# What are people's options to obtain health insurance if the ACA is repealed **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [November 9, 2016, 8:07pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271 "2016-11-09T20:07:58Z")\ **Posts on this page:** 18\ **Page:** 3
**Author:** ![rbroome](https://avatars.discourse-cdn.com/v4/letter/r/838e76/32.png) [@rbroome](https://boards.straightdope.com/u/rbroome)\ **Post date:** [November 12, 2016, 3:30pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/41 "2016-11-12T15:30:44Z")
“I’m an Australian, low-income earner and have no private health insurance. I pay app $500 per year into the public health system (Medicare) via my tax payments. For that, I can see a doctor whenever I wish, be referred to medical specialists as per need, and have surgery also as needed at no extra expense. If I am seriously ill or have been involved in an accident, I will be treated at a world-class medical centre by world-class doctors.” “If you don’t have it and are poor you get Medicaid, which is like what you have.” I revise my earlier comment about puddlegum’s experience with Medicaid. There is no place in America that has any medical insurance, private or public, that approaches what Australia offers. If you work for a hedge fund that provides full medical insurance coverage, the cost is 50 times or more the cost given in the above post. ---
**Author:** ![Bookkeeper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bookkeeper/32/281_2.png) [@Bookkeeper](https://boards.straightdope.com/u/Bookkeeper)\ **Post date:** [November 13, 2016, 3:09am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/42 "2016-11-13T03:09:09Z")
> [@rbroome](#): > > “I’m an Australian, low-income earner and have no private health insurance. > I pay app $500 per year into the public health system (Medicare) via my tax payments. > For that, I can see a doctor whenever I wish, be referred to medical specialists as > per need, and have surgery also as needed at no extra expense. If I am seriously ill > or have been involved in an accident, I will be treated at a world-class medical > centre by world-class doctors.” > > “If you don’t have it and are poor you get Medicaid, which is like what you have.” > > I revise my earlier comment about puddlegum’s experience with Medicaid. There is no place in America that has any medical insurance, private or public, that approaches what Australia offers. If you work for a hedge fund that provides full medical insurance coverage, the cost is 50 times or more the cost given in the above post. As a Canadian, I will chime in to say that our situation is similar to Australia. When my father was in the hospital for almost a week recently, the main financial concern was the high cost of parking when we went to visit him ($3.50 per ½ hour!). I actually have supplemental health insurance that covers prescriptions, glasses, dental, and other miscellaneous stuff that is usually not covered by the government health services. It costs $80 a month. When I hit 65, my prescriptions will then also be covered by the government. ---
**Author:** ![Lee\_Q](https://avatars.discourse-cdn.com/v4/letter/l/aeb1de/32.png) [@Lee\_Q](https://boards.straightdope.com/u/Lee_Q)\ **Post date:** [November 13, 2016, 11:49pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/43 "2016-11-13T23:49:17Z")
> [@Gatopescado](#): > > Couldn’t afford it before Obama, can’t afford it with Obama, probably won’t afford it when its gone. > > So, the option is “go without”. Exactly this. And some of us live in states that chose NOT to expand Medicaid which has to this day left lots of very poor Americans who can’t afford Obamacare premiums completely uninsured even after passage of the ACA. It’ll be interesting to see if Trump and the repub Congress is able to do as he said and come up with something “much better” that would make everyone happy. I seriously doubt it, but as we’ve recently seen, maybe it’s best to never say never… ---
**Author:** ![brujaja](https://avatars.discourse-cdn.com/v4/letter/b/4af34b/32.png) [@brujaja](https://boards.straightdope.com/u/brujaja)\ **Post date:** [November 14, 2016, 7:09am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/44 "2016-11-14T07:09:56Z")
Has anyone mentioned that, if you can’t afford any insurance at all, the federal government confiscates your income tax refund? ---
