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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsHow affordable are the Health Care Exchanges really?
I'm not asking as an attack Obamacare, I am by no means opposed to it, but the numbers don't necessarily make a lot of sense to me. CBS News presented a scenario last night for a single guy making $36,000 per year and how happy he was with a policy costing $285 per month. It has a $1300 deductible.
By my calculation his take home pay is $569 every two weeks, so to start with his premium is almost precisely half of one paycheck. In what universe is one fourth of your take home pay affordable? And it's a policy that doesn't kick in until you have coughed up $1300, and how affordable is $1300?
Further, the true premium is $464/mo according to CBS News, and it's reduced to $285 by a tax credit. Unless I'm missing a special provision in how tax credites are handled differently under ACA than they are for everything else, you only receive them when you file your taxes, so he'll have to actually pay the $464 per month and then get a refund of $2148 in April of the following year. That means he's coughing up almost the entirety of one paycheck (82%) every month. How "affordable" is that?
Am I missing something?
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lancer78
(1,495 posts)Item 1, someone who is making 36,000 a year is taking home around $1,250 every 2 weeks, not $569. He is limited to spending only 9.5% of his income on a premium. That is what the silver plan subsidy calculator says. I also understand that the tax credit subsidy will be available to be paid out by the month and not at the end of the year.
telclaven
(235 posts)I believe his point is the take-home pay, which deducts SS, Medicare, Fed Tax, and State Tax. $596 per week is pretty much right.
uppityperson
(116,020 posts)
karynnj
(60,968 posts)uppityperson
(116,020 posts)OP's math was wrong. Lancer tried to correct. It read to me like telclaven disagreed with Lancer. I was trying to point out lancer78's $1250/2 wks and telclaven's $569/wk are about the same. OP's math was off.
karynnj
(60,968 posts)uppityperson
(116,020 posts)karynnj
(60,968 posts)$36.000. For federal taxes, with the standard deduction and the personal deduction, that is for federal purposes - $26.000. The effective rate would be 10% on the first $8925, and 15% on the amount above that - about 3319, which is slightly less than 10% of 36,000. ss is 6.2% and medicare is 1.45. Altogether the federal taxes at this income level are - less than 19% in total. State taxes are far below the 31% needed to get to 50%.
Links - 2013 tax rates and deductions - http://www.forbes.com/sites/kellyphillipserb/2013/01/15/irs-announces-2013-tax-rates-standard-deduction-amounts-and-more/
FICA amounts - http://www.controller.iastate.edu/payroll/fica.htm
MFrohike
(1,980 posts)15% starts at 36250 for singles in 2013. This guy would be at 10% period. Otherwise, thanks for the info.
IRS link for 2013 brackets - http://www.irs.gov/pub/irs-drop/rp-13-15.pdf
karynnj
(60,968 posts)$36250 is the TAXABLE income at which the 15% band ends.
Note that as I showed taxable income is not gross income - his marginal rate for part of his income will be 15%.
MFrohike
(1,980 posts)The OP quotes a total of 36k a year, which we can assume as gross income (not adjusted gross income). If taxable income is gross income minus exemptions and deductions, how would he pay 15% on any portion of his income when the entirety of it falls in the 10% band? Taxable income, by definition, is less than gross for most people, so I'm confused how it would lead to a higher marginal rate in this situation.
I freely admit I'm no tax expert. I just don't see how a distinction between gross and taxable matters for calculating top marginal rate when the entirety of the income is in one band.
karynnj
(60,968 posts)threshold - the 15% band does. Look back at the chart in your link.
Oh man, I read the wrong line. Whoops!
SoCalDem
(103,856 posts)
PoliticAverse
(26,366 posts)
winter is coming
(11,785 posts)
Nye Bevan
(25,406 posts)and wait until tax time to get the difference refunded. Fortunately, that's not how it works, as you point out.
Lydia Leftcoast
(48,223 posts)I knew it.
Nuclear Unicorn
(19,497 posts)This is marching citizens onto the corporate customer rolls as a condition of not going to jail.
JayhawkSD
(3,163 posts)It does, however strike me as involving a tremendous amount of paperwork, complicating tax returns for beneficiaries and with a great many chances of error. Still, it's good that provision has been made to pay it in advance.
It doesn't say what percentage of cost it pays after meeting the deductible, and even at $285/mo and with a $1300 deductible... It's not awful, but I don't really see a whole lot to cheer about.
