Presidential Race 2016

[Strollen]

It’s not just college students. Some industries have been moving toward more contractor use for more than a decade, including the one I am in (Management Consulting). Also, consider anyone who starts or joins a small business, if they can’t get covered through their spouse’s employer.

I’ve watched clients work to shed the burden of providing employee benefits for decades. Temps, contractors and the like are more of the work force every year. Insurance reform was absolutely critical to this group, simply to ensure they’re able to purchase insurance at all.

I agree that seems to be the direction we are heading and we desperately need to disconnect health care from employment. But ACA piled huge layers of complexity on an already way too complicated health care system and did so in a totally partisan fashion.

[Dan_Theman]

Deductible and out of pocket are two different things. Deductible is what you have to pay before insurance covers anything. After that, you need to handle the copay. Maximum out of pocket is the most you will pay when adding the deductible and the copayments together for the year.

[ArmandoPenblade]

Deductible and out of pocket are two different things. Deductible is what you have to pay before insurance covers anything. After that, you need to handle the copay. Maximum out of pocket is the most you will pay when adding the deductible and the copayments together for the year.

Coinsurance is probably slightly more accurate; co-pays tend to be standardized within a plan (e.g., $15 flat fee for chosen PCP, $65 for specialist, etc.), while coinsurance is the insuree-expected payment on most other goods/services after the deductible has been cleared (e.g., 20% of all bloodwork, inpatient services, etc., lending these things a variable potential cost), but before the maximum out of pocket has been reached.

Possible those terms aren’t broadly used, but the definitions seemed pretty consistent among the dozen or so insurance plans I’ve read into carefully for various reasons.

Just, you know, tossing that out there while we’re in the midst of precisely defining things to make sure we’re not all talking past each other ;)

[Oghier]

…did so in a totally partisan fashion.

Obama’s choices were 1) Do something without GOP support or 2) Do nothing. The GOP is fundamentally against the government taking action to help people.

I of course agree that we need to disconnect health care from employment. I just don’t see any way that could possibly happen.

[Scuzz]

Not to mention getting people health care so that health issues can be looked at immediately, instead of festering and getting worse. I believe I’ve mentioned before how my wife’s uncle had an individual policy, had health issues, ignored them due to fears of raising rates, and nearly died for it. Now he is effectively disabled, has chronic health issues, and no longer able to contribute to society due to this. Short term his health care costs were shorter (due to not getting treatment), but long term the costs are far higher.

This is the kind of thing that takes years to manifest. In the short term there was always, and honest appraisement admitted, going to be an increase, as people who previously would not have gotten health care did. But long term we should expect there to be a reduction in costs as long term health issues and the like are treated sooner, when they are cheaper.

Now there is also the issue of over reliance on emergency rooms for treatment, but that is a public awareness campaign issue, not a health insurance failure issue.

My wife is an insurance coder. Recently she has moved to coding ER work. She says the things people go to the ER for are a joke. There are many people who actually go to the ER to get their drug prescriptions renewed. WTF?

[Nesrie]

I agree that seems to be the direction we are heading and we desperately need to disconnect health care from employment.

This is what I want to see here. We’ve lost the days of parking yourself at an employer for decades until retirement. It makes no sense at all that healthcare is even tied to an employer. If they want to contribute part of the salary they give their employees towards paying for a health package, then fine but it should be the employee who makes the choice of the plan and that plan should go with you or at least allow you to keep it so long as you are in the same region.

Deductible and out of pocket are two different things. Deductible is what you have to pay before insurance covers anything. After that, you need to handle the copay. Maximum out of pocket is the most you will pay when adding the deductible and the copayments together for the year.

Don’t forget co-insurance. A lot of people confuse copays with co-insurance. A co-insurance of 40% looks pretty darn scary when you are in the six figures or even in the tens. Drug costs are not minor for some of the very rare treatments… just look at the corporate weasel that shows up in the news now and then.

