Uh-huh. And the Republicans tried their best to kill ACA. Because they’re that cruel.
The ACA was a big step in the right direction, but even beefed-up subsidies won’t resolve the crisis because most of the marketplace plans have high OOP maximums. Case in point: My friend V. , who was diagnosed with breast cancer last year. She got insurance through the marketplace because she works for a business with fewer than 50 employees. She hit her OOP maximum, $6,000, but she didn’t have $6000. She arranged to make payments. This year she again reached the OOP maximum, $6000. She hadn’t finished paying off the first $6000, so now she owes $10,000 she doesn’t have.
There were plans that had lower OOP maximums, but she couldn’t afford the higher monthly premiums. She lives frugally, but it’s still going to take her 5 years to pay off her medical debt, and that’s assuming she doesn’t accumulate more.
A lot of employers offer plans with high OOP maximums, so it’s not the ACA that’s the problem, but the ACA isn’t the fix, either.
I don’t think so. Most employers use health insurance as a tool to attract and retain employees. If this were not true, they would offer the least expensive plan they could get away with.
Particularly in this economy with low unemployment, employers want to do what they can to get and keep good employees while minimizing the cost to them. That means that if competitors are offering decent health insurance and underwriting 3/4 of the cost, they have to offer something else to make it as good or better deal for employees to buy MFA.
Since they can pay more in salary and reduce their own administrative expense, I think some will do so. Remember too that health care costs have of late increased more rapidly than salaries.
Yeah, that’s why I’m pretty pessimistic about anything good actually happening. Any real reform is going to require the conversion of the company scrip into something like a payroll tax, whether that goes to the state directly or to the employee’s choice of insurer (as in Germany and other places). And that’s going to be crazily disruptive to the entire system. And the disruption is what’s actually controversial; the maximalist version of Medicare For All doesn’t really take away many people’s choices, since most people only have one choice, but it would mean change for everyone, and the change is what people don’t want.
People’s Stockholm Syndrome about “their” insurance is so strong that my preference for a hypothetical Democratic trifecta is to just skip healthcare this time, or do something fast and mediocre like throw subsidies at the exchanges and create a federal Medicaid program for the states that didn’t expand Medicaid.
Incorrect. Obviously, you’re not an accountant. Non-profit accounting doesn’t even include the term “profit” on the statement of statement of activities, since there isn’t any.
Also, there aren’t any shareholders since the organization has no equity.
Your cites are b.s.
Price points have to be set such that the costs are limited as a % of income. The main problem with the ACA is that it wasn’t rich enough in making the exchanges a good deal for a broader group. If we had a cheaper premium for people who are buying richer plans, and we didn’t cut off subsidies at 400% FPL, then I think we’d get a much larger risk pool, and healthier, in the exchanges. And it would actually compete with employer insurance, as more people would see it as valuable.
The main problem with the ACA right now (other than the attacks by trump/republicans, etc) is that middle-class people who don’t have employer insurance are priced out of affordability on the exchanges. This has to be fixed in order to make the ACA what it could be. The second problem is that there’s no mandate penalty, so healthy people don’t have an incentive to join the exchanges. The third problem is the politics of red states that won’t accept the medicaid expansion and that won’t promote the exchanges to get more people aware and interested in exploring.
Good post. As I said earlier, alot of the attacks on these non-profits (like insinuating that they’re “really” profit in disguise) are ideological.
To me, it is wrong framing to ask “do you like your insurance.”
I have my quibbles with my employer-provided insurance, but overall the quality of service has been satisfactory.
What’s never going to be satisfactory is that I can’t contemplate changing jobs, or taking some time off, without the risk of changing doctors/hospitals/networks (or just going outright uninsured).
It’s stupid the way the US impedes the free movement of capital and labor by making people afraid to change jobs because of insurance. We can do better.
Well, except for the "massive payouts to executives” part.
Nope, not an accountant, never claimed to be and I’m not looking at this through an accountant’s lens. You are, but that doesn’t compel anyone else to do so. Of course they never state a profit. That doesn’t mean they don’t make money.
Refute these cites, please, and we’ll talk all about it.
These Hospitals Make the Most Money Off Patients and They’re Mostly Non-Profits (WaPo)
Not-For-Profits Dominate Top 10 List of Hospitals With Biggest Surpluses (Modern Health Care)
You can view this through whatever lens you like, but non-profits can be and are used as pass through entities to distribute money to, for example, administrators, charities (some of which are questionable), parent companies and others that do have shareholders. They also use the funds to purchase real estate which they then hold in perpetuity. If you’re an accountant, you know this to be true.
This whole discussion is off topic, so I won’t address it further unless you offer something substantive.
Maybe I’m just being a bit, um, obtuse but why on earth would someone answer in the affirmative when asked if they like having their healthcare company?
