Many Say High Deductibles Make Their Health Law Insurance All but Useless

[eridani]

http://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html

But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

Sara Rosenbaum, a professor of health law and policy at George Washington University who supports the health law, said the rising deductibles were part of a trend that she described as the “degradation of health insurance.”

Insurers, she said, “designed plans with a hefty use of deductibles and cost-sharing in order to hold down premiums” for low- and moderate-income consumers shopping in the public marketplaces.

Comment by Don McCanne of PNHP: The deductibles are out of control. The anecdotes in the full article (link above) demonstrate that many people find that their insurance is “all but useless” simply because they cannot afford to pay the deductibles. Anecdotes do not constitute a scientifically valid study, but they certainly do tell us what is happening to individuals out in the real world.

Insurers needed to keep premiums affordable in order to maintain a viable market of private plans. They do that by shifting costs to patients through ever higher deductibles. This was inevitable through the reform model selected for the misnamed Patent Protection and Affordable Care Act. Because of the large deductibles, actual health care is not affordable for individuals with modest incomes and thus patients do not have the protection that they need.

The three trillion dollars that we are already spending on health care is enough to provide all essential health care services for everyone. With a properly designed financing system there is no need to erect financial barriers to care since cost containment can be achieved through patient-friendly policies such as those of a single payer national health program.

Without proper reform, “degradation of health insurance” will progress. People will face greater financial hardship because of medical bills. People will suffer more because of forgone health care. People will die.

This isn’t right. We need an improved Medicare that includes everyone.

[n2doc]

1. A plan that is paid for but isn't used is pure profit

That is the ultimate goal.

[rjsquirrel]

4. Or you know, "insurance."

You don't get a refund on home insurance or car insurance for not using it.

Health care should be provided as a public good. But until it is, we have insurance for catastrophic things, and we pay for other things we need or want.

One way or another health care is not free and in fact is crazy expensive because Americans are both bad at taking care of their own health and litigious.

As someone who pays $6500 a year to docs instead of an insurance company (the meaning of a high deductible plan, you self-insure the first $6k, and my spouse and I pay less than $1600 a year in premiums as a result, meaning we end up spending maybe. $7600 total on health care, which is less than the $10k a traditional low deductible insurance plan would cost us), I really like the high deductible plans.

Let m'e stress: my spouse has stage 4 cancer and we save money on a high deductible plan. Save, as in spend less than we used to.

[pangaia]

11. I understand what you say and it certainly is true.

I have Medicare and a very good gap plan. (Well, it WAS good until last year when they changed the chemo coverage to include a 20% co-pay ! Smart, aren't they. :&gt )

I also had cancer, although much less serious than your wife's, if ANY cancer can be considered not serious. The coverage was excellent. And of COURSE it is not 'free.'

Best wishes for your wife.

[SammyWinstonJack]

5. It was and is, the ultimate goal.

But it was the best we could do.......

[SickOfTheOnePct]

37. Not really

A plan that is paid for and isn't used is being used for someone else that is able to use the coverage. That's the whole point of insurance.

But single payer is the way to go.

[mythology]

38. Given that ACA put in requirements an insurance company has to pay out to customers

that's not an efficient way to make money given that they have to send money back.

[n2doc]

43. But not to the people paying

Fact is, the scheme is to incentivize poorer people to not use insurance for anything other than the most extreme events, and use that money to subsidize others, including those rich enough to buy the fancier plans that they can effectively use to do preventative care.

And of course, expenses get taken out anyway, including CEO salaries.

There are winners and losers. The American Dream.

[SickOfTheOnePct]

44. Your first statement is simply not true

First, preventative care is free under all plans - that's part of the law.

Second, the "fancier" plans, as you call them, are much more expensive than the bronze plans, and they aren't being subsidized by the other plans, they're being paid for with high premiums.

