So grateful for the ACA

[JDARNELL]

Don't those military health programs have to meet the ACA requirements? The ACA may still apply to you.

Yes military and VA health programs have to meet the requirements but it's really a non issue for the ones in this boat. Each year we get the "yes your plan meets the ACA compliance" at tax time but for me it goes into the trash as it means nothing.

I really don't understand anything about the ACA as I have never had to deal with it. However I am glad the pre-existing conditions aren't an issue anymore.

 

[Texas Proud]

I think the bigger issue for ERHoosier is the lack of participating doctors in good (PPO) style plans. That is a big negative of the ACA plan, where coverage can differ greatly even in the same state.

I know.. and I said crappy plans are crappy... but he seemed to indicate he had a bad plan because of preexisting conditions.... it does not...


AND, I have had the crappy plans with no good option unless I wanted to pay a LOT more... like $1,000 per month more... even then they were not that great...

 

[kongmen]

"Access to negotiated rates for health care services"


When we were on it we found that stand alone cash prices were far better than using the exchange provided insurance plan rate.


In fact we've had more than one conversation with providers where we would be quoted a much higher price if we let them run our exchange insurance card vs paying cash without running the insurance card.

 

[orchid55]

We had the same experience with cash prices versus exchange negotiated rates.

 

[pb4uski]

It must depend on where you live and the specific services that you need. I've had mixed results, sometimes yes and sometimes no.

 

[Yipper]

Reading this thread and some of the criticisms of the ACA reminds me that what we call "ACA" today is a subset of the actual legislation that was passed and even then, a fraction of how it was originally conceived.

Remember when the ACA was passed and everyone (read - young, healthy people) were required to have a basic plan or pay a tax penalty? Those were the payers that would be subsidizing the older/sicker people who received guaranteed acceptance.

By removing that requirement but leaving the guaranteed acceptance clause, we're in the situation we're in today. Without getting political here as I know that's verboten, it was probably by design as the system will eventually fail. And they knew it would cause tension.

 

[Yipper]

For me, the ACA is a benefit because I can pick and choose which plan and insurance company works best for me each year without fear of being denied. I am guaranteed coverage regardless of my existing health conditions (currently blood pressure meds) and I am sure of the basic aspects of what the plan will cover.

I also am grateful that I am certain what my MOOP will be if something catastrophic happens to us health-wise. Without the ACA things would not be as certain.

Is the ACA perfect? Of course not, but it's what we have today so I'm grateful for that.

 

[pb4uski]

Reading this thread and some of the criticisms of the ACA reminds me that what we call "ACA" today is a subset of the actual legislation that was passed and even then, a fraction of how it was originally conceived.

Remember when the ACA was passed and everyone (read - young, healthy people) were required to have a basic plan or pay a tax penalty? Those were the payers that would be subsidizing the older/sicker people who received guaranteed acceptance.

By removing that requirement but leaving the guaranteed acceptance clause, we're in the situation we're in today. Without getting political here as I know that's verboten, it was probably by design as the system will eventually fail. And they knew it would cause tension.

I don't know where that is coming from. From everything that I know, the system is thriving. Insurers are getting their cost of claims and up to 20% for taxes, overhead and profit. We haven't heard anything from insurers about problems with the system. People are paying premiums commensurate with their income.

Premiums are still expensive but that is prncipally due to the high cost of health care services since insurers are limited to no more than 20% for taxes, overhead and profit.

It doesn't seem at all that they system will eventually fail to me.

 

[Yipper]

I don't know where that is coming from. From everything that I know, the system is thriving. Insurers are getting their cost of claims and up to 20% for taxes, overhead and profit. We haven't heard anything from insurers about problems with the system. People are paying premiums commensurate with their income.

Premiums are still expensive but that is prncipally due to the high cost of health care services since insurers are limited to no more than 20% for taxes, overhead and profit.

It doesn't seem at all that they system will eventually fail to me.

My point was the commentary about people saying it's not actually "affordable" and there's a reason it's not exactly inexpensive if subsidies aren't factored in. Sorry if my point wasn't clear.

 

[MichaelB]

Health care insurance is expensive in the US because health care is hugely expensive. The average cost of a family policy is 1/3 of the median total household income before payroll and income tax. A cash payment for an urgent care clinic or lab test might be affordable but comprehensive care certainly isn’t.

Virtually all health care insurance in the US is subsidized. That includes employer provided, Medicare, Medicaid, CHiP, Tricare, and ACA Marketplace plans.

The ACA has accomplished many good things, as highlighted in earlier posts in this thread. It cannot make health care less expensive. It can, and has, enabled previously uninsured people to get health insurance and then pay for it.

 

[Yipper]

Health care insurance is expensive in the US because health care is hugely expensive.

I wonder how the US compares to other countries - specifically the top 25 or so industrialized countries. I have frequently heard that we're the most expensive but have middling or worse outcomes.

Again, not to get political here but it seems like human healthcare for profit is somewhat immoral. I'm all for capitalism but maybe human healthcare should be off limits?

 

[RetiredHappy]

I think one thing that is not mentioned here and I learned recently is that when someone goes to ER without medical insurance and they truly have no money, the hospital provides them with a Medicaid application form. I think this is driven by ACA which is a good thing. I had mentioned in another thread here about this woman who had a divorce and got nothing due to a pre-nup. She had no money and went to ER and got treated. Her Medicaid application got approved and I am so happy for her.

 

[MichaelB]

Again, not to get political here but it seems like human healthcare for profit is somewhat immoral. I'm all for capitalism but maybe human healthcare should be off limits?

That is such a relevant and important question, and also the most difficult to answer.

 

[MichaelB]

I think one thing that is not mentioned here and I learned recently is that when someone goes to ER without medical insurance and they truly have no money, the hospital provides them with a Medicaid application form.

I’ve never heard of this. A hospital cannot enroll Medicaid patients, but it probably has a social worker staff that can assess whether an uninsured person is eligible for Medicaid, and can help apply.

 

[RetiredHappy]

I’ve never heard of this. A hospital cannot enroll Medicaid patients, but it probably has a social worker staff that can assess whether an uninsured person is eligible for Medicaid, and can help apply.

Correct. The hospital cannot enroll Medicaid patients. This person was given the Medicaid form when she said that she had no income and no health insurance. She was subsequently approved for Medicaid, which also meant that the hospital got paid.

 

[braumeister]

Thanks for the interesting discussion.