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Old 12-06-2013, 04:01 PM   #41
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A higher premium, or the potential of one, is not enough to conclude one is worse off under the ACA , because this possibility always existed in the individual insurance marketplace. Prior to 2010 health insurance policies were subject to recission and underwriting, so at any time each of us could find ourselves without coverage or facing a steep price increase. There was never any assurance that the low price someone had would continue into the future. We all now enjoy the benefit of guaranteed access, and while I would not venture to assign a dollar value to that, it is safe to assume that our premiums will rise in a very predictable way, limited to age, geographic location and overall healthcare inflation, but not any other personal factor. In 2012 the average premium for private group coverage was $5615. That's a good baseline, as it covers over 85% of the private insurance market. A policy with a rate far below that enjoys an advantage no one else has. That advantage will go away for some, and it is a loss, but it puts them back onto a level playing field.
Well stated and accurate assessment. I am heading your way, but still find myself reducing all insurance to a nuisance cost that is like throwing money into the trash can. If I had every penny spent on insurance by me or for me and invested it the past 30 plus years, I would be...well I don't even want to know. Good fortune and good health have clouded my judgement into thinking of being a "loser" on cost basis alone. But I think that on all insurance, as I have maybe had $500 worth of claims in all insurance combined my whole life. Yes, I know tomorrow could be different, but I prefer it not to be so I can continue to complain about paying for it.
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Old 12-06-2013, 04:35 PM   #42
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I believe that hospitals do allow people to pay off the debt in installment with low or no interest. For very serious life threatening illnesses or injuries, a $6K cost is quite "affordable", compared to what it was before. So, our young man or woman will have to drive the old car for a few more years and eat out less, but he/she stays alive. And that's more important.

My state has a program to help indigenous people with healthcare. It may be a form of Medicaid, I think, and my friend has a nephew who was saved from a serious cancer with this program.

All the above existed prior to ACA, by the way.
Of course $6k OOPmax is less $$$ than full bill with no insurance, but "affordable". Servicing a single yr's $6+k ($12k family) med debt (plus HI premiums, etc) on $20k income could work out over several yrs, but for chronic serious illness (i.e. mult yrs of OOPmax) it is not sustainable. Billing dept's now generally expect payment plans to be reasonable (e.g. specific pay off target date vs 'perpetual $25/mo'). And in many areas copays (below deductible) are now usu collected at time of service. Sadly, if the provider's 'charity care quota' is full the eventual outcome in high debt-to-income cases is too often either bankruptcy or cutting one's income (& living standards) enough to qualify for Medicaid (depending on state). ACA has not solved this dilemma for low income workers just because they now "have health insurance".
Maybe a bit OT, but this is an argument many 'young invincibles' give for not buying HI. With the big co-pays/OOPmax, even with HI they're busted anyway if they get seriously ill. Study this Fall by (pro-ACA) Robert Wood Johnson Fdn found that most young adults believe they need HI, but sizable minority (35+%) say it's not worth the cost.
http://www.rwjf.org/content/dam/farm...013/rwjf407851
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Old 12-06-2013, 05:58 PM   #43
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The ACA also did away with health insurance policy limits. My wife has benefited tremendously from this feature. I am not totally broke due to her sickness, thanks to the ACA. No anecdotes, my personal experience.

Remember that there was gnashing of teeth for both SS and Medicare.
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Old 12-06-2013, 07:56 PM   #44
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Of course $6k OOPmax is less $$$ than full bill with no insurance, but "affordable". Servicing a single yr's $6+k ($12k family) med debt (plus HI premiums, etc) on $20k income could work out over several yrs, but for chronic serious illness (i.e. mult yrs of OOPmax) it is not sustainable.
A person with chronic illness or with a somewhat higher need of medical services at that income level would best be served by selecting a Silver plan with the cost-sharing reductions.

http://www.kaiserhealthnews.org/feat...subsidies.aspx
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In California, for example, a standard silver plan will have a $2,000 deductible, a $6,400 maximum out-of-pocket limit and a $45 copayment for a primary care office visit. Someone whose income is between 150 and 200 of the poverty level, on the other hand, will have a silver plan with a $500 deductible, a $2,250 maximum out-of-pocket limit and $15 copays for primary care doctor visits.
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Old 12-06-2013, 11:01 PM   #45
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Another true story. I will retire in January. Only reason I can retire is the ability to buy health insurance under the ACA. Due to pre-existing health issues I am not sure we could have gotten insurance at any cost, little lone one we could afford. Thought I was going to have to work until 65 just to keep insurance. Just one couples story.
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Old 12-06-2013, 11:46 PM   #46
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The beauty of anecdotes is that you can find one to fit whatever your agenda is. I'm going to just sit back and see how this all plays out. Me, with my secure, ex-employer supplied insurance.
True, best to see how things play out. Anecdotes aside, the fact is that most young folks just have no incentive to sign up as they are smart enough to know they will merely be subsidizing the older or sick folks. The numbers certainly bear that out thus far.

