# So who are these people that "can't afford" ACA? **URL:** \ **Category:** Great Debates\ **Created:** [January 14, 2016, 12:09am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090 "2016-01-14T00:09:22Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [January 14, 2016, 1:27pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/21 "2016-01-14T13:27:51Z")
> [@Broomstick](#): > > 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? I don’t think so–the website I linked to didn’t ask about income so I don’t think subsidies were factored in. ---
**Author:** ![not\_what\_you\_d\_expect](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/not_what_you_d_expect/32/3246_2.png) [@not\_what\_you\_d\_expect](https://boards.straightdope.com/u/not_what_you_d_expect)\ **Post date:** [January 14, 2016, 2:05pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/22 "2016-01-14T14:05:31Z")
> [@Frylock](#): > > 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](http://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? I’m in California and we are both near 60. Neither of us use tobacco. I don’t know why it’s so high, but it sure is. I wish our monthly income was in the tens of thousands. I wouldn’t be feeling the pinch so much. And the budgeting can really be a pain. I had to pay $4000.00 in income taxes last year because of job and income changes through the year. Even when you report the change timely to Covered California, it can take months to get the premium amount corrected at Anthem and so you end up receiving a subsidy that you are no longer qualified for. I hate it. ---
**Author:** ![Boyo\_Jim](https://avatars.discourse-cdn.com/v4/letter/b/87869e/32.png) [@Boyo\_Jim](https://boards.straightdope.com/u/Boyo_Jim)\ **Post date:** [January 14, 2016, 2:45pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/23 "2016-01-14T14:45:05Z")
I was unemployed for more than 3 years. I could not afford health insurance, car insurance or my mortgage payments. Was I being “screwed”? I don’t know – you tell me. Luckily I didn’t have any catastrophic health issues during that time. ---
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [January 14, 2016, 2:54pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/24 "2016-01-14T14:54:49Z")
> [@not\_what\_you\_d\_expect](#): > > I’m in California and we are both near 60. Neither of us use tobacco. Okay, I tried Irvine zipcodes for married couples 59 years old no tobacco and yep they get quite a bit more expensive. ☹ I was finding around $900. Dang, this is a problem especially in areas where everybody is either wealthy or lower middle (or less) class–like Irvine. (I’m assuming premium amounts are based on averages or something). Subsidies should often help but yeah it is true that at certain income levels, you get no subsidy, AND the cheapest insurance is pretty unaffordable. Something needs to be done about this. Better to fix the problem though rather than scrap the whole program. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 14, 2016, 4:41pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/25 "2016-01-14T16:41:06Z")
> [@Quartz](#): > > That’s not really correct. Insurance isn’t gambling; it’s risk management. I’d say insurance is gambling, but so is not having insurance. You could win or lose in either case. With insurance, you’re betting on having an expensive injury or disease, which is a pretty good bet in the long term. Without insurance, you’re betting that you won’t, which might also be a good bet in the short term, but probably not over the long term. The problem is when insurance isn’t a gamble. What are you “insuring” when routine checkups are covered? They’re a necessity, not an unpredictable catastrophe. At that point it’s basically just a “valued customer” plan, with some included “Medbucks” you can redeem at participating hospitals and doctors offices. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [January 14, 2016, 4:50pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/26 "2016-01-14T16:50:07Z")
> [@Shagnasty](#): > > 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 Can another family member have an HSA? Must it be used for the owner of the account? ---
**Author:** ![Diceman](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Diceman](https://boards.straightdope.com/u/Diceman)\ **Post date:** [January 14, 2016, 6:24pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/27 "2016-01-14T18:24:33Z")
> [@Shagnasty](#): > > 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 is my situation. I get healthcare thru work, and split the cost with my employer. I have a low deductable ($1250), but I pay much more per month than if I went with the high-deductable option. Around the time ACA was enacted, I started having to deal with coinsurance. First it was 10%, but this year it jumped to 20%. I’ve been avoiding the high-deductable option (because most years I’d be paying premiums but getting nothing in return), but if premiums go up much more next year I may have no choice. > [@Wesley clark](#): > > 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. Yep. The arrival of ACA coincides perfectly with our PPO plans turning into EPO plans. And there is a difference. Because of some family healthcare issues, we met our deductable last year, but I had to spend well over $1250 before my insurance started to kick in, because some providers were out of network, and circumstances did not allow the luxury of screening everyone for in-network-ness. ---
