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Old 10-29-2014, 05:02 PM   #41
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Part of this is because healthcare services, especially hospital, lab and specialized practice, have a preferential price for insurers and a penalizing price for cash payers. It doesn't make sense, but it dramatically increases the risk of being uninsured.

Last year when I did my yearly or biyearly (whenever I get in the mood to do it), I did my blood work and it was list price of $700 negotiated down to $115 because of "insurer preferential pricing". Big savings huh? Not quit, I'm still being ripped off. I have found an independent lab nearby that does it for under $50. I'm telling Doc next time I will send him the results. A person could probably save a bunch of money by doing certain things, but you have to know what you are looking for and how to do it. And I certainly am not smart enough to find and avoid the gotchas.


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Old 10-29-2014, 05:09 PM   #42
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Originally Posted by anethum View Post
I think that the ACA was a necessary first step which needed to be taken before we can start to tackle medical care costs.

Also, the NYTimes article failed to mention that the provision of the ACA which abolished lifetime caps will likely lower the number of personal bankruptcy filings. Plus, the ability of people to purchase policies regardless of pre-existing conditions should help lower that figure, too. Pre-ACA, medical bills were the single biggest cause of personal bankruptcy filings, even when people had health insurance. Obviously, another benefit of the ACA is the ending of those lousy policies which didn't really do what insurance is supposed to do.
+1. I bolded the last sentence because that applied to me. As I mentioned in a previous post, I had a bare-bones policy because the premium for my more comprehensive policy had risen 50% in 2 years. I had no plan to keep this policy as it was merely an interim policy to get me to the end of 2013. I recall getting a letter from my insurance company near the end of 2013 telling me the policy would be discontinued in 2014 because it was not ACA-compliant. Part of me was glad this policy would be gone but a bigger part of me didn't really care because I was dropping it anyway. My new policy through the state's exchange was with the same insurance company as the discontinued policy, and caused some minor confusion until it got all straightened out.
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Old 10-29-2014, 05:52 PM   #43
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I certainly would not have a problem with that. Because at this point I do not know if this ACA insurance is better than what my underwritten plan is. This is all anecdotal of course, but I read a lot about people really struggling to find doctors who take it. I read this week in USA Today one lady had to talk to 40 doctors before one would accept her insurance. Then you run the possibility of getting treated like a Medicaid person even though you paid cash for the policy. Then increasing narrow networks can screw you over and the insurance companies take no responsibility to stay current on who is in their network.
This hasn't matched our experience on an ACA PPO plan. DW has needed to use healthcare a few times -- she just goes to the provider website, looks up who are the relevant doctors and makes a phone call to schedule an appointment.

For non-urgent care, she may have had to wait a week or so for an appointment. But this appears no different than when we were on employer healthcare.
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Who Obamacare has helped the most
Old 10-29-2014, 06:28 PM   #44
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This hasn't matched our experience on an ACA PPO plan. DW has needed to use healthcare a few times -- she just goes to the provider website, looks up who are the relevant doctors and makes a phone call to schedule an appointment.



For non-urgent care, she may have had to wait a week or so for an appointment. But this appears no different than when we were on employer healthcare.

I sure hope I have the same success, that your wife has had Photoguy. The system isn't going away, so I sure hope it works. I just don't want it to affect me like this.
Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.

"The exchanges have become very much like Medicaid," says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. "Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they're not going to be in business very long."

http://www.usatoday.com/story/news/n...tors/17747839/

Maybe only the bad stories catch my eye, because I am on the other less populated side of the issue that most early retirees are not on; having their own insurance that they wanted to keep. I will get over it eventually. If not I will have a reason to celebrate my 65th birthday.


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Old 10-29-2014, 06:40 PM   #45
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My nephew came home recently and found his toddler with an open bottle of Tylenol. Taking no chances, he took the kid to ER and they gave the kid a test to see if he had taken any capsules, then kept him overnight for observation. The bill was $55,000.