This is not gloom and doom, just the facts with a healthy dose of common sense. To pretend (hope?) otherwise since it may benefit us individually as early retirees, if you receive an entitlement/subsidy or not, is really to just bury your head in the sand.
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Old 12-07-2013, 12:03 AM   #47
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Actually young people should sign up, if they are smart. A medical bankruptcy is still a bankruptcy. Granted they don't have assets to protect, but a bankruptcy affects credit ratings and makes it hard to buy a car, rent housing and even get a job resulting in lower life time earnings. Additionally, a high percentage of young people can be predicted to have pregnancies and some unlucky ones do get bad diseases. There are also a lot of reasonably healthy young people with pre-existing conditions who wish to be covered. Most young people qualify for subsidies and cost sharing and would be foolish to not take the opportunity to protect their financial futures.

Mulligan, you may make it to 65 unscathed, but I'm not betting my retirement on my own prospects, myself. If you do get sick, that low premium would soar under the pre-ACA system. There are some cost controls built into the ACA, but any really powerful cost containment would set somebody squawking. Remember "gutting Medicare" and "death panels"? One estimate is that 99% of insured Americans have limited networks already, so the fussing about that effect from the ACA is really just silly.
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Old 12-07-2013, 05:27 AM   #48
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I am not a young person, but ACA is going to be great for us (DW and myself). Being I retired last year our cost for health insurance was the biggest hit of our fixed income. Last year it cost us $514/month and this year it will be $348/month. Plus I have a better policy and we have dental insurance again.
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Old 12-07-2013, 07:22 AM   #49
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Actually young people should sign up, if they are smart. A medical bankruptcy is still a bankruptcy. Granted they don't have assets to protect, but a bankruptcy affects credit ratings and makes it hard to buy a car, rent housing and even get a job resulting in lower life time earnings. Additionally, a high percentage of young people can be predicted to have pregnancies and some unlucky ones do get bad diseases. There are also a lot of reasonably healthy young people with pre-existing conditions who wish to be covered. Most young people qualify for subsidies and cost sharing and would be foolish to not take the opportunity to protect their financial futures. Mulligan, you may make it to 65 unscathed, but I'm not betting my retirement on my own prospects, myself. If you do get sick, that low premium would soar under the pre-ACA system. There are some cost controls built into the ACA, but any really powerful cost containment would set somebody squawking. Remember "gutting Medicare" and "death panels"? One estimate is that 99% of insured Americans have limited networks already, so the fussing about that effect from the ACA is really just silly.
. The fact is that medical costs are the easiest debts to discharge in bankruptcy. If student loans were as easy to discharge then they would be the number 1 reason for bankruptcy filings.
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Old 12-07-2013, 10:19 AM   #50
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Actually young people should sign up, if they are smart. A medical bankruptcy is still a bankruptcy. Granted they don't have assets to protect, but a bankruptcy affects credit ratings and makes it hard to buy a car, rent housing and even get a job resulting in lower life time earnings. Additionally, a high percentage of young people can be predicted to have pregnancies and some unlucky ones do get bad diseases. There are also a lot of reasonably healthy young people with pre-existing conditions who wish to be covered. Most young people qualify for subsidies and cost sharing and would be foolish to not take the opportunity to protect their financial futures. Mulligan, you may make it to 65 unscathed, but I'm not betting my retirement on my own prospects, myself. If you do get sick, that low premium would soar under the pre-ACA system. There are some cost controls built into the ACA, but any really powerful cost containment would set somebody squawking. Remember "gutting Medicare" and "death panels"? One estimate is that 99% of insured Americans have limited networks already, so the fussing about that effect from the ACA is really just silly.
I agree as currently I would much rather complain about paying the premium than worrying about a possible health issue while being uninsured. But I do worry about the premium "death spiral" occurring. Once it reaches a certain point if it occurs, I must admit, I will drop it too and take my chances.
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Old 12-07-2013, 11:44 AM   #51
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The law will impact people in different situations differently. If a person's situation changes it will impact that individual differently at different times. It's just a new fact of life.
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Old 12-07-2013, 11:57 AM   #52
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Thanks folks.

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