3781

And you naysayers don’t think that premiums were going up like crazy every year before Obamacare was the law? What country have you been living in?

3782

No they have been going up for many, but the ACA does push them up further. We have a great company we work with that helps us with our company insurance, and we have actually kept our rates pretty constant. But the ACA forced us to go to much higher deductible plans, and changes such as having to hit the family deductible (which is now higher) rather than the individual deductibles before the insurance kicks in at all. Also, to avoid other ACA penalties, we’ve had to separate out our dental from the medical, and that is costing our employees more. Then lastly, the reduction in the max Flex Saving Plan to $2500 has hurt a number of our employees who have predictable higher medical out of pocket this year (I’m in that category.)

Many of us have been saying since day one that any talk of the ACA reducing the costs to the average person was BS and it is. It is going to cost the average person who had decent coverage more money. That is the cost of covering a lot of people who have not been covered in the past.

3783

The “average person who has decent coverage” is way richer than the average employee.

3784

I’m not sure what that means. For example, my daughter is a school teacher, first year, doesn’t make much money at all, but has decent coverage. Our hourly operators in our plants also don’t make a ton of money, but they have our coverage (which is decent, not outstanding.)

3785

On paper, my wife’s coverage looks good. In practice, the insurance company, Aetna, has found every possible reason to decline coverage. We’ve actually found that in practice healthcare is more affordable if we claim to have no insurance, at which point the doctors and such switch to a different set of prices which are actually reasonable.

The entire damn system is broken and filled with thieves.

3786

True, there were always going to be additional costs to cover the people who couldn’t afford health care. Insurance companies seeking greater profits will push this higher, a factor many other countries don’t have to deal with.

3787

Yeah, between $4000 for my wife’s required oral surgery (insurance will cover $1500 only) and her emergency room visit and ambulance transfer to another hospital, overnight stay in the cardiac unit, etc. we’re looking at about $6000 out of pocket this month. That’s with “pretty good” insurance this year.

3788

Thats crazy. As a reference up here in Canada my roommate had to have foot surgery. She’s a server, and head of wardrobe for the local theatre company so having her foot swell up every day and being in excruciating pain was not going to go well for her. They had to cut down to the bone and chisel bone. She had to have exotic anesthesia because she’s allergic to everything. Multiple hospital visits, specialists etc.

Total out of pocket expenses, without insurance? $400 for surgery, $100 for a brace. She would never be able to afford American rates on insurance, and given another year she’d be unable to work or walk almost at all. Oh yes, total wait? 2 months.

3789

Government-related jobs is the other outlier on good insurance coverage. The average is bad. About 16% have no insurance at all. I can’t find a good short summary of what the average private sector insurance program looks like, but the short version is that it’s bad.

3790

Ouch, my sympathies.

Hopefully, 6000$ bill will not put you into poor house, but for many other Americans medical bills are #1 reason for declaring personal bankruptcy. Most of these are people that at least started with a health insurance.

I also read somewhere that average out of pocket bill for having a baby is $2000 for insured couple. Really?

3791

I’m an American who moved to Canada in his 30s, so I’ve seen both sides in person. I recently experienced a medical issue that cost $0 out of pocket due to work sponsored extended medical coverage. The cost would’ve been around $1,000 if I didn’t have my very generous work package. Top end insurance in the US would’ve left me with a $6,000 bill and no insurance would’ve pushed this to lower five figures.

Health care works in the US if you’re wealthy, don’t have any major problems, or work for the government.

3792

Yeah, I was just looking at this:

Most people who work have insurance, and the number goes up pretty dramatically once you are working for a company with more than 100 employees. But I haven’t seen any data that leads me to conclude that the coverage is “bad.” And “outliers” such as government and most union bargained for packages are quite good (my daughter’s coverage, as a first year middle school teacher, is much better than mine, and I would say mine is pretty good.)

The problem with ACA is that, from what I can see, it predictably has made coverage more costly and “worse” for the average worker who is already covered. Higher deductibles, separating out programs from medical to avoid the “Cadillac” penalty (which is ridiculous in terms of calling that level of coverage “Cadillac”) significant limits on Flex Savings Accounts, higher premiums, and on and on.

All predictable due to for profit insurance companies, with CEOs and executives still accountable for making as much money as possible, still being in charge.

3793

You need to see what kind of co-pays and deductibles are out there, compare them to the average available funds to those with the plans, and then look at typical health care expenditures. It’s a complicated formula to arrive at deciding what is “good” and what is “bad” coverage. Logic tells me that people who carry high deductible/high co-pay plans are those most likely to need a boost to their monthly income and therefore the most exposed by inadequate coverage when something happens. I just don’t know how prevalent those plans are compared to others.