My point is that even a minor event can have crushing medical expenses attached.
Is there an extra zero in the bolded (by me) figure?
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Old 10-29-2014, 07:08 PM   #46
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I sure hope I have the same success, that your wife has had Photoguy. The system isn't going away, so I sure hope it works. I just don't want it to affect me like this.
It does seem like people are having very different experiences with finding physicians. I wonder if anybody actually measures network size/quality of the ACA plans and if there are any common trends among the health plans that are downsizing.
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Old 10-29-2014, 07:21 PM   #47
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Even doctors who accept a particular plan may not be taking any new patients--this has been true long before ACA.
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Old 10-29-2014, 07:42 PM   #48
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Is there an extra zero in the bolded (by me) figure?
Nope. $55,000
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Old 10-29-2014, 07:52 PM   #49
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Although I have to say that guaranteed coverage is priceless, and keeping kids on your policy till 26 is a win for all. I assume you still pay a premium for the kids, and I'm sure premiums went up to pay for guaranteed coverage. However, I'd say it is a price I'm willing to pay.

+1

The pre-existing condition piece is a major benefit for my family with both of us being self employed.
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Old 10-29-2014, 08:05 PM   #50
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Nope. $55,000
I hope there were a couple of meals included in that bill..
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Old 10-29-2014, 10:22 PM   #51
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Nov 4th is coming, I expect a flood of such articles and posts before that date extolling the wonders of the ACA. Very "timely". C'mon, who are we trying to "help the most . . . ?"
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Old 10-29-2014, 10:38 PM   #52
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Nov 4th is coming, I expect a flood of such articles and posts before that date extolling the wonders of the ACA. Very "timely". C'mon, who are we trying to "help the most . . . ?"
The 10 million (or maybe much more per MichaelB's post) formerly uninsured and the people like me who had insurance but still couldn't afford to pay ~$50K for medical costs alone per year?
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Old 10-29-2014, 10:52 PM   #53
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The 10 million (or maybe much more per MichaelB's post) formerly uninsured and the people like me who had insurance but still couldn't afford to pay ~$50K for medical costs alone per year?
That's great. Somebody is paying. TANSTAAFL. So, I'll wait to see the evenhanded article that covers that. But until then, it's bread and circuses.
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Old 10-29-2014, 10:58 PM   #54
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That's great. Somebody is paying. TANSTAAFL. So, I'll wait to see the evenhanded article that covers that. But until then, it's bread and circuses.
Almost all other developed countries seem to be able to afford some form of universal healthcare:

Here's a Map of the Countries That Provide Universal Health Care (America's Still Not on It) - The Atlantic

"The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world."

The ACA funding is shown in these charts:

http://www.washingtonpost.com/blogs/...in-two-charts/
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Old 10-29-2014, 11:13 PM   #55
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It is natural for the recipients of transfer payments ("free stuff") to be in favor of such transfers. There can, of course, be many other reasons to favor this particular program and it's many atributes, and many valid reasons to oppose it/them.
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Old 10-29-2014, 11:24 PM   #56
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The number is greater. This website (here) has tracked enrollments (including non-payment dropouts) by state exchange and type of coverage since the rollout. They record 11m new Medicaid, 7.3M policies from exchanges, another 8M policies directly from insurers, and another 1M "other". Their estimate is between 19-25m newly insured individuals. Their spreadsheets can be downloaded.
Most reporting shows that while the # of insured has increased since ACA, we still do not have solid 'steady state' numbers. IMHO- This may take a few years to settle out. It is a very difficult issue to study, even in CA with its Covered CA exchange and Medi-Cal, as researchers from Berkley have explained. I share their views that enrollment numbers are at best point-in-time estimates, and that the real goals are continuity of care and reducing chronic "uninsurance".
http://laborcenter.berkeley.edu/pdf/...enrollment.pdf
Others have reported more recent stats on the variances between initial ACA enrollment and ongoing insurance. Washington seems to be the only state that has subtracted 'no-pays' from its initial sign up figures. And that state further says that about 1/3rd of its HI "attrition" (initial paid HI enrollees who later drop) are actually switches to Medicaid (so counted in both sign up and Medicaid figures). Data for larger states also suggest that # of actual insured will settle out somewhat lower than initial enrollments. Latest figures from CA and FL are ~20% lower, with other states (inc MN, AR, CT, OR) reporting smaller differences (5-15% lower). FWIW- Private insurers are reporting similar differences with their Exchange plan policies. Aetna, among the largest Exchange insurers offering plans in 16 states, says it's total paid Exchange plan numbers have dropped 17% from their peak in May.
http://finance.yahoo.com/news/obamac...225300234.html
I suspect these differences between enrollment and ongoing coverage stats will narrow in the next year or two, but only time will tell.

