Obamacare

[travelover]

.......
Matthews and Litow: ObamaCare's Health-Insurance Sticker Shock - WSJ.com

I'd take any article written by a Rupert Murdock owned paper with a grain of salt.

 

[pb4uski]

.....We compared the average premiums in states that already have ObamaCare-like provisions in their laws and found that consumers in New Jersey, New York and Vermont already pay well over twice what citizens in many other states pay. Consumers in Maine and Massachusetts aren't far behind. Those states will likely see a small increase.....

The thing about this that doesn't make sense to me is that I'm in Vermont and currently pay ~$630/month for HDHI coverage for DW and I. I expect to pay $750/month for similar coverage next year (before subsidies)...BUT my HDHI COBRA from a large national firm (more than 25,000 employees across the US) was $900.

If this article is right and we pay twice what other citizens in many other states pay then I would think that my COBRA should have been less that what I was able to get in the individual market.

The claim in the article makes no sense to me.

 

[bUU]

The way it was explained to me, there's a single limit, which matches whatever the requirement for HDHPs is that year. Again, I think I remember seeing that that's going to be around $6,750 next year. That has to include the out-of-pocket maximum plus the deductible. The combined limit makes more sense than specific limits on the deductible (even though it makes things more complex) because if either the deducible or the co-pays weren't limited, then a plan could simply bypass the intent of the ACA by inflating the unlimited variable. So the law seeks to control how much any individual would have to pay, at most, and the specific policy can have either a high deductible or high co-pays or some medium-ground in between.

I think there are also some limitations on certain classes of health plans, some with hard limits on deductibles and/or out-of-pocket maximum (i.e., $2000 individual/$4000 family; which is what we have in our ACA-compliant health plan).

 

[Mulligan]

I'd take any article written by a Rupert Murdock owned paper with a grain of salt.

It is definitely only a guess, I certainly concur. But let's be a bit realistic. I have founds hundreds of articles from many sources claiming how insurance costs in individual markets of "low cost states" will jump considerably. I haven't stumbled across one yet saying they are going down in these states, unfortunately. So in totality no matter where the source is I believe my costs are going to go up considerably if I am in the exchange. Btw- Kaiser estimated mine to be up more than 500%, so I would be jumping for joy if that article was correct and I only got a 75% increase hung around my neck.

 

[Mulligan]

The thing about this that doesn't make sense to me is that I'm in Vermont and currently pay ~$630/month for HDHI coverage for DW and I. I expect to pay $750/month for similar coverage next year (before subsidies)...BUT my HDHI COBRA from a large national firm (more than 25,000 employees across the US) was $900.

If this article is right and we pay twice what other citizens in many other states pay then I would think that my COBRA should have been less that what I was able to get in the individual market.

The claim in the article makes no sense to me.

I think PB, some of the wild ranges in premium percent increases and guesstimates are based on some apple to orange comparisons. For example me... If I am forced to pay $500 up from my current sub $100 premium but now have a $2k deductible, instead of $5500, is that really a 500% increase for me? I would assume people more logical than me would say it is substantially less than 500% because I would have a significantly lower deductible. But to a hard head like me, I am sticking to the higher number because I never would reach either deductible...at least at this present moment.

 

[Fermion]

For those of us who will need to pick a state to call home because we are doing the RV thing, what are the plans looking like?

I estimate we will be around 150% to 200% of FPL using dividends and interest plus already taxed cash.

I was going to base our home state on low taxes (was thinking Nevada) and low vehicle registration/ability to re-register from out of state.

Now the smarter choice might be to pick a state with the best healthcare insurance exchange rates.

Or will we need to have some sort of national policy?

 

[pb4uski]

For those of us who will need to pick a state to call home because we are doing the RV thing, what are the plans looking like?

I estimate we will be around 150% to 200% of FPL using dividends and interest plus already taxed cash.

I was going to base our home state on low taxes (was thinking Nevada) and low vehicle registration/ability to re-register from out of state.