**Author:** ![Diceman](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Diceman](https://boards.straightdope.com/u/Diceman)\ **Post date:** [January 14, 2016, 6:26pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/28 "2016-01-14T18:26:42Z")
> [@carnivorousplant](#): > > Can another family member have an HSA? Must it be used for the owner of the account? Any family member can use the money in an HSA, but only the owner of a qualified account can have one. And because the money is tax deductable, the feds place limits on how much money you can put in an HSA account. ---
**Author:** ![GargoyleWB](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gargoylewb/32/199_2.png) [@GargoyleWB](https://boards.straightdope.com/u/GargoyleWB)\ **Post date:** [January 14, 2016, 6:29pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/29 "2016-01-14T18:29:22Z")
> [@Grrr](#): > > 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 lived many years on the edge, and didn’t spend money on cable TV, sports car, etc because +/- $20 really did mean the difference between making rent and utilities. In the hierarchy of needs, financial responsibility is below financial _survival_, so I went without health insurance, life insurance, renter insurance, retirement contribution, etc. To very many people barely making ends meet, responsibility = luxury item. ---
**Author:** ![Gary\_Kumquat](https://avatars.discourse-cdn.com/v4/letter/g/4491bb/32.png) [@Gary\_Kumquat](https://boards.straightdope.com/u/Gary_Kumquat)\ **Post date:** [January 14, 2016, 6:33pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/30 "2016-01-14T18:33:55Z")
> [@Hilarity\_N.Suze](#): > > 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. Sincere question from a non-american who doesn’t know anything about how the system actually operates there . Considering that sooner or later you’re going to get very ill, how do you believe that you would ever end up losing out? If you get terminal cancer without insurance, I take it the bills would be picked up by you as an individual, up to the point where you can no longer afford them and it’s game over. What happens if you get cancer when you have insurance? Doesn’t the insurance policy have to cover them till there’s no further treatment, or is there some get out clause they can invoke so you’re out of cover? Because if they do have to cover you, and you do accept that you will get seriously ill sooner or later, surely it has to work out in your favour eventually? ---
**Author:** ![amarone](https://avatars.discourse-cdn.com/v4/letter/a/e0b2c6/32.png) [@amarone](https://boards.straightdope.com/u/amarone)\ **Post date:** [January 14, 2016, 6:53pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/31 "2016-01-14T18:53:22Z")
> [@Gary\_Kumquat](#): > > Sincere question from a non-american who doesn’t know anything about how the system actually operates there . Considering that sooner or later you’re going to get very ill, how do you believe that you would ever end up losing out? > > If you get terminal cancer without insurance, I take it the bills would be picked up by you as an individual, up to the point where you can no longer afford them and it’s game over. What happens if you get cancer when you have insurance? Doesn’t the insurance policy have to cover them till there’s no further treatment, or is there some get out clause they can invoke so you’re out of cover? > > Because if they do have to cover you, and you do accept that you will get seriously ill sooner or later, surely it has to work out in your favour eventually? If your last paragraph were true, then it would also follow that the insurance companies must eventually lose out. Obviously that is not the case or they would all have gone out of business. Also note that when you are most likely to need treatment is when you are older, and at 65 you qualify for Medicare. Moving to your middle paragraph, note that something like half personal bankruptcies in the US are caused by, or largely caused by, medical expenses. And most of those people have health insurance. The insurance company has to keep paying, but with one big get out clause - not if you stop paying your premium. Why on earth would you do that, you say, when you need the insurance? Because you lose your job through being too sick to work and with no employer paying any of it, you owe $1,500/month for family coverage but you have no income because you lost your job. ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [January 14, 2016, 7:22pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/32 "2016-01-14T19:22:25Z")
