in our mid-50's and are in a 2-3 month gap without employer-supplemented health insurance. (Usually costs are split between my employer and me, but not right now.)

COBRA is $1350 for the 2 of us (medical only, additional for dental and/or vision).

ACA coverage would be between $915 - $2,085 for the 2 of us depending on the plan we chose. The $915 policy has a $14,700 deductible.

If I were attempting early retirement (I'm not), for our mostly-healthy-2xmid-50's household I'd budget $20K/year for medical/dental/vision expenses.

[corn18]

I hope this info might be useful for those contemplating early retirement who wonder how much health insurance would cost. With so much talk about FIRE, I feel concern for younger people who might be choosing early retirement unaware of what they are looking at down the road in terms of health care costs.

If you have employer-sponsored health care and have no idea what it's worth, when you get your W-2 look at the figure next to DD in box 12.

DH & I are in our mid-50's and are in a 2-3 month gap without employer-supplemented health insurance. (Usually costs are split between my employer and me, but not right now.)

COBRA is $1350 for the 2 of us (medical only, additional for dental and/or vision).

ACA coverage would be between $915 - $2,085 for the 2 of us depending on the plan we chose. The $915 policy has a $14,700 deductible.

If I were attempting early retirement (I'm not), for our mostly-healthy-2xmid-50's household I'd budget $20K/year for medical/dental/vision expenses.

Great point. And it gets even more expensive when you start thinking about long term care when you are old. Medicare is nice but it might not cover a place you want to stay in when you need LTC. It's one of the biggest what if's people try to address when deciding when they have hit their number.

[msomnipotent]

I'm extremely worried about how we will cover healthcare later on. Our rates went up this year, as expected. Including both our portion and his employer's payment, it is $2,500 per month for us for health and dental. Our retirement savings wouldn't go far at this point if we had to pay COBRA, so I think my husband retiring early is out of the question unless we win the lottery. Or maybe the bull market continues for a few more years.