ACA, Subsidies and Better off Americans (which means many FIRE)

[euro]

Free has to be below cost to produce, even if you advertise there in the Georgian version of the thrifty nickel.

Well, true for that particular drug, but it is possible that Gilead can reap other benefits (research credits, higher prices for other drugs in their portfolio, etc) to make up for it.

 

[Texas Proud]

The prices in ANY market is a reflection of what that market will bear in that particular location, and it has little or nothing to do with where the research and development are done. The US market, becasue it can/is willing to bear the highest prices, is the most lucrative market for for ALL pharmaceutical companies, regardless of where they are located, and ALL companies will charge the maximum they can get. It's the free market system. Capitalism is good, but it is NOT perfect.

The drug market does not work like other markets... it is not really what the market will bear as there is not a single buyer vs a single seller...

The drug companies are gaming the system....

I was reading about one company that had a drug that 'cost' $100K... but the drug company was aware of the problem some people would have paying their share... so what did they do Reimburse that money back to the patient!!! SOOO, the patient was not out any money so was not complaining... and in fact was saying they NEEDED this drug even if the insurance company did not want to pay the high price... So, the drug company nets $80K from some people but $100K from others.... where if it were a free market it might only cost $20K... (which, IIRC, it cost overseas)....

That is what Mylan did to try and get people off their back... they did not reduce the price since they want to get the maximum from the insurance plans that pay most of the drug costs... so if you have a $20 or so copay you do not care that it cost $600...

https://www.epipen.com/copay-offer

 

[pjigar]

Not to mention Docs pushing brand name. My Doc pushes a brand name drug every time a new one comes out and I have to push her back to generic covered by my plan. One more thing: If a drug is a life saving drug then you will pay anything to get it. Does that make a ridicules drug price fair?

 

[ziggy29]

Not to mention Docs pushing brand name. My Doc pushes a brand name drug every time a new one comes out and I have to push her back to generic covered by my plan. One more thing: If a drug is a life saving drug then you will pay anything to get it. Does that make a ridicules drug price fair?

Fortunately I've never seen that happen first hand though I've certainly heard about it. And in reality, in many situations unless the Rx is written to specify "name brand only", a generic can be dispensed, and usually will be (in my experience) under most health plans which will usually not cover the full cost of name brands with generic alternatives except in a few cases where medical necessity can be established.

 

[GTFan]

The problem that I had is the high deductible... where you paid almost everything out of pocket until you paid over $6K for one person... the premiums were not a concern...

You've got half the problem covered - high deductible. The other half you're completely missing, because I don't know how else to explain that $700-800 premiums are unaffordable. You keep saying that people should be able to get subsidies but that is 100% untrue for any single person (or family) making just over the 400% FPL cliff. And that is NOT uncommon regardless of your local experience. It's just basic math regardless of the cost of living - no single person wants to make another rent payment for health insurance when they're only making $50k a year.

I'll make it easy for you - go to healthsherpa.com and put in a single 62 year old female for zip 30126 making $50k. Tell me what you see.

These are the staff I volunteer for at my local charity, and they hate the ACA (for good reason given this issue).

 

[pb4uski]

That is where the cliff doesn't make much sense... for someone just before the cliff we're willing to subsidize to limit their costs to 10% of their income but if they are just over the cliff then there are no subsidies at all. But OTOH, if we extended subsidies so no one would pay more than 10% of their income for health insurance then the deficit would explode.

 

[travelover]

Fortunately I've never seen that happen first hand though I've certainly heard about it. And in reality, in many situations unless the Rx is written to specify "name brand only", a generic can be dispensed, and usually will be (in my experience) under most health plans which will usually not cover the full cost of name brands with generic alternatives except in a few cases where medical necessity can be established.

Depends on the state - see my post #153

 

[Texas Proud]

You've got half the problem covered - high deductible. The other half you're completely missing, because I don't know how else to explain that $700-800 premiums are unaffordable. You keep saying that people should be able to get subsidies but that is 100% untrue for any single person (or family) making just over the 400% FPL cliff. And that is NOT uncommon regardless of your local experience. It's just basic math regardless of the cost of living - no single person wants to make another rent payment for health insurance when they're only making $50k a year.

I'll make it easy for you - go to healthsherpa.com and put in a single 62 year old female for zip 30126 making $50k. Tell me what you see.