MindMover
(5,016 posts)
SammyWinstonJack
(44,316 posts)SSDI with medicare. Even with that, he had to pay Humana monthly for part D and $40 per copay for his scripts, the ones he can afford that is, since four months into the yr, he falls into the donut hole.
We can't afford his two of his scripts for 8 months of the yr, but I am suppose to buy mandated health insurance? 
Hoyt
(54,770 posts)As one who paid for my mom's meds when there was no Medicare drug coverage and who will be on Medicare shortly, that is huge.
MFrohike
(1,980 posts)I'd been wondering about this, so thank you so much for sharing it.
alc
(1,151 posts)We won't know until everything settles down. Nobody on either side can tell you. We'll learn a lot the first year.
Will insurers keep rates low (or lower them)? Or need to raise them? Or raise co-pays? Or deductibles? Since 80% of premiums must go to medical costs, they LOSE money if they decrease medical costs but can argue for increased premiums (and profit) if costs go up. The MLR gives them an incentive to raise costs and cover EVERYTHING.
How will regulators react? Allow premium increases? Or deny premium increase and have insurers say they want to cover EVERYTHING but the "death panels" won't let them?
How will providers react? Will they accept the insurance? Or go to a cash basis? Will cash providers be outlawed?
Will improved records management and simplified insurance increase providers' profit without increasing rates?
Will doctor's offices' become production lines which push as many people through as possible? With more mis-diagnosis and more return trips (and additional co-pays). Practices are streamlining their patient care already and have to do more if reimbursement rates go down.
If too many providers drop out of networks, how long a drive/trip will it take to see a doctor? How long will the wait be? An all-day trip to the doctor will cost a day's worth of wages. Some medicare patients currently have all-day trips to see a doctor who takes new medicare patients (my dad drives one of them when his friend needs to see a doctor for a "routine" visit)
Things may turn out great. But don't look at low initial premiums the final success. Insurers and providers will continue to "improve" their services (with profit goal) as they learn how the law works and will continue lobbying. If ACA supporters stop fighting, it will go the wrong direction very quick.
PoliticAverse
(26,366 posts)instead of paying the penalty (which is only $95 the first year). This number will greatly affect
future premium adjustments. Note that many insurance companies are non-profit or mutual
(owned by the policy holders) and don't have profit as their goal only a form of 'break even after
costs'.
enlightenment
(8,830 posts)increases annually - without review. Over 10% the insurers have to prove why they need that much. So, technically, in three years your premium could increase up to 29% without anyone blinking an eyelash - and so on and so on.
Bait and switch.
JayhawkSD
(3,163 posts)With higher prices being billed by hospitals, drug companies, laboratories, etc, the restriction on cost is not really even nominal.
pnwmom
(110,261 posts)an increase, based on whether it is "reasonable." And 80-85% of premiums must be spent on actual patient care, rather than administrative expenses, or it has to be returned to the customers. This has already led to reimbursement checks for many people.
http://www.ncsl.org/documents/health/HRPremium.pdf
enlightenment
(8,830 posts)http://www.californiahealthline.org/articles/2013/9/13/hhs-aca-rate-oversight-mlr-provisions-saved-consumers-billions
Here's another version of the above:
http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Review-of-Insurance-Rates.html
My comments have to do with increases BELOW the 10% threshold.
Edited for second link
Ms. Toad
(38,637 posts)to the 85%/15% limitation on healthcare/administrative expenses. So if they increase them too much, they will have to issue refund checks.
enlightenment
(8,830 posts)HHS apparently feels that anything up to 10% is not too much - otherwise they'd set the bar lower. I am quite sure they will be able to justify a 9.99% increase annually; look at how much Medicare "D" plans get away with (up to 30%) without anyone blinking an eye, except the seniors who have to pay the increase.
I'll tell you what. Let's get back on this in three years and we'll discuss how much consumer costs increase under the ACA. At the moment all we can discuss are hypothetical scenarios, based on regulations that are conveniently vague and overly complex (and yes, I have spent many hours looking not just at the ACA but at the body of laws that the ACA modifies).
If it works out peaches, I'll be happy to say I was wrong about the potential for the insurance companies to use their regiment of lawyers and accountants to successfully navigate the rules that will presumably control their ability to profit enormously from their newly expanded user base.
Ms. Toad
(38,637 posts)If a 10% increase makes the administration to health care ratio too high, the insurance company has to refund the difference.