[Oghier]

This is what I want to see here. We’ve lost the days of parking yourself at an employer for decades until retirement. It makes no sense at all that healthcare is even tied to an employer. If they want to contribute part of the salary they give their employees towards paying for a health package, then fine but it should be the employee who makes the choice of the plan and that plan should go with you or at least allow you to keep it so long as you are in the same region.

COBRA does something like that already, though for a limited time (18 months, as I recall). That still doesn’t solve the problem of getting healthcare if your employer does not offer it.

[Papageno]

Obama’s choices were 1) Do something without GOP support or 2) Do nothing. The GOP is fundamentally against the government taking action to help people.

I of course agree that we need to disconnect health care from employment. I just don’t see any way that could possibly happen.

SO MUCH THIS. The GOP stance on health care reform during Obama’s first year and a half was all “Sure, Obama, I’ll go in on a pizza with you. Except it can’t have veggies, meat, cheese or tomato sauce, I hate all those. I’m even a little iffy on it having crust. But I’m totally down for some pizza!”

[Scuzz]

Maximum out-of-pocket of $2k is insanely low.

Didn’t used to be. :)

[Dan_Theman]

Coinsurance is probably slightly more accurate; co-pays tend to be standardized within a plan (e.g., $15 flat fee for chosen PCP, $65 for specialist, etc.), while coinsurance is the insuree-expected payment on most other goods/services after the deductible has been cleared (e.g., 20% of all bloodwork, inpatient services, etc., lending these things a variable potential cost), but before the maximum out of pocket has been reached.

Possible those terms aren’t broadly used, but the definitions seemed pretty consistent among the dozen or so insurance plans I’ve read into carefully for various reasons.

Just, you know, tossing that out there while we’re in the midst of precisely defining things to make sure we’re not all talking past each other ;)

lol - totally fine.

Edit - in the linked-to Gold plan above, the deductible for an individual is $1165 ($2535 for a family), and the annual out of pocket maximum is $4708 per person ($9634 for a family).

[Scuzz]

This is what I want to see here. We’ve lost the days of parking yourself at an employer for decades until retirement. It makes no sense at all that healthcare is even tied to an employer. If they want to contribute part of the salary they give their employees towards paying for a health package, then fine but it should be the employee who makes the choice of the plan and that plan should go with you or at least allow you to keep it so long as you are in the same region.

I think part of the problem is that since employers paid for health insurance many people really didn’t know what it cost or appreciated the massive price increases in health insurance that employers have absorbed over the last 10-20 years. Suddenly they are being asked to pay for it or increase their percentage and they think this is all the ACA’s fault. No, employers are just reaching a tipping point. A crappy economy didn’t help with this either.

[Oghier]

Didn’t used to be. :)

True! Mostly. I remember the last time I had a full-on, go anywhere, pay nothing, everything-is-covered plan from an employer. It was awesome. I paid $80 a month, with no co-pays for anything. Then I left that employer for another job, but I had to wait out a three month non-compete. I continued in that plan with COBRA.

It cost $1,100 a month, for a single male in excellent health (and this was nine years ago). The costs being eaten by my employer obviously impacted my salary, but I would never have known what those costs were had I not born them myself for a while.

[ShivaX]

So your anecdote is better than his anecdote or my anecdote? Bad insurance companies existed. Surprise, they still exists. I find it hard to believe ACA somehow will change the way insurance companies do business. I handle insurance for a small company and what your describing has never happened with us. Doesn’t mean it won’t someday, but characterizing everything by your experiences doesn’t always cover everyone’s experience.

No that was exactly my fucking point. He dismissed facts with anecdotes, which I could also do. Anecdotes are bullshit responses to subjects this big.

[Nesrie]

COBRA does something like that already, though for a limited time (18 months, as I recall). That still doesn’t solve the problem of getting healthcare if your employer does not offer it.

