Who Obamacare has helped the most

[samclem]

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 . . . ?"

 

[daylatedollarshort]

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?

 

[samclem]

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.

 

[daylatedollarshort]

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...ow-congress-paid-for-obamacare-in-two-charts/

 

[samclem]

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.

 

[ERhoosier]

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/2014/churn_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/obamacare-enrollment-7-3-million-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.

 

[daylatedollarshort]

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/...fordable-care-act-working.html?_r=0#uninsured

 

[bUU]

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.

 

[MichaelB]

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.

 

[marko]

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.

 

[2B]

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'.

Everyone should take advantage of whatever program is available to them. If you can, I don't see any reason to not suppress taxable income to get the subsidy. There is also no "fair" tax rate the "rich" should pay. There is no reason not to take advantage of any benefits available in the tax code. I have personally decided it's not worth going for the subsidy. I think I'm better off doing Roth conversions aggressively in my pre-RMD years.

Taxpayers are now paying for the tide of new Medicaid and subsidized health plans. People love "free" even if it isn't.

 

[marko]

Everyone should take advantage of whatever program is available to them. If you can, I don't see any reason to not suppress taxable income to get the subsidy.

A few years ago, I would have strongly disagreed.

I've come around.

 

[frank]

I wonder how the uninsured vs the insured between 2013 and 2014 was affected by the number of immigrants, illegal and otherwise that have insurance now and could not get it before?

 

[MichaelB]

Immigrants lawfully present in the US are eligible for ACA policies, some assistance is available but restrictions apply.

 

[Mulligan]

Everyone should take advantage of whatever program is available to them. If you can, I don't see any reason to not suppress taxable income to get the subsidy. There is also no "fair" tax rate the "rich" should pay. There is no reason not to take advantage of any benefits available in the tax code. I have personally decided it's not worth going for the subsidy. I think I'm better off doing Roth conversions aggressively in my pre-RMD years.

Taxpayers are now paying for the tide of new Medicaid and subsidized health plans. People love "free" even if it isn't.

I agree with you and Marko on this.... It is natural, at least to me anyways, to complain about programs or taxes I get hosed on, and then conveniently shrug off any I benefit from. And my beef with getting smacked with a 300% plus increase in premium costs come January would largely go away if they would let me pay my premium with pre-tax dollars like workers through employers are currently afforded.


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[Walt34]

Nope. $55,000

Amazing - where do they come up with these numbers?

Last summer I had a three-day stay in the hospital, two in cardiac care and one in ICU and had two stents put in a heart artery. Bill to the insurance company was $45k.

 

[heeyy_joe]

PPACA got me out of job-lock.

 

[photoguy]

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.

A little under 10 years ago, I spent a night in the ER due to food poisoning. They did an echocardiogram but basically did nothing but observe. The hospital billed insurance $10k of which they paid $1k.

 

[gauss]

Amazing - where do they come up with these numbers?

Last summer I had a three-day stay in the hospital, two in cardiac care and one in ICU and had two stents put in a heart artery. Bill to the insurance company was $45k.

Under my state's no-fault auto insurance law, if an auto accident occurs the auto insurer must pay full retail rates to the hospitals for medical expenses.

When a patient shows up in an emergency room, they ask quite a few times if an automobile was involved...

-gauss

 

[travelover]

In my state, by law, if an auto accident occurs, the auto insurer must pay full retail rates to the hospitals.

When a patient shows up in an emergency room, they ask quite a few times if an automobile was involved...

-gauss

By law, huh? I guess we know who paid for that legislature.

 

[brewer12345]

Amazing - where do they come up with these numbers?

Last summer I had a three-day stay in the hospital, two in cardiac care and one in ICU and had two stents put in a heart artery. Bill to the insurance company was $45k.

And a couple years ago dad fell at a resort in Mexico and ended up with a bad concussion in the hospital. He was in a 5 year old hospital which had been built and set up to 5 star international standards with all the latest everything. He spent 2 or 3 days in ICU and a week or more in a regular room. Mom spent the time at an on-site hotel that had everything you could ever ask for. When they finally released him as safe to travel home, the total bill was a mere 18k. I don't know what the equivalent treatment in the US would have cost, but I bet it would have been a six figure bill.

 

[Birdie Num Nums]

Almost all other developed countries seem to be able to afford some form of universal healthcare:....
"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."
....

Sheesh! Even the brand-new state of Iraq, of all countries, the one we spent incalculable resources to create, has a constitutional guarantee of universal health care. Yet, oddly enough, from what I could find, not a constitutional right to keep and bear arms.

 

[daylatedollarshort]

Sheesh! Even the brand-new state of Iraq, of all countries, the one we spent incalculable resources to create, has a constitutional guarantee of universal health care. Yet, oddly enough, from what I could find, not a constitutional right to keep and bear arms.

Interesting point, but I am not sure it was incalculable resources. The estimate I read was $6 trillion dollars:

Iraq war costs U.S. more than $2 trillion: study | Reuters

While the ACA is actually predicted by the Congressional Budget Office to reduce deficits over the next 10 years and in the subsequent decade:

CBO's Estimate of the Net Budgetary Impact of the Affordable Care Act's Health Insurance Coverage Provisions Has Not Changed Much Over Time | Congressional Budget Office

 

[pb4uski]

.... How can a middle class family making $50K a year, with preACA type faux insurance, afford to pay $40K - $50K in medical costs in one year?

Even pre-ACA maximum out-of-pockets were a lot less than $40-50k, so how could this possibly happen if someone has insurance? especially if they stay within network.

 

[pb4uski]

The surgery in our family last year was $150K without insurance, and under $50K with insurance company negotiated rates for most of the bills. It is a legalized scam to make the uninsured pay many times over what insurance companies pay.

But the reality you overlook is that the uninsured don't really pay the rack rate. Many of them don't pay at all or negotiate a bill that is much lower than the rack rate. I would agree that the rack rates are ridiculous and should be abolished.

Under my plan in a case like you outline, even if the rack rate was $150k and the negotiated rate was $50k, the insurer would pay $43,750 and I would be billed $6,250. I can often get a 20% discount from the provider for immediate credit card payment and 2% cash back from the credit card company, so my net cost might be as low as $4,900.