This particular issue really has nothing to do with hypothetical situations - it has to do with the law - does a 10% increase automatically gets a pass because HHS thinks it is reasonable? No, it doesn't. If there is a 1% increase, or even a 0% increase, but the administration/health care ratio is too high the company will have to refund premiums to its customers - as many already have for the past two years.
enlightenment
(8,830 posts)HHS is writing the regulations. To suggest that they don't matter is beyond ludicrous.
SHOW me where, in the last two years, a company that has increased premiums less than 10% has been forced to refund anything. If it's fact, you can prove it.
Ms. Toad
(38,637 posts)to how much of your premiums an insurance company ultimately is able to retain.
The cap on premiums is a back-end cap. All that is reviewed is how much was taken in in premiums, how much was spent on administration, and how much was spent on health care.
The increase (or lack thereof) isn't even part of the review - so your challenge is just silly. I'm sure part of the $ 1/2 billion which was refunded in 2012 (and about the same expected in 2013) came from companies with premium increases in the 0% - 10% range. The companies forced to issue refund checks in 2012 (for 2011) is here, but whether those companies increased their premiums for the applicable plans isn't part of the publicly available data - since the point I have been trying to get across is that those are two entirely separate questions.
enlightenment
(8,830 posts)Unfortunately, that is not the argument you were making above.
Ms. Toad
(38,637 posts)but it is exactly the argument I have been making all along.
Premium increases - and the opinion of HHS about those premium increases is ultimately irrelevant. No insurance company gets a free pass because their rate increase is below 10%. The mechanism for adjusting correcting a premium that is too high (whether it was too high because of a rate increase - or was just always overpriced and there was no annual increase at all) is a refund - which many companies have been forced to make the past two years. That is purely a mathematical calculation to which ALL insurance companies are subject - even if their rate increase was 0%.
enlightenment
(8,830 posts)I'll accept that - and not bother to ask why you addressed my original post with a different topic. We're talking apples and oranges here, despite what you think, and I don't agree with your assessment of what will happen come the day. I asked you for proof, which you cannot provide - understandably - so I think I'll just wait and see how this washes out over the next few years.
pnwmom
(110,261 posts)truedelphi
(32,324 posts)My big concern where I live regards Calif.'s exchange- only two actual possible providers out of three listed. (Kaiser has NO hospitals, clinics or doctors in my county, yet that HMO still was allowed to present itself as a choice. I have no idea why that was allowed.)
What if many of the doctors here do not want to see anyone on the exchange? Then what? I will be paying X amount, and getting very little in return, if the doctors don't exist. I can be penalized, but it doesn't seem that the providers can be.
Of course, I guess time will tell.
Pretzel_Warrior
(8,361 posts)Get real. The state of how providers operate will continue to be pushing many people through. Why would providers stop taking payment from large insurance groups? That's ridiculous.
A lot of fretting going on.
Once Obamacare is more fully implemented in 2014 and 2015, the key focus will be on driving down typical health care costs to achieve desirable health outcomes.
It will happen.
Hoyt
(54,770 posts)uppityperson
(116,020 posts)it wil at minimum half. My current and soon new policies have $10K deductible, fwiw.
Egalitarian Thug
(12,448 posts)something really serious happened to you? Do you have $10K to shell out? Can you handle the co-pays required by that policy? How long can you get by with no income while simultaneously being burdened with significantly increased expenses?
bluestate10
(10,942 posts)work for the republican right as they attack the ACA and save republicans the work. How sad given those people will instantly attack anyone who question their logic as Obama apologists, DLC or republican-lite.
uppityperson
(116,020 posts)Last edited Tue Sep 24, 2013, 06:05 PM - Edit history (1)
uppityperson
(116,020 posts)Of course we ran the numbers. Yes, we "actually worked out the consequences".
Getting a catastrophic plan was the cheapest overall and better than no plan and risking losing our place. A plan with a decent deductible would have run us more than $15K per year.
Thank you for your concern but yes. We " actually " did work out the numbers.
I am very much looking forward to the end of the year changes, being able to stop going into debt and getting insurance we can afford and use.
pnwmom
(110,261 posts)SNIP
On July 1 — I must’ve just received my paycheck — I bussed up to Cleveland Park, a quiet neighborhood in Northwest D.C., to meet my sister and brother-in-law for a celebratory dinner. They had just moved back to Washington after many years, and this was the first time she and I would be living in the same city. I met them at their new condo, with an envelope in my back pocket, we walked south down Connecticut Ave toward the restaurant, but before we reached our destination, I dropped the envelope into a corner mailbox.