COBRA requires you pay the full amount. What would be more ideal, assuming we don’t move to a SP system, is if the payor offered X amount to contribute to the purchase of insurance. You would select from a pool while employed. If that same pool was offered to the employed, unemployed and small businesses, then we might see more affordable options. After all the bigger pool an insurance company can draw form the more likely they can be profitable since the number of high usage lives and less usage lives would be more balanced. Part of the problem with the current coops is they have the more unhealthy and those without access to healthcare elsewhere seeking these plans. Imagine if you were taking from the same pool that say Boeing employees did.

[ShivaX]

In California it’s awesome. You can sign up as a permanent absentee and they send you a ballot and a huge book explaining all the initiatives a month before the election.

But now I live in Georgia and it appears that they don’t take kindly to that sort of thing. I can’t find a way to get an absentee ballot reliably.

I think studies have shown that most non-military absentee ballots tend to vote Democratic, so really, it just explains itself.

[Nesrie]

I think studies have shown that most non-military absentee ballots tend to vote Democratic, so really, it just explains itself.

And isn’t some of the Southern states that wind up with three hour lines to vote. I’m on salary, but I think I’d still have to politely tell my boss that I am going to vote and be back… some day with those kind of waits. Fortunately, mail ballots all around here… and guess what party tries to get rid of our system almost every year it seems.

[Strollen]

Obama’s choices were 1) Do something without GOP support or 2) Do nothing. The GOP is fundamentally against the government taking action to help people.

I of course agree that we need to disconnect health care from employment. I just don’t see any way that could possibly happen.

I think that attitude is why we have such a problem. GOP isn’t against the government helping people. Have you ever heard a GOP candidate advocate disbanding the State Insurance Commission? Yes we oppose involving the Federal government in everything. Insurance has been regulated at the state level, and Republican want to enable people to buy insurance across state-lines.

I am absolutely delighted that Mitt Rommey put together a system in Mass. I would hope that other states could try different ideas, including single payer like VT was experimenting with. If people are allowed to buy insurance across state lines, eventually the best products will win out. But ACA has all but eliminated these experiments in favor of one size fits all monstrosity.

I wanted to give Nikki Haley a big hug when she gave a shout out to the 10th amendment last night. Don’t mistake Republican versions to Federal government doing stuff as the hatred of all things government.

“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”, providing health care and education are a classic example of things better done at a state level.

[magnet]

If people are allowed to buy insurance across state lines, eventually the best products will win out.

People are already allowed to buy insurance across state lines. For instance, my insurance is sold by an out of state company.

[wahoo]

Pre-existing conditions was a big push by the ACA not HIPAA. HIPAA may have limited how the insurance companies collected that information, but it certainly didn’t eliminate it… and it started in 2014 I believe. I think the lifetime maxes might have been address by 2010…

Nope. Sorry HIPAA did eliminate pre-x for most people with continuous group coverage. You could change employer sponsored plans and still get new coverage even with a pre-x as long as coverage was continuous. IE, if you dropped coverage for more than a few months you could be denied a group plan for pre-X.

The individual market had no such protection under HIPAA, which was a real problem. The ACA eliminated pre-ex for everyone which is why it needs the mandate and a tight enrollment window. Insurers are losing money b/c the Administration has basically kept the enrollment window open. CMS has said that is going to change now.

My pt was would have been better to extend same pre-X conditions to individual market that were under group/ESI market.

People are already allowed to buy insurance across state lines. For instance, my insurance is sold by an out of state company.

Only if that insurance company meets state benefit requirements and is also licensed to sell in that state. Several states have a near monopoly by some insurance companies which increases prices (hello southern Blues)

[inactive_user]

Yeah, there are all those majority-GOP states doing such a great job helping their less-fortunate and making life less shitty for their people.

Or are those the ones in a race to the bottom, sucking at the Federal teat to take care of their icky poors while deregulating themselves into a fully supine position for maximum corporate profiteering? I get those mixed up sometimes.