**Author:** ![control-z](https://avatars.discourse-cdn.com/v4/letter/c/eada6e/32.png) [@control-z](https://boards.straightdope.com/u/control-z)\ **Post date:** [November 14, 2016, 4:49pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/45 "2016-11-14T16:49:25Z")
> [@brujaja](#): > > Has anyone mentioned that, if you can’t afford any insurance at all, the federal government confiscates your income tax refund? I’m dealing with that, my strategy is to structure my paycheck deductions so I don’t get a refund. I’ll see how that works come April. ---
**Author:** ![RealityChuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/realitychuck/32/195_2.png) [@RealityChuck](https://boards.straightdope.com/u/RealityChuck)\ **Post date:** [November 14, 2016, 7:34pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/46 "2016-11-14T19:34:24Z")
The premium jumps this year have little to do with Obamacare. Insurance payments went up for me and I’m not on it. Insurance companies need to cover their costs and the $66 million [their CEO gets.](http://www.dailykos.com/story/2015/4/9/1376712/-UnitedHealthcare-myUHC-CEO-Stephen-Hemsley-took-home-66-million-in-2014-102-million-in-2010) The issue is that of cost control, and a big factor of that is drug prices. Remember Martin Shkrelli, the “pharma bro”? He was castigated for the insane increase in his prices. Or the Epipen scandal a month ago? Those are egregious examples, but people aren’t realizing that _all_ prescription drug prices are increasing. And generics aren’t helping – they sell for less than brand names, but their prices have been going up, and generic drug makers tend to charge the same prices for their drugs as other generic drug makers. It’s not price fixing, since there’s no overt collusion, but the result is the same. Their argument is that most people pay lower prices than list, but that’s just false ingenuousness. Sure your insurance company can negotiate a lower price, but the negotiation begins at the company’s list price. If they triple it, that’s where the negotiations begin. They’ll knock it down at only a 50% increase and pretend they’re doing you a favor. And your insurance company has to pay for that increase. At the same time, hospitals are charging more for their services. The high prices were supposedly justified to pay for uninsured patients, but the prices have gone up even though there are 20 million fewer uninsured. Most hospitals are monopolies these days, with lip service about how it gives a central place to care, but it also means they have a captive audience. Basically, the health care industry is not in business for your health. ---
**Author:** ![jtur88](https://avatars.discourse-cdn.com/v4/letter/j/e9c0ed/32.png) [@jtur88](https://boards.straightdope.com/u/jtur88)\ **Post date:** [November 14, 2016, 7:49pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/47 "2016-11-14T19:49:36Z")
Don’t worry, your friendly USPS mailman will quickly begin packing your mailbox full of alternatives. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [November 14, 2016, 7:49pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/48 "2016-11-14T19:49:37Z")
> [@Lee\_Q](#): > > Exactly this. And some of us live in states that chose NOT to expand Medicaid which has to this day left lots of very poor Americans who can’t afford Obamacare premiums completely uninsured even after passage of the ACA. > \<\>… And all these states (Hint: Dem Governors to the expansion, GOP, wanting to see anything “Obama” fail, refused) all voted for Trump. I do hope they enjoy their pneumonia, TB - and the (anti-vax) kids their Mumps, Measles, and, if they hit gold - Polio! ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [November 14, 2016, 8:15pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/49 "2016-11-14T20:15:46Z")