As to your title, if the money isn't getting back to the actual policy holders, that isn't the fault of the insurance companies, that's the fault of whomever is administers the plans. For an employer sponsored plan, the money goes back to the employer, and they can choose to give it back to their employees in the form of cash, in the form of reduced employee premiums for the next policy years, or they can keep it themselves.

Yes, CEO salaries are included in expenses, which in the aggregate can't exceed 20% of the money they bring in.

Single payer is the way to go, IMO, but let's at least be intellectually honest about what the ACA does and doesn't do.

[n2doc]

45. The OP-linked article says you are wrong

Wishing that the system worked like you want it to doesn't mean that it does. That is being 'intellectually dishonest". I have read many articles interviewing people who do not use the insurance because they can't use the deductibles. Doesn't mean that no one benefits. Means there is a problem, that should not be minimized and ignored because of ideology.

I can state from personal experience that high quality plans with lower deductibles get used, and save money. But one has to be able to afford the monthly payments first.

[SickOfTheOnePct]

46. I saw nothing in that article that refutes anything I said n/t

[n2doc]

47. Of course you don't

Yes, they can undoubtedly go in once a year to see some doctor to poke and prod them. But if said doc finds anything wrong, well, they are screwed. Can't afford to fix it. That's what passes for health care for the working poor. Especially in Red states.

[SickOfTheOnePct]

50. That's a valid complaint, no doubt

But the rest of what you said and that I responded to? Not so much.

[TM99]

2. This was predicted as a possible

very negative outcome of the ACA.

It is proving to be true.

My partner has simply not purchased a plan because being self-employed the costs for a Bronze plan PLUS the high deductibles are such that she might as well just pay out of pocket. She has no medical issues but does get yearly physicals, pap smears, and such which she can do for a fraction of the cost out of pocket at the medical clinic attached to the naturopathic medical school here in Tempe.

But heaven's forbid if she needs emergent care or develops a chronic or life-threatening illness.

Health care should not be a gamble. And it pisses me off that we are one of the few if only major world economies that has its citizens weighing costs over care.

[rjsquirrel]

3. We *love* our high deductible plan

Because we can afford to self insure the first $6000 we pay very little for the premium every month. But my spouse has a serious illness that guarantees we will hit the out of pocket max by mid-year. We end up keeping a good deal more than we used to with an all-in plan.

High deductible plans make sense for the very healthy and the very sick, if you have resources. But others, especially lower income folks, are getting suckered by the low premium.

You don't get something for less without making a compromise. It is a stupid way to run a health care system, and someday we will have a public option for everyone. But until then, if you go cheap up front make sure you understand the financial risk and can afford to take it. If you only want catastrophic coverage, don't complain when you're out of pocket for minor procedures. Read the fine print.

[WinkyDink]

6. Morever, hospitals discharge early with "instructions for home care."

[Number9Dream]

7. Our company's Capital Blue Cross deductible has doubled to $3,000. Co-pays doubling too.

This keeps the premiums just barely affordable.

My wife's Silver Scripts keeps moving her generic drugs into much more expensive tiers.

Affordable Care... yeah right. National single-payer now!

[dembotoz]

9. how to have insurance with out having insurance

got switched to an hmo this year....don't let me get started.....anyway
first time with new doc...i am rather older >60 and he wanted to know when i had my last
colonoscopy...told him never? eyebrows raised....never had decent enuf insurance...eyebrows back down....

[Omaha Steve]

10. Medicare part E (for everybody!)

K&R!

Didn't Hillary say Saturday night that won't work? That means she won't try to do it.

OS

[dsc]

12. Medicare has deductibles and co pays

just like other insurance. Medicaid is the insurance that doesn't have those.

[Omaha Steve]

13. Medicare has a $12,000 a year or more deductible?

https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

[dsc]

14. From your own graphic

Medicare has a 5040 deductible for a family of 4 (the 12k dedecutible you referred to is for such a family).

