Repealing ACA

Jolie, BSN · Aug 4, 2017

With all due respect, Muno, I would appreciate your not assuming that you know my family's coverage status better than I do.

I am well aware of the coverage of our previous and current plans, and the limitations of both. Nursing has not been my only career. I have extensive professional experience related to health insurance.

We were forced to give up an affordable catastrophic plan tailored to our family's needs, which dovetailed nicely with our savings habits,financial situation, and risk-tolerance. Since then we have had THREE different Obamacare-compliant plans, because insurers keep pulling out. This year, our 4 family members are covered by 3 different plans, since not a single option remains in our state that will provide anything other than ER care for our daughters when they are at college out of state.

Our fixed costs (premiums, deductibles, and OOP maximums) have tripled in 3 years, while our coverage has essentially disappeared for everything but a yearly well visit per family member. (Even with very high cost estimates, that care would run us no more than a few thousand dollars per year.) So we are paying $18K per year for 4 doctor's visits. One doesn't have to be very bright to understand that is non-sensical and non-sustainable. And next year's estimates are for premiums alone to rise to $30K.

We are reasonably well-off financially, but that will be our breaking point.

Please, fellow posters, raise your hands if you would be willing to spend $30K to insure a married couple and one daughter, who will still need a second insurance policy to cover her at school. Keep in mind that policy will have a $15K deductible, so we will be out $45K before it covers anything beyond routine preventive healthcare. It will NOT be considered catastrophic coverage, because Obamacare won't allow that at our age, and will not be eligible for coordination with a pre-tax spending account, nor can pre-tax dollars be used to pay those astronomical premiums.

Would you sign up for that? I don't intend to. Unlike many families, I can afford to pay tens of thousands of dollars towards my healthcare, if need be, and I am willing to do so. But I'm not willing to pay tens of thousands in premiums and then still have to pay tens of thousands for my family's care.

While I pray for a reasonable resolution, I almost hope our state ends up without an insurer in the individual market. Then there is at least a small chance that we will once again be able to purchase truly catastrophic coverage free from the mandates and non-competitive practices that have (predictably) led to the failure of Obamacare.

Again, I understand that precious few who are not self-employed can relate to this mess, but what is happening now in the individual market will eventually spill over into group plans, so it is in everyone's interest, regardless of the source of their insurance coverage to educate themselves to the catastrophic (no pun intended) effects of this disastrous law.

Tenebrae, BSN, RN · Aug 4, 2017

I'm just wondering this, why are people against paying for healthcare? They have no problems paying for the latest iPhone, Michael Kors purses, retro Jordan sneakers..... But the thought of paying for life saving medications or appts to see a doctor is completely unreasonable? Do we as nurses not deserve to be paid for how hard we work? Because that's basically what the current attitude here in the US says to me.

I have no issues with paying for my healthcare, the issue I have is when people are being made bankrupt because of basic healthcare needs, such as needing inhalers to manage medication, or are being put on dodgy medications like haldol to manage schizophenia, because thats all their insurance will pay for despite the massive side effect profile, including tardive dyskenesia.

Plus, everyone still wants top of the line healthcare for no cost. I've been reading up on how it's done in Europe. Did you know they have public and private hospitals? That the private hospitals require insurance?

The care provided in public hospitals is still top of the line. If someone is in an accident, becomes acutely unwell, they get the care they need without having to worry about a bill for $100,000s dollars.

We pay tax, hopefully we never need to use it through hospital admission, speaking from experience, I was very glad a few years ago when I was admitted to hospital with septicemia. The total bill from surgery and a six day stay zero, the only cost was $10-20 for discharge ABs.

Private hospitals tend to cater toward elective surgery and things slightly less life threatening and yes, they do require insurance, although here often publicly funded operations may get done in private hospitals simply to get through the lists

Single payer systems do not work.

Completely untrue.

I

Hospitals lose tons of money a year on people that have no insurance.

So are you saying that Mrs Smith who works full time at Taco Bell unable to buy health insurance because shes the sole bread winner for her family, who needs urgent medical treatment following an MI should simply miss out because she cant afford insurance.

Bottom line for me is we need to change the mentality here in the US that healthcare is free and nobody should be paying a dime.

. I think you over simplify it. I haven't seen anyone necessarily argue for free healthcare, what most people object to is the threat or imminent bankruptcy or needing to sell a vital organ just to pay their medical bills

Not everybody will be seen by a doctor right away.

