Confused by Health Care? Here Are the Absolute Basics
motherjones.com
motherjones.com
Pair that with our upfront survey and recommendation and the 4hr paper process turns into 20mins.
It's pretty crazy that 95% of the insurance industry still relies on paper enrollments where you have to fill out your own address (which your HR already has) ten times.
There is little chance of ObamaCare working as-is or with planned modifications. The big problem is that as soon as you eliminate pre-existing conditions clause, the cost to insurance company sky rockets. Even a single diabetic person can put a hole of 10s of thousands of dollars in insurance company's balance sheet. To compensate for this you need to either charge huge premium to everyone or have tons and tons of healthy people who are just giving away money in premiums. Neither of that is happening. As long as cost of health care is an couple of orders of magnitude over the norm, this can't work.
BTW, the reason this "works" for employed people is because cost of insurance remains hidden. An average employed American would easily earn 20-30% more income if employer didn't took away part of his/her paycheck and gave it to insurance companies.
Let's be realistic. The employer would be making 20-30% more profit, none of it would go to the employee. But I hear you on your other points.
It is the "little yellow box" in the first graphic.
Also, no mention of the real reason none of this really works. There is no attempt at controlling costs or even identifying the transparent pricing problem.
Or would they be additional spending on top of the billions shown there?
I don't see that as a "scamola".
People with employer provided coverage don't share the costs of those high risk individuals. And the companies providing them coverage deduct whatever they do spend on their cheaper plans.
There were also plans for risk corridor payments, but they weren't funded.
And the ACA did bend the cost curve down. That of course doesn't fix the cost problem, but it was quite likely an improvement over doing nothing.
I'm referring to employers and by extension their employers, not insurers, as not paying their fair share. If you work for a large corporation that self insures (think pretty much any F500 company), you and your employees are entirely off the grid when it comes to health insurance. As such, they don't contribute to covering the statistically sicker people on the individual market.
The ACA sky rocketted unsocial premiums AND deductibles AND max out of pockets. The insurance most people have through it barely qualifies as catastrophic coverage as they'd have to spend 5-10K before it even kicks in. That's on top of the 10-15K of premium dollars. It's. it health care, it's a scamola that was designed by, and for, insurance companies to rape the unsuspecting public.
Sadly Obama was both stupid enough to fall for it and not ballsy enough to push further for a single payer plan. The end state now is the worst possible of all situations. People are forced to buy a product that has no cost controls associate with it. Oh and the product doesn't actually do anything.
So no, they aren't entirely off the grid when it comes to the ACA, they kick in billions of dollars, as shown in the chart I mentioned above.
The fees for self funded plans are a joke. Seriously go look them up. They amount to less than $10 per person on those plan (per year) and on top of that the majority of it is set to be phased out or already did.
Not just plans, contractual obligations that are now the subject of a class action lawsuit by insurers.
Employer group plans are already large group plans that include individuals who would not have been insurable in the pre-ACA private marketplace. The exchanges were a mechanism to achieve that effect in the individual market. (And, additionally, everybody who pays taxes under the ACA was supposed to be contributing to covering the loss risk of high-risk individuals in the exchange plans, but then Republican Congresses choose not to fund the risk corridors as a means of sabotaging the ACA.)
A surgeon fit me in the same day for an initial appointment -- working with the fact that my COBRA term was ending. But after an examination, he said he wouldn't operate. The hernia was too mild.
So, per a very well-regarded surgeon, there was nothing to be done.
Nonetheless, my application for an individual policy was rejected.
It was only because I had a long-term personal professional relationship with someone with significant seniority and status in another insurance company having a cooperative agreement with the company in question, that my rejected application received a second review. They'd made two minor mistakes in processing it, and ultimately, at a very high level within the company, they decided to remedy this by writing me the individual policy -- with exclusions for my allergies and for this minor hernia, along with the urologist's prior, incomplete diagnosis.
THIS is how the insurance market was, before the ACA.
Oh, and that employer-provided health insurance? You'd better not have had a gap in coverage in the... I forget, now, two? years prior. Otherwise, any and all pre-existing conditions could be excluded for coverage... for a year, I think, perhaps two, under that employer-provided coverage.
Most of the bitching I hear and read about the ACA, is simply unfounded. Or, it is based on incomplete where not simply wrong information.
For example, the big spike in premiums for marketplace plans, and reduction in participating insurers and plans? That was not the ACA, per se. The law had provision for making insurers whole for the first two or three years (two, I think, and I think it should have instead been five) for losses they experienced. This was to allow time for them to learn what the newly covered population was composed of and to develop actuarial studies of it by which to set more accurate future pricing.
Well, you can pass any law you want. It is a separate law -- the "budget process" -- that ultimately pays for it. And the Republican Congress chose to ignore this provision of ACA law in the budget process, leaving it unfunded and thereby stiffing the insurance companies.
The ACA is a failure because the Republicans wanted it to be a failure and went to great lengths to make it so. Because, to them, politics and power are more important than effective policy and public health.
