Repealing ACA

MunoRN, RN · Aug 9, 2017

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.

MunoRN, RN · Aug 9, 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.

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?

Robert.CFRN · Dec 2, 2017

It's rather simple. The best way to make anything really expensive and really inefficient is to get the government involved. Hospitals are regulated by over 20 different agencies, with tens of thousands of pages of regulations. Nurses have to spend as much time charting as we do taking care of sick people. Huge and expensive hospital bureaucracies have been created just to try to be compliant with all of the regulations.

The answer, which would be far less expensive, is government supplemented high risk pools and the free market. Allow insurance to be sold across state lines. Have health care providers be more transparent with costs so that people can shop for better prices. Radically decrease the regulation that is burdening our health care providers. Get tort reform so that ambulance chasing lawyers aren't forcing doctors to practice defensive medicine.

And stop listening to Democrats. Wanting to remove burdensome and unnecessary regulations isn't the same as wanting old people to die. Not favoring an all-powerful confiscatory Mommy government isn't the same as wanting to give money to rich people. Yes?

So there ya go...

MunoRN, RN · Dec 3, 2017

It's rather simple. The best way to make anything really expensive and really inefficient is to get the government involved. Hospitals are regulated by over 20 different agencies, with tens of thousands of pages of regulations. Nurses have to spend as much time charting as we do taking care of sick people. Huge and expensive hospital bureaucracies have been created just to try to be compliant with all of the regulations.
The answer, which would be far less expensive, is government supplemented high risk pools and the free market. Allow insurance to be sold across state lines. Have health care providers be more transparent with costs so that people can shop for better prices. Radically decrease the regulation that is burdening our health care providers. Get tort reform so that ambulance chasing lawyers aren't forcing doctors to practice defensive medicine.
And stop listening to Democrats. Wanting to remove burdensome and unnecessary regulations isn't the same as wanting old people to die. Not favoring an all-powerful confiscatory Mommy government isn't the same as wanting to give money to rich people. Yes?
So there ya go...

Maybe you could expand on how "government supplemented high risk pools and the free market" and selling insurance across state lines would reduce the overall costs of healthcare?

Accolay · Dec 3, 2017

Maybe you could expand on how "government supplemented high risk pools and the free market" and selling insurance across state lines would reduce the overall costs of healthcare?

Because those that are really sick in the high risk pools wont be able to pay for healthcare anymore and they'll just die. No joke.

Robert,

How soon some forget what this wonderful free market system was doing to healthcare costs prior to Obamacare and what it's doing now. Yes some insurance plans went up in cost after the ACA, but a lot of those plans were absolute junk, and now they have to meet actual standards. Another reason they are going up is because one party in congress has not made any fixes to the ACA (how many times did they work on repealing it though?) and the current administration is actively working on undermining the law by withholding payments, and depenalizing the individual mandate thereby destabilizing the market. The ACA wasn't and isn't great, but it's better than what was there before however, nobody has been attempting to improve it

Also would like to add that the often cited "tort reform" argument doesn't hold water.

https://www.forbes.com/sites/stevecohen/2015/03/02/on-tort-reform-its-time-to-declare-victory-and-withdraw/2/#8a709873da0d

If you've got a problem with Obamacare it should be that it's a giant giveaway to insurance companies. They're still posting record profits.

Also, what regulations are too burdensome for providers? Specifically- I'd really like to know.

There is one big fix, one that grown up countries have, countries that have much better healthcare outcomes and spend much less money than the United States on healthcare

There you go sir.

Robert.CFRN · Dec 3, 2017

True, the previous health insurance doesn't cover what Obamacare requires. My son, rather than being able to pay out of pocket and just have catastrophic coverage, now has government mandated gynecology and obstetric coverage. For many, insurance premiums have increased over 100%. My deductibles have doubled.

My position remains the same. The best way to make something more expensive and more inefficient is to get the government involved. Worse, to put the government in charge. I'm a veteran, and I've been to VA hospitals. Do you seriously think that putting the government in charge of all health care is going to result in better quality and lower costs?

No, I'm not going to dig through a hundred thousand pages of government regulations to explain how government regulations are burdensome. I'm also not going going to explain that the sky is blue. A 2014 report found that it takes over 79,000 employees working 2000 hours a year just to do the paperwork necessary to comply with the ACA. Talk to any hospital CEO about the cost of complying with federal and state regulations. The following is from a CATO institute report:

"Contrary to popular belief, the U.S. health care sector is no more a free market than other nations' health systems. In the United States, government directly or indirectly controls more than 80 percent of health spending (Figure 35.1). It controls 51 percent ($1.7 trillion in 2016) directly by taxing that money away from the people who earned it. It controls another 21 percent ($707 billion) by penalizing workers unless they surrender control over those earnings to their employers and let their employers choose their health plans. Government effectively controls the 10 percent of U.S. health spending that consumers pay toward private health insurance premiums ($345 billion) by penalizing consumers if they don't purchase a government-designed health plan. At best, consumers control just 10 percent ($350 billion) of U.S. health spending. Yet even that is an overestimate, since patients spend much of this money under terms dictated by government and employers."

The article further explains how government regulation artificially hamstrings health care in the United States, raising costs and preventing access. A Physician in Nebraska can't do a patient telemedicine consult with a patient in Ohio without going through the burdensome process of getting an Ohio medical license. Prepaid health insurance plans are prohibited. Paying out of pocket and maintaining catastrophic coverage is illegal. The article is long and strong in detail. 35. Health Care Regulation | Cato Institute

Government is not the answer. Government is the problem.

