# 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:** 7
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 4:10am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/121 "2016-01-16T04:10:18Z")
> [@DrCube](#): > > Yes. The problem isn’t lack of insurance, its lack of _healthcare_. A $5k/year premium plus a $3000 deductible is just as devastating to a person making $13k/year as a couple of ambulance bills they will also never be able to pay. The problem is that people are poor and can’t afford healthcare. Whether a middleman is involved to help them spread that cost around is irrelevant if they can’t afford it in the first place. Well, I see your point in that. But that seems to lead to the fact that ALL insurance is unneeded, and any type at all is worthless. ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 4:16am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/122 "2016-01-16T04:16:03Z")
> [@DrCube](#): > > Looking strictly at the financial side, insurance is not a good deal for people who are poor or in decent health. So in the scenario up thread, you would tell the girl making $10 an hour and can’t afford health insurance - “Don’t worry, it’s better for you if you don’t have insurance”? ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 16, 2016, 4:34am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/123 "2016-01-16T04:34:33Z")
> [@Slash1972](#): > > So in the scenario up thread, you would tell the girl making $10 an hour and can’t afford health insurance - “Don’t worry, it’s better for you if you don’t have insurance”? No, I’d say “if you get a disease or injury you’re fucked, just like if your car breaks down or you get pregnant”. Poor people have it bad. You’re missing my point. Poor people can’t afford insurance _or_ medical treatment. As long as the government is assisting them, it makes more sense, to me, to just give them money for health care rather than give them money for insurance. ---
**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 16, 2016, 4:44am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/124 "2016-01-16T04:44:10Z")
> [@Voyager](#): > > I’d guess your kid would rather you be alive with a stent than get your money. You’d guess wrong. And I’m honestly happy for you that your dad lived to 95. I’m glad mine didn’t. His last year was the utmost shit, for him mostly… and everyone else involved. No amount of insurance (he had it, to the max) or money could alter the outcome. We all die. Its just how much it costs us and our loved ones. Time, money, emotions, whatever. name your currency. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 16, 2016, 4:52am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/125 "2016-01-16T04:52:28Z")
> [@Slash1972](#): > > Well, I see your point in that. But that seems to lead to the fact that ALL insurance is unneeded, and any type at all is worthless. Pretty much. The exceptions would be coverage for an asset you’re using to secure a loan, like a house or car, and liability insurance. Because they won’t let you get the loan or drive without them. The other ones aren’t worthless, they’re just a tradeoff. Tradeoffs with costs. Costs that many poor people can’t afford. The ability to say “a flood that may not happen for forty years would bankrupt me, but a couple hundred extra a year won’t break the bank, so I’ll play it safe and get flood insurance” is a _luxury_. Luxuries can be worth it to people who can afford them. The problem with not having universal healthcare isn’t that people don’t have the luxury of an insurance plan. It’s that they don’t have the _necessity_ of important health care. Just like the problem of unemployment isn’t that people don’t have something to keep them busy most of the day, it’s that they don’t have money to pay their bills. The bottom line is poverty in each case. And you fix poverty by giving people money and healthcare, not paying some third party that may or may not help people after they line their own pockets first. ---
**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 16, 2016, 7:37am UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/126 "2016-01-16T07:37:39Z")
> [@Slash1972](#): > > Well, I see your point in that. But that seems to lead to the fact that ALL insurance is unneeded, and any type at all is worthless. If we all had exactly the same medical bills, guaranteed, every year, insurance would be worthless, since we could budget for them. But there is a large number of people with small bills and a tail of people with gigantic bills. “Losing” money if you are in the majority is no big deal (if you have it) and you get peace of mind. But you can’t budget for being an outlier, so if you wind up there without insurance you get screwed. This is because there is only one of you. If you are an insurance company or a big company who self-insures you can predict your costs. That’s why big companies self insure - it is cheaper, and the insurance company they contract with just administers the plan. If you are Bill Gates you don’t need insurance because no expense is going to be a problem for you. If you have a reasonable amount of money paying for insurance is not a problem, but getting hit with a gigantic bill. But if you don’t have a lot of money the pain of insurance is great enough you may want to bet you don’t get sick. It is all statistics and the differing value of money depending on how much you have. ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 12:47pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/127 "2016-01-16T12:47:46Z")
