# We had health care sign-up yesterday at work. Here's how it went. **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 14, 2013, 12:36pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899 "2013-11-14T12:36:48Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![kiz](https://avatars.discourse-cdn.com/v4/letter/k/7feea3/32.png) [@kiz](https://boards.straightdope.com/u/kiz)\ **Post date:** [November 14, 2013, 10:48pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/21 "2013-11-14T22:48:44Z")
> [@yellowjacketcoder](#): > > If ‘Peggy’ is making $9/hour and has two kids and a single-earner family, how is she not eligible for medicaid? Even working 40 hours a week, 52 weeks a year, she’s only making $18,720, less than the federal poverty level of $19,530 for a family of three. If I were her, I wouldn’t sign up either, since I’d be getting free healthcare from the government. A lot of people fell under this same umbrella where I work before universal healthcare was enacted here. Most of them quit when the state mandated that all employees HAD to take the insurance our employer offered – no way could you take the insurance AND be on Medicaid. It’s one or the other. ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [November 14, 2013, 11:42pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/22 "2013-11-14T23:42:49Z")
> [@RTFirefly](#): > > The legal challenges to the ACA could have gone a lot of different ways, but even in retrospect, the justification for the SCOTUS decision seems to have been invented out of whole cloth. You can’t defend against every random thought that passes through a Chief Justice’s brain. I’m not enough of a Constitutional scholar to argue this either way. > [@](#): > > Oh, bullshit. The choices were to pass a not-totally-polished bill, or pass nothing. Is it possible that the better course was in fact to pass nothing? ---
**Author:** ![DigitalC](https://avatars.discourse-cdn.com/v4/letter/d/ebca7d/32.png) [@DigitalC](https://boards.straightdope.com/u/DigitalC)\ **Post date:** [November 15, 2013, 1:16am UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/23 "2013-11-15T01:16:50Z")
> [@iamthewalrus\_3](#): > > I’m not enough of a Constitutional scholar to argue this either way. > > Is it possible that the better course was in fact to pass nothing? The choices were take a step forward towards universal healthcare or a step backwards, we chose right. ---
**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:** [November 15, 2013, 1:44am UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/24 "2013-11-15T01:44:48Z")
I’m in California, I’m pretty sure they did expand medicaid. Dewey, I think she qualified for a subsidy, but I can’t swear to it. I found it interesting that the two people who signed up are a mother and son and both of them are up to their eyeballs in debt with medical bills. ---
**Author:** ![Obnoxious\_Hood\_Ornament](https://avatars.discourse-cdn.com/v4/letter/o/3be4f8/32.png) [@Obnoxious\_Hood\_Ornament](https://boards.straightdope.com/u/Obnoxious_Hood_Ornament)\ **Post date:** [November 15, 2013, 3:06am UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/25 "2013-11-15T03:06:14Z")
> [@MilTan](#): > > If making your plans ACA-compliant increased premiums by 40%, I shudder to think how little coverage your plans used to offer. Most individual plans that are going up by a lot either a) offered very little actual coverage and/or b) were only available to very healthy individuals. Given that you seem to be in a group-coverage setting, I imagine that (b) doesn’t really apply. You’d think that, right? Sadly, in this case you’d be wrong. Coverage is very close to what it originally was. We got some extra stuff thrown in for substance abuse programs and several more preventive measures are covered, but it looks like it was an excuse to take another dip into our wallets. I’ve got friends working for other large-ish companies in the city and they are reporting similar, although obviously not identical, results. We actually have an on-site clinic that is staffed five days a week, from 9 AM - 2 PM. Anything that happens in the clinic is 100% covered, which is a huge boon. Fortunately, that wasn’t axed. ---