What the ACA did was create standards for plans. Plans that didn’t meet those standards had to be discarded. The new plans may be more expensive, but they were actually good plans. Lots of people are ignorant of what’s in their plan and how insurance companies use loopholes to refuse payment. So they think they had a good plan that went up in price. Instead, they should be thanking Obama for getting them plans that actually covered them. Sure, some will pay more, and that’s not ideal. If the GOP actually gave a damn about the people whose plans they want to repeal, they’d work with Obama to expand Medicare and create better plans, or single-payer. But that’s not the goal of the GOP Congress. Their goal is to enrich themselves and their friends by destroying the social safety net. So there will never be a Republican alternative to the ACA ---
**Author:** ![monstro](https://avatars.discourse-cdn.com/v4/letter/m/ba9def/32.png) [@monstro](https://boards.straightdope.com/u/monstro)\ **Post date:** [January 14, 2016, 7:58pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/33 "2016-01-14T19:58:13Z")
> [@GargoyleWB](#): > > I lived many years on the edge, and didn’t spend money on cable TV, sports car, etc because +/- $20 really did mean the difference between making rent and utilities. In the hierarchy of needs, financial responsibility is below financial _survival_, so I went without health insurance, life insurance, renter insurance, retirement contribution, etc. > > To very many people barely making ends meet, responsibility = luxury item. There are also many fiscally responsible things competing for a person’s limited resources. Like retirement savings. Is a person being irresponsible if they decide that putting $300/month towards retirement makes more sense than putting it towards health insurance they may not even use? Both are luxuries, so which do you choose? I’m guessing most people would choose to save (at the very least, for the benefit of their emergency fund). ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [January 14, 2016, 8:41pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/34 "2016-01-14T20:41:23Z")
> [@YogSosoth](#): > > how insurance companies use loopholes to refuse payment. So they think they had a good plan that went up in price. Instead, they should be thanking Obama for getting them plans that actually covered them. Sure, some will pay more, and that’s not ideal. If the GOP actually gave a damn about the people whose plans they want to repeal, they’d work with Obama to expand Medicare and create better plans, or single-payer. But that’s not the goal of the GOP Congress. Their goal is to enrich themselves and their friends by destroying the social safety net. So there will never be a Republican alternative to the ACA I think the insurance companies use any loophole in the Affordable Care Act to pay less. I’ve noticed that my insurance company doesn’t pay the full physician’s charges. The physician used to eat this, but now they charge me for it. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [January 14, 2016, 9:00pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/35 "2016-01-14T21:00:39Z")
> [@Hilarity\_N.Suze](#): > > 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. Insurance is not normally characterized as a gamble. It is far more frequently characterized as a hedge. How is paying into a universal health care fund different from paying into an insurance fund? Sure there are some differences but not really enough to justify supporting one and hating the other. ---
**Author:** ![sleestak](https://avatars.discourse-cdn.com/v4/letter/s/919ad9/32.png) [@sleestak](https://boards.straightdope.com/u/sleestak)\ **Post date:** [January 14, 2016, 9:30pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/36 "2016-01-14T21:30:08Z")
> [@YogSosoth](#): > > What the ACA did was create standards for plans. Plans that didn’t meet those standards had to be discarded. The new plans may be more expensive, but they were actually good plans. Lots of people are ignorant of what’s in their plan and how insurance companies use loopholes to refuse payment. So they think they had a good plan that went up in price. Instead, they should be thanking Obama for getting them plans that actually covered them. Sure, some will pay more, and that’s not ideal. If the GOP actually gave a damn about the people whose plans they want to repeal, they’d work with Obama to expand Medicare and create better plans, or single-payer. But that’s not the goal of the GOP Congress. Their goal is to enrich themselves and their friends by destroying the social safety net. So there will never be a Republican alternative to the ACA What the ACA did was take options that people wanted away from them while not really fixing any of the core problems. Also, I find it interesting that you know more about other peoples financial situations than the people who are actually in those situations. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [January 14, 2016, 9:30pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/37 "2016-01-14T21:30:09Z")