These are the staff I volunteer for at my local charity, and they hate the ACA (for good reason given this issue).

You seem to not get that I am not talking about them.... I am talking about the people who do not get coverage and do qualify for a subsidy....


So, looked it up... I see a plan for $673....

AND... the people you talk about can qualify for a credit if they made $3K less... then they would qualify for a credit of $5,472 and the premiums would be $217... for a net credit of $2472.... which brings there net net cost down to $467 per month....


Also, when I was working a few years back I was paying almost $1K per month for my family... and that was subsidized cost.... I would not think of going without health insurance just like I do not go without car or home insurance....

Insurance for all calamities is the largest cost to me... and I bet it is too a number of people... before credits, all my insurance cost me close to $20K.... that is why I wonder about people who say they can live on $20K and pay everything.... but that is another issue...

 

[Fermion]

But post ACA what is going to be the premium for that person who is age 62 and making $50k?

They might hate the ACA, but I think they are going to hate post ACA just as much. Especially if they get sick.

Then again, insurance companies, hospitals and drug companies might magically agree to drastically lower prices to help out everyone post ACA.

 

[aaronc879]

But post ACA what is going to be the premium for that person who is age 62 and making $50k?

They might hate the ACA, but I think they are going to hate post ACA just as much. Especially if they get sick.

Then again, insurance companies, hospitals and drug companies might magically agree to drastically lower prices to help out everyone post ACA.

I agree that health care costs are not going to magically go down by a large amount when/if the ACA gets dismantled. If the income based subsidies go away I would have to pay over $4K/yr for premiums and the first $6K or so in health care all on an income of around $25K/yr being self employed. I would likely have no choice but to go without health insurance. Because of that, I have started to look for a regular full time job with health benefits. I was hoping to do contract work on a part time basis for the next 20+ years but now I will have to go back to painful factory work with union benefits. I hope all those people who retired early thinking they would continue to get big subsidies are able to cut back in other areas so they don't have to go back to work.

 

[Texas Proud]

But post ACA what is going to be the premium for that person who is age 62 and making $50k?

They might hate the ACA, but I think they are going to hate post ACA just as much. Especially if they get sick.

Then again, insurance companies, hospitals and drug companies might magically agree to drastically lower prices to help out everyone post ACA.

I agree... so many people are putting the blame on the ACA... when in reality they were not able to afford insurance before it passed...

Also, the cost of healthcare was going up at a high rate prior to it passing... so the pain that people feel now would have come about anyhow...

 

[Fermion]

Anyway, what we have now is subsidies until 2018, because they are not planning to repeal and cut instantly. It isn't time to panic yet but you don't want to stick your head in the sand either.

Medicaid in some states is always an option for those of us who are very mobile and have great income flexibility.

 

[aaronc879]

I agree... so many people are putting the blame on the ACA... when in reality they were not able to afford insurance before it passed...

Also, the cost of healthcare was going up at a high rate prior to it passing... so the pain that people feel now would have come about anyhow...

I went without health insurance when I left my job in late 2011 thru start of 2014 when I could get ACA subsidies. Now I will have to go back to no insurance unless I can get back onto employer insurance. The ACA didn't make insurance unaffordable.

 

[jim584672]

Medicaid in some states is always an option for those of us who are very mobile and have great income flexibility.

That will no longer be an option since it reverts back to pre-ACA, which means you must be disabled, elderly or blind and spend down before it kicks in.

 

[euro]

The drug market does not work like other markets... it is not really what the market will bear as there is not a single buyer vs a single seller...

The drug companies are gaming the system....

I was reading about one company that had a drug that 'cost' $100K... but the drug company was aware of the problem some people would have paying their share... so what did they do Reimburse that money back to the patient!!! SOOO, the patient was not out any money so was not complaining... and in fact was saying they NEEDED this drug even if the insurance company did not want to pay the high price... So, the drug company nets $80K from some people but $100K from others.... where if it were a free market it might only cost $20K... (which, IIRC, it cost overseas)....

That is what Mylan did to try and get people off their back... they did not reduce the price since they want to get the maximum from the insurance plans that pay most of the drug costs... so if you have a $20 or so copay you do not care that it cost $600...

https://www.epipen.com/copay-offer

Yes, that's my point: the drug company will adjust pricing/marketing strategy to optimize profits depending on what their markets will bear. Capitalism at its best (and worst).

