Pro-UHC Dopers: Make Me Feel Better About My Family Getting Screwed

Great Debates
1

In various UHC threads around here, I often bring up my HSA, and no one seems willing to address it. So I started my own thread.

The background: My family has a high-deductible insurance policy. It has a $10,000 yearly deductible for the family as a whole, no annual or lifetime limits, and costs us $256.67 per month. In addition, we make $250/month deposits into an HSA.

The reason we went with the HSA is because my husband’s insurance costs $660 per month for the family, and while it covers medical care, it does not cover dental or vision. And, with per visit co-pays of $25, and prescription co-pays of some higher amount, the costs per month well exceed the cost of the HSA/HDCP plan we chose.

Now, of all the reading I’ve done, and by studying the careful language of the “grandfather clause” in the House bill, it appears that the HSA/HDCP will go the way of the dodo, since the premiums will go way up, and then be unaffordable.

Here’s why I’m feeling screwed: We’re doing The Right Thing. We’re involved in our health care decisions, we take care of ourselves, and we are careful to make sure we can cover our health care costs. And we are lucky - none of us really need medical care, just occasional check-ups. What we do need is vision and dental.

So, once we get the revised premiums from our HDCP company, we’ll be forced back onto hubby’s employer plan. Which costs $100+ more per month. Which does not cover what we need, and means for this family, we’d need to come up with an additional $1500-2000 per year for our eyes and teeth.

Now, based on our income and geograpgic location, we are almost the definition of “middle class”. We’re paying attention to what we need to do medically and economically, and use only the most basic of government services, like the roads and police services. We have no access to government help, on either the low or high income levels.

So: Why is it okay for us to be getting screwed on UHC, and what answers do you have for my family when we have to put off new glasses for another few months?

2

Expanding on this would be a good start – your entire OP rests on accepting a bundle of assumptions.

3

On the one hand, I can see that it sucks for your family. On the other hand, your basically taking advantage of a tax-payer subsidy (in the form of your HSA being tax-free), to buy glasses for your middle-class family. The gov’t has decided that they’d rather divert the resources that were going into helping you buy glasses into making sure more basic care is more universally accessible, so I think I agree with the gov’t decision (assuming that HSA’s are actually killed by the final reform bill, I too thought the current plan was to grandfather existing ones).

So I’d shrug and say you got a good deal for a few years, but that it wasn’t a particularly great use of gov’t resources.

4

Our HSA was funded by our own post-tax dollars. We got some meager tax deduction at the end of the year, but it was not a dollar-for-dollar deduction.

So, yes, we paid for our own glasses.

5

I have a daughter and a son who work at employers who don’t offer health insurance. We’ve worked with agents, brokers, internet spam, you name it. And they can’t get any kind of policy at all – not high-deductible, not waivers against pre-existing conditions, not at high cost, not anything.

Or my friend who was on the news because she had been laid off from her job, her COBRA is running out and she can’t get health insurance. After she was on the news, insurance brokers kept telling her they could find her a policy. They can’t – not high-deductible, not waivers against pre-existing conditions, not at high cost, not anything.

Or my sister, who had cancer and is hoping against hope nothing more happens to her until she qualifies for Medicare. Or my nephew, who’s diabetic.

I’m sorry if you’re feeling screwed, but the current system has screwed my family and friends, as well. Tell me what alternative to UHC you’d favor.

6

Er…one of us is confused about what an HSA is then? I thought the whole point was to be a tax-shelter for medical expenses. Otherwise, what’s the point? I mean, I can pay for glasses with post-tax dollars without any special account.

Here’s wikipedia:

Bolding mine.

7

I don’t have a high deductible plan and I’ve got access to an HSA. It’s the kind where any money left unspent at the end of the year reverts to the plan. I’m guessing that’s how the company providing it gets their profits, or at least one way that they do.

Anyway, you don’t need to have a high deductible plan to get an HSA.

8

You don’t need a HDCP for an HSA, but you need some kind of insurance. So, you must have some kind of insurance, or you’re breaking the law.

9

I think that’s an FSA (read my quoted wikipedia bit above). HSA’s can hold money for longer then a year, which makes them a considerably better deal.

10

Many HSAs/HRAs are funded in part by your employer, from pre-tax dollars. Our employers did not offer them, so we get our paycheck, with taxes taken out, then make a deposit into a separate account from those funds. We do get a tax deduction at the end of the year, but it’s not dollar-for-dollar.