> [@DrCube](#): > > Pretty much. The exceptions would be coverage for an asset you’re using to secure a loan, like a house or car, and liability insurance. Because they won’t let you get the loan or drive without them. Why is that? Why is car insurance mandatory even if you own the car without any loan? Is that just a scam to line the car insurance providers’ pockets? ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 12:49pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/128 "2016-01-16T12:49:46Z")
> [@DrCube](#): > > No, I’d say “if you get a disease or injury you’re fucked, just like if your car breaks down or you get pregnant”. Poor people have it bad. You’re missing my point. > > Poor people can’t afford insurance _or_ medical treatment. As long as the government is assisting them, it makes more sense, to me, to just give them money for health care rather than give them money for insurance. Well, I don’t understand what you would do instead of the insurance paradigm for health care we have today. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [January 16, 2016, 1:43pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/129 "2016-01-16T13:43:56Z")
> [@Slash1972](#): > > Why is that? Why is car insurance mandatory even if you own the car without any loan? Is that just a scam to line the car insurance providers’ pockets? There are multiple kinds of car insurance. The mandatory one (liability) is the one that will pay for the other party’s car if you cause an accident that damages it. It’s up to you if you want the kind that pays to repair your own car (collision/comprehensive). ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [January 16, 2016, 1:47pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/130 "2016-01-16T13:47:20Z")
> [@SmartAlecCat](#): > > There are multiple kinds of car insurance. The mandatory one (liability) is the one that will pay for the other party’s car if you cause an accident that damages it. > > It’s up to you if you want the kind that pays to repair your own car (collision/comprehensive). Yes, I understand what car insurance is. Why is the liability portion mandatory? Why can’t I opt out and just choose to pay with my own money if I cause an accident? ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [January 16, 2016, 2:49pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/131 "2016-01-16T14:49:27Z")
I know a number of people in Florida who fall into the “working poor” (or “working working class”) segment who are really getting nailed under the ACA, both because the plans are overpriced (lack of oversight from insurance commissioner) and because Florida didn’t expand Medicaid or take any money from the federal government to help out people with modest means. That’s not the fualt of the ACA; that’s the fault of the posturing asshats who were elected to state government posts. It is really hard on those people affected. > [@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). How is the employer’s decision to purchase that health care plan the fault of the ACA? > [@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. This is why I hope that high-deductible plans go by the wayside – they are a false savings. People wait until they’re really sick to see the doctor for exactly the reasons \*\*Shagnasty \*\*describes. Then treatment costs more to the insurance company. It’s ridiculous, and we know from a LOT of data analysis that it’s a stupid way to try to save money. I really hope that people get fed up enough with the bullshit with insurance companies blaming the ACA for everything, and still screwing the insured, and we finally manage to get universal, single-payer coverage. I’d be putting myself out of a job, but damn, it’d be worth it to find another career. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [January 16, 2016, 2:51pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/132 "2016-01-16T14:51:47Z")
> [@Slash1972](#): > > Yes, I understand what car insurance is. Why is the liability portion mandatory? Why can’t I opt out and just choose to pay with my own money if I cause an accident? Because there is no guarantee you’ll have the money to pay for the other guys car. What if you hit an $80,000 car brand new off the lot and total it. And the guy inside gets hurt and needs $200,000 worth of medical care. And you have a net worth of $30,000? The other reason some people can’t afford insurance is that not all states took the medicare expansion. That leaves a fairly significant gap. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [January 16, 2016, 3:49pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/133 "2016-01-16T15:49:19Z")