3794

From what I could see, talking with our long term adviser (for the company) as we looked at our company options for 2013, most plans were moving to higher deductible/higher out of pocket as the insurance companies make up for the additional costs to them. IIRC the plans we looked at from Aetna, Blue Cross, and most of the “majors” were all pretty consistent that way. And so everyone is pushing “wellness” programs, as well as the health savings accounts (which are a good thing in that they are basically 401Ks for health expenses, but take a while to build up and don’t help much in the first year or so, plus they are one more deduction from the check of people who are struggling already with the increase in insurance costs.)

3795

Just as a note to this, if you work for a large corporation like I do, the employee health insurance plan is likely self-funded and Aetna, Blue Cross, etc., is acting as the plan administrator. In that case, it’s the employer saving costs by going to high deductible plans. Same difference to you, but it’s not just the insurance companies saving money this way. Then, of course, you’re going to have companies like the fast food chains, who have mainly provided only crap health insurance to their employees, who are going to drop coverage altogether and pay the cheaper Obamacare penalty.

3796

Yeah, I don’t actually have concrete numbers, but I gather than most private sector plans are sky-high deductible at this point.

On the Cadillac plan, take a look at what the level is:

The Patient Protection and Affordable Care Act (as amended by the Health Care and Education Reconciliation Act of 2010) imposes an annual excise tax on plans with premiums exceeding $10,200 for individuals or $27,500 for a family (not including vision and dental benefits) starting in 2018.[4]

Median household income is only $45k. The average family plan costs around $13k.

3797

Yeah, and this is why dental and vision and other items now need to be pulled out of medical insurance plans. An interesting note in the link you provided:

A study published in Health Affairs in December 2009 found that high-cost health plans do not provide unusually rich benefits to enrollees. The researchers found that only 3.7% of the variation in the cost of family coverage in employer-sponsored health plans is attributable to differences in the actuarial value of benefits. Only 6.1% of the variation is attributable to the combination of benefit design and plan type (e.g., PPO, HMO, etc.). The employer’s industry and regional variations in health care costs explain part of the variation, but most is unexplained. The researchers conclude “…that analysts should not equate high-cost plans with Cadillac plans, but that in fact other factors—industry and cost of medical inputs—are as important in predicting whether a plan is a high-cost plan. Without appropriate adjustments, a simple cap may exacerbate rather than ameliorate current inequities.”[5]

I have no problem with the stated intent of the tax on true Cadillac plans, and they always used examples of Goldman Sachs CEO type plans where there is no co-pay, no deductibles, no limits on how much the plan pays, etc. But Cadillac as defined covers a LOT of middle class standard plans now, and I get that it is just another way to raise cash and help out the insurance companies. They have also included things beyond just the premiums paid by the employer and company. Premiums are also not “equitable” and there is no adjustment on what a Cadillac plan is - for examples, some states have much higher premiums than others. It also hurts smaller companies in a disproportionate way, since they can’t negotiate for smaller premiums the way a larger company can.

For example, I have a young lady who works in my lab who has a child with serious health problems, so they have put back a lot into a flex savings plan in the past to help some with the costs beyond what insurance covers. That is now included in the “cadillac” calculations (plus it has now been cut back so you aren’t allowed to put more than $2500 in your account.) Something like cutting back how much you can put into a Flex Spending Plan isn’t targeted at better health care and making things better for the employee, it is again all about raising cash.

It’s not a small tax, it’s 40% paid by the employers, and the Joint Committee on Taxation predicts it will hit about 40% of family plans in a few years. The consequence will be reduced coverage and much higher deductibles, which again isn’t a good thing for most people.

I wanted passage of the ACA, but I argued then and do today that it wasn’t made clear to most people that it was going to make their health care and insurance a lot more expensive (and the people who said it would make a person’s premiums go down were just lying.) That is the cost of making private, for profit insurance companies cover a lot more people than they do today.

3798

A very damning part of that report is the bit that says “These benefits were offered to 24 percent of part-time workers and 86 percent of full-time workers.” It’s missing raw numbers, but when you take into account the increasing number of companies, especially retail and minimum wage payers, who are pushing employees to part-time specifically because their company policy is to pay for insurance for full-time but give nothing to part-time employees, the result is that the 24 percent is shrinking as the raw number is growing.

3799

Yeah, and I think as the costs go up more companies will try to see if they can get by with more less than fulltime employees.

3800

It shouldn’t have increased premiums by too much, since it projected to ‘only’ increase coverage by 10-15% (IIRC). However, since it didn’t increase supply by a corresponding amount it is possible that the rates will go up much more for a (perhaps large) number of years.

And OF COURSE it wasn’t talked about (or rather it was shouted down by the liberals) since it would never, ever, pass as a bill which will probably increase costs and wait times but will cover more people.

We’ll have to see how this plays out in the coming years.