If they are needing urgent medical or accident care, they will be seen straight away. GP access is straight away, less life threatening issues are prioritised, and yes, people still have to wait much to long for non urgent elective surgery eg hip hoperations and the like, no system is perfect

Patients won't be able to demand a litney of testing and we will no longer pull out all the high end stops to save their loved ones.

Speaking as a registered nurse who works in a single payer system my colleagues and i have absolutely no barriers to pulling out all the stops to save the lives people loved family members.

Sure, patients may not get to demand every bell and whistle, however when I read about the family of Jahi McMath who have managed to keep her corpse breathing for the last four years, thats not necessarily a bad thing

The government will decide every aspect of their healthcare

I cant believe people actually believe this.

ILUVERNSG, MSN, RN · Aug 4, 2017

Funny. As recently as 2013, before the full implementation of Obamacare, the family policy we purchased directly from BCBS (with a premium under $600/month for a family of 4) was considered "catastrophic" coverage. It had a family deductible of $5000. Care in our primary physician's office (regardless of the nature of that care) was covered from the first dollar without regard to deductible. We OPTED out of maternity coverage, fully aware of the ramifications of that choice. We had vision benefits, but no dental, and were able to utilize a pre-tax spending account to meet non-covered expenses.
We currently pay over $18,000 per year in premiums for 3 family members. One child is now on her own. We have a $15,000 deductible that is STANDARD for many individual family policies, and NOT considered catastrophic. Our plan is not eligible for coordination with a healthcare spending account. Other than the Obamacare mandated "essential benefits" most of which we have no use for, we must pay $33,000 out of pocket per year before our coverage begins. But that is no longer considered high deductible or catastrophic. Go figure...
We recently attended a meeting held by our state insurance commissioner who predicts that next year our premiums will be over $30,000 due to loss of competition in the individual marketplace. He was outlining a proposal he is making the federal government that would keep premiums "more affordable" at about $24,000, because he accurately predicts that premiums as high as they are otherwise projected to be, will collapse the individual market altogether in our state. He's right. But there is no guarantee that the feds will approve his plan, or that it will sustain individual insurance here beyond one more year.
This is what Obamacare has wrought (and what many of us here accurately predicted) in the individual market. Most people have no comprehension of the state of the individual market, because they continue to receive benefits from employers or other group sources. This situation hits small businesses, farmers and other self-employed individuals and families in a devastating way.
We just want government out of the way so we can take care of ourselves and our families.

This is complete MADNESS! People are going broke paying huge premiums while others are asking me to call for their 'Medicaid cab'.

Orca, ADN, ASN, RN · Aug 4, 2017

In one word: Lawyers! 94% of the worlds lawsuits are filed in the USA. If you want to control healthcare costs, you have to control the lawsuits including the class action ones!

I can't watch any program, especially at night, without seeing a solicitation to join a class action lawsuit regarding some drug or medical device. It has become a cash cow for certain law firms.

For those saying that the current situation regarding the Affordable Care Act was predictable, bear in mind that a lot of this is the result of the instability created by the current administration and the unpredictability of their actions. Insurance companies are bailing because they have no idea what to expect.

Jolie, BSN · Aug 5, 2017

I can't watch any program, especially at night, without seeing a solicitation to join a class action lawsuit regarding some drug or medical device. It has become a cash cow for certain law firms.
For those saying that the current situation regarding the Affordable Care Act was predictable, bear in mind that a lot of this is the result of the instability created by the current administration and the unpredictability of their actions. Insurance companies are bailing because they have no idea what to expect.

I agree that there is currently much uncertainty in the insurance market. But this is the 3rd straight year we have received notice that our insurance plan is being discontinued on December 31. Keep in mind those first two letters came during the Obama administration. This law was designed to fail, and it is doing just that.

