A possible unintended side effect of Obamacare

[yurbud]

California has set up their exchange and has a calculator to show what your premiums would be if you used it to get your insurance.

My family is currently covered through my job, though if my wife lost her job, I'd have to pay quite a bit to cover her and my daughter with my job's insurance.

So I was curious to see what the exchange would cost.

I plugged in our numbers and got about $1200 a month for the three of us for the gold coverage (the ones below that had such high deductibles it wouldn't make sense for us).

I had two reactions to seeing that number:

1. That is significantly cheaper than it would cost to get covered in the past (I've checked).

2. It's still a hell of a lot.

That second reaction is the one I'm wondering if more people won't have.

Since most people get their insurance through their job, they probably have no idea what the total cost of their coverage is.

I've worked with my union local, and the only time I felt the least bit sympathetic for management was when I heard how much health insurance costs went up every year.

I think a lot of people will appreciate the lower cost, but after the initial gratitude wears off, I wonder if they won't be a bit critical of the total number and ask if their isn't a way to reduce it further--like taking the for-profit leeches out of the equation altogether.

[enlightenment]

1. A lot of people have been asking for that

for quite a while now. I seem to recall some of them being turned away from the table when discussions began.

[solarhydrocan]

4. "turned away"? How about arrested and marched out

How quickly people "forget"

[RC]

5. I have not forgotten.

Nor will I. Where is the voice of the people in our government?

[yurbud]

34. outside, on the steps at best (if we're lucky)

[icymist]

44. At the 'You're allowed to voice your protest here' zone.

Everybody else must go home.

[NightWatcher]

2. Would you qualify for a subsidy to help with that amount?

I'm curious how those are going to work. Will they be tax credits or will they directly discount your premiums?

It's going to jumbled for a while as this gets rolling.

[yurbud]

8. I think my wife and I together make too much--though student loan payments take a bite

out of that income already.

[Ms. Toad]

18. Discounted premium.

You don't have to pay the premium and then wait for a tax credit.

[NYC_SKP]

3. People who now pay their own costs will be thrilled! My COBRA is $1,432.49/month.

It will go down to around $700, so I'm delighted.

Others who don't pay their own way or who have never had the displeasure of finding and paying for their own private plan might not be so happy.

[yurbud]

9. There were times when I could have gotten individual insurance for that but couldn't afford it

[MH1]

15. And, COBRA is for a limited time, right?

I remember getting COBRA over a decade ago. I looked up the cost it would be for me to get insurance under ObamaCare - just out of curiosity since I have insurance through my employer - and it wasn't much more than I remember paying for COBRA way back when. So I thought that was probably a good deal.

But anyone who hasn't ever bought COBRA may not realize how high the premiums are. I remember having sticker shock the first time I got it.

[NYC_SKP]

17. 18 months and then 18 months again = 3 years.

Oddly, the same coverage through the same employer when I quit in 2006 was almost 1/3 the monthly cost.

They've bumped it WAY up over just a few years.

Can't wait til 2014!

[Ms. Toad]

20. Should be far less than COBRA. n/t

[bluestate10]

25. I pay for my own, but am lucky enough to live in the only state that has implemented

health care reform. My Gold level plan costs $1,100/month before the ACA kicks in. I saw a poster below decry the have versus have-not aspect of health insurance. The complain is good class warfare folder, but the reality is that health insurance is one of the largest expenses that we face outside of housing. The "real" costs have always been there, but have been paid by employers that offer health insurance coverage. Anyone can choose to go without health insurance and pay the penalty, but that is a horrible idea.

Back to the class warfare stuff. People that earn less than a certain amount per year can not only get subsidies, but also can qualify for additional state assistance in blue states like my state and your state, that tiered assistance reduce the cost of health insurance to an affordable level for low income people. Class warriors fight some good battles, but when attacking someone for health insurance coverage under the ACA, class warriors are out of line.

[yurbud]

35. It's not the "real" cost of health CARE, it's the real cost of health INSURANCE COMPANY PROFITS

That drives costs over the cliff

[Hoyt]

53. That profit is definitely waste, but at best eliminating "profit" from premiums will save only 10%

or so. A savings for sure, but not enough where anyone will be jumping up and down celebrating. $1200 a month, goes to $1080. Still a lot.

Could also squeeze some profits from providers, I suppose.