One advantage is that it can be used for any medical expense - organ transplants, teeth cleaning, OTC medicines, or even band-aids. And, it accumulates tax-free interest, and can be used for any expenses once you reach age 65.

These are the (limited) benefits we get for being engaged in our health-care decisions and aware of the cost-benefit ratio of how our health care dollars are spent.

11

It’s actually an exceedingly good deal for the government. Under an HSA, the cost of the glasses is equal to the amount of tax revenue forgone. For a $200 pair of glasses, at a tax rate of 20%, it only costs the government $40 to make sure Sateryn76 gets a good pair of glasses.

Under an UHC type plan, it will cost the government the full amount, minus whatever they can negotiate. But I seriously doubt they’ll negotiate the pair of glasses down by 80%.

12

That will no longer be the case under HR 3962, under the ‘Medicine Cabinet Tax’. Both FSA and HSA contributions can’t be used for non-prescription medicines.

That’s another tax increase that hits the middle and lower classes right in the pocket book.

13

Well yes, that’s what “tax deduction means”. So after single people subsidize your kids education, and you pay less taxes when you have children even though it costs us all more, and you get a tax deduction for your HSA, you are still whining?

You know who gets screwed? A self employed gay person in a long term relationship living in an urban area like San Francisco. Urban areas in general pay more in Federal and State taxes than they get back in spending, CA in particular pays far more in Fed taxes than they get back in spending, gay people can not deduct their spouse as a dependent, if they don’t have kids they are paying a share to educate yours, then they give you tax deductions for your kids, and because they are self-employed there is no employer to pay for HC with pre-tax dollars.

14

I doubt many of the gov’t subsidized plans under the current reform proposal would cover glasses, so the cost to the gov’t would be 0$. And the extra premiums Sateryn will pay for eyes/dental will presumably cover the costs of glasses/dental for her family to the private insurer.

OK, but then my original point remains, the advantage to you is that you get a subsidy to pay for your glasses/dental in the form of a tax break (“being able to pay for organ transplants, teeth cleaning, etc” isn’t really a benefit, you can do that with regular money to). The gov’t has decided that that isn’t a great use of resources, so your going to loose the subsidy. I’ll grant it sucks somewhat for your situation, but I think its a better call for tax-payers.

Out of curiosity, what is the tax break if you pay in yourself? Do you not pay income tax, but still have to pay FICA? Not “dollar for dollar” is a little vague.

Also, do you have a cite that you can’t be grandfathered in?

15

We also have a high-deductible health plan, and an associated HSA.

In our case, we didn’t have a choice – it was the only kind of plan offered by my employer. However, the deductible isn’t quite as high as yours – I think our company uses the IRS minimum.

We have not been as healthy as you are. I have some issues, and my wife has had a few surgeries in previous years and is currently pregnant. So we’ve used a chunk of the HSA money from time to time.

I don’t understand the indignation about this. It’s just the medical plan we have at this time. If in the future it becomes unavailable, or another kind of plan turns out to work out better for our family, we’ll switch to that. In the meantime, we’ll have saved up some money in the HSA that can be used for whatever medical expenses won’t be covered by insurance, either now or in the future.

16

The Health Care plan is as yet undetermined. It may not happen at all. The Senate has to develop and pass a plan of their own. Then the house and senate plans have to be combined into one grand plan. So you may be getting angry way too early.

17

I used glasses because that was the example being used. Feel free to substitute in any other health care cost. It’s still the same. The government is exchanging a small subsidy in exchange for the full cost.

18

Under the proposed house bill? I don’t see how. I don’t think anyone will have any of their full medical expenses paid for by the general fund under that plan (well, maybe medicaid, but the op obviously isn’t going to be under medicaid). Some lower income folks will have their premiums subsidized, so the gov’t will indirectly subsidize their medical expenses, but not cover the whole thing. The small number of people under the public option will have all their (qualifying) medical expenses paid, but out of their own pool of premiums, not out of the general fund.

19

How about you only spend $60 on a good pair of glasses? I did, and they’re fantastic.

Seriously, I’ve got titanium frames, hardened plastic, spring hinges, everything. Cheap as hell, and really worth knowing about.

That said, I don’t know, but I’m going to go ask someone who probably will. Maybe I’ll have more info for you in time.

20

Hmm…well,