Six hours later two EMTs wheeled me into a trauma center.
My medical bills totaled about $200,000, mostly attributable to major surgery and a 10-day hospital stay. My deductible more than cleared out my bank account, but in the end, my insurer paid almost every other penny, and saved me from bankruptcy or a lifetime of debt. For $200,000 you can buy an Ivy League education, a home, a law degree, a secure retirement or a splenectomy. But there’s no equity, dividend or residual value in a splenectomy.
I don’t know how much difference that scary (but extremely fortunate) timing made. It’s possible my insurance would have covered my bills even if I hadn’t mailed the check that night. But that’s sort of beside the point. The point is that I’d just enrolled in insurance I never thought I’d need, and then unexpectedly needed it — badly — just a few days later. It cost me about $100 — about the amount millions of young people will be asked to pay out of pocket under Obamacare. Two-thousand-to-1 is a pretty good payout.
SNIP
Ms. Toad
(38,637 posts)than with none.
Egalitarian Thug
(12,448 posts)Ms. Toad
(38,637 posts)You likely qualify for both reduced/free premiums and reduced/free cost sharing.
And - you're still considerably better off than you are without catastrophic coverage. A debt of $10,000 (because that is the maximum out of pocket you would ever owe in this scenario) is more easily paid off than one of $10 million. People can, and do, manage to get back on their feet after debts of $10,000. Not everyone. But considerably more than get back on their feet after an unexpected medical debt of $10 million.
uppityperson
(116,020 posts)Why do you question whether or not I have "Actually worked out the consequences" and talk bad about my only being able tonafford, and not even that, catastrophic which would still leave me with a $10k debt but not lose my home? Do you realize how condescending this sounds?
I will be very glad to get the changes at the end of the year as It will be a great help.
Egalitarian Thug
(12,448 posts)What these other people are doing, I have no idea and couldn't care less.
As for the $10K question, good for you, millions of others couldn't and would likely never be able to pay it back, so the specific number is irrelevant since it will have the same result.
Skittles
(171,710 posts)
Steerpike
(2,693 posts)Last edited Wed Sep 25, 2013, 10:14 PM - Edit history (3)
oop is the devil in the details. 68.00 for my p/t job monthly...then I get to spend 2200.00 a year oop. This is recalculated and really comparable to my insurance at my old job.
Skittles
(171,710 posts)mine is 5,000 
That's cause you are a high roller...rolling in the dough. Apparently this is all speculation until Oct 1st. 
Skittles
(171,710 posts)of course it doesn't work - insurance companies f*** you one way or another
Drahthaardogs
(6,843 posts)come from? A family of four making $98,000 still qualifies for some (although I would expect small) subsidy. How are the subsidies funded for this plan?
PoliticAverse
(26,366 posts)
Recursion
(56,582 posts)Pretty much a win-win there.
Recursion
(56,582 posts)Most of the funding for ACA came from changing how we do student loans, so that banks no longer skim nearly as much profit.
Another chunk came from cutting funding for Medicare Advantage plans.
A smaller chunk comes from taxes on certain medical devices (including tanning booths).
notadmblnd
(23,720 posts)will pay 77.00 a month for the silver plan. That's 19.25 a week from a take home of about 370.00
http://laborcenter.berkeley.edu/healthpolicy/calculator/
MindMover
(5,016 posts)mainly so that you can teach your son to take on his own responsibilities .... and keep shoveling money into the insurance companies coffers .... ??????????????????????????????
notadmblnd
(23,720 posts)I do expect that his employer will be providing some type of plan, so who knows it may be cheaper
Right now, he is on mine and can stay on mine til he's 26 as long as I can claim him on my taxes, but I think he's going to make too much for me to do that this year. So yeah, if he finds hislef uninsured, it will be worth it for him.
MindMover
(5,016 posts)20 a week is a whole hell of a lot of money .....
uppityperson
(116,020 posts)if they want to or if it is more affordable.
notadmblnd
(23,720 posts)Hell, he's gonna spend 20 at some fast food restaurant every week.
MindMover
(5,016 posts)Humanist_Activist
(7,670 posts)and in either case, he will, depending of severity, take years to pay off that bill, or declare bankruptcy.