Now the smarter choice might be to pick a state with the best healthcare insurance exchange rates.

Or will we need to have some sort of national policy?

I don't know the answer but would agree that it seems likely that the deciding factor will likely be differences in health insurance rates rather than tax rates given your income is low.

 

[M Paquette]

I'd take any article written by a Rupert Murdock owned paper with a grain of salt.

In particular, "articles" that appear in the Opinion section of the paper.

Last time I checked, the Opinions section had various opinion pieces in it, whose fact content might vary. (Facts measured by weight, not volume. Some settling may occur in shipment. Objects in mirror are closer than they appear. Dramatization only. Please obey all park rules. Professional driver; Do not attempt. Warning: Cape does not allow wearer to fly.)

 

[travelover]

I think PB, some of the wild ranges in premium percent increases and guesstimates are based on some apple to orange comparisons. ...........

In particular, "articles" that appear in the Opinion section of the paper.........

Exactly. Remember we are talking about an industry that consumes nearly 20% of the largest economy in the world - about $8000 for every man, woman and child in the country. Everyone is trying to shade the facts to make it favorable to them.

 

[ERD50]

I'd take any article written by a Rupert Murdock owned paper with a grain of salt.

So just which paper/source can you read w/o any skepticism at all?

"The Economist" is probably the most balanced publication I can think of, yet I still consider whether the writer has an agenda - whether conscious or not. I'm not trading my salt-shaker for a pitcher of Kool-Aid anytime soon.


bold mine...

It is definitely only a guess, I certainly concur. But let's be a bit realistic. I have founds hundreds of articles from many sources claiming how insurance costs in individual markets of "low cost states" will jump considerably. I haven't stumbled across one yet saying they are going down in these states, unfortunately. So in totality no matter where the source is I believe my costs are going to go up considerably if I am in the exchange. Btw- Kaiser estimated mine to be up more than 500%, so I would be jumping for joy if that article was correct and I only got a 75% increase hung around my neck.

So despite the fact that every source you have found agrees, travelover wants to discount that source you linked solely because of the owner. Incredible.

-ERD50

 

[MichaelB]

So just which paper/source can you read w/o any skepticism at all?

Two excellent sites, I haven't seen any partisan l agenda in either and have found both to be extraordinarily helpful.

KFF The Henry J. Kaiser Family Foundation - Health Policy, Media Resources, Public Health Education & South Africa - Kaiser Family Foundation
Health Reform GPS Health Reform GPS: Navigating the Implementation Process

So despite the fact that every source you have found agrees, travelover wants to discount that source you linked solely because of the owner. Incredible.

-ERD50

Could be a thousand sources, still says nothing about quality. The one linked earlier was interesting in that it was authored by an actuary but the analysis was devoid of hard data and based on generalizations and assumptions that may not be representative of real life for any of us or healthcare in general in the US.

 

[Mulligan]

Two excellent sites, I haven't seen any partisan l agenda in either and have found both to be extraordinarily helpful.

KFF The Henry J. Kaiser Family Foundation - Health Policy, Media Resources, Public Health Education & South Africa - Kaiser Family Foundation
Health Reform GPS Health Reform GPS: Navigating the Implementation Process

Could be a thousand sources, still says nothing about quality. The one linked earlier was interesting in that it was authored by an actuary but the analysis was devoid of hard data and based on generalizations and assumptions that may not be representative of real life for any of us or healthcare in general in the US.

I would certainly agree with your assessment. I also want to reinforce that I am not saying this is bad policy in general either. My concerns on potential "rate shock" is directed specially for my situation. Healthy, under 50, male, underwritten policy, with no premium subsidy from government. Someone in my same state in the "high risk pool" (assuming there is one) or low income maybe even my same age, might come out better financially than what they now are paying, so yes, generalizations are impossible. But for me, I appear to be the "poster boy demographic" for a nice rate increase.

