So who are these people that "can't afford" ACA?

So I keep hearing about how ACA is putting people in poor house.

And then I hear stories from actual poor people that espouse ACA is the greatest thing ever.

So who are these people getting “screwed”?
(Apologies if I poisoned the well)

Well here’s the thing. There are people who have a limited amount of money. What this means to those people is that if they spend the money on one thing then they don’t have it for another thing.

In this case they are being forced to spend the money on something they don’t want, which means they don’t have it for something they do want. Like rent, for instance.

Insurance is gambling. You’re gambling that you will spend less by getting insurance than if you got services and paid out of pocket, essentially. I can pretty much guarantee that I will spend less out of pocket, as I never go to medical doctors. Only if I’m hauled in unconscious, pretty much. So “health insurance” in any form is really no-win for me. If I was right on the margin I would deeply resent it.

On the other hand, if I’m paying into a fund for universal health care, that’s different. But that’s not what I’m paying for right now.

My guess is the people getting screwed are like me, not desiring care from the medical establishment for whatever reason, but being forced to pay for it anyway. And the people who like it are people who have conditions and go to the doctor a lot, or they or their family members have pre-existing conditions and now they can get coverage.

Is it they can’t afford rent? Or they can’t afford the premium sports package on Time Warner Cable?

Because one of those things garners more sympathy from me than the other.

I can speak to one segment. Pre-ACA, I had a great employer sponsored health plan with a $1500 deductible for a single and $4000 for a family. Everything was covered at 100% after you met your deductible so it was a pretty good deal. After ACA, the deductibles skyrocketed to $6000 for a single and more for a family with 20% coinsurance (you still have to pay 20% of your bill even after you met your deductible).

This was a reputable plan through an employer committed to exceptional benefits yet we effectively didn’t have anything except catastrophic insurance. You could spend $500 a month on doctors visits, medication or anything else as a single and much more as a family and you didn’t get anything from the insurance company except the benefit of negotiated rates. That is after the employer shelled out big bucks on top of that so that we could have a “decent” plan (downgraded from “great”).

In a country in which most people say they can’t even come up with $2000 to cover emergency expenses, deductibles that high can be a real problem and they are very common now even among reputable insurance companies and employers. The reasonably healthy but supposedly insured don’t get many benefits at all from their insurance even though it is still very costly and required for both them and their employer. It is great to have it if you have expensive chronic problems or suffer a major medical problem but most people, most of the time are just throwing a whole lot of money into a pile that that gets spread among others with no option to just pay for routine care and minor emergencies themselves (which they have to do anyway because many deductibles are so high even with insurance).

Why? Who are you to say what they spend their money on?

Well, I’d like a new sports car, but you know, my electric needs to get paid.

My argument is that insurance is a financial responsibility. It’s not a discretionary item. You NEED insurance, regardless of one’s health.

I should add, high-deductible plans cause people to change their behavior as well. I have some medical issues that probably need to be monitored but I am not going to pay full price for both insurance and doctors appointments unless I am bleeding out of my eyes AND ears. I didn’t go to the doctor at all last year intentionally and I told my doctors why I was doing it. I have a health savings account (HSA) that is tax deductible but I can only save a little over $3000 a year in it by law (those that are good at math may notice that is significantly less than a $6000 deductible). What I can do is go to a bi-yearly medical schedule. That means that I just save up money and doctors visits so that they are used only every other year. I can pay for everything out of the money I accumulated in my HSA while I was waiting, meet my deductible and then the sky is the limit. Get every test, specialist appointment and everything else taken care of until January 1st kicks over again. This is an “On” year medically speaking so I will be busy catching up.

If that sounds like a stupid medical strategy, it is but it is also very sound financially in my case. It saves literally thousands of dollars just by paying close attention to the calendar.

Several groups of people fall through the cracks with the ACA:

People who have an epo health plan who end up (intentionally or unintentionally) getting out of network care. PPOs have been replaced by EPOs which do not have any out of network coverage. So if you go to the hospital but the Dr isn’t in network, or they order labs and the lab isn’t in network, or the surgeon is in network but the surgeons assistant is not, etc. etc. you could get a bill for hundreds or thousands.

Healthy people who bought plans on the individual marketplace. These people were hit because their rates went up to cover all the new coverage options and help pay for the sicker people being added to the exchanges.

Families of people who get insurance at work. I believe if your employer offers health insurance, but only for the employee (not the employees family) then the family does not get a subsidy. So if the husband gets insurance but his wife/kids are not on his employer plan, and he only makes 20k a year, his wife/kids insurance rates could be 1k a month or more. I hope I’m wrong on this loophole but I’ve heard of it happening.

People who make too much to get subsidies but due to age or location cost a lot to insure. A person making 50k gets $0 in subsidies, but an insurance plan may end up costing them $700 a month if they are close to medicare age. So that is 20% of gross annual income in premiums alone not including deductibles or copays.

So there are lots of people who fell through the cracks. Having said that it is still an improvement, the same way a C- is an improvement over a D+.

You only NEED catastrophic insurance and a way to pay for routine care responsibly no matter how that is. You don’t NEED to subsidize other people’s healthcare if you are generally healthy and have the means to take care of your own and that of your immediate family. That is a social policy debate.

I can’t afford it.