**Author:** ![Tethered\_Kite](https://avatars.discourse-cdn.com/v4/letter/t/a5b964/32.png) [@Tethered\_Kite](https://boards.straightdope.com/u/Tethered_Kite)\ **Post date:** [November 15, 2013, 3:09am UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/26 "2013-11-15T03:09:56Z")
> [@Moonlitherial](#): > > You guys studied what other countries do and decided it wouldn’t work for you. It would have essentially put your entire health insurance industry out of work. Thanks. Don’t know why I didn’t know that. Many of the well-practiced doctors I’ve talked to have plans to get out of the profession. They are not happy. A couple of years ago I got transferred over to a Nurse Practitioner when my doctor retired. I noticed that our local high schools are starting to offer basic nursing practices classes. I’m guessing that eventually we won’t have the luxury of seeing a doctor unless we are very ill. I see the Baby Boomers as presenting a real problem in the future if more young people don’t register. With good health care, we as a group, are probably going to be pretty long-lived. How many young people can afford to pick up the slack? I am incapable of fathoming where all the money is going to come from. ---
**Author:** ![AuntiePam](https://avatars.discourse-cdn.com/v4/letter/a/f19dbf/32.png) [@AuntiePam](https://boards.straightdope.com/u/AuntiePam)\ **Post date:** [November 15, 2013, 3:24am UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/27 "2013-11-15T03:24:14Z")
Anyone think people would have been happy to start with the basics and go from there? Expand Medicaid to cover low-income families who rely on emergency rooms, make it illegal to deny coverage for pre-existing conditions, and keep dependents eligible until age 26. I’ve heard that HSA’s won’t be pre-tax after 2014. Or something like that. I’m getting feedback from municipal employees, some of whom are happy and some not. ---
**Author:** ![Sal\_Ammoniac](https://avatars.discourse-cdn.com/v4/letter/s/8dc957/32.png) [@Sal\_Ammoniac](https://boards.straightdope.com/u/Sal_Ammoniac)\ **Post date:** [November 15, 2013, 3:30am UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/28 "2013-11-15T03:30:19Z")
You’d never think that our dear friends in an adjacent country had actually solved this problem. Why, up there they have universal coverage, with no crazy-making insurance B.S., with better health outcomes, greater longevity, and all at a significantly lower cost. I guess they’re not doing it right. Look at all the fun they’re missing! ---
**Author:** ![MilTan](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@MilTan](https://boards.straightdope.com/u/MilTan)\ **Post date:** [November 15, 2013, 1:15pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/29 "2013-11-15T13:15:25Z")
> [@Obnoxious\_Hood\_Ornament](#): > > You’d think that, right? Sadly, in this case you’d be wrong. Coverage is very close to what it originally was. We got some extra stuff thrown in for substance abuse programs and several more preventive measures are covered, but it looks like it was an excuse to take another dip into our wallets. I’ve got friends working for other large-ish companies in the city and they are reporting similar, although obviously not identical, results. Then it sounds more like your insurance provider is using the ACA as an excuse to jack up premiums. Your company should probably shop around a bit. The list of essential health benefits that plans must cover under the ACA is [pretty small](https://www.healthcare.gov/glossary/essential-health-benefits/): > [@](#): > > ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. The only other thing that ACA really does to the group market is eliminate lifetime caps. If your insurance already covered those things, and had a pretty high (or non-existent) lifetime cap, there’s no reason that the ACA should lead to higher premiums. ---
**Author:** ![yellowjacketcoder](https://avatars.discourse-cdn.com/v4/letter/y/4bbf92/32.png) [@yellowjacketcoder](https://boards.straightdope.com/u/yellowjacketcoder)\ **Post date:** [November 15, 2013, 1:29pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/30 "2013-11-15T13:29:05Z")
> [@AuntiePam](#): > > make it illegal to deny coverage for pre-existing conditions If you do that without also putting in a mandate, then insurance costs spike way up as sick people join the rolls but aren’t offset by healthy people doing so. The thing that bothers me when people (not **AuntiePam** in particular, i mean scuttlebutt around the net) complain about the individual mandate, is that if you wanted all the other nice things in the bill, someone had to pay for them, and the individual mandate is the way it’s paid for - by healthy people getting into the system. If we as a nation had gone single payer, everyone would be paying for it also but probably on a more progressive scale so it wouldn’t soak the poor-but-not-poor-enough-for-medicaid. ---