> [@Hilarity\_N.Suze](#): > > 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. I can assure you, that unless you have the good fortune of being run over by a truck before you ever get sick, you will eventually need insurance. Especially if you get run over by a truck and survive. The healthy lose on the deal. For me personally I’ve paid a lot more for insurance (not even counting employer contributions) than I’ve ever used. Your aversion to doctors in no way guarantees that you will never come down with something, which in the old days would be a pre-existing condition which would prevent you from getting coverage. So, you’d go bankrupt. And who pays? Me, that’s who. And all of us who pay higher hospital bills to cover those who couldn’t afford to pay. I’m 64 and have only spent one night in the hospital my entire life. But I don’t regret having to pay for health insurance one little bit. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [January 14, 2016, 9:31pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/38 "2016-01-14T21:31:07Z")
> [@Shagnasty](#): > > 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. Did your premiums go down? If you get $3000 per year towards your HSA, I am going to guess that the employee side contribution for health care is about $3000/year (or at least that is what I have seen around here in Northern Virginia) High deductible health plans are all the rage among health care policy wonks. Its supposed to bring market discipline to the health care market or some shit like that. These are basically a combination of a catastrophic health plan plus health savings account. They usually include free preventative care (you might have to pay out of pocket for some specialized tests) and you pay for treatments. Do your typical medical expenditures in a year exceed $6000/year? What you normally see is a family that spends $1000/year and accumulate $2000/year in their HSA. Your posts are a little inconsistent. At first you say that your co-insurance requires you to pay 20% even AFTER you have hit your deductible and here you say that after you hit your deductible, the sky is the limit. I have had a HDHP for several years and I have several times my deductible saved up in my HSA (invested in some sort of mutual fund that I don’t keep track of). I can cash in that money when I get old enough. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 14, 2016, 9:45pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/39 "2016-01-14T21:45:03Z")
> [@Damuri\_Ajashi](#): > > Insurance is not normally characterized as a gamble. It is far more frequently characterized as a hedge. > > How is paying into a universal health care fund different from paying into an insurance fund? Sure there are some differences but not really enough to justify supporting one and hating the other. The big difference is that it’s not gambling when you have all the information. The US government (and insurance companies) know (probably within 5%) the number of people who will get cancer this year. If they make the decisions, it’s not gambling. They know all the costs, all the benefits, and how to make sound financial decisions with that information. An individual patient is like a casino patron. They’re just guessing, and it mostly comes down to luck. The insurance companies and the US government are like the casino. It’s gambling in the first instance. It’s just business in the second. Furthermore, in the case of universal healthcare, we’re providing for people who can’t afford it. It’s kind of like a casino who makes sure their poorest patrons don’t go broke, rather than just telling them that if they currently can’t afford to live, they should just keep playing the slots until they can. That’s a significant difference. ---
**Author:** ![Gatopescado](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gatopescado/32/5711_2.png) [@Gatopescado](https://boards.straightdope.com/u/Gatopescado)\ **Post date:** [January 14, 2016, 11:26pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/40 "2016-01-14T23:26:01Z")
> [@Grrr](#): > > My argument is that insurance is a financial responsibility. It’s not a discretionary item. You NEED insurance, regardless of one’s health. I would agree with you, but then I would be wrong. > [@Quartz](#): > > That’s not really correct. Insurance isn’t gambling; it’s risk management. Institutionalized Extortion. [Previous page](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090.md?page=1) [Next page](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090.md?page=3)