ACA at risk?

[pb4uski]

....Three important roles government could play (IMO):
1) Create standardized coverages and descriptions. This was done in the case of Medicare supplement insurance, and significantly benefited consumers. Insurers/providers >hate< transparency and standardization, consumers benefit from it. It makes price comparisons simple and turns these services into commodities. This would not prohibit providers from throwing extras into their "purple" package, but all purple plans would have basic attributes in common.

2) Collect and make usable by consumers health care/provider outcome information and patient satisfaction information. This is critical information consumers need to choose well, and to build a functioning free market. If people in a region can see that those insured by Helping Hand insurance hate their plans, or that they wait 10 months for a knee replacement, then they may be more likely to choose a different "agent".

3) Discontinue policies that encourage a linkages between employment and health care. (This could be controversial )

Agree with all of these, particularly the last one... except it should say health insurance rather than health care. People who get laid off regularly or change jobs really get jerked around on health insurance under the current system... in this day and age there is no good reason for employment and health insurance to be co-dependent... besides, I think it would foster more competition as insurers vie to garner market share of a big, humungous group.

 

[Cut-Throat]

Agreed up to that point, but the ACA absolutely increased premium and deductible costs (massively, and there are nearly endless examples of people's HC premiums doubling, tripling (or more) to the point they can't begin to afford the premiums, let alone the big deductibles). That's partly because the insurance companies now need to cover everybody, have no limits on coverage, plans now need to be consistent in coverage regardless of a person's need (ie: my plan covers pregnancy for a mid 50 yo man), etc.

I'm not saying those things are necessarily wrong (except perhaps the equal coverage for things people don't need), but absolutely were a big part of the (massive) premium and deductible increases when the ACA got created..

From my perspective, I'd much rather the .gov continue to provide subsidies for those who truly cannot afford HC, and let those of us who wish to purchase policies on the open market - even across state lines - do so. And those policies should not IMHO be forced to "have" certain things (pregnancy coverage for a mid 50 yo male or a 60+ yo female, for instance) in them, but let the people CHOOSE their policy coverage.

I'd expect that a large part of the reason we can't get something like that passed is the .gov wants too much control over people, and there's nothing as controlling as HC. But it's as American as apple pie to let people choose to buy what they want to buy, politics aside.

Here is a Personal Finance article that will explain what the ACA actually did.


https://www.thebalance.com/the-truth-about-obamacare-3306075

 

[24601NoMore]

Here is a Personal Finance article that will explain what the ACA actually did.

https://www.thebalance.com/the-truth-about-obamacare-3306075

Appreciate the article, but a few seconds of googling show the author's obvious political leanings (e.g.: her Twitter feed), so it's no surprise she tries to justify and explain away or in some cases even attempt to refute the most common objections about the ACA.

Regardless of attempts by the author of the article and others to try to justify the changes the ACA brought and to sway public opinion, the reality is that premiums and deductibles have indeed massively increased under the ACA - to the point they are not affordable for the vast majority of people who are not receiving subsidies. Even those of us who "can" pay them are paying 2-3X+ what we used to pay for premiums and deductibles, pre-ACA. That's my sole objection about the ACA - COST to those of us who are not being subsidized by the .GOV. And, those massive cost increases are not due to "increasing medical costs" but in large part a direct cause of the vast changes the ACA brought overall to the US Healthcare system.

 

[pb4uski]

....Pre-ACA, we did not have $7K PP deductibles (in most cases) and premiums were far more reasonable...

Not at all in my experience.... I was working prior to ACA and my employer was incentivizing employees to high-deductible plans... premiums were lower and the employer would make $110/month contributions to your HSA if you chose a high deductible plan. Deductibles were more like $5k as I recall, but that was 10 years ago. The 2012 COBRA premium for that plan for 2 was $900/month and the employee premium was $250/month for a couple (employer presumably subsidized $700/month).

Once I retired we bough health insurance on the pre-ACA individual market and unsubsidized ACA insurance since ACA. Our BCBS pre-ACA premiums were $556/month and $629/month for a couple for 2012 and 2013, respectively. Our first year of ACA in 2014 was $682/month for a couple... the same policy today is $993/month for a couple.