“Do you enjoy the relationship you have with the corporate adversary you have been pitted against due to the hand your were dealt by your employer, whose sole reason for existence is to deny you as much legitimate, doctor ordered health care as possible, while simultaneously paying for as few legitimate claims of health care as possible?”
Who the fuck would answer in a positive way to that framing of the question?
Non-profits don’t have shareholders to distribute to, even to parent companies. You are simply incorrect.
What Aspenglow said is exactly right - you are allowed to make a profit as long as it is related to your mission statement and is reinvested in activities related to your mission statement.
If your mission statement is related to healthcare, it makes you a ton of money and you pay it out to any employee or business who in some way furthers your mission your 501c3 status is not in jeopardy.
Cite: Tax Concerns When Your Nonprofit Corporation Earns Money | Nolo
Well, I understand my insurance company is an adversary and not an ally. So with that in mind, I can only evaluate their performance in the context that it’s what they are contractually obligated to do for me.
My insurance is OK. I understand that everyone’s isn’t. But the thing that should bind us all together is that if you can lose insurance at any time, then it isn’t worth much. My insurance is actually fairly generous, but if my employer hoses me, then I and my children are scrambling. Not because any of us took any extra health risks, simply because control of my salary changed hands.
You’d have to factor in cost of living in the customer’s area of residence, number of family members in the plan, as well as other factors, and you’re still going to have to convince insurance companies.
I’m talking about the subsidies and things like CSR payments (which Trump stopped paying, as part of his attack). There’s reinsurance, too. Mechanisms were in place to make the markets stable, to help insurance companies stay in them, to help people afford the coverage, and so forth. These items were put in place in the states where the exchanges operate. It just wasn’t originally set up with rich enough subsidies, and some of them were sunsetted too early. That needs to be fixed, and won’t require insurance company approval. Nor will it require a new health insurance or health care system.
Almost everything that’s brought up in these threads as a critique can be fixed within the basic structure of the ACA, but just with more money committed to it by the government. Technically, it’s simple at this point. The problem is politics.
A couple of random observations about the last few hours of discussion:
From what I can gather, employers are reluctant to get on board with UHC because of the leverage they would lose with employees. Leverage supported by the current systemic mess. If UHC was implemented, I wouldn’t expect wages to go up in accordance with employers’ direct cost savings; they’ll go up for competitive and market reasons as always. Besides, employers are probably going to pay higher tax rates as their share of contribution to the national program.
Non-profits, like the one for which I work, certainly generate surpluses which are the real life equivalent of profits (I’m an accountant). So the semantics are unimportant from a certain POV. However, a non-profit is tasked for a mission and that mission is controlled by a board that does not seek the enrichment of itself, it’s executives nor its shareholders. It’s not just a money making entity for the people who run it.
Finally, too many people, like the OP, are concerned with health *insurance *instead of health care and Americans’ access to it.
Just for a point of comparison, I’ve worked at five companies- one small one, one subsidiary of a colossal European aerospace company, one large US healthcare company, one mid-sized consulting firm, and one large municipality over the last 22 years.
Not ONE of them offered to boost your take-home pay if you opted not to take health care coverage. It was always offered as a perquisite that you could take or leave as you saw fit.
And I agree… I don’t understand why businesses aren’t pushing the universal health care angle a lot harder- it would save them a bundle of cash. About the only reason I can think of, and it’s not a terribly strong one, is that maybe they perceive it as a competitive advantage in attracting workers. Which is funny, because most people I know aren’t in a position to go “Hmmm… potential job X has Cigna plan Q, while potential job Y has Cigna plan R. I think I’ll go with Y, because I like their plan more.”
Instead, most are approaching it from a perspective of “Current job has Y insurance plan, potential job has X insurance plan. Are they broadly comparable, and do they cover any specifics that I know my family or myself needs?”
100% agree – except I prefer “Medicare For Anyone” to “Medicare For All Who Want It” because it’s punchier.
But the Dem candidates have seriously got to drop this storyline about taking away people’s insurance. Right or wrong, people like the OP just won’t get behind it, and they may even vote against it. Is pitching your ideal solution (that almost certainly won’t transpire anyway) really worth 4 more years of Trump?
In the United States, there is a lot of paperwork that accompanies billing Medicare. It varies from practice to practice. It is still fundamentally procedure and diagnosis coding, but it is vast and complex and requires staff trained to do it well. You can take a glance at the Medicare billing regulations if you want a sense of it. That is the nature of a healthcare system that is much larger and more complex than Canada’s, perhaps among other differences.
You don’t get rid of that paperwork by eliminating private insurers. As I conceded in the post which you’re labeling “categorically false,” you may well marginally reduce the administrative cost associated with billing. But you don’t likely reduce it so much that you gain all the savings of having all that staff and staff time.