[Omaha Steve]

16. Look at the COST & deductable difference for our area on the cheapest plans

Doesn't Medicare for all look better at much less cost?

https://www.healthcare.gov/see-plans/#/plan/results

[dsc]

17. these are for families of four

not one so divide them by four and Medicare is lower but not out of reason lower.

[Omaha Steve]

21. The Obamacare quote was just Marta & I both age 59, non smoker, not pregnant

So it does make a difference.

Improved Medicare and for profit insurance companies out of the picture. Technically Blue Cross NE is non-profit. Ya right.

[dsc]

23. the amount paid may be for two

but the deductible is clearly labeled as applying to a family of 4.

[Omaha Steve]

25. Point taken

[fasttense]

15. Medicare ain't all that good

You have to pay $200 to $1000 a month, depending on you income and which parts you have, as a premium for it. Then you have to pay 20% of the bill for everything else.

My husband is on dialysis and let me tell you that 20% can add up quickly to tens of thousands.

[eridani]

48. Single payer Medicare would eliminate deductibles entirely

Copays will depend on how the details are negotiated.

[Atman]

18. I totally agree with this sentiment. Our insurance is worthless.

I feel as if we're just handing over thousands of dollars to Big Insurance, because I'd have to have a brain transplant and all of my organs replaced in order to meet the deductibles. We're fairly well off, we make too much money for any subsidies. At this point, it really makes more sense to pay out-of-pocket for all basic procedures and doctors visits, then buy insurance if something catastrophic happens. As it stands, I should probably see a doctor, as I'm 56. My physical last year was A-OK. I'm not on any meds or have any known health issues. But I can't afford for him to find out anything now. My wife's medical practice is likely to be bought out by one of the giant hospital chains in the region, early next year. If that happens, we'll be covered with high-end insurance and normal, reasonable deductibles. But until then, I'm just crossing my fingers and sending money to pay for some CEO's billion-dollar salary.

[elias49]

19. We Americans are hard to please.

As a T-shirt I saw last week said: In a perfect world, all man's problems would be fixed with Duct tape and WD40.
But it's not a perfect world.

[Cal Carpenter]

20. Funny you should say that since 'we Americans' are pretty much

the only one among our peers who do NOT have a simple, single payer system or some other version of health care for all.

We are behind the global curve in a major way on this.

So I can't help but point out how odd it is that you characterize Americans as hard to please about this.

[dsc]

24. that just isn't true

There are very few single payer systems in the world. The rest of your post is accurate in terms of universal care but the only major countries with single payer are the UK and Canada.

[zipplewrath]

27. It is true

Yes it is poorly worded, but it is a variation of what Bernie is talking about. The vast majority of our major trading partners have some variation of universal access/care. Furthermore, most (nearly all) of our major "first world" trading partners pay easily 1/3rd of what we pay for health care. Yes, many countries actually have "insurance" companies. They are HIGHLY regulated and in favor of the individual. And the costs that are paid are well within the "affordable" range because of the underlying "social safety net" that those countries have. Our systems sucks and the ACA was a minor improvement on the system. Mostly it just federalized the regulation of the health insurance industry. Currently it has accomplished little except to increase the number of insured by about 5 - 7%. The point of this article is some fraction of that is insured but basically still not getting health CARE.

[Humanist_Activist]

30. UK doesn't have single payer, but NHS, the government employes the doctors and hospitals are...

mostly government operated.

The only reason to advocate for single payer here in the United States is because the transition should be easier and faster than adapting other systems.

We could keep the system of subsidies and such, but greatly expand them, but that may end up costing more than single payer, especially if the US is still toothless in price negotiations and/or price controls for medical services and drug costs.

[eridani]

49. Though oddly enough, the two countries who most recently implemented universal health care--

--chose single payer. Taiwan and South Korea.

[Doctor_J]

33. yeah, we just want what everyone else in the world has

How presumptuous

[elias49]

34. Really. It's bitch, bitch bitch with us.

Who thought life could be so friggin hard!

[Skittles]

41. what is wrong with you?