OCNRN63, RN · Dec 3, 2017

I think a combination of catastrophic care plus health savings account would be the way to go. A catastrophic policy is usually pretty inexpensive but takes away the financial worry if something major happens. A health savings account would pay for the routine stuff and you would be using the money you otherwise would for high premiums.
I have noticed that people absolutely hate the idea of using their own money for health care. I don't know why that is. We use our own money for everything else.

Try paying for certain chemo out of pocket. I'm on a PARP-inhibitor that costs thousands of dollars a month. That's just for one med. If you can't work, how are you supposed to set money aside for health care, let alone pay for the health care you need?

heron, ASN, RN · Dec 4, 2017

Try paying for certain chemo out of pocket. I'm on a PARP-inhibitor that costs thousands of dollars a month. That's just for one med. If you can't work, how are you supposed to set money aside for health care, let alone pay for the health care you need?

It's not just chemo. Most of us would be shocked at the retail prices of caregiver appointments, labs and procedures, drugs, medical supplies and dme. Lantus insulin costs well over $300/10ml vial. Test strips are $1.00 apiece ... $50 per box of 50 strips.

MunoRN, RN · Dec 4, 2017

I have a number of questions about what you would propose instead, but I'll start with this:

True, the previous health insurance doesn't cover what Obamacare requires. My son, rather than being able to pay out of pocket and just have catastrophic coverage, now has government mandated gynecology and obstetric coverage. For many, insurance premiums have increased over 100%. My deductibles have doubled.

Your son, assuming he is unable to get pregnant, does not pay for gynecology and obstetric coverage, to include that in the actuarial cost of a plan would actually be illegal under Obamacare.

Formerly, the individual market was not required to commit to coverage, if you ended up in the hospital with major costs, the insurer was free to just drop your coverage, shifting your costs mainly to the group market. Prior to Obamacare the rate of individual coverage denials was rapidly increasing, which is why the cost of plans in the group market was increasing at an unsustainable rate. What Obamacare changed was that if you buy a plan in the individual market and get sick and incur major costs, the plan needs to cover your costs, which seems pretty reasonable.

Your son is still allowed to buy a plan where he pays out of pocket up until a set spending point, and insurance only kicks in after that. This is what a high deductible plan is, and one of the main complaints about Obamacare is that the plans that are offered have deductibles that are too high. So high much higher should the deductibles be?

Accolay · Dec 10, 2017

Do you seriously think that putting the government in charge of all health care is going to result in better quality and lower costs?

Yes. See Canada. See England. See France. See Australia. See Netherlands. See Germany. Et Cetera.

As stated, the Republican controlled congress (since inception) and the current administration has been undermining the current health care law causing instability and uncertainty in the health care market. This is why premiums, your premiums, have been increasing at an astronomical rate. Once the new tax plan eliminates the individual mandate, see how much they cost then. That is the fault of your elected leaders.

Regulations are burdensome to whom? I agree, we sometimes have to do seemingly idiotic things at work sometimes. Do you know why? Probably we killed someone. Maybe it's not that government isn't the answer, maybe it's just that our government isn't the answer, as stated that somehow other countries have better outcomes at lower cost than ours does. Although not perfect, I'd argue they're much better.

Your source is from the Cato Institute. I'm sorry that I have to disregard that as a biased source, considering who they are. The first sentence state they want to do away with licensing of medical professionals (with recognizing other states licenses only as a preliminary step) Yikes.

AutumnApple · Dec 11, 2017

Just a general question for those who are of the point of view that the healthcare system is working in Canada (or anyone else who wishes to respond). Why do you believe it's working?

I've heard it does require you to go in for routine things, and people in general are more compliant to making their routine visits but I've always been told there is a lot of bad too. It taking forever to get things done that are necessary (cholecystectomy for example) is one big concern. Literally, I hear it's over a year from being told you need it to when it's scheduled. I know of a family whose father was on hospice and his care needs kept getting more and more difficult, yet he never actually got put in a hospice. He did have homecare nurses visit but they could only do so much. Also, it's very budgeted from what I understand. What I mean is: If it's near the end of the fiscal year and the money is all spent, no matter what your needs are, you're going to wait for the next year to start.

I'm no expert on this stuff, but I've heard more bad than good. I don't know if I'm misinformed or, maybe it's like everything else and its "take the good with the bad."

Accolay · Dec 11, 2017

Just a general question for those who are of the point of view that the healthcare system is working in Canada (or anyone else who wishes to respond). Why do you believe it's working?
I'm no expert on this stuff, but I've heard more bad than good. I don't know if I'm misinformed or, maybe it's like everything else and its "take the good with the bad."

Well fortunately we have Wikipedia to assist with your quest for truth. No hearsay necessary.

Comparison of the healthcare systems in Canada and the United States - Wikipedia

Seems to me their whole population is insured and they get way more for their dollar than Americans.

Taking the good with the bad is what we have to deal with in anything, we're doing that with Obamacare now. No system will ever be perfect. But it's embarrassing to me that the supposed "greatest nation on earth" has 40% of its population without adequate insurance, with 24% of that with "skeletal" health coverage that barely covers anything according to the article.