**Author:** ![MilTan](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@MilTan](https://boards.straightdope.com/u/MilTan)\ **Post date:** [November 15, 2013, 1:34pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/31 "2013-11-15T13:34:07Z")
It doesn’t help that there are plenty of people going around spreading FUD. For example, I’m not sure who has been telling **AuntiePam** ’s acquaintances that HSAs won’t be pre-tax after 2014, but that’s not true. What _is_ true is that some existing HSAs don’t comply with the ACA’s minimum standards (but most probably do), so they wouldn’t be offered anymore. ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [November 15, 2013, 1:35pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/32 "2013-11-15T13:35:42Z")
> [@MilTan](#): > > The only other thing that ACA really does to the group market is eliminate lifetime caps. If your insurance already covered those things, and had a pretty high (or non-existent) lifetime cap, there’s no reason that the ACA should lead to higher premiums. Yeah, I’d really like to see some actual figures on these employers who are jacking up prices and telling their employees it’s because of the ACA. My employer is very up-front about their costs versus our costs (I even think their cost is a line item on my paycheck.) I’m not sure if everyone is doing that or not, but I suspect some of these group insurance “the ACA is making you pay more!” schemes are the employers finding a scapegoat that lets them change the percentage they pay versus what the employee pays and not get blamed for it. But who knows? I could be wrong. I haven’t seen any real data other than my own company, where the cost to me didn’t change at all. ---
**Author:** ![MilTan](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@MilTan](https://boards.straightdope.com/u/MilTan)\ **Post date:** [November 15, 2013, 1:43pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/33 "2013-11-15T13:43:27Z")
I forgot one other thing the ACA added: more dependents can be covered on their parents’ insurance. But that might actually have the effect of _lowering_ premiums, because adding a bunch of 18- to 26-year-old people to a risk pool probably makes the pool healthier overall. To add a data point here, premiums at my large (self-insured) employer went _down_ this year. The coverage rules shifted around a bit, and arguably got bit worse: deductibles went up and we switched from co-pays to co-insurance (though given the typical insurance-negotiated doctor’s fee, co-insurance will often be cheaper than the co-pays were). But nevertheless, there is nothing like the 40% increase that other people are reporting. ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [November 15, 2013, 2:57pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/34 "2013-11-15T14:57:26Z")
> [@DigitalC](#): > > The choices were take a step forward towards universal healthcare or a step backwards, we chose right. How do we know it’s a step forward? To be clear, I’m not arguing that the ACA is bad. I’m arguing that we don’t really know yet, because we haven’t seen what the outcome is. So far, it appears pretty flawed. It appears to me that you are arguing that it’s good because we had good intentions, and we want it to be good, regardless of what it actually ends up doing. Is that no true? ---
**Author:** ![Silophant](https://avatars.discourse-cdn.com/v4/letter/s/a698b9/32.png) [@Silophant](https://boards.straightdope.com/u/Silophant)\ **Post date:** [November 15, 2013, 3:31pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/35 "2013-11-15T15:31:12Z")
Millions of people who could not get health coverage before, now can. How is that not a step forward? ---
**Author:** ![DigitalC](https://avatars.discourse-cdn.com/v4/letter/d/ebca7d/32.png) [@DigitalC](https://boards.straightdope.com/u/DigitalC)\ **Post date:** [November 15, 2013, 3:50pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/36 "2013-11-15T15:50:28Z")
> [@iamthewalrus\_3](#): > > It appears to me that you are arguing that it’s good because we had good intentions, and we want it to be good, regardless of what it actually ends up doing. Is that no true? It has nothing to do with good intentions, if we had not passed the ACA the next attempt many years from now would have been even more watered down like this was watered down from Clinton’s attempt. Failure to pass anything would have been a step back because the next attempt would have been weaker. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [November 15, 2013, 4:22pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/37 "2013-11-15T16:22:12Z")