Here is an example, of the US nightmare: I had VERY nice health insurance - the kind that gets you admitted and have doctors actually WANT to talk with you. I went to an ER Bill presented to insurance company: $2800 Insurance company: You know that Deductible on your policy? We’ll just put this bill against that (at least they credited the full $2800, instead of the amount they would have paid\*) So: I am now personally liable for $2800 for about 30 minutes of work (during which no fewer than THREE doctors found something to say to me\*\*. I call the hospital - “We were expecting the insurance to pay us. What happened?”. Me: “They put it all toward the Deductible”. Hospital: “Yeah, that’s what we figured”. Upshot: They’ll (the hospital, and only the hospital) settle for $600. Actually, for other reasons, I filed bankruptcy. - the usual bill: “Amount Charged:” $2800 “Amount allowed/Negotiated amount:” $1100 “Insurance paid” $1000 “Your Portion: $100” (the insurance company will never pay more than $1100, no matter what. If you don’t have insurance, you get billed for $2800. Many do not realize that is highly negotiable) \*\* - the hospital bill is for the physical structures and (some) equipment. Doctor’s fees, comestibles (fluids, single-use tools, etc) and drugs are EACH separate bills. ER doctors rarely get paid full rates, and often do not get paid at all. When someone with real insurance comes in, they see: PAYDAY at Last! ---
**Author:** ![amarinth](https://avatars.discourse-cdn.com/v4/letter/a/3be4f8/32.png) [@amarinth](https://boards.straightdope.com/u/amarinth)\ **Post date:** [November 14, 2016, 9:47pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/50 "2016-11-14T21:47:47Z")
> [@kambuckta](#): > > Can someone PLEASE explain to this dumb furriner how the American health system works (esp wrt insurance)? Even after being on this board for so many years, it befuddles me totally. > > FTR, I’m an Australian, low-income earner and have no private health insurance. I pay app $500 per year into the public health system (Medicare) via my tax payments. For that, I can see a doctor whenever I wish, be referred to medical specialists as per need, and have surgery also as needed at no extra expense. If I am seriously ill or have been involved in an accident, I will be treated at a world-class medical centre by world-class doctors. > [@puddleglum](#): > > The way it works is: Most people get insurance through their work. This is because the value of insurance is not taxable while salary is. If you don’t have it through work you can buy an individual plan on the open market. ? Just to add a little more - insurance may mean that some, but possibly not all of the costs are taken care of. So, typically, if someone insured wants to see a doctor, they’ll pay a co-pay for the visit (it depends on the insurance plan. Somewhere between $20 & $40 is normal). Then the doctor’s office will bill the insurance company. The insurance company & doctor will come to some kind of conclusion about how much the visit ended up costing. For many services, insurance doesn’t cover any of the costs until the patient has paid a certain amount themselves (“met their deductible”) for the year (anywhere from a few hundred to a few thousand dollars). If the patient hasn’t done that, the doctor will bill the patient for the amount that the doctor & insurance negotiated. If the patient has met the deductible, then, depending on the type of service, insurance covers a certain percent of the costs. The insurance company pays their share, the doctor bills the patient for their share. (Just to add, if you seeing more than one medical professional (e.g., there are multiple doctors or you’re using a lab or visiting a hospital), it’s likely that each one is a separate transaction and will be evaluated and billed separately). So, assuming you’re insured, should you want to see a doctor it could cost anywhere from a few bucks to several thousand, depending on the service, the doctor, the time of year, and type and level of insurance. And you probably won’t know exactly how much until after you get the bill. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [November 14, 2016, 11:19pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/51 "2016-11-14T23:19:48Z")
One thing that would seem to be easy to fix is the ridiculous billing procedure where provides produce fictional bills that are often 10x more than the rates that the pre-negotiated rates that insurance companies actually pay. What drawback or opposition could there be to simply passing legislation that all providers must bill everyone at the same rate for the same service? None of this nonsense of a $10,000 bill when the hospital has agreed to provide the service to an insurance company for $800. It would require some oversight to prevent cheating by calling a substantially identical service something different, but heavy fines should do the trick. ---