Steerpike
(2,693 posts)Humanist_Activist
(7,670 posts)as far as I'm aware of, there is some help on the way, but can't find anything with dollar amounts, or even percentages on this. Also, the max out of pocket for silver plans on that website seems absurdly low, considering that the deductible is supposed to be higher than that.
Puzzledtraveller
(5,937 posts)as I am a medicaid caseworker. I think it will hurt most families. That's just my opinion.
MindMover
(5,016 posts)Puzzledtraveller
(5,937 posts)People will conflate expanded medicaid with the main component of the ACA which begins October 1st. Expanded medicaid is good, I support it and my state chose to. It was important for that part of it to stand but the scotus saw to it that it did'nt. It was the window dressing to hide the effects of what is about to take place.
Recursion
(56,582 posts)They're a much bigger subsidy to private for-profit insurance than ACA. Should we get rid of them?
MindMover
(5,016 posts)here is a little lesson on medicare
http://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html
Recursion
(56,582 posts)Both are provisioned by private companies, ie, the Federal government pays them to do the actual insurance part.
Response to Recursion (Reply #58)
MindMover This message was self-deleted by its author.
MindMover
(5,016 posts)PoliticAverse
(26,366 posts)MindMover
(5,016 posts)uppityperson
(116,020 posts)
cilla4progress
(26,525 posts)Trained in the program as a volunteer "in-person assister." Our monthly premiums will be increasing under ACA, based on current calculations, which I suppose could change..
Major Nikon
(36,925 posts)Prior to ACA if you couldn't get a group plan you were at the complete mercy of insurance companies. By the time you paid your premiums and deductibles it was almost impossible to come out ahead at the end of the year and the plans had catastrophic maximums that were extremely low which virtually guaranteed the insurance company was always going to win. If you had a pre-existing condition, forget it. It wasn't covered, ever.
From the insurance companies' perspective, this only made sense. People who didn't fall under group plans generally didn't buy insurance unless they knew they were going to use it.
With ACA, everyone who buys insurance on the exchanges falls into a group which spreads out the risk which is the only practical way insurance can work effectively. That's why employer sponsored plans were always cheaper and covered more. Now everyone has access to a group plan which lowers costs for the same coverage.
Compare any non-group plan pre-ACA to an ACA plan off the exchanges and you'll find the coverage is much greater even if the price is the same or slightly more.
Pretzel_Warrior
(8,361 posts)See? Two opinions completely unsupported by facts.
Yo_Mama
(8,303 posts)I've just been taking the states that have published details one at a time and running examples, and for many it's going to be tough.
The very worst, though, are the families in which the primary worker can't afford to cover wife/children through the employer insurance (the 9.5% cost is only for the worker), but under IRS rules those families won't be able to get a subsidy on the exchange.
LWolf
(46,179 posts)This is exactly why both of my adult sons will probably choose to pay the smaller penalty rather than be force-fed insurance that is not affordable.
NYC_SKP
(68,644 posts) they go to urgent care and pay the bill over time.
Just like I have to do with my insurance, because my deductible is too high.
Not to mention the copays.
The difference is that my insurance costs too much every month for that privilege.
bhikkhu
(10,789 posts)It will be free to my family for the first two years, then will increase to $100-200, depending on how long the kids stay on. Once they're grown, its still well within my means. In my area cost of living is very low, but $30k per year is a pretty good income. Most people are under it, and it will be very affordable.
A co-worker is all up in arms because he and his wife will pay $200 a month combined, but they have no kids and make $400 more a month than I do. In spite of the complaints, they can afford it, and being over 50 and with several big risk factors, they really need it too, whether they think so or not.
My employer has had his family covered for years, at $12 a year in premiums with a $20k out of pocket limit (which he has reach the last two years). He should have his expenses cut in half, easily.
Recursion
(56,582 posts)Though IIRC there are two states that "improved" this where it doesn't.
mzmolly
(52,793 posts)paycheck. And you're missing the comparison between what he is paying for employer based health care, pre ACA.
WCGreen
(45,558 posts)People do that all the time for the Earned Income Credit.
I've been doing taxes for the better part of 25 years and credits are treated as dollar to dollar refunds.
Steerpike
(2,693 posts)tax rebates are ok. but middle class can suck lemons on that. plus you are not allowed to have payments on a house or auto...cause that don't count. must live a meaner life...but must work harder and longer.
dflprincess
(29,341 posts)and if you need to buy single or family coverage.