And as consumers, we could accept less tests, longer wait time, restrictions on expensive treatments/procedures in later years of life, forgo the latest drug that is basically the same as the cheaper old ones, etc. But, then, government would be accused of "death panels."

If we won't truly affordable health care, we are going to have to stick it to providers and consumers (and perhaps tax the "rich" more, but good luck with that).

I'm not sure most folks are ready to sacrifice to get truly affordable care. I would like to be wrong, but . . . . . .

I do see one advantage to allowing insurers to make a "reasonable" profit -- the government does not have to come up with the hundreds of billions of dollars necessary to invest in the massive system necessary to manage health care/insurance. And insurers end up taking a big portion of the risk for covering some 30 million uninsured, and moving to Obamacare.

(Before someone says, Medicare does it of 3 to 6% -- remember insurance companies currently do most of the administrative work for Medicare. The feds make the rules, and Blue Cross, Cigna, etc., administer the program. Further, 28% of Medicare beneficiaries have voluntarily chosen to enroll in Medicare Advantage Plans offered by . . . . . . .the same insurance companies we are griping about.)

Health care is not going to be an easy fix, no matter how we do it. I'm just glad we've made a small start, rather than kicking the can down the road like we did with Hilliarycare in the 1990s.

[bunnies]

54. and for those who dont live in "blue states"?

What about those people? Make less than 11k a year and you dont get subsidies. You have to pay FULL PRICE for the plans on the exchange. Poor people? Fuck em. No, thats not class warfare. Not at all.

[Demo_Chris]

6. The average Walmart worker earns about 17K a year...

This thread is an excellent illustration of the divide in our party and nation between the haves and the have-nots.

Not really sure what else can be said.

Anyway, enjoy your fifteen-thousand a year healthcare.

[MH1]

16. Those will have subsidies

does Walmart cover their health care insurance now? If not, what does the "average Walmart worker" do for health insurance now?

[bluestate10]

26. That average Walmart employer would get insurance that are virtually free to them under the

ACA after subsidies kick in and if they are lucky enough to live in a blue state, can tier up their plans at little added expense.

[Egalitarian Thug]

37. Not to worry Demo_Chris the poor people will be dumped into the so-called bronze plans

so that they can be taxed for a plan that they can never afford to use. So they will go on as before, waiting until it is too late and then go to the emergency room.

They throw these numbers around as if they were insignificant and surely anybody that isn't just a lazy bum will be able to come up with the thousands of dollars every year to pay into the for-profit system that sustains the parasites.

[Demo_Chris]

39. Sadly, the mandated premiums demanded of the poor...

Left unused due to unaffordable copays and deductibles, will be used to reduce costs for the wealthy. Obamacare, they say, does not work without this influx of cash. The question is for whom does it work.

[Egalitarian Thug]

41. I don't think there's any question of for whom it works, at all.

If you have absolutely nothing, nothing will change very much if at all, you will still have no access to health care in America except for the emergency rooms which are inadequate now. The working poor that already don't have enough will have even less as this debacle sets up an inverse subsidy once the threshold of "affordability" is crossed.

And of course the hardest hit group will be the not-quite-middle-class. The two income family whose incomes are $10 - $16 p/hr, full time with minimal or no benefits. These people's premiums will be subsidizing the expenses of the people "above" them and on up the chain. Trickle down health care is going to work just as well as trickle down economics does.

[Demo_Chris]

42. This is my read on it as well..

And let us not forget the insurance industry. Not only are they collecting the forced premiums while offering nothing (to many) in exchange -- they sill also be collecting and pocketing the federal subsidies.

Interestingly enough, those subsidies are likely more then enough to provide healthcare entirely were they not handed off to Obama's friends in the insurance industry. But there you are.

[Orangepeel]

47. Not entirely. Some wellness/preventative measures will be free

Like screenings, counseling and immunizations.

Not that that's a lot or enough.

There is also some money for community health centers, thanks to Bernie Sanders. I know little about that, although I assume that's not a lot or enough either.

Also, more people will get Medicaid. Also not enough, especially in republican states, but that's a good thing.

[Laelth]

7. That would be a very good side effect.

Might even get us where we want to go, eventually.

