Repealing ACA - page 3

I have been closely watching both the House and Senate's efforts to repeal the ACA. As nurses, we are on the frontline of our nation's health care delivery system, and it seems to me that we have... Read More

  1. by   ILUVERNSG
    Quote from Jolie
    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'.
  2. by   Orca
    Quote from soutthpaw
    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.
  3. by   Jolie
    Quote from Orca
    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.
  4. by   MunoRN
    Quote from Jolie
    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?
  5. by   MunoRN
    Quote from Jolie
    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.
  6. by   Jolie
    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.
  7. by   Jolie
    Quote from MunoRN
    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.
  8. by   Susie2310
    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.
    Last edit by Susie2310 on Aug 7
  9. by   Susie2310
    Quote from Susie2310
    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 . . . "
  10. by   Susie2310
    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.
    Last edit by Susie2310 on Aug 7
  11. by   MunoRN
    Quote from Jolie
    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.
    That's how it worked before which was a big part of why everyone agreed some sort of health coverage reform had to occur.

    In the individual market, a plan might list hospital stays as something that it might cover, but it wasn't the same as the obligation to cover claims that existed in the group market. Insurers were denying claims at a progressively faster rate to keep the cost of coverage down, which didn't prevent those covered by those plans from transferring their costs to others.

    The basic purpose of insurance is to pay someone's healthcare costs beyond a predetermined amount that the consumer agrees to pay first (the deductible). If the costs for everyone in a plan beyond the deductible amount is $10 million, and there are 1000 people in the plan, then the premium is 10000 per person plus the insurers fee. How would you suggest they "craft a policy" that better meets their customers budget needs? The only apparent way is to not pay for the full amount of care that people require above the deductible amount, so what care shouldn't be provided?

    If those costs are primarily focused on a small portion of the insure pool, then we could just drop coverage for those folks, or move them to a different risk pool, which then results in far more ridiculous premium costs for those in that pool that they can't pay, which then requires others to cover the costs, so there's no avoiding those costs, we can only shift them around a bit which if anything just adds to the cost with extra administrative costs. I don't really see the benefit of moving those with higher costs out of my plan if I'm just going to end up paying for them anyway through other means, particularly if that process ends up costing me even more.
  12. by   MunoRN
    Quote from Jolie
    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.
    If your plan has a $15,000 individual deductible, rather than a $15,000 family deductible / $5,000 individual deductible than I would suggest getting a different plan. I see no plans in your area that have a $15,000 individual deductible, for the price you're paying they all have a $5000 individual deductible, you apparently don't have an ACA compliant plan if that is how much you are paying.

    There is a very big difference between a plan exiting the market and switching to a new plan, and having your coverage cancelled when you get sick, I have a feeling you are aware of that important difference. In one case you're going still always provided coverage, and in the other you're not.

    There's no arguing our healthcare system is very expensive, there are certainly options to reduce those costs, but until then our premiums are defined by your share of the costs beyond the deductible amount. If the premiums are too high then where is that extra money? As you've pointed out, insurers often leave individual coverage markets, and it's not because they're making too much money. Hospitals are barely in the black (they were actually in the red just before the ACA), so where is the extra money that you're paying that you don't need to be?

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