I’m not sure I follow the point made with the math either, normally the way it works is the money coming in is $500 X 10 X 12 = $60,000. Potentially the members can rack up $40,000 in deductibles before we start to pay claims. But usually what happens is one or more people meet they’re deductible and then we pay one person’s bills for a $30,000 car accident and another $24,000 ER visit when their kid ate paste, leaving $6,000 to pay our employees and a the light bill (our overhead is around 10%).
It wasn’t originally my example or my math. But my original question was whether the ACA itself mandates that deductibles be raised or whether that was a decision made by the individual insurance companies.
I guess it’s been answered then, but can confirm: there is nothing in the ACA that mandates raising or lowering deductibles, provided they are under the limits set for all plans. If the deductibles are below the limits, raising them might be one way an insurance company would offset increased costs due to other mandated benefits, in addition to or instead of premium increases.
Right. More accurately, it is a shift of money from healthy people to unhealthy people regardless of income. All healthy people pay higher premiums so that unhealthy people can afford insurance or even have it at all. A healthy person making $50k per year pays a higher premium so that an unhealthy person making $50 million per year can pay a lower premium.
Although, this is positive as far as it goes, government programs and redistribution is usually done through the progressive income tax system with wealthy people paying the vast majority of the expenses. This is a straight transfer from healthy to unhealthy regardless of whether one can afford it. That is the insidious part about this law.
As usual, the very rich can afford it, and the very poor receive Medicaid. SOME middle class people get subsidies, but if your employer covers you but not your family, you pay the brunt. Who feels the pinch? The healthy working stiff making $40k per year with a family.
The individual plan quoted sounds crazy low. At those rates it certainly doesn’t include maternity coverage. Are they factoring in the 10k+ they presumably had to pay for each delivery, assuming they were simple!
The actual insidious part of this is that the middle class, who is bearing the brunt of the cost (whether sick or not) is losing purchasing power by market forces already, and this is costing them even more. The employer health plans are all going up, too, so it’s not like there’s a way out for them.
Well, except when they’re not. In an updateto the original blog post, the wife now says the family got coverage for everyone via healthcare.gov and ALLKids for a grand total of…$413, or only $33 more per month (and that’s only if we believe her claim of Individual BCBS coverage for a family of four, including dental, and including one child with a non-covered, pre-existing condition (ADHD) being 100% covered with no co-pay).
When her private insurance company jacked up her rates, Obamacare and ALLKids provided her family with…Affordable Care. Imagine that.
It’s a world gone mad.
So given this was originlly seen by many as an indication that AFA was failing, is it equally seen as an indication that it’s working?
Of course not. As soon as word came out that the family wasn’t, in fact, ‘devastated’ by Obamacare, the comments completely shut down once those little inconvenient facts no longer aligned with their preconceived notions of Obama as the anti-christ.
If they had one of the very high deductible plans that covered only the (up until then) legal minimums that be possible. What a lot of people didn’t realize is that those insurance plans actually aren’t very good if you suffer and actual serious illness or injury.
Plans that actually provide comprehensive coverage that will do you some good under those circumstances do tend to cost more money. The ACA forces some of the crappy, high deductible plans with attractive price tags off the table and yes, does force people to buy actually useful coverage. Which costs more.
I’m also curious about how much of a subsidy this family is eligible for. I’m running into a lot of people who see the premium cost and totally ignore/disregard the tax subsidy they are eligible for. This can drop the monthly cost by huge amounts, which is what makes the premium affordable.
That doesn’t apply in the OP’s case, as no one in the family was getting employer sponsored insurance. What you mention is a valid issue, but a different issue from the OP.
See, this gets me steamed - they qualify for a subsidy, but they’re still whining. Because they don’t want to be “those people” who need government help. Why? Because they now feel tainted?
Look, your kids are covered and you can still afford to pay your other bills. This is a problem… why? It turns out the way you were doing things wasn’t in your best interests. Boo-hoo. I just don’t understand the mindset that would rather hurt themselves than take anything back from the government and the programs their taxes pay for.
This is an example that NO, it’s NOT inevitably costing the middle class more or wrecking them. But the middle class is going to have to swallow hard and take the subsidy. They’re the only class that doesn’t - the wealthy have corporate welfare and special programs, so do the poor. It’s time for the middle class to stop hurting itself with misguided pride and realize that they’re allowed to benefit from the government just like the wealthy and the poor.
Yeah, the “OMG we are reliant on the governmentz!” thing is kind of absurd.
I feel so terrible using government roads to get to work. My pride is hurt using government mail to post my letters. I can’t believe us middle class people have to rely on government police like paupers!
Even before the ACA, insurance premiums were heavily influenced by the fact that other people are covered by Medicare.
Not to mention sending the kids to government schools.
Is ‘Government’ the new term for ‘socialized’?
I was talking about the middle class as a whole. I already made a remark about their success. Even with subsidies, a 27 year old making $25,000 a year would pay $131 - 180. A family of four making $50,000 a year would pay between $500 and $800, depending on state. And these costs are for the silver plans where after your payment, you get to pay an average of $5000 in deductibles. (Anecdotally, for my state the range in silver I have seen is $2,000 to $6,200)
Worse, if you are offered employer coverage and you decide to shop around, you don’t get subsidies. You have to stick with your employer’s decisions about what your health care looks like and costs unless you have the money to escape to another plan.
It would be much cheaper to stop with the farce of “insurance” and instead move to Single Payer. And the people who think this law is a stepping stone to that are kidding themselves. The insurance industry isn’t going to get squeezed out existence anytime soon.
It IS costing the middle class more, both in premiums and what they have to pay out of pocket. Everyone’s premiums, no matter where you get the insurance, went up because of the ACA. In the rare event that you qualify for a secondary government program, you can get help. But the normal person’s subsidy is inadequate or the insurance is priced too high. Either way, this squeezes the middle class, who is already losing purchasing power on the general market, even more.
What’s to miss? Their premiums went up when it was promised it would go down. Seriously, what don’t you understand? This program caused all kinds of financial misery for a lot of people. What was the purpose of it again?
It’s not the job of businesses to insure people and for a government to mandate this was economic suicide. The trend now is to hire part time temps. If that’s not possible because the product is sold on a world market and the cost can’t be passed on then those jobs will be moved offshore. It’s not the job of businesses to employ Americans.
You can’t wave your hand and raise the cost of doing business without financial consequences.
It’s that simple.
That blog post that you linked to is not exactly a ringing endorsement of the ACA.
Well, the problems I suspect were at least partially self-inflicted - who calls in late Friday or Sunday night to call in for assistance? OR waits until the last day before deadlines? Plus it’s a brand new operation. A few teething problems are par for the course.
More importantly - sure, it looks like she went through some bureaucratic hassles…but come on. Who -doesn’t- have a nightmare experience with one of their insurance companies?? This is a problem unique to the ACA…how, exactly?
The issues she reported where largely in dealing with agencies other than insurance companies - agencies she never had to deal with before and, at least as regards the state Medicaid program, agencies she did not want to deal with then. So in that way it is a bit unique to the ACA
As I read her blog posts it seemed that much of her frustration was borne out of frustration with poor administration of the program and not as much about the insurance premium. She worried about not getting calls back when promised. She found it confusing when one child but not the other was to be covered under state Medicaid. She worried about having to appeal as time was ticking down to a deadline. She worried about not knowing whether she had coverage. These are worries about the process that is entirely the ACA.
Isn’t that true for health insurance in general?
Couldn’t you likewise say that auto insurance is a shift of money from safe drivers to people who get involved in accidents?