-Laelth

[yurbud]

10. I don't think it's the intent, but I hope it's an effect nonetheless

[Recursion]

11. As a side point, that's cheaper than Medicare

The full unsubsidized Medicare premium for 2 people is about $1900 per month. It's just that for most couples most of that $1900 comes out of the Trust Fund.

[RebelOne]

12. You can't be serious.

My Medicare premium is only $105 a month for just me. Of course, I just have the basic plan.

[Recursion]

14. You presumably have paid in to the system, yes?

If you're in a situation where you haven't but you still get Medicare, the full premium is over $900. That's just for Part A. If you've paid into the system and you're over 65, then the Trust Fund covers most of that for you.

[RebelOne]

52. I am over 65 and I think I just have Part A,

but it is still only $105 a month.

[Recursion]

57. Almost nobody has to pay the Part A premium (except for the Medicare trust fund)

$105 / month sounds like the subsidized Part B

[bluestate10]

28. Most people that have jobs that provide health care coverage never see the real cost of their

insurance. As a result, many people do risky behaviors such as smoke or drink alcohol heavily.

[Recursion]

29. That goes on this year's W-2's, right?

Employers have to start listing how much they paid for your health insurance

[RebelOne]

51. You must be kidding.

I am on Medicare and pay $105 a month premium for just me.

[Hoyt]

56. But Part A - hospital - is "free," and you only pay about 1/3 average of Part B.

[Recursion]

58. That's the subsidized Part B premium

If you've worked more than (caveat: this is from memory) 24 quarters in a job that withheld Medicare levies, Part A is free to you (but still comes out of the trust fund) and Part B is heavily subsidized (also from the trust fund). That's the same Medicare trust fund that was set to be exhausted in 2017 but now should last until 2030 or so.

[pnwmom]

13. I understand that if you get a silver plan, many people can get subsidies for out-of-pocket costs,

including deductibles.

If the end result of this will be to take the for-profit insurers out of this forever, I think most of us would applaud.

[bluestate10]

22. A person or family must earn below a specific amount for subsidies. In my state, a

single person earning less than $34,000 can apply for subsidies, the amount is higher for families. A person must read the published amounts listed for a plan. Some Silver plans have deductibles and out of pocket maximums.

[bluestate10]

19. BINGO. We have a WINNAH!!!

Large companies pick up 80-90% of premiums for singles and families. People that have not seen those actual costs get sticker shock. Small and many medium sized companies pick up less of the employee costs. My Gold level plan costs $1100/month, without Dental, the same plan with dental would cost maybe $60/month, with Dental coverage through a large employer.

[JaneyVee]

21. I once got a quote out of curiosity from Blue Cross over the phone, the guy actually said

To me "are you sitting down?", I said yeah why? He said it would cost $2700/month for me and family. That was Blue Cross Blue Shield n NYC.

[bluestate10]

23. The quote was likely for a top of the line Gold plan. Search on your ACA Exchange.

Blue Cross tends to offer one of the pricier plans because of it's extensive network. You can find cheaper Gold plans with the possibility that if you or your family need medical care out of network, you may have to pay something out of pocket. The out of network, out pocket amount isn't much, maybe a couple hundred buck at the maximum end and some plans will refund that money.

[JaneyVee]

24. This was 4 years ago. I was agreeing that most people don't know how much

Healthcare plans actually cost since many get it through their employer. Obamacare is doing a great job at cost controls.

[yurbud]

33. I was actually looking at Kaiser. I like the way they deliver services.

[arcane1]

27. My prediction: The ACA's greatest contribution will be to show the wisdom of single-payer n/t

[PoliticAverse]

30. "they probably have no idea what the total cost of their coverage is."

One of the parts of the PPACA is a requirement that employers list the cost of provided health insurance on issued
W2s. So most employees with coverage should have some idea now.

http://www.irs.gov/uac/Form-W-2-Reporting-of-Employer-Sponsored-Health-Coverage

The Affordable Care Act requires employers to report the cost of coverage under an employer-sponsored group health plan. Reporting the cost of health care coverage on the Form W-2 does not mean that the coverage is taxable. The value of the employer’s excludable contribution to health coverage continues to be excludable from an employee's income, and it is not taxable. This reporting is for informational purposes only and will provide employees useful and comparable consumer information on the cost of their health care coverage.