**Author:** ![Lee\_Q](https://avatars.discourse-cdn.com/v4/letter/l/aeb1de/32.png) [@Lee\_Q](https://boards.straightdope.com/u/Lee_Q)\ **Post date:** [November 15, 2016, 12:01am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/52 "2016-11-15T00:01:43Z")
> [@usedtobe](#): > > And all these states (Hint: Dem Governors to the expansion, GOP, wanting to see anything “Obama” fail, refused) all voted for Trump. > > I do hope they enjoy their pneumonia, TB - and the (anti-vax) kids their Mumps, Measles, and, if they hit gold - Polio! You are exactly right about the first part. My state is in the south and though it flipped a couple die-hard red counties blue this past gen election, the majority of the state is very red. The GOP governor chose not to expand Medicaid. Many poor adults are in the “coverage gap” and have no insurance at all even with the ACA. Including lots who vote republican, against their own self interest, over and over. A story old as time. ---
**Author:** ![Lee\_Q](https://avatars.discourse-cdn.com/v4/letter/l/aeb1de/32.png) [@Lee\_Q](https://boards.straightdope.com/u/Lee_Q)\ **Post date:** [November 15, 2016, 12:05am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/53 "2016-11-15T00:05:50Z")
> [@usedtobe](#): > > Here is an example, of the US nightmare: > > I had VERY nice health insurance - the kind that gets you admitted and have doctors actually WANT to talk with you. > > I went to an ER > > Bill presented to insurance company: > $2800 > Insurance company: You know that Deductible on your policy? We’ll just put this bill against that (at least they credited the full $2800, instead of the amount they would have paid\*) > > So: I am now personally liable for $2800 for about 30 minutes of work (during which no fewer than THREE doctors found something to say to me\*\*. > > I call the hospital - “We were expecting the insurance to pay us. What happened?”. > Me: “They put it all toward the Deductible”. > Hospital: “Yeah, that’s what we figured”. > > Upshot: They’ll (the hospital, and only the hospital) settle for $600. > > Actually, for other reasons, I filed bankruptcy. > > - the usual bill: > “Amount Charged:” $2800 > “Amount allowed/Negotiated amount:” $1100 > “Insurance paid” $1000 > “Your Portion: $100” > > (the insurance company will never pay more than $1100, no matter what. If you don’t have insurance, you get billed for $2800. Many do not realize that is highly negotiable) > > \*\* - the hospital bill is for the physical structures and (some) equipment. Doctor’s fees, comestibles (fluids, single-use tools, etc) and drugs are EACH separate bills. ER doctors rarely get paid full rates, and often do not get paid at all. When someone with real insurance comes in, they see: PAYDAY at Last! This sucks so bad. But you know what? At least most hospitals and clinics and even some physicians will let you make payments when it’s a high amount like that. In my experience, as long as you stay in contact with them so as not to look like you’re a deadbeat trying to dodge the bill, mostly they’re good about coming up with an amount you can afford to pay each month until it’s paid off. You’re also right that fees can be and often are negotiated, sometimes before the patient even receives the bill. On such bills sometimes there will be a column that shows the “list price” so to speak for a procedure and right next to it a column that says outright “negotiated amount” or similar. Sometimes the difference is very significant. ---
**Author:** ![Battle\_Pope](https://avatars.discourse-cdn.com/v4/letter/b/4bbf92/32.png) [@Battle\_Pope](https://boards.straightdope.com/u/Battle_Pope)\ **Post date:** [November 15, 2016, 12:24am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/54 "2016-11-15T00:24:18Z")
In Australia a doctors visit costs around $70 -$80 where I am. Depending on which doctor you see some are ‘bulk-billing’, that is, everything gets charged to Medicare and you don’t pay anything out of pocket when you see the doctor as long as you have a valid Medicare card. I go to a billing practice, so I pay $75 at the time of the consultation but get about 50% of that refunded within a few days directly to an account of my choosing via Medicare. The main difference in the different type of billing model tends to be that the ‘bulk-billing’ joints are more of a ‘walk-in’, get the next doc available on the list sort of affairs while with a charging practice you tend to have a choice of GP and can continue to see the one you prefer. Most specialist fees or test procedures are covered by a mix of Medicare, private health insurance and on occasion some out-of-pocket expenses. Just FYI - this is the site of one of the bigger private health insurance companies here: [https://www.hcf.com.au/insurance/health/get-a-quote/show-me-packages](https://www.hcf.com.au/insurance/health/get-a-quote/show-me-packages) How does their set-up and results compare to the US if you go through the process of selecting cover? ---
