Obamacare / Affordable Care Act : classic or dud?

Also, good luck with this one, Milo.

milo what if you get a hernia? etc etc? i understand being annoyed at the cost but without insurance you could literally end up bankrupting not just yourself but your relatives.

that was what finally made me realize why insurance was kind of non-negotiable: my parents were like, who do you think is going to have to pay for it if you get clipped by a taxi and need surgery?

That's a pretty big hypothetical Matt.

Not really, no

well, insurance doesn't mean that you won't have to pay a large amount of $ if something horrible happens to you. A friend of mine, who was insured through Healthy San Francisco, got hit on his bike by a city vehicle and his medical bills are probably up to a million dollars at this point.

Milo don't you shoot guns as a hobby?

The plans I could afford would have done almost nothing for me in the event of an emergency

So presumably the subsidies for low-income earners either didn't apply to you or the amount was inadequate to make the insurance affordable. If it's the first case, then you may need to look at your finances and figure out how to lower your expenses. If it's the second, then the subsidy levels in the law may not be generous enough to accomplish its stated goals.

If it's the second, then the subsidy levels in the law may not be generous enough to accomplish its stated goals.

Um, pretty sure it's the latter! No surprises there!

Not really, no

What if he only had $5k in med debt but $15k in revolving credit debt? Or $100k in mortgage debt + $5k in med debt?

Aimless OTM.

xp

Supposedly, the fines for refusing insurance will help fund the subsidies for those who participate. If there is a massive refusal, then the subsidy funding ought to be readjusted to reflect that fact, since the revenues from the fines should be much higher than anticipated.

i think you can be exempt from the fine if insurance is 40% or more of your adjusted gross income or if you are not required to file a federal tax return. I think the original idea -- or one that bleeding hearts like me wanted to be the original idea -- was that Medicaid/Medicare would cover the lower income people who couldn't afford the cheaper plans

/Not really, no/

What if he only had $5k in med debt but $15k in revolving credit debt? Or $100k in mortgage debt + $5k in med debt?

Aimless OTM.

xp

But that's not what he said, he said that 5k in debt was functionally the same for him as 15k (and of course it could be much more than that).

I think there is something to Milo's point here - if you can only afford the cheapest plans, you migh also probably not the kind of person who has an easy time keeping an extra $5k in dry powder in case of a catastrophe. If anything, the low-cost, high-deductible plans are probably more ideal for a young healthy person with good income/assets who just doesn't care about anything other than catastrophic events.

That said, not having 5K lying around doesn't mean that 5K = 15K = 100K in terms of the consequences.

well, insurance doesn't mean that you won't have to pay a large amount of $ if something horrible happens to you. A friend of mine, who was insured through Healthy San Francisco, got hit on his bike by a city vehicle and his medical bills are probably up to a million dollars at this point.

That's why the caps on out of pocket pay are the second best part of the law.

xp - well if you are barely scraping by financially as it is, and you are healthy enough not to need medical care on a regular basis, then paying for health insurance that you don't immediately need, and potentially being penalized for not doing so -- that's adding insult to injury. It feels like being penalized for being poor.

That said, not having 5K lying around doesn't mean that 5K = 15K = 100K in terms of the consequences.

this is key

perceptually, though, any of those amounts would equal being financially fucked

you can't afford not to afford care

Medicaid/Medicare would cover the lower income people who couldn't afford the cheaper plans

They do to some degree, right?

I think this was discussed either way upthread or in a politics thread, but some states are not complying with this

If I needed a long hospital stay or a major surgery I'd be fucked in any case, so I'll just go to the county hospital and they can try to squeeze the money out of me.

I'm not understanding why you'd be fucked if you had insurance

because he can't afford an insurance plan that would cover enough of the costs to make it so he isn't financially fucked!

even if ACA works as intended, our system is such a ridiculously fucked up one, only a matter of time before it needs another major overhaul. which is why I'm getting fuck out of health care industry asap.

there are debt relief options out there and obviously debt relief is more effective for 5k than 100k

for any non-emergency condition, he could just go out and get insurance and then get the surgery or whatever, and then cancel coverage.

which is why ACA is flawed. Insurance works on either risk management or the vast majority of a population buying in. I think private insurers should be able to decline offering insurance to anyone they deem to be a bad risk BUT there needs to be valid public option for those declined to fall into.

and a public option that is affordable (even free) to poor people

takers!