 

[Texas Proud]

I believe bUU to be in the ball park. One thing that disappointed me is I believe they have not allowed your HSA contributions to count toward meeting that coverage amount which would have been a huge plus for some policies to reach accepted coverage. Someone please correct me about this if I am wrong, but Texas if you are on an individual plan now, it is too late to jump ship to the $5k deductible. Yes, you could do it for the rest of the year, but then you would definitely be in the exchange next year. You have to have been signed up for a plan back in 2010, to have any chance of maintaining grandfathered status.
Take some solace in knowing Texas is an second lower tier of states expecting possible significant rate increase... I found mine today, and I am in with the group expected to get hit the hardest.

We compared the average premiums in states that already have ObamaCare-like provisions in their laws and found that consumers in New Jersey, New York and Vermont already pay well over twice what citizens in many other states pay. Consumers in Maine and Massachusetts aren't far behind. Those states will likely see a small increase.

By contrast, Arizona, Arkansas, Georgia, Idaho, Iowa, Kentucky, Missouri, Ohio, Oklahoma, Tennessee, Utah, Wyoming and Virginia will likely see the largest increases—somewhere between 65% and 100%. Another 18 states, including Texas and Michigan, could see their rates rise between 35% and 65%.

Matthews and Litow: ObamaCare's Health-Insurance Sticker Shock - WSJ.com

I am in a group plan.... still getting a paycheck.... our plan does not include an HSA as our company helps pay for the $5K deductible... you can not have this combined with and HSA....

 

[Texas Proud]

The way it was explained to me, there's a single limit, which matches whatever the requirement for HDHPs is that year. Again, I think I remember seeing that that's going to be around $6,750 next year. That has to include the out-of-pocket maximum plus the deductible. The combined limit makes more sense than specific limits on the deductible (even though it makes things more complex) because if either the deducible or the co-pays weren't limited, then a plan could simply bypass the intent of the ACA by inflating the unlimited variable. So the law seeks to control how much any individual would have to pay, at most, and the specific policy can have either a high deductible or high co-pays or some medium-ground in between.

I think there are also some limitations on certain classes of health plans, some with hard limits on deductibles and/or out-of-pocket maximum (i.e., $2000 individual/$4000 family; which is what we have in our ACA-compliant health plan).

Interesting.... but I want to see if I am understanding what you are writing... the $6,750 is a hard limit.... which includes the co-pays to doctors

What about drugs? Are these included in that limit, or are they still separate?


In the end I do not think it makes much difference to us as we have only hit our current max one time when my DW had foot surgery...


This might be a whole different thread, but it does not include dental.... we are going to have to pay $10K on my DW's teeth.... we have been to two highly trained specialist and both said the same thing.... not good for her....

 

[youbet]

+1. Any change is opposed by those benefiting from the status quo.

Any change is promoted by those benefitting from it.

 

[youbet]

I would certainly agree with your assessment. I also want to reinforce that I am not saying this is bad policy in general either. My concerns on potential "rate shock" is directed specially for my situation. Healthy, under 50, male, underwritten policy, with no premium subsidy from government. Someone in my same state in the "high risk pool" (assuming there is one) or low income maybe even my same age, might come out better financially than what they now are paying, so yes, generalizations are impossible. But for me, I appear to be the "poster boy demographic" for a nice rate increase.

Earlier on this thread, we established that there will be winners and losers as a result of Obamacare. While the overall net outcome may be a postive good for the country (by someone's standard of measure), it's a shame that the changes weren't written to avoid having "losers."

An "everyone wins or stays the same" outcome would have been nice. But, so be it.........

 

[bUU]

Interesting.... but I want to see if I am understanding what you are writing... the $6,750 is a hard limit.... which includes the co-pays to doctors

I wouldn't call it a hard limit. It's a formula based on a bunch of variables. But in a specific year, yeah, it would be a "hard limit".

What about drugs? Are these included in that limit, or are they still separate?