If you live in the Minneapolis metro area, are 60 years old, single and your adjusted gross income is more than $46,000 the "silver" plan will cost you just over $400/month as you won't qualify for a subisdy at that income. That does not strike me as especially affordable at that income level (and the "bronze" plan has a deductible that's too high for even a healthy 60 year old to gamble on).
The other way you get ripped off on the exchange if you don't qualify for a subsidy is that not one cent of the premium you pay can be treated as "pretax" dollars the way your portion of the premium on an employer sponsored plan may be.
Humanist_Activist
(7,670 posts)Note: I'm not on the plan, but its about 75 dollars a pay period, or, about 9.3% of my total income, if I signed up to it. It is, at best, a bronze level plan, and because my employer offers it, I can't get on the exchanges, so I guess I'm SOL.
Also, I'm poor enough, that if I were on the exchanges my share of premiums would be reduced to 4.7% for a silver plan, or 0% for a bronze level plan.
dflprincess
(29,341 posts)but, if you don't, and you're just over the income limit it may not be such a great deal.
I know that I am fortunate that my employer provides a great plan (somewhere between what's now called "silver" and "plantimum" and what a single employee pays is a really reasonable amount per pay check - not sure what the family plan costs as I didn't need to consider that.
Humanist_Activist
(7,670 posts)and our insurance is truly crappy, the owner of the company was shocked when he got billed over 200 dollars for a simple doctor's visit, and he fired the person who signed us up to this new plan, but we are stuck with it until enrollment time in December. I didn't sign on when we got the paperwork last year because I read it, noticed I would be paying a shitload of money, and the plan doesn't cover shit, so I opted out.
Maybe it will change when open enrollment starts in December, if it doesn't improve drastically, I guess I'll have to find another job or something, maybe even take a pay cut and try to get on Medicaid, don't know what else I can do.
duffyduff
(3,251 posts)The policymakers couldn't care less whether the masses have "affordable" health insurance and health care; this is all about shifting costs from companies to workers where company-paid health insurance still exists. The top of the top one percent will cash in again.
I predict in five years the only places that will still have employer-based coverage will be the public sector and unionized private sector--the same sectors that are about the only ones with pension coverage anymore.
I saw this "health care reform" coming from a mile away. There will be NO single-payer system for years and years, if ever, while people will die because they have crappy coverage from these "exchanges."
This is almost identical to the gutting of pension coverage for the vast majority of workers in favor of junk 401(k)s.
You'd think people would get wise to this by now.
Nay
(12,051 posts)benefits, but until ACA came along, many felt that it was the only way to attract and keep good employees. Now that they have ACA to blame, they will dump their health plans, keep the money for themselves, and blame Obama.
duffyduff
(3,251 posts)They will get Washington politicians to put some lovely loopholes to make it possible for companies to continue to either not provide health insurance at all or to get rid of it altogether.
This is the ultimate goal of ACA, or the ultimate effect of ACA, whether people want to believe it or not.
We have the pension mess as a model. We also have the MSAs as a model, which were actually designed to replace company health insurance plans, but they never really caught on in a big way.
Companies also want to get out of paying their share of the Social Security tax hence the attempt to try and privatize it.
This is another demented neoliberal fantasy to try and make the US "competitive" with slave wage countries.
KentuckyWoman
(7,401 posts)People are going to be paying a lot for "coverage" and if they actually need to access medical care services they may or may not be able to cover that cost. However, before this we had insurance companies taking excruciatingly high premiums and then when the time came to access services refuse the pay for the bills.
The provider got the shaft.
The patient got the shaft.
The dozen or so people who hold 90% of whatever insurance company's stocks made out like bandits.
This is not the perfect step ...... and quite frankly I'm not happy with this at all..... but it does a few really good things.
1. Gets people in the mindset that medical insurance is personal and has nothing to do with where, or if they work. The benefits of that mindset are huge.
2. Will eventually get people to ask more difficult questions of providers with regards to the need for multiple expensive medical tests and the alternatives to expensive medical intervention.
3. Will eventually get tweeked just like Social Security was to include more people as employers do what they generally do .... looking to profit an extra dime by screwing their workforce. There will be more and more companies drop kick medical insurance benefits for employees... forcing them into the exchanges. Over time the vast majority of Americans will be in the exchange and maybe then will demand universal single payer instead of this complicated mess we are putting in place now.