One other thing: The ACA has saved insurance companies lots of money (compared to estimated costs absent the ACA) in areas outside of the marketplace plans, e.g. in their traditional group coverage. Of course, they don't factor those savings in when complaining about the costs they've borne as a result of the marketplace insurance plans -- said costs, again, having been greatly exacerbated by the Republicans sabotaging the law and stiffing them, in the budget process.
The ACA was a starting point -- the most that could be passed in the face of "the Party of No" that from the initial days of Obama's presidency declare total obstruction to be their over-riding, primary policy objective and political strategy.
Like any law and program -- just like those in private sector business -- it required management and improvement. Unfortunately, we instead got obstruction.
Law and regulation aren't magic, and they aren't "set and forget". You have to manage them, just like everything in this world.
I agree that traditional group insurance should not be separated from the individual market. Insurance companies shouldn't be permitted to cherry pick, neither by population selection nor by pricing. Frankly, I don't see private profit as basically compatible with what I see to be a public investment in the public's health. But with law and regulation, we seem to get at least partway there.
But then, the public's not too rational about this, itself. As I mentioned elsewhere, I spent a lot of my time and effort helping an addict of 20+ years, with two kids to care for, get clean, this past year. This included thousands of dollars of in-patient hospital treatment and aborted rehab program attendances, paid for by Medicaid that was greatly expanded, including especially drug and alcohol treatment, under the ACA.
In addition to the ACA's contribution, I stepped up personally, when this person couldn't hack the rehab programs, and I spent 3 months basically full time getting them to AA meetings, helping them find and get to work, covering with child care, etc. They managed to stay clean, and as far as I know, about one year out, now, they still are.
This fall, after they got back with their big "C" conservative significant other, I had to endure a long flurry of Facebook posts expressing their vehement support of Trump. The face of the very fellows (and yes, I use that gender choice somewhat specifically) who want to choke and kill off the very programs that helped this person get clean. AND that have enabled me, as I explained to them at one point, to be able to purchase health care insurance at all -- with no subsidy, for me.
In short, in my personal, anecdotal experience, I've found opponents of the ACA to be irrational people acting against their own self-interest. And selfish people, who take aid and have no concern for the next person who's going to come along and need it.
And while the ACA is far from perfect and has had to struggle, the preponderance of rhetoric against it is equally ill-informed and selfish. IMO and experience.
It was born in Massachusetts under the Romney government. Nationalized as the ACA, it was meant to be a middle of the road proposal that left the existing powers in place. It was proposed as a first year initiative at a time when not just individuals but businesses were making great outcry about increasing health care expenses -- year upon year double digit percentage increases in insurance premiums -- saying they wouldn't be able to compete with businesses in other nations having national health care and so much lower health care costs. It was obviously planned and queued up before the Obama campaign and nascent administration were made aware of the full depth and severity of the financial crisis. (Something for which I am still upset with Obama for not turning the FBI and Justice loose as was done in the wake of the Savings and Loan scandal in the '80's.)
Republicans initiate their selfish, self-serving doctrine of "No". ('We're going to make his a one-term presidency.' That was not just their politics but their operating policy.) They label the health care initiative "Obamacare". They make up the incendiary, false rhetoric of the supposed "death lists" that would be forthcoming.
They, up through Trump's election, eight years later, have presented no and have no sign of possessing any alternative plan for health care. Despite the endless rhetoric that they would "fix" health care.
If you're not part of the solution, you're part of the problem. The ACA wasn't perfect, but it was a serious attempt to move towards a solution.
All the rest -- well, all it's proven itself to be is the problem.
All it's offered is a big pack of lies.
Bullshit. He could have pushed for a single payer plan but didn't have the balls. Caving in to the insurance companies and lobbyists so early on in his presidency was a sad sign of how the rest would play out.
The Democrats had the House, a super majority in the Senate, and the POTUS. They had the one chance to do it and either didn't have the cajones to move forward with it, or, more likely, have too many hands in the pockets of insurers and big pharma. Good luck getting that to happen again.
> Like any law and program -- just like those in private sector business -- it required management and improvement. Unfortunately, we instead got obstruction.
The starting point was the worst possible combination of public + private sector. Obstruction is the only thing that has kept the tentacles of the ACA from further rooting themselves in the American healthcare system.
> Law and regulation aren't magic, and they aren't "set and forget". You have to manage them, just like everything in this world.
You also have to hold representatives, senators, and the executive branch accountable which is what happened in the 2010 elections and more recently in 2016.
> I agree that traditional group insurance should not be separated from the individual market. Insurance companies shouldn't be permitted to cherry pick, neither by population selection nor by pricing. Frankly, I don't see private profit as basically compatible with what I see to be a public investment in the public's health. But with law and regulation, we seem to get at least partway there.
And the ACA did nothing to make that happen. Arguably it made things worse as companies could point individuals to the individual market and say, "Hey you can take care of yourself with an overly expensive plan from there now".