 

[travelover]

I agree... so many people are putting the blame on the ACA... when in reality they were not able to afford insurance before it passed... .........

Any many had crap insurance with a low lifetime limit. They just didn't know it because they had not had a big medical expense.

 

[samclem]

That will no longer be an option since it reverts back to pre-ACA, which means you must be disabled, elderly or blind and spend down before it kicks in.

You don't know what will happen. None of us do. Some qualifiers are definitely in order, anybody speaking in hard declaratives is talking beyond the known facts.

 

[MRG]

Any many had crap insurance with a low lifetime limit. They just didn't know it because they had not had a big medical expense.

+1

Many years ago my Megacorp insurance didn't include mental coverage. No problem, I had just been diagnosed with hypertension and my PCP really impressed on me how serious it could be. Like here's my home phone number and don't mess with anything.

I wasn't feeling well and went home. My chest felt tight and my left arm was numb! OMG I am having a heart attack! To the closest ER I go cause I am dying! Not so fast, it's my first ever panic attack. Yeah glad those dollars were in 1990s health care costs.

 

[Big_Hitter]

Here is a good read on what can or can't be changed via the budget reconciliation process:

https://www.segalco.com/media/2918/me-12-22-2016.pdf

 

[Sue J]

I'll make it easy for you - go to healthsherpa.com and put in a single 62 year old female for zip 30126 making $50k. Tell me what you see.

I tried it at Healthcare.gov. In 30126 the SLCSP is $836/mo. There is no subsidy at $50k. There are 2 bronze plans under $700/mo. At $47,519 the subsidy is $443/mo. If it was me I'd put $2500 in an IRA and get the MAGI under the 400% cliff.

In my low cost of living area a single person making $50k can be very comfortable. But would they want to pay almost $700/mo for a bronze plan with a $6,000 deductible? Nope.

I also noticed that in zip code 30126 there are only 2 insurers.

Just for comparison, for this same person in 44223 the SLCSP is $564/mo. There are 10 bronze or silver plans in the $507-$600/mo range with deductibles of $3,500 to $6,650. At a MAGI of $47,519 the subsidy is $180/mo.

Very interesting. Your location makes such a difference in what choices are available.

We have family in 07901, Summit, NJ. For a 62 year old female the SLCSP is $793/mo. At income of $47,519 the subsidy is $407.

 

[Texas Proud]

Any many had crap insurance with a low lifetime limit. They just didn't know it because they had not had a big medical expense.

OH... I agree... the loss of the really crap plans can be attributed to the ACA....

I remember reading about one (it could have been some McDonald's) where they would pay for some Dr appts etc., but if you got really sick and went to the hospital you got zip... so in reality no insurance at all.... but, as you say, if you never had it happen to you you never knew and went along with your life thinking you were covered by insurance...

 

[pb4uski]

.....In my low cost of living area a single person making $50k can be very comfortable. But would they want to pay almost $700/mo for a bronze plan with a $6,000 deductible? Nope. ....

Just a reminder that if the lowest cost bronze plan exceeds 8.13% of your income then you can by catastrophic coverage even if you are over 30. While the price difference is not much in many states (especially those with age-rating) in some states it is considerably less expensive (45% where I live and the benefits are not very different).

 

[Texas Proud]

Just a reminder that if the lowest cost bronze plan exceeds 8.13% of your income then you can by catastrophic coverage even if you are over 30. While the price difference is not much in many states (especially those with age-rating) in some states it is considerably less expensive (45% where I live and the benefits are not very different).

None of the sites I have looked at have ever shown a catastrophic plan, so I have no idea what they cover or what they cost....

 

[pb4uski]

They are hard to find, you have to dig a lot online, or sometimes you have to call.

 

[Ian S]

Most of the deficiencies of the ACA could be addressed if we ever had a functional Congress. For example, the "cliff" could be easily converted to a graduated slope which would be far fairer IMHO. Ultimately, though healthcare in this country is expensive. Have you seen some of the newer hospitals that look like luxury hotels? Also I think doctors are overpaid compared to other countries although maybe not when we look at what pro athletes are paid. LOL!