MunoRN, RN · Aug 6, 2017

With all due respect, Muno, I would appreciate your not assuming that you know my family's coverage status better than I do.
I am well aware of the coverage of our previous and current plans, and the limitations of both. Nursing has not been my only career. I have extensive professional experience related to health insurance.
We were forced to give up an affordable catastrophic plan tailored to our family's needs, which dovetailed nicely with our savings habits,financial situation, and risk-tolerance. Since then we have had THREE different Obamacare-compliant plans, because insurers keep pulling out. This year, our 4 family members are covered by 3 different plans, since not a single option remains in our state that will provide anything other than ER care for our daughters when they are at college out of state.
Our fixed costs (premiums, deductibles, and OOP maximums) have tripled in 3 years, while our coverage has essentially disappeared for everything but a yearly well visit per family member. (Even with very high cost estimates, that care would run us no more than a few thousand dollars per year.) So we are paying $18K per year for 4 doctor's visits. One doesn't have to be very bright to understand that is non-sensical and non-sustainable. And next year's estimates are for premiums alone to rise to $30K.
We are reasonably well-off financially, but that will be our breaking point.
Please, fellow posters, raise your hands if you would be willing to spend $30K to insure a married couple and one daughter, who will still need a second insurance policy to cover her at school. Keep in mind that policy will have a $15K deductible, so we will be out $45K before it covers anything beyond routine preventive healthcare. It will NOT be considered catastrophic coverage, because Obamacare won't allow that at our age, and will not be eligible for coordination with a pre-tax spending account, nor can pre-tax dollars be used to pay those astronomical premiums.
Would you sign up for that? I don't intend to. Unlike many families, I can afford to pay tens of thousands of dollars towards my healthcare, if need be, and I am willing to do so. But I'm not willing to pay tens of thousands in premiums and then still have to pay tens of thousands for my family's care.
While I pray for a reasonable resolution, I almost hope our state ends up without an insurer in the individual market. Then there is at least a small chance that we will once again be able to purchase truly catastrophic coverage free from the mandates and non-competitive practices that have (predictably) led to the failure of Obamacare.
Again, I understand that precious few who are not self-employed can relate to this mess, but what is happening now in the individual market will eventually spill over into group plans, so it is in everyone's interest, regardless of the source of their insurance coverage to educate themselves to the catastrophic (no pun intended) effects of this disastrous law.

Correct me if I'm wrong but you stated you had a plan through the individual market prior to Obamacare, these did not offer the same protections as the group market, I think you're confusing an individual market plan as including hospital coverage with whether or not they had any obligation to actually pay claims for hospitalizations. The main difference between individual market plans and group market plans prior to the ACA was that individual market plans were free to not play claims, which made them much cheaper than group market plans, the problem was they didn't really reduce the risk of someone being bankrupted by medical costs, or reduce the likelihood of a hospital or other provider going unpaid for services rendered. This is why there's been no push even by republicans to go back to the pre-ACA individual market "junk" insurance.

What defines the cost of premiums is primarily how much you're willing to pay before insurance kicks in, ie the deductible amount. The amount of healthy vs higher risk people in the plan also determines the cost, and as insurers have pointed out, premium costs are higher than predicted because fewer low risk people have signed up, the obvious fix for that is to require them to sign up. Considering most of services that result in these major costs are legally required to be provided, it only seems fair that people should be required to pay into the system that ensures those costs are paid for.

I agree it would be nice if we could all somehow pay half as much, but without changing the costs of the system (expensive futile care, private insurer high overhead, etc) cutting the amount of money we put into healthcare would cut the amount of healthcare in half; would could only take care of half as many patients in hospitals, cancer treatment, etc., which put us in the position of envying the healthcare many third world countries provide.

How would you suggest we maintain a workable healthcare system with half the revenue?

MunoRN, RN · Aug 6, 2017

I agree that there is currently much uncertainty in the insurance market. But this is the 3rd straight year we have received notice that our insurance plan is being discontinued on December 31. Keep in mind those first two letters came during the Obama administration. This law was designed to fail, and it is doing just that.

This is supposedly what we wanted, an insurance market that is at the whim of market survival-of-the-fittest, if such a system is working properly then plans and companies will come and go frequently.

Jolie, BSN · Aug 7, 2017

Muno, you are an intelligent and well-written individual.

You can't possibly miss the irony of the argument you continually make that our previous catastrophic insurance plan was substandard because it COULD HAVE BEEN discontinued at the insurer's will, when the policies that ACTUALLY HAVE BEEN cancelled are the Obamacare compliant policies we carried in 2015, 2016 and again in 2017.