> In short, in my personal, anecdotal experience, I've found opponents of the ACA to be irrational people acting against their own self-interest. And selfish people, who take aid and have no concern for the next person who's going to come along and need it.
I'm adamantly against the ACA and I'm far from irrational. If anything I'd classify myself as hyper-rational.
I'm fine taxes going toward a single payer plan.
I'm also fine with eliminating insurance for routine healthcare and returning to a direct payment for service model.
The middle ground we're at now where we dump the expense of the high risk portion individual market on the self employed is what doesn't work for me. You end up with people paying $12+K per year in premiums for nothing (since their deductibles are $5-7K as well).
> And while the ACA is far from perfect and has had to struggle, the preponderance of rhetoric against it is equally ill-informed and selfish. IMO and experience.
> It was born in Massachusetts under the Romney government. Nationalized as the ACA, it was meant to be a middle of the road proposal that left the existing powers in place. It was proposed as a first year initiative at a time when not just individuals but businesses were making great outcry about increasing health care expenses -- year upon year double digit percentage increases in insurance premiums -- saying they wouldn't be able to compete with businesses in other nations having national health care and so much lower health care costs. It was obviously planned and queued up before the Obama campaign and nascent administration were made aware of the full depth and severity of the financial crisis. (Something for which I am still upset with Obama for not turning the FBI and Justice loose as was done in the wake of the Savings and Loan scandal in the '80's.)
> Republicans initiate their selfish, self-serving doctrine of "No". ('We're going to make his a one-term presidency.' That was not just their politics but their operating policy.) They label the health care initiative "Obamacare". They make up the incendiary, false rhetoric of the supposed "death lists" that would be forthcoming.
If they didn't do that we'd be deeper in the ditch that it's digging for our healthcare system with even less chance of digging out.
> They, up through Trump's election, eight years later, have presented no and have no sign of possessing any alternative plan for health care. Despite the endless rhetoric that they would "fix" health care.
> All it's offered is a big pack of lies.
I'm disappointed at the alternatives offered so far though I do feel that even eliminating the ACA with no replacement is an improvement in my book.
My own idea is to:
- Ban employer provided health insurance.
- Eliminate tax deductions for companies providing health insurance for employees.
- Allow individuals to deduct premium payments (up to a cap)
- Require insurance companies to offer all plans publicly to all takers.
- States can mandate insurers cover wide ranges of the State rather than pick their own zones
This would lead to a single risk pool (per region covered by an insurer) with competition between insurers. It would also level the field for the little guy because he would be able to get coverage at the same terms that big business is supplying it for their employees today.
Net winners are:
- High risk individuals get to be part of a much bigger pool (lower $$$)
- Individuals on individual market get to be part of a much bigger pool (lower $$$)
- Completely separates health insurance from employment (seriously who's stupid idea was that?!)
- Small businesses (don't have to compete with big corps who can offer cheaper coverage)
- Entrepreneurs (insurance isn't tied to employment so can quit working for big corp without losing coverage)
Net losers are:
- Insurers (have to actually compete with each other)
- Insurers (they're product becomes a commodity)
- Insurers (have to offer flat pricing to everybody)
- Insurance salesmen (no more corporate policies to sell though I guess they can sell individual ones)
- Large corporations that previously were self-insuring (can't leverage their large employment base to get lower insurance costs)
- Employees at large corporations will pay more for health insurance but it won't be like the ACA premium increases as it's spread across 100M people.
That's the only plan I've come up with that can lower costs, cover everybody, and does not involve a single payer system.
As a bonus, having a "Federal Health Care Insurance Company" that acts as a competitor of last resort might lower costs further but it's not strictly necessary.
I didn't want to leave thinking I was just ignoring it -- my apology.
Basically, I'd prefer Medicare for all or at least a "public option", as well.
I was mostly saying that, imperfect as it is, most of the ACA bashing I've been hearing isn't even accurate, nor does it take into account the larger perspective, e.g. preventive care keeping people healthier and thereby having a large downward influence on costs, over the long term.
Cost is a component of the access problem, and there were measures to address overall cost in the ACA (and overall cost growth went down with it.)
In order to address the access problem, costs also needed redistributed as well as controlled, which means that classes of people that were on average better off ended up paying more of the cost, which meant that some people saw dramatic cost growth (and because the targetting wasn't perfect, there were some perverse effects in who that hit.)
My own preference remains to find a non-zero-sum solution, where access goes up but overall cost goes down. I think that in order to manage costs, the cost structure of the system has to be greatly simplified. Presently, there are too many business entities and relationships, so it's impossible to even know where the money is going. Somebody is gouging us, but we don't know who, and everybody can point to somebody else. It may be that countries where costs are lower, simply have better ways of tracking who ultimately gets paid for what.
Compared to the pattern experienced under preexisiting policy, that's exactly what the ACA did (it wasn't enough to stop overall cost growth, but it slowed it.)
Obviously, more of that effect would be better.