The silver plan for my husband and myself this year is $1555.00 per month. That has a deductible of $4000.00 or $6000.00 (I can’t remember) and a co-pay of $65.00 per doctor visit.

So I just dropped it to a bronze plan, which has even worse coverage, with higher deductibles and co-pays and for that I get to pay $1155.00 per month.

I’ve had insurance all of my adult life. I make decent money, but this is making it difficult for me to make ends meet.

I can afford it, but just barely. I take home about $1550 monthly. Out of that comes my rent, which is $950, my electricity bill which averages $125, gas which averages $25, internet service which is $65, and gasoline for my commute, which is about $160. That adds up to about $1325 in non-flexible expenses each month, leaving me with about $225. My fiance gets financial aid and student loan money (she’s working on her Master’s thesis), so that (usually) covers our phone bill and groceries.

I was able to get a very good medical plan because I’m young and healthy. I can see a doctor pretty much whenever I want for a $15 co-pay. This plan costs me $200 per month. It completely wipes out that small amount of extra money. I am happy to have it, and I have no complaints - but it makes me even more financially unstable, and I can easily see how it might be an insurmountable burden for other working poor like me.

Me. Although it’s not that I can’t afford it, it’s just that I had to downgrade my policy to keep the premium in the same ballpark as it was before. But I’m healthy, self-employed and everyone knew folks like me were going to be losers in this change. Oh, and I just got my new premium for 2016 and it went up 15%. I don’t mind so much being the sacrificial lamb if it makes most other people’s healthcare costs more affordable, but a little acknowledgement would be nice.

I acknowledge your sacrifice. Thank you, John Mace. You are a man of honor.

That’s not really correct. Insurance isn’t gambling; it’s risk management.

Thank you for helping subsidize the healthcare of the less fortunate in society. It’s people like you who help keep my husband alive, out of the hospital, with his limbs and eyesight intact. You’re helping in your own small way to keep people alive and reduce suffering. You are correct, your sacrifice should be acknowledge more often.

I feel better already! :slight_smile:

Where I grew up most people have seasonal income, and are not very good about managing money on a monthly/annual budget. I hear a lot of complaints from these people, including relatives. I also have a lot of friends who are self-employed and have unstable income. Add to that couples who do not share finances, sometimes with 1 who qualifies and 1 who doesn’t and it’s all pretty complicated. I have experience walking through the enrollment with some of these people and seeing how confusing it is. But it’s mostly on their end and not understanding. Example: You make $5000 in June but $800 in March, your insurance is still $500. Or not getting the fact your spouse’s income and subsidy affect yours.

Which brings me to my first thought: Aren’t there percentage of income caps? If your premiums are in the thousands, isn’t your income in the tens of thousands, monthly? Not saying it doesn’t suck for you, but making 6 figures and saying a grand a month bill puts you in the poor house is a little different than people who work full-time and barely earn a grand a month and insurance was really not an option at all before (and still isn’t for some, depending on state).

As far as the point of having insurance in general goes: I was also in the young, healthy, doesn’t go to the doctor category. Then I had a fairly common emergency that required multiple hospital stays and an operation. It was definitely made worse by me being “tough” and delaying treatment. Then I had to wait months for the operation while I spent a summer in pain and limited. Lost income and would have lost a lot more and faced certain bankruptcy if I didn’t have 3rd party health coverage.

A couple years ago, my dad suddenly lost the ability to walk. And work or do anything else. Had to stay in multiple hospitals, rehab centers, etc. He took care of himself, was healthy, and relatively young. Nothing that happened to him could have been prevented by any type of preventative measure, diet, exercise, what. Same with what happened to me.

Health emergencies are unpredictable and often unpreventable. Obviously, it’s reasonable to debate whether insurance should be required and at what levels, but I think as a personal financial/health decision it’s a good idea to at least have catastrophic insurance. It was harmful to tie insurance to employment, subsidize it, apply that subsidy to favored industries at the expense of others, incentivize insurance plans that went way beyond insurance and conditioned people to expect to have free routine care, etc.

How can this be? That is far, far higher than the bronze plan was that we had. And nearly twice the average premium ($600) I find for bronze plans for a married couple at finder.healthcare.gov.

I imagine relevant variables could be location (we’re in Indianapolis) and age (we’re 37). And tobacco usage. Can it make that much of a difference though?

Indiana has remarkably good state subsidies for a red state for low income people (thank you Mitch Daniels) which competes with private insurance. I’m wondering if that’s a factor?

This happened to my daughter. She worked in a small shop with 3 employees, so no employer-sponsored insurance.

She qualified for a small subsidy, but would still have to pay just under a week’s take-home pay per month for the premium. We won’t even discuss the deductibles and copays. She went without health insurance for almost 2 years. She finally got a job with benefits back in November.

Prior to the ACA she had a private, concierge-type of insurance that was used by her medical group, along with catastrophic rider. So when she had a bout with mono a few years back, it covered her visits and tests with her medical group. It was a more affordable $119 per month. That went away when the ACA came in.

Too bad. She was exactly the type of person you want in the pool - young, healthy, low maintenance.

Premiums here are high. We looked at the premiums in other states and were green with envy. She considered moving out of state for a while just to get an affordable premium. Then a better job opened up and she took it.