> [@Slash1972](#): > > Well, I don’t understand what you would do instead of the insurance paradigm for health care we have today. Right now the government gives money to insurance companies so that poor people can have access to health care they can’t otherwise afford. I propose that the government give money to hospitals and doctors (or the patient themselves) instead, bypassing the expensive and useless middle men. Basically expand medicaid to cover people who can’t afford insurance, except I’d probably go a step further and expand medicaid to everyone, and eliminate the need for insurance companies entirely. > [@Slash1972](#): > > Why is that? Why is car insurance mandatory even if you own the car without any loan? Is that just a scam to line the car insurance providers’ pockets? Because it’s illegal to drive without liability insurance. But an important distinction is that you don’t need insurance just to own a car, only to drive it on public roads. And nevertheless, many people drive illegally without insurance. That’s a legit, though illegal, decision if you can’t afford insurance and you need a car to earn a living. I mean, you can mandate something all you want, but you can’t get blood from a stone. ---
**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 16, 2016, 5:01pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/134 "2016-01-16T17:01:10Z")
> [@Diceman](#): > > That’s the problem with subsidies. When money gets tight, subsidies are the first thing that gets the axe. cite? ---
**Author:** ![UberArchetype](https://avatars.discourse-cdn.com/v4/letter/u/2bfe46/32.png) [@UberArchetype](https://boards.straightdope.com/u/UberArchetype)\ **Post date:** [January 16, 2016, 5:02pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/135 "2016-01-16T17:02:01Z")
> [@Slash1972](#): > > Yes, I understand what car insurance is. Why is the liability portion mandatory? Why can’t I opt out and just choose to pay with my own money if I cause an accident? Because nobody likes to be tied up in court for years trying to get blood from a turnip. ---
**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 16, 2016, 5:18pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/136 "2016-01-16T17:18:28Z")
> [@DrCube](#): > > A hedge is a gamble too. Airlines tried to hedge against rising fuel costs and locked in $3/gallon. Now that gas is $1.70/gallon they’re regretting that decision, because they lost that bet. > > The thing about insurance is that you can’t expect to “win” like you can in the stock market. It’s like gambling at the casino. Some people may win, but the casino sets things up so that on average, they take in more money than they lose from paying out jackpots. The insurance company has stacked the deck in their favor. On average, their customers will pay more in premiums than they will get in reimbursements. If that wasn’t the case, the insurance companies wouldn’t be in business. I don’t normally carry water for insurance companies but…you have a distorted view of insurance. Most insurance is a hedge, but hedges are not necessarily insurance. Put simply, insurance is the pooling and distribution of risk so in that sense its a bit different than using oil futures to lock in a price. You are paying a premium (which is close to your expected cost of health care minus copays and deductibles) to avoid the cost associated with health care. > [@](#): > > So not only does the insurance company have more information than you, they have tilted the playing field in their favor. I don’t see how it isn’t the same as a lottery. Or an extended warranty. You’re betting that your stuff will break, against a company who knows exactly how often things will break, and has set up the rules so that they can’t lose money on the deal. There is enough competition in the insurance field (and now there is a legal requirement) that the cost of insurance approximates the amount paid out in benefits minus administrative costs. > [@](#): > > It’s a legitimate decision to avoid those costs if you feel that you can’t afford them. And for a lot of people, a lifetime of potential medical bills doesn’t seem all that much worse than a lifetime of certain insurance premiums. Especially when you realize that for an average person, those premiums will cost you more than the medical bills over the long term. And what if you aren’t that average person? Then you impose a cost on the rest of society. > [@](#): > > Of course, things are more complicated than that. There’s a lot of nuance to be hashed out, but that’s the basic economic reality of things. No, not really, its a distorted view of things. > [@](#): > > Obamacare is not universal at all. I know people who can’t afford insurance. Hell, I know people who get free insurance but can’t afford the copays. Or they have Medicaid but it doesn’t cover specialists (which is who everyone