[FLPanhandle]

22. I alway choose the highest deductable option.

To me insurance is insurance against a health care disaster.

I'd rather pay less in premiums and reallocate the savings to the cost of minor health care cost.

Insurance is just to guard against the massive bills that would take the house and savings.

[peace13]

52. Spoken like a person with a house and savings.

Now imagine a person paying high premiums on a policy mandated by law, who doesn't have money for the huge deductible or big premiums and doesn't have a home or savings. That person will never benefit from the policy....ever. At least you are insuring your home and savings with the health policy. Now if the person who doesn't have a home or savings gets sick and goes to the hospital...the hospital will get paid but the patient will still be billed a large amount for the deductible that will seem small to some but not to theses with nothing. This piece of the puzzle is the huge markup by the hospital. So in the end the hospital gets paid and the patient is still in the desperate hole to refill the hospital's gravy boat!

[lumberjack_jeff]

26. Hyperbole. All things being equal, of course we'd prefer low (or no) deductibles and copays.

But prior to the law, you didn't have access to the free checkup that detected whatever it is that you're seeing the doctor for now. Left untreated, prior to 2014 that illness became a crisis that resulted in bankruptcy.

It's not useless if for no other reason than it's an order of magnitude better than what existed before.

My wife is going to have both knees replaced in the near future. We were surprised to find that our $1100 monthly (both of us) insurance annual maximum out of pocket cost is $5000. I find this reasonable for a $100,000 surgery.

If we're going to complain about costs, we need to look at the medical bills themselves, not the insurance.

You could fly to India, buy a condo, pay for the surgery, and fly home for less than the cost of the surgery here - even if you walked away from the condo.

[zipplewrath]

28. Yes we did

But prior to the law, you didn't have access to the free checkup that detected whatever it is that you're seeing the doctor for now. Left untreated, prior to 2014 that illness became a crisis that resulted in bankruptcy.

Yes, I did have access to that. The model that the ACA used to create this feature (which is now federally mandated) existed in many plans prior to the ACA. My plan prior to the ACA look much like the "Gold" plans now being sold. It was very close to being a "Cadillac" plan.

And people are still going bankrupt from illness, however there are fewer.

And I'm not sure how you get from 5-7% to an "order of magnitude". Do you even know what that means?

[Runningdawg]

29. Missing a day of wages

-100$ Price to see Dr - 45$. Total of lost income for the week - 145$ This is before gas money, test or Rx.
This is with a private insurer through my husbands job, not ACA. We STILL can't afford to get sick, preventive care is a joke, just like the policy.

[colsohlibgal]

31. A True Example of American Exceptionalism

For profit healthcare is evil and sadistic. They want to gouge profit....we want to stay well and alive. We have different priorities.

It is one big scam and we the public are the losers.

[agnostic102]

32. self employed

Im self employed in california. There is a good local doctor that charges 79 dollars per visit and 50 dollars per xray.. walmart has "DECENT" drug prices.. im torn between keep paying cash for the few times a year if at all of using the doctor.. or pay the monthly premium just in case my bladder explodes LOL its tough.. the deductibles kind of do suck.

[theaocp]

35. Fucking duh.

IIRC, SiCKO was a movie designed to shed light on those WITH health insurance that couldn't afford to use it. I. despise. health. insurance. companies. They have a financial incentive to avoid paying out coverage. Monsters.

[Duppers]

36. K & R

[area51]

39. Kick for the night crew, n/t

[Skittles]

40. aw gee, who could have seen that coming?

the only thing that has REALLY changed is that the taxpayers are now helping in funding this fraud

[Fumesucker]

42. Mission Accomplished

We were chumped.

[Erich Bloodaxe BSN]

51. Who could have ever guessed?

That pulling out and dusting off a decades-old Republican 'Healthcare' plan would wind up screwing over many 'consumers'?

[Freddie]

53. People buy Medicare supplement plans

Why don't they sell Obamacare supplement plans for just this reason?