> [@iamthewalrus\_3](#): > > How do we know it’s a step forward? > > To be clear, I’m not arguing that the ACA is bad. I’m arguing that we don’t really know yet, because we haven’t seen what the outcome is. So far, it appears pretty flawed. > > It appears to me that you are arguing that it’s good because we had good intentions, and we want it to be good, regardless of what it actually ends up doing. Is that no true? If it doesn’t end up being good, we can back it out or change it then. But we won’t really know until the data comes in. It was designed so that: 1. People who couldn’t afford insurance now can. We will see when the data comes in how effective this has been, it might take a year or two. Right now, its anecdotal and the anecdotes really seem to be dependent on your political beliefs. My liberal friends are all talking about the people they know who are writers and artists who are being insured for the first time. My conservative friends are talking about how no one at work signed up. 2. People with preexisting conditions can now get covered. I live in Minnesota, where this has been law for some time, but my brother in law, when he had cancer, had to switch insurance three times due to job changes, loss, change in financial circumstances. Without the ability to get insurance, he would have had to spend down all his (limited) assets and then go on Medicaid. We will also have to wait for numbers to see how big a deal it is. If it works, the number of people going on Medicaid should drop. 3. Fewer people should go bankrupt due to medical expenses. The lifetime cap was easy to hit for someone with cancer or cerebal palsy. If that works, that should also be better for the stability of our economy. Bankruptcies aren’t good . Right now, there are holes in it - holes that have been punched in it, not holes that were designed into it. And there are huge technical issues - once again, not completely the fault of the federal government - states could have set up their own exchanges (Minnesota’s is functioning fairly well). I’ll admit I’m a little confused by the whole “the federal government can’t do anything right so we insist on having state based exchanges” followed by not setting up the exchanges and making the inept federal government do it - seems like if you don’t trust the federal government, you should have set up your own exchange. But, hey, maybe I expect consistency of words and action in my political discourse. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 15, 2013, 4:55pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/38 "2013-11-15T16:55:32Z")
> [@MilTan](#): > > It doesn’t help that there are plenty of people going around spreading FUD. For example, I’m not sure who has been telling **AuntiePam** ’s acquaintances that HSAs won’t be pre-tax after 2014, but that’s not true. What _is_ true is that some existing HSAs don’t comply with the ACA’s minimum standards (but most probably do), so they wouldn’t be offered anymore. The ACA does not impose any new requirements on HSAs. It imposes some new requirements on the high deductible health plans that are paired with them. ---
**Author:** ![AuntiePam](https://avatars.discourse-cdn.com/v4/letter/a/f19dbf/32.png) [@AuntiePam](https://boards.straightdope.com/u/AuntiePam)\ **Post date:** [November 15, 2013, 5:03pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/39 "2013-11-15T17:03:21Z")
I misspoke. Turns out what some city employees are complaining about is that previously, if they were covered under a spouse’s plan, the city was allowed to put some money in their paycheck - pretax – rather than cover the employee under the city’s plan. They’re being told that money won’t be pretax anymore. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [November 15, 2013, 5:21pm UTC](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899/40 "2013-11-15T17:21:01Z")
> [@AuntiePam](#): > > I misspoke. Turns out what some city employees are complaining about is that previously, if they were covered under a spouse’s plan, the city was allowed to put some money in their paycheck - pretax – rather than cover the employee under the city’s plan. They’re being told that money won’t be pretax anymore. Never should have been. That didn’t change. You can’t give someone money without taxing it. [Previous page](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899.md?page=1) [Next page](https://boards.straightdope.com/t/we-had-health-care-sign-up-yesterday-at-work-heres-how-it-went/673899.md?page=3)