**Author:** ![Cyberhwk](https://avatars.discourse-cdn.com/v4/letter/c/7993a0/32.png) [@Cyberhwk](https://boards.straightdope.com/u/Cyberhwk)\ **Post date:** [November 15, 2016, 5:40am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/55 "2016-11-15T05:40:49Z")
I guess I’ll go back to the policy I had that had 15x the deductible, 7x the OOP Maximum, and zero prescription coverage for the same price. (Not really, I’ll just go without.) ---
**Author:** ![kambuckta](https://avatars.discourse-cdn.com/v4/letter/k/53a042/32.png) [@kambuckta](https://boards.straightdope.com/u/kambuckta)\ **Post date:** [November 15, 2016, 7:12am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/56 "2016-11-15T07:12:17Z")
> [@Battle\_Pope](#): > > The main difference in the different type of billing model tends to be that the ‘bulk-billing’ joints are more of a ‘walk-in’, get the next doc available on the list sort of affairs while with a charging practice you tend to have a choice of GP and can continue to see the one you prefer. I know you said ‘tend’, but with the advent of online booking, it’s dead-easy to see your doc of choice even in a bulk-billing joint. Of course, if it’s more urgent, you’ll get the next available doc regardless, but if it’s urgent I’m sure we don’t actually give a toss who we’re seeing. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [November 15, 2016, 9:23am UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/57 "2016-11-15T09:23:03Z")
I suspect that ACA will largely be left intact, with some changes (including adoption of Medicaid expansion by red states) so the GOP can take credit for it. The alternative would be too disruptive; dissolving ACA now would cause too much anti-GOP anger. Perhaps this is too optimistic, but the GOP claim that they want to repeal Obamacare has always been mainly an anti-Obama publicity campaign. It will be interesting to see how the GOP amends ACA. Most of the good changes would be to make the program even more “progressive,” so Republicans have a real challenge threading this needle! ~ ~ ~ ~ ~ ~ ~ > [@kambuckta](#): > > Can someone PLEASE explain to this dumb furriner how the American health system works (esp wrt insurance)?.. > > I’m an Australian … I pay app $500 per year into the public health system (Medicare) via my tax payments. Is this $500 related to your income? Would you pay more if you earned more, less if you earned less? In that case you are a victim of _ **Marxism** _: “From each according to his abilities; to each according to his needs.” You foreigners are living just like the slaves of North Korea and don’t even know it. Right-thinking Americans know that if you can’t afford a doctor, and your ethnicity appeals to no well-funded charity, then you do not deserve medical care. [/sarcasm] ---
**Author:** ![Translucent\_Daydream](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/translucent_daydream/32/16170_2.png) [@Translucent\_Daydream](https://boards.straightdope.com/u/Translucent_Daydream)\ **Post date:** [November 15, 2016, 5:37pm UTC](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271/58 "2016-11-15T17:37:41Z")
> [@brujaja](#): > > Has anyone mentioned that, if you can’t afford any insurance at all, the federal government confiscates your income tax refund? Do we fill out different tax returns in Oregon than everyone else? There is a box that you check on the form that waives the fee for not having insurance if you couldn’t afford it. We couldn’t afford it last year, so we didn’t have any. We made 60k. The fee was waived for us because we didn’t have the funds to pay 900 a month each foe insurance… Everyone I know in Texas that was uninsured seemed to have to pay this fee and they made a lot less than we did last year. What give [Previous page](https://boards.straightdope.com/t/what-are-peoples-options-to-obtain-health-insurance-if-the-aca-is-repealed/771271.md?page=2)