Nor your explanation that our pre-Obamacare catastrophic policy did not include hospitalization (it did.) This year, our daughter had emergency surgery and a 3 day hospital stay. We are grateful that her condition was promptly and effectively treated with minimal expense. Because her covered expenses were billed at less than $15,000, our insurance paid nothing. We wrote checks totaling nearly $13,000, and are still battling with the insurance company over the final $300 for oral medications dispensed during her inpatient stay that they say should have been filled at a local pharmacy. So yes, given this scenario, we were much better off pre-Obamacare when we would have paid the first $5000, then cost shared to our OOP max. Pre-Obamacare, we paid about $1000 LESS in monthly premiums than we do now, another $12,000 in yearly savings.

I'm amused by your repeated questions about my suggestions for making healthcare more affordable. We've done this dance before, so feel free to scroll thru the archives. My ideas haven't changed much over the years.

My purpose for posting our family's experience is to call attention to the INDIVIDUAL MARKET, which few people, including many posters here understand. Obamacare is failing in virtually every respect, but no-where as fast and furious as in the individual market. The numbers change rapidly, but somewhere in the neighborhood of 60% of Americans who must purchase individual (family) insurance have no choice of policies or insurers. Imagine if every employer in a particular state was forced to drop insurance plans that they and their employees found satisfactory and instead enroll in a single, crappy plan with high costs and few providers. Then imagine that happening over and over again every year, with costs going up and provider lists shrinking until there was no plan left at all. And then imagine that those employees had to fully pay the premiums and out of pocket costs (upwards of $30,000 to $45,000 per year) with after-tax dollars. And then imagine if those employees with college age children attending school away from home had to purchase yet another insurance plan for those young adults because theirs provided no services (other than ER) for out of area care.

This is what happens when people fail to understand that insurance is not the same thing as healthcare. At this rate, we will soon be among the growing ranks of people carrying very expensive insurance cards in their wallets that they can not afford to use. Or not. As our state insurance commissioner accurately predicts, next year's premiums may well be the breaking point for a majority of non-subsidized individual policyholders. We can no longer afford to pay for everyone else's healthcare before our own.

Jolie, BSN · Aug 7, 2017

This is supposedly what we wanted, an insurance market that is at the whim of market survival-of-the-fittest...

This is not a marketplace of survival of the fittest. If it were, insurers would be allowed (encouraged) to innovate by crafting policies that meet their customers' needs, desires and budgets.

Food, shelter and clothing are universally viewed as basic life necessities. Yet when the government (by way of taxpayers) provides these things for people unable to do so themselves, the offerings are basic safety nets. And the government does not mandate that when self-supporting individuals CHOOSE to purchase these items for themselves they must meet specific standards. The lack of freedom of choice is one way in which Obamacare prevents survival of the fittest, rather than embracing it.

Susie2310 · Aug 7, 2017

In my area, unsubsidized health insurance policies on the individual market cost over $800 for an individual and are set to rise by double digits for the next enrollment period. As in other states, there is a shortage of insurance companies participating in the individual market. With Out of Pocket costs at over $7000 a year, an individual can pay over $17,000 yearly for an individual market unsubsidized plan. This is about more than just health care being very expensive. In my area certain physician/hospital groups that participate in the individual market also dominate the health care market in the state, regularly making very good annual profits. This is about charging all the traffic will bear to a captive market.

I don't agree with repealing the ACA, but something needs to be done to fix the individual market.

Susie2310 · Aug 7, 2017

In my area, unsubsidized health insurance policies on the individual market cost over $800 for an individual and are set to rise by double digits for the next enrollment period. As in other states, there is a shortage of insurance companies participating in the individual market. With Out of Pocket costs at over $7000 a year, an individual can pay over $17,000 yearly for an individual market unsubsidized plan. This is about more than just health care being very expensive. In my area certain physician/hospital groups that participate in the individual market also dominate the health care market in the state, regularly making very good annual profits. This is about charging all the traffic will bear to a captive market.
I don't agree with repealing the ACA, but something needs to be done to fix the individual market.

Edited to add that I meant to write: "In my area, unsubsidized health insurance PREMIUMS on the individual market cost over $800 for an individual . . . "

Susie2310 · Aug 7, 2017

On the individual market a number of people receive subsidies based on their income up to a designated threshold. Subsidized individual market policy purchasers pay part of their health care costs and the government provides the rest of the insurance (subsidy) payment. Unsubsidized individual market policy purchasers are responsible for the entire cost of their insurance regardless of whether any annual increases in costs are reasonable or not. Unsubsidized individual market policy purchasers are at the mercy of the free market for both the insurance companies and the physician/hospital groups. This situation is very unfair and needs to be addressed politically.