Employers that provide "applicable employer-sponsored coverage" under a group health plan are subject to the reporting requirement. This includes businesses, tax-exempt organizations, and federal, state and local government entities (except with respect to plans maintained primarily for members of the military and their families). However, federally recognized Indian tribal governments are not subject to this requirement.

[TheKentuckian]

36. Probably a good thing but I'm not really personally pleased as that piece will make my

insurance cost higher because it means my company can no longer do "banding" which allows high earners to subsidize costs for lower income employees. I feel this was a very progressive policy that benefited the many within the context of our company and I can't say that I'm happy to see it go, even if it makes folks more aware of the real cost of their coverage because I don't see how it means much since the knowledge of that value doesn't translate anywhere not being lawfully considered owed compensation. If we were entitled to compensation to make up for those dollars if plans are ended or benefits reduced then it would mean something when the rubber hits the road but there is nothing to provide any anchor point to the number that I can see.

This is where the unions are rightfully pissed, they have traded away wages over decades to keep good coverage and now that compensation will be robbed, in my opinion (though I have always felt that wages should have been the focus for many reasons, most importantly a bigger paycheck is always a noticeable benefit of membership while maintaining coverage levels is less apparent and over time becomes baseline) and now in AusterityLand, they will never recoup the losses.

Of course I already understand that my buddy who brings home 5k+ more than me has a much lower overall compensation package than I do because he gets no insurance, no disability, no life insurance, no "retirement", and like a week of PTO so I don't need the reminder on my W-2 for a decade or two to "get it" and since "getting it" doesn't translate those dollars to ca$h to me if the cost of the benefit is reduced then I see little to no power in this knowledge. By the same token, I don't personally care about the often ballyhooed rebates because they just go back to the plan sponsor, who can use the money as they see fit and do not have to reduce employee share to reflect it as long as it goes back to healthcare which in this case seems to be funding a bogus ass wellness plan and maybe set aside supposedly to hedge against future costs or some such accounting trick.

I also tend to think the push to shove us into these high deductible plans will keep ratcheting up over time too, which also fails to translate to a wage increase.

I'm glad the individual market is having the worst law of the jungle excesses sanded down some and that the destitute will largely get a better shake but keep in mind most folks are covered and most are in the group market and those less than enthralled will potentially be less pleased than they are now.

[yurbud]

45. I'm glad that's in there. I hope people actually look at it.

[DevonRex]

31. And the more who sign up, the less HC is linked to a specific job.

Over time we can sever that relationship as we push for nonprofit single payer. It gives people more mobility with jobs, too. How many of us have stuck with the worst employers ever because of the health insurance?

Now you can take that job at a smaller, friendlier company because there's another option for health ins.

[TheKentuckian]

38. We effectively cannot, not most of us. Our employer contribution is not portable and we can't get

subsidies if our employer offers coverage. The ramping sucks ass and is designed to keep most out of the exchanges. Our real hope is that employers drop coverage but it seems that most want to maintain the existing relationship, I believe because it is cheaper to provide the benefits than actual pay and perhaps even more so for the control.

As constructed, the CBO had little basis to estimate any huge shift at least over the next two decades because the law is designed to prevent any such flight.

For folks who make a living wage, the conversation is moot. You stay with what you got (if you can) to maintain income AND because you are captured by coverage because the exchanges offer little harbor. I'd have to get a huge raise in order to tread water, much less come out ahead being in line for little to no subsidy and not having access to the tax breaks the employer benefits from.

[DevonRex]

40. I'm looking at it this way.

Another smaller company may not offer insurance but can offer higher pay. Maybe they're closer to your home. Have better hours. A combination of factors that, taken together, make it worth it or affordable to use the exchange instead of being stuck with the company you really hate for a variety of reasons.

[TheKentuckian]

46. They better pay a hell of a lot more and magically spring up within walking distance.

They also better have some pretty interesting tax shelters, contracts, and practices to be able to have a payroll outlay that can best a Fortune company, even after benefits. I just don't see much opportunity for the scale and market penetration to allow such generous revenues that allow such payrolls.

Aka Fantasy Island.

It may happen but no way it happens regularly. Small business is tight and thrifty. Small business is at a number of competitive disadvantages.

I've worked plenty of both, I don't know what the color of the grass is but if how green depends on money and benefits then you'd best shop the corporate market. Probably more room for advancement too, unless you go public.