I really don't remember all the details. Now I'm going to have to look this stuff up. Check ACA Section 1302

(c) REQUIREMENTS RELATING TO COST-SHARING.
(1) ANNUAL LIMITATION ON COST-SHARING.—
(A) 2014.—The cost-sharing incurred under a health plan with respect to self-only coverage or coverage other than self-only coverage for a plan year beginning in 2014 shall not exceed the dollar amounts in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986 for self-only and family coverage, respectively, for taxable years beginning in 2014.

(3) COST-SHARING.—In this title—
(A) IN GENERAL.—The term ‘‘cost-sharing’’ includes—
(i) deductibles, coinsurance, copayments, or similar charges; and
(ii) any other expenditure required of an insured individual which is a qualified medical expense (within the meaning of section 223(d)(2) of the Internal Revenue Code of 1986) with respect to essential health benefits covered under the plan.
(B) EXCEPTIONS.—Such term does not include premiums, balance billing amounts for non-network providers, or spending for non-covered services.

Any change is promoted by those benefitting from it.

That's actually not the case in many cases.

it's a shame that the changes weren't written to avoid having "losers."

No such thing: Someone will always claim to be aggrieved by anything ever proposed.

 

[youbet]

That's actually not the case in many cases.

Not true IMO. I think that most of the time people are in favor of changes that benefit themselves, loved ones or that enhance or support their personal value system.

No such thing: Someone will always claim to be aggrieved by anything ever proposed.

OK, I suppose someone will. But that doesn't justify writing a plan that omits some form of relief to individuals and families who will suffer negative consequences from the plan.

 

[MichaelB]

Here's a paper by KFF that discusses cost sharing http://www.kff.org/healthreform/upload/8303.pdf . The insurance companies are free to design any combination of cost sharing between deductible and copay, but the policy must meet the actuarial value targets established by HHS.

I would call the total out of pocket a pretty hard limit for in network, covered services.

 

[bUU]

Not true IMO. I think that most of the time people are in favor of changes that benefit themselves, loved ones or that enhance or support their personal value system.

That's a lot different from what a typical reader would infer from, "Any change is promoted by those benefitting from it."

It is true that people will not support things that they don't care about.

But that doesn't justify writing a plan that omits some form of relief to individuals and families who will suffer negative consequences from the plan.

What do you feel, specifically, was omitted, that could have been included without omitting something else or otherwise undercutting the whole in some other way? Omitting something that if included would undercut the whole is sometimes or often very appropriate. It's the nature of compromise.

I would call the total out of pocket a pretty hard limit for in network, covered services.

Except I believe that it changes every year. That is what I meant earlier.

 

[MichaelB]

Let's keep the discussion on what the PPACA is and implementation issues. Further need for health care change or reform can be take up in a new thread.

 

[MichaelB]

Except I believe that it changes every year. That is what I meant earlier.

Are you referring to inflation or COL adjustment?

 

[bUU]

Are you referring to inflation or COL adjustment?

I'm not sure. All I know is that the HSA threshold (which is used as the cost-sharing limit for ACA) changes year to year.

 

[youbet]

.

What do you feel, specifically, was omitted, that could have been included without omitting something else or otherwise undercutting the whole in some other way?

You can review the twenty-some pages of this thread for examples.

I'm mystified as to why some people seem to be pleased that there are "losers" in the new plan. What satisfaction are they getting from it? Is it because Obamacare was a political battle and, now won, must extract some blood from the losers for the delight of the "winners?"

Edit: I'm now seeing the mod warning above posted while I was typing. I'll exit this discussion.

 

[bUU]

You can review the twenty-some pages of this thread for examples.

Though I don't agree that any such examples were included that meet the criteria I outlined.

I'm mystified as to why some people seem to be pleased that there are "losers" in the new plan.

I don't know of any people who are.

I'm going to keep my ears open on Friday; I might overhear from the other room some updates on the educational aspects we've been referring to. I can tell you that the were supposed to be a lot more efforts to roll out the information we're talking about here, many of which were short-changed by inadequate funding. I'll try to share as much as I am legitimately able given the means by which I'm obtaining the info.