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Comment by kodablah | Hacker News Reader

Most freelancers/entrepreneurs would be helped by simply returning to pre-ACA options.

> pre-ACA options

Pre-ACA, I was denied coverage at 30 with a wife and kid, with no pre-existing conditions and from the same companies I had health insurance from when working fulltime. This was in 2011, it was scary and I felt the system was broken. I was healthy and had no idea why it happened, both BCBS, Aetna and other large private insurers hate individuals and small companies because they group by company not across everyone and individuals are riskier to them with that system. Aetna and BCBS are employer focused rather than individual/consumer focused.

Post-ACA pre-existing conditions are covered and everyone has to be approved for coverage, breaking healthcare from employers as the customer and making them focus on consumers is key and ACA started that movement and better private markets even if it was a rocky start.

Healthcare is the riskiest part of freelancing/contracting and now at least you can get it guaranteed with ACA.

If we removed it from employers entirely and made individuals/families the customers rather than get it through the job, it would help people change jobs, start businesses, travel, reduce ageism and allow us to compete better with countries that do have single payer/universal or healthcare not attached to employers over consumers, it may also fix pricing when it is closer to the consumer or there is a public Medicare for all option for competition that the individual can choose.

Employers don't want to pay for healthcare and people shouldn't want employers knowing their private health, nor choosing the service for them. Employers don't get your auto or home insurance, nor should they, why healthcare?

Private insurance or public options like Medicare for all will make business easier and healthcare more consumer focused, it is a pro-business way to set it up, right now we have anti-business healthcare legacy systems and it is making US companies less competitive because they are expected to offer it. They can pay more for employees to go get their own, they don't need to choose and manage it. That will also help reduce the 'real compensation' parasitic leech that healthcare costs are hiding under, sucking up raises and wage increases into 'real compensation' for healthcare benefits rather than actual wage increases.

While I sympathize and agree with all you wrote, I think it's devolving from a macro economic statement to a micro discussion with morality included.

Ok, we can agree to disagree on morality it is more about a broken focus in essentially a scam system with the focus on employers and insurers not paying when time comes, rather than a focus on individuals/consumers and larger more sensible grouping of covered people to spread risk and not have insurance rates spike for entrepreneurs, small businesses or people with pre-existing conditions. Employers shouldn't have anything to do with providing healthcare or deciding/choosing for you, making people have to change insurance to change jobs and people losing insurance if they do need it as employers and insurers drop you if that happens.

At a macro level, everyone would be served better by healthcare where the consumer/individual is the customer focused on, not some deal with large employers where they are the customer. That current setup in healthcare purposefully tries to exclude people who are individuals, smaller businesses or other due to broken grouping that insurers use. We'd be better served by large groups across all ages, conditions and states, that would truly be insurance, more like auto insurance which is not bound to employers.

We don't get our auto or home insurance from employers. Why do we get the most private of insurance, healthcare, from employers? It is a legacy broken system that most of the world has moved on from. Benefits are one thing, pay is another, but healthcare should not be provided by employers as it leads to broken fixed pricing between large insurers, medical suppliers and the consumer is considered last if at all, leading to the worst pricing fixed market maybe in history. If you support entrepreneurs and small business growth, the engine of America, you'll come around.

Unless those freelancers/entrepreneurs happen to have any kind of health history what so ever. In that case they'd have to stick with a large employer group plan.

Fun fact: in 2011 nearly half of the US population had a preexisting condition that would have affected pre-ACA medical underwriting.

https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-...

Absolutely not. Pre-ACA options were heavily biased to healthy, young individuals.

This is not the profile of freelancers and entrepreneurs, and especially not the profile of the most qualified contributors to an entrepreneurial market.

As you get older, you get more experienced and better networked, which can yield the best opportunities for freelancing and entrepreneurialism. But you also accumulate dependents, medical conditions, and risks of the sams. All of thess were grossly penalized pre-ACA, to the point that many would-be entrepreneurs and freelancers wouldn’t be eligible for coverage at all.

I'd say biased to mostly healthy, not-old individuals and I would say it's a reasonable profile for most. At the least, not "absolutely not". What makes one qualified or more valuable is a different discussion as is morality.

And the old and sick would be harmed.

Americans really need to decide if people's medical costs should be shared, or if it's every man for himself.

It's not that binary. Strict rules on insurers essentially means shared. Shared by law requires trust in government spending, something there is little of and the spending is volatile per cycle.

It is binary. Pre-ACA options might have been cheaper because sick people weren't in the pool. If you want to cover old and sick people, then you have to pay more. Doesn't matter if it's taxpayers paying or taxpayers paying via insurance premiums, it has to come out of someone's pocket.

Most of that is not true if you recognize costs are as much of a problem as distribution. When you only target recipients/insurers/payers instead of the providers with these rules, it sure can seem like the only option is to have most people pay more. And then treating that as the only way, stating it as fact, and making the discussion binary limits true solutions to these problems from even being discussed.

Insurance premiums when people with pre-existing conditions were not covered are lower than when people with pre-existing conditions are forced to be covered. That statement would be true no matter how much providers are getting paid.

Lack of supply of providers or fraudulent billing by providers is a separate cause of increased insurance premiums, but I don't see what ACA has to do that, and if anything, healthcare spending increases are slowing down since the passage of ACA, and premiums are even decreasing in many parts of the country.

My original response was to your claim that freelancers were better off in pre-ACA times, to which I wanted to point out that was only because people with pre-existing conditions were denied insurance. Nothing in ACA has caused the amount paid to providers to increase.

Unless you have a preexisting condition. Yeah, it's expensive now, but it's a much more improved situation when the insurance companies can't say no (and the alternatives that have been proposed, like high risk pools, have so far been trash in terms of quality of lifetime care compared to current status quo)

How do you figure? Please elaborate on this. I don't see how subsidized premiums and guaranteed coverage would be a detriment to freelancers... Yes, the cost of healthcare was cheaper back then, but it likely would have risen more without ACA.

Your last sentence is pure speculation. There was never an equivalent rise. The spike is due, in part, by the ACA’d requirements that covered more than the original plans covered. Some of use didn’t want to cover those costs. When I priced a plan before ACA, $300 family of two. Closest plan after $750. I didn’t qualify for credits. So I had two mortgage payments:650 for house 750 for medical. SMH.

I can't speak to individual anecdotes, I was talking about healthcare spending overall. It's not speculation, here are some sources:

https://wire.ama-assn.org/ama-news/growth-health-spending-sl...

Also, regarding out-of-pocket spending: https://www.bloomberg.com/opinion/articles/2018-01-04/out-of...

Obamacare exploded the cost. It’s hollow succor to say the rocketing costs are accelerating less. All your supposed evidence shows is that the markets are getting worse. The ACA is plagued by dine and dashers. https://johnhcochrane.blogspot.com/2018/06/aca-dropouts.html

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