I think private insurers should be able to decline offering insurance to anyone they deem to be a bad risk BUT there needs to be valid public option for those declined to fall into.

so it's structurally baked in that the government takes care of the expensive cases and the private insurers take care of the cheap cases? hmm

not to mention the incentive for private insurers to bump the expensive cases they already have OFF their roles -- the govt will take em!

well, that's why it's called the Affordable Care Act. The concept of insurance has been warped for a long time.

so it's structurally baked in that the government takes care of the expensive cases and the private insurers take care of the cheap cases? hmm

either way we are all paying for everyone else's healthcare, whether it's premiums or taxes. Something like Germany's system seems far better than anything we've come up with.

not to mention the incentive for private insurers to bump the expensive cases they already have OFF their roles -- the govt will take em!

you can't just "bump" expensive cases off your roles

like even before ACA, you couldn't do that

I'm admittedly in the same boat as milo. don't qualify for medicare, and the cheapest plan available for me through the state marketplce is $300 a month, which is a big chunk of my income. Want to support the system but it might just make more sense to pay the fine

There are no bronze or catastrophic plans available in your state? No federal subsidies?

those are the bronze plans... i really need to look them over again, but the NYS site goes down every other day

Just 4 People Have Enrolled In Obamacare In Delaware

whoah, comments on that article are super-gloaty

Pretty sure bronze plans aren't 300 bucks. I have what amounts to a silver/platinum plan with free doctors visits and free yoga and all kinds of holistic shit with freelancers union and it's only 345 and that's pre-ACA. There are already ways to get bronze level plans for 150 ballpark from Freelancers, Fractured Atlas and other sources.

maybe a testament to how well romneycare is going to work out is "conservatives" lying about how expensive it's going to be, by always leaving out the subsidy effect? if romneycare sucked so much, they wouldn't have to lie at all . . . unless "conservatives" just can't help being deceitful, that is

this seems like a good, concise summary:

Here Are The Five Big Reasons Obamacare Is Changing People's Insurance Premiums

last paragraph of that is key

xxxp - On the national exchange, I think bronze plans (for me) were ~$250 before subsidy.

Milo you're in Texas, right? You can still get a nonACA plan. Though come 2015 you'd have to switch to ACA anyway, as I understand it.

so if you wanted high deduct plan and you're relatively young and no significant med history, your premium would be way lower than $250

last paragraph of that is key

actually, that's how i came to the story, because digby was praising the article as a whole but taking issue with the final paragraph.

here's the final paragraph:

ACA supporters need to argue not that these people don't exist or that their circumstances only changed because of greedy insurance companies; they need to argue that their losses are more than offset by the gains of the sick and uninsured who will get better and more affordable coverage under the law.

here's digby:

I'm sure that many people are moved by altruism and fully understand that some must pay more so that others can have insurance. But many of the people I know who are being hit with higher premiums live in or near expensive cities where many salaries above the cut-off for subsidies (around 45k for a single person) don't go very far. After factoring in housing and transportation they don't actually have a lot of disposable income. So this is going to hurt.

I have been talking about this for a long time. Lecturing middle class workers and small business people who are already feeling squeezed about how they should be happy to be the only people who will have to sacrifice for the greater good in this scheme just doesn't strike me as a big winner. Unfortunately, it seems to be the only rationale on offer.

Lecturing adults is always a sign of shaky leadership.

xp yeah that seems to be one of the biggest flaws with the act -- it seems to shift a lot of the burden for paying for the poor onto the barely-not-poor. I wouldn't say it's a fatal flaw, but it's something that should be worked out with further reforms imo.

wonder how the romneycare website would be operating right now if the republicans hadn't shut the federal government down the day the website went live