goes to when their health problem gets beyond the “turn your head and cough” stage). > > Universal healthcare is when you can just stop by the hospital, get treated, and nobody mentions money at all, and nobody sends you a bill. UHC is about supplanting the asymmetric customer/insurance company casino-style relationship with a symmetric government/medical industry business relationship. It’s not about just mandating that everyone buys insurance. That’s like Marie Antoinette trying to stifle the revolution by mandating that everyone buys cake. It just helps the bakers and doesn’t alleviate the problem at all. What you are talking about is either nationalized health care or single payer health care, universal health care is a much more flexible definition. You can mandate that everyone buys health insurance if you also provide subsidies to anyone that cannot afford the premiums. The problem is that Obamacare’s method of subsidies included an expanded medicaid that some states decided to reject. ---
**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 16, 2016, 5:27pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/137 "2016-01-16T17:27:37Z")
> [@UberArchetype](#): > > “Some” differences? Ya Think? :rolleyes: > > Insurance premiums and the “not sunk” (for the insurance companies) cost of copays and deductibles goes to the revenue side of the balance sheet. Insurance companies do not by any stretch of the imagination run a “fund.” And unlike most business ventures, the lion’s share of insurance revenue goes to profit, judging by market valuations alone. You realize that under Obamacare, it is illegal for insurance companies not to pay out at least 80% (75%?) of the premiums it collects in the form of benefits. They actually have to refund money to the customer so that the amounts paid by the customer base is no more than 125% of the benefits paid in benefits to the customer base. Its called the medical loss ratio and most insurance companies have no problem meeting it, most of them had no problem meeting that ratio even before Obamacare. So you are factually wrong (unless you think 20% or 25% is the “lion’s share”). You might argue that letting insurance companies keep 20% of the revenues to pay dividends, salaries, taxes and other business expenses is too rich but they are not using the “lion’s share” to pay these things. ---
**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 16, 2016, 5:29pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/138 "2016-01-16T17:29:46Z")
> [@DrCube](#): > > Yes. The problem isn’t lack of insurance, its lack of _healthcare_. A $5k/year premium plus a $3000 deductible is just as devastating to a person making $13k/year as a couple of ambulance bills they will also never be able to pay. The problem is that people are poor and can’t afford healthcare. Whether a middleman is involved to help them spread that cost around is irrelevant if they can’t afford it in the first place. Someone making 13K/year is eligible for medicaid. They don’t pay anyone including an insurance company. ---
**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 16, 2016, 5:34pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/139 "2016-01-16T17:34:52Z")
> [@alphaboi867](#): > > When a provider is “in-network” with an insurance company that means they’ve signed a contract with the insurance company to accept their rates, follow there rules about filling claims, getting advance approval for performing certain procedures, etc. A provider who hasn’t signed a contract with an insurance company (aka “out-of-network”) doesn’t have to do any of that. Barring a government regulation to the contrary they free to charge whatever they want, go after the patient anytime they disagree with that the insurance company pays, or make the patient pay for everything up front and sort the claim out with his insurance company on his own. So isn’t the answer that you should use an in network doctor or choose an insurance company that your doctor has an agreement with. If you are using a doctor that basically doesn’t take insurance then that sounds like a personal decision. ---
**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 16, 2016, 5:37pm UTC](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090/140 "2016-01-16T17:37:20Z")
> [@DrCube](#): > > No, I’d say “if you get a disease or injury you’re fucked, just like if your car breaks down or you get pregnant”. Poor people have it bad. You’re missing my point. > > Poor people can’t afford insurance _or_ medical treatment. As long as the government is assisting them, it makes more sense, to me, to just give them money for health care rather than give them money for insurance. Sure, until they get really sick and some of them invariably will, in fact poor people tend to get sick a lot more frequently than wealthier people. [Previous page](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090.md?page=6) [Next page](https://boards.straightdope.com/t/so-who-are-these-people-that-cant-afford-aca/743090.md?page=8)