BTW- The website you link is.....interesting. The concept of a website following HI trends is great, but the presentation is annoyingly partisan and the underlying data are suspect. The global stats in site's headline come from the site's spreadsheet, yet the SS figures often do not match those reported by official sources... even sources cited in the site's own blog. Such as for CA where the SS shows 1.38M Paid Exchange QHPs (Qual Health Plan), yet the blog quotes CA officials as stating that number at 1.12M. Similar issue for CO stats where state officials quoted in the blog state 114K paid Exchange plans but SS shows 131k.
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Old 10-29-2014, 11:40 PM   #57
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Most of the surveys on the subject are statistical sample surveys asking people questions about insurance coverage. There are different independent polls by the Harvard School of Public Health, Gallop, Rand and more all coming up with the same order of magnitude numbers. Even if all these independent sampling polls by nonpartisan groups were all independently wrong by a margin of 50% on the high side, we'd still have 5 million more people with health insurance, or the entire population of Norway, gaining health insurance. That's huge.

The NY Times link posted earlier shows major drops in uninsured from surveys by Commonwealth Fund’s Affordable Care Act Tracking Survey, RAND Health Reform Opinion Study, Urban Institute Health Reform Monitoring Survey, Gallup-Healthways Well-Being Index, and the Centers for Disease Control and Prevention’s National Health Interview Survey.

The common findings are: "The number of uninsured Americans has fallen by about 25 percent this year, or about eight million to 11 million people."

http://www.nytimes.com/interactive/2..._r=0#uninsured
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Old 10-30-2014, 03:06 AM   #58
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My step sister is one of the beneficiaries, finally having healthcare after many years of doing without. Who knows if going untreated caused permanent damage that cannot be rectified or not. Now, it is just about the treatment to make her life as good as it can get. It would have been nice for the rest of us if the intent of ACA was to make healthcare less about profit but that wasn't the intent - it was just to make it more affordable to those who could least afford it before. Maybe someday there will be another effort that will try to bring about a reduction in cost for each person instead of for just those who most needed it.
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Old 10-30-2014, 07:25 AM   #59
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BTW- The website you link is.....interesting. The concept of a website following HI trends is great, but the presentation is annoyingly partisan and the underlying data are suspect. The global stats in site's headline come from the site's spreadsheet, yet the SS figures often do not match those reported by official sources... even sources cited in the site's own blog. Such as for CA where the SS shows 1.38M Paid Exchange QHPs (Qual Health Plan), yet the blog quotes CA officials as stating that number at 1.12M. Similar issue for CO stats where state officials quoted in the blog state 114K paid Exchange plans but SS shows 131k.
I agree the blog owner is partisan, that is annoying, and also the reason I didn't link the site until now. The data is not suspect, unless you can provide another source with similar (scrutinized) breakdowns and sources showing different numbers. It's probably the best overall (and most heavily scrutinized) source of ACA data to be found anywhere - and it does distinguish paid vs not paid. It also carries a monthly count by exchange, so we can see month to month changes by program by state. The data sources are the state exchanges, the state insurance oversight agencies, and many insurers around the country.

We know the 10M Medicaid numbers are net newly insured. There are another 15M qualified health plans (paid). We don't know how many of those are newly insured and probably won't ever know, because health care coverage iwas not subject to reporting requirements. It was all survey.

We still don't know how many people in the US have qualfied health care, because employer plans are also not subject to the same reporting requirement.
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Old 10-30-2014, 07:37 AM   #60
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An acquaintance of ours was "employee #52"...it helped ease him into an early (unexpected) retirement. He now collects UEI and plays golf every day instead, getting his HC for 'almost free'.

SIL was a part time employee of a large supermarket chain; her hours were reduced from 34 to 25 hours (management: "to deal with the benefits problem") allowing her to spend more time with her family.

It motivated a neighbor who splits time between here and Costa Rica to move permanently over there. "I can get HC there for $80 a month instead of being forced to spend $1800 a month here...and the weather is better".

I'm not trying to be snide...I think this has helped a lot of people get out of their rut and look at things differently.

The whole 'millionaire subsidy' issue (discussed ad nauseam on this forum) has allowed me to re-evaluate my view on work/life balance and what I used to derisively call 'handouts'.

In a way, this prompted my OP on "Millennials and Work" thread and how they view work/life and not killing themselves for a job that provides HC.

As an aside, our own HC plan was shifted to a HD plan which now allows us access to an HSA; we were paying a for a lot of stuff out of pocket (about $5K a year) and the tax breaks on the HSA will work well for us.
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