The law is designed to keep as many people as possible out of the exchanges for as long as corporations want to play gatekeeper. If you want a different paradigm then it will have to be fought for, it is not to be expected as a natural consequence here.

[Thinkingabout]

32. I would like to see a single payer system and though I was covered over the years by insurance I

Still saw the need of all to have health care. I am currently on Medicare as primary and secondary to my benefit package. Medicare is $104 a month but still a good deal. Hopefully the anti ACA Congressional members will be able to see their way to a single payer system soon.

[okieinpain]

43. good god his insurance is 1200/mth. who

can afford that. my lord, I thought my wifes' company(mid-del school board in oklahoma) insurance was high at 600 for the two of us (and that was the cheap one), but I would have to go heisenberg at 1200/mth. lol.

[LWolf]

48. I've been saying this

since single-payer was forcibly rejected.

My employer pays most of my insurance premium. The total is more than my younger son's mortgage on his first house, bought a year ago. I have a $1500 deductible and 20% copay. That insurance policy has yet to actually pay for anything; what I use comes out of my pocket. Unless something catastrophic happens, they never will, because I can't afford the $1500, so I get as little care as possible. In the last 5 years, I've been treated for shingles and an abscess, and haven't been near a doctor or medical building otherwise.

Edited to add:

My results, when I enter my information at my state's exchange site, say:

"You may be eligible to get quality health insurance through the Health Insurance Marketplace. But based on the information you provided, you probably won’t qualify to save money on your monthly premiums or out-of-pocket costs. You'll find out for sure when you apply for coverage starting October 1, 2013."

[DevonRex]

49. I agree with you.

And it gives me some hope and a big reason for all of us to organize a push for single payer again. I think it's pretty apparent that the Republicans are scared to death of further reforms, too.

LWolf, I'm worried about you. It's obvious you make a good living but have a lot of obligations, other people to care for maybe, and so you're stretched as far as you can be financially speaking. I also know you're not a big spender because of your philosophy of life and government. So, since people are so much more than numbers, I would suggest actually speaking to someone about ACA at the 24-hour Call Center 1-800-318-2596. You can also do a live chat online. https://www.healthcare.gov/contact-us/

We've talked about the HRSA clinics before. You probably used the Hill-Burton rates to figure out if you qualified or not. My husband says that's a very old system, the HB system, and that you should use the link to find a health center. Then you can either call them or go there to find out if you might qualify. If you have people in your household that you're supporting due to the economy or illness or aging, disability or addiction, they will take that into account. I would suggest asking for an appointment to discuss eligibility. I don't know if they do that or not. Each clinic is run differently. I have been in one near here. It was actually very nice, with a pharmacy on site.
http://findahealthcenter.hrsa.gov/Search_HCC.aspx

I really, really would like you to be able to get health care. I understand your situation. Lots of people are like you and it's criminal, IMO. Paying premiums for nothing. I know what it's like myself to put off going to the doctor or refilling medications because we couldn't afford the copays just then or the coinsurance. It's really galling to know that my son who lives overseas had surgery and was hospitalized for 3 days paid a grand total of $250 for the entire thing, including CTs. I had emergency surgery in August and the hospital bill was $45,000. I stayed one night. The insurance company and hospital are arguing so we don't know what our part will be yet. But we'll be billed just in time for the government shutdown.

[LWolf]

50. I guess I'll find out SOMETHING for sure on October 1st.

In the long run, though, it's not going to matter. The exchanges may offer cheaper insurance, but since my employer pays most of my premium, but won't pay through the exchange, it would still end up costing me more. Which means it won't happen.

Meanwhile, I'll keep doing what I always do; take care of myself and make healthy life choices to the best of my ability, and be careful.

[yurbud]

59. Before I got coverage through a job, I used to do the math on premiums vs my out of pocket costs...

and somehow, it was always cheaper to do out of pocket (unless I got catastrophically sick like you said).

Health insurance is essentially Tony Soprano charging you to see your doctor then telling you whether he's actually going to let you see him.

[LWolf]

60. Yes.

That's how it's worked. Why are people so surprised when having to pay for insurance is not so inspiring?

[pnwmom]

55. Many people see the ACA as a large step toward the real goal

Medicare for all or single payer.

And to that end, the ACA will be funding state experiments in single-payer, as in Vermont, for example.