We actually currently pay $489/month for two because we fell into the affordability exemption allowing us to by catastrophic coverage available to people 30 and younger and our state is one of the few states that prohibits age rating but similar coverage would be $993/month in 2019 so catastrophic premiums are significantly lower than normal premiums.

 

[BeachOrCity]

Great idea on making pregnancy coverage optional or “opt in” below. This way only women planning to get pregnant would buy it and the insurance company’s would just price it based on average cost for maternity and delivery in the USA. So take the say 8k per year cost of a platinum plan for a 30 year old and add to that another 10k for pregger coverage and any woman thinking of having a kid needs to have 18k just for the insurance portion.

It’s called “adverse selection” and it’s why the ACA has a std set of coverage benefits. Otherwise it could be cost prohibitive to cover Many serious conditions such as drug addiction, mental health, lung cancer, and heart disease for fat (or unlucky) people.

Oh and prior to the aca individual Heath insurance plans almost NEVER covered pregnancy due to the above.

Agreed up to that point, but the ACA absolutely increased premium and deductible costs (massively, and there are nearly endless examples of people's HC premiums doubling, tripling (or more) to the point they can't begin to afford the premiums, let alone the big deductibles). That's partly because the insurance companies now need to cover everybody, have no limits on coverage, plans now need to be consistent in coverage regardless of a person's need (ie: my plan covers pregnancy for a mid 50 yo man), etc.

I'm not saying those things are necessarily wrong (except perhaps the equal coverage for things people don't need), but absolutely were a big part of the (massive) premium and deductible increases when the ACA got created..

From my perspective, I'd much rather the .gov continue to provide subsidies for those who truly cannot afford HC, and let those of us who wish to purchase policies on the open market - even across state lines - do so. And those policies should not IMHO be forced to "have" certain things (pregnancy coverage for a mid 50 yo male or a 60+ yo female, for instance) in them, but let the people CHOOSE their policy coverage.

I'd expect that a large part of the reason we can't get something like that passed is the .gov wants too much control over people, and there's nothing as controlling as HC. But it's as American as apple pie to let people choose to buy what they want to buy, politics aside.

 

[pb4uski]

Agreed up to that point, but the ACA absolutely increased premium and deductible costs (massively, and there are nearly endless examples of people's HC premiums doubling, tripling (or more) to the point they can't begin to afford the premiums, let alone the big deductibles). ....

A lot of what you write is true but what we'll never know is how much health insurance would have increased without ACA.

ACA gets blamed a lot for health insurance premium increases, but few people understand that by law that health insurers must pay at least 80% of premiums for claims (to medical service providers)... leaving 20% of premium to cover overhead, taxes and profit. Thus, the increase in health insurance premiums is driven principally by the dramatic increase in health care... and ACA didn't directly impact health care costs.

 

[LARS]

Socialized medicine scares the bajeebus out of me. Do you seriously want the life or death of your very loved ones to be subject to some bureaucrat's decision? Because that's precisely what socialized medicine is.

If you doubt that, take a look at what's happened in the UK. Very long wait times to see a provider. Frequently denied treatments.."he/she is too old..let's give them 'comfort' in the end of their life..(via some hard drugs).."

God help us if that ever comes to the US.

Not sure it is any worse than having the life and death decision reside with an insurance company...

 

[gerntz]

- A problem with single payer is the large number of non-citizens crossing our borders who will be eligible & thus add to costs - as they already do for schools and other social benefits.
- We can state that insurance company overhead drives up costs, but government overhead would exist for single payer.
- If some think ACA unconstitutional, it's their right to challenge it regardless of the consequences. I suspect it would be allowed to continue to exist for some period even if found uc.
- Basing insurance cost or subsidies on wealth would be a nightmare imo. For starters, how much is real estate worth each year
- Perhaps a replace law to ACA would be less contentious if both parties had input to it. Then again, maybe not.
- Drug prices are so high due to USA allowing pharmas recovery of development costs & significant profit while other countries don't. That needs to be corrected.

 

[ShokWaveRider]

Maybe it is just another distraction that the administration like to use to keep them in the constant Media Cycle and take people minds off other stuff. Otherwise it seems like another nail in the coffin for 2020.

 

[Walt34]