US-Politics The Resistible Rise of Donald J. Trump

[A Horse Named Stranger]

The old thread was full and I wanted to name a thread for once.

[TrackerNeil]

Great news about the Affordable Care Act. Despite conservative fear-mongering, young people are deciding to pay for insurance and get something instead of paying the fine and getting nothing. So far, every horror story from the right-wing fever swamp ("No one will pay their premiums!" or "Young people will prefer the fine!" and "The exchanges will raise premiums!") has turned out to be just a story.

[Lany Freelove Cassandra]

To be fair, the exchanges raised our premiums a lot this year (before income based discount).  So much so that we opted for the husband's crappy & expensive coverage (we also lost most of our discount too).

That does not mean I am against it, I still think it is really great, especially for those just above the medicaid cutoff (which is where we were last year)

[Larry of the Lawn]

Glad to hear the ACA is helping some young people get coverage, and while I think it's a big step forward it hasn't done anything for me.  I qualified for some subsidies, still couldn't afford the payments on what was one step above a catastrophic plan.  I know it's not a normal situation but I made a lot more money in 2012 and 2013 than I did in the last two years, and since they base how much you can pay on what you made the year before, I wasn't able to pay an extra $175 a month to maintain the insurance.  So I lost it half-way through last year.  This year I should qualify for Medicaid, but in the meantime I lost a lot of time at work due to a car accident this year.  Even if I had insurance I couldn't have afforded to go to the doctor, mine didn't pay for shit until you pay out $6000 or thereabouts.  Even with the insurance, I still would have been stuck going to the ER for a neck sprain from the car accident, because it's the only place that doesn't make you pay out of pocket.  What good is insurance that only kicks in after you spend $6000 out of pocket?  I guess it's good for preventing bankruptcy, but that's about it.  In the meantime it's just an extra kick in the balls.

So for the last 18 months I've been uninsured.  Honestly the ACA might be the thing that makes me go work for someone else, it's pretty much impossible to afford insurance and be self-employed and making under $30k.  There's just no room for anything to go wrong.  

[NestorMakhnosLovechild]

Great news about the Affordable Care Act. Despite conservative fear-mongering, young people are deciding to pay for insurance and get something instead of paying the fine and getting nothing. So far, every horror story from the right-wing fever swamp ("No one will pay their premiums!" or "Young people will prefer the fine!" and "The exchanges will raise premiums!") has turned out to be just a story.

Uh... Health insurance premiums have increased dramatically across the board as a result of the Affordable Care Act. This is not even in dispute. In fact, this is specifically addressed in the article you linked to, which also links to ANOTHER article by the same author (Sarah Kliff) on why Obamacare premiums are spiking in 2016. From that article:

 

 

No matter how you slice the numbers, Obamacare premiums will rise significantly next year. The Obama administration estimates rates will rise 7.5 percent in 2016, compared with 2 percent in 2015.

Insurance markets are complicated. But the story of Obamacare's 2016 premium increase is actually pretty simple: Many health plans — even those with decades of experience selling insurance — underestimated how sick health law enrollees would be.

This meant that in 2014, many insurers spent more paying out medical bills than members paid in premiums. Premera Blue Cross Blue Shield of Alaska lost $9 million covering just under 8,000 Obamacare enrollees that year. In Colorado, Rocky Mountain HMO found medical bills to be about 36 percent higher than premiums.

Now insurers are raising their rates to make sure premiums do cover claims. In some states, that means double-digit rate hikes.

 

[NestorMakhnosLovechild]

Glad to hear the ACA is helping some young people get coverage, and while I think it's a big step forward it hasn't done anything for me.  I qualified for some subsidies, still couldn't afford the payments on what was one step above a catastrophic plan.  I know it's not a normal situation but I made a lot more money in 2012 and 2013 than I did in the last two years, and since they base how much you can pay on what you made the year before, I wasn't able to pay an extra $175 a month to maintain the insurance.  So I lost it half-way through last year.  This year I should qualify for Medicaid, but in the meantime I lost a lot of time at work due to a car accident this year.  Even if I had insurance I couldn't have afforded to go to the doctor, mine didn't pay for shit until you pay out $6000 or thereabouts.  Even with the insurance, I still would have been stuck going to the ER for a neck sprain from the car accident, because it's the only place that doesn't make you pay out of pocket.  What good is insurance that only kicks in after you spend $6000 out of pocket?  I guess it's good for preventing bankruptcy, but that's about it.  In the meantime it's just an extra kick in the balls.

So for the last 18 months I've been uninsured.  Honestly the ACA might be the thing that makes me go work for someone else, it's pretty much impossible to afford insurance and be self-employed and making under $30k.  There's just no room for anything to go wrong.  

To be clear, the ACA is not "helping" young people get coverage. The ACA is penalizing young people in order to try to compel them to get coverage that they would otherwise not be inclined to get because the insurance industry now NEEDS young, healthy people who are going to pay more into the system into premiums than they will take out in medical care in order to subsidize all of the additional sick people that have been added to the rolls under the Affordable Care Act. 

This is not meant to be a loaded criticism of Obamacare. It's just reality. Forcing young people into getting health coverage that, all things considered, they could really do without, is a part of managing the overall insurance risk pool. But it's not "helping" them do anything. It's basically just taxing young, healthy people to pay for coverage for older, sicker people. Which, again, is not a criticism. 

[Ser Scot A Ellison]

Tracker,

It is as I said.  The ACA addresses the symptom not the problem.  Sharpely rising premiums (thank you Nestor) reflect that the problem is still there the high cost of healthcare.

[TrackerNeil]

Tracker,

It is as I said.  The ACA addresses the symptom not the problem.  Sharpely rising premiums (thank you Nestor) reflect that the problem is still there the high cost of healthcare.

Actually, the ACA does address the rising cost of care; for example, with penalties for readmission. I don't have the data now, but hospital readmissions have gone down since the ACA was enacted. There are other cost-controlling measures in the law, but I certainly agree that more can and should be done. Like most other progressive legislation, the ACA doesn't do everything at once, but it's one hell of a start.

[Ser Scot A Ellison]

Tracker,

Which is why it's just wonderful to face a 7.5% average premimum jump in a year because Health care costs are well under control.

[Bold Barry Whitebeard]

The problem is that health insurance is what causes the high cost in healthcare.  Because health insurance companies lobby to get group discounts, the healthcare industry artificially inflates the price of their services.  That's why, if you look at your health insurance statement, the doctor charges the insurance $1000 and the insurance ends up paying $150 or so, while you kick in your $30 copay or whatever it is.  It works out great for people with insurance, but everyone else gets hosed.

Which is why, a lot of the time, even without insurance you can convince the doctor to lower the price of the service and charge you what they would charge an insurance company.

[Fez]

Glad to hear the ACA is helping some young people get coverage, and while I think it's a big step forward it hasn't done anything for me.  I qualified for some subsidies, still couldn't afford the payments on what was one step above a catastrophic plan.  I know it's not a normal situation but I made a lot more money in 2012 and 2013 than I did in the last two years, and since they base how much you can pay on what you made the year before, I wasn't able to pay an extra $175 a month to maintain the insurance.  So I lost it half-way through last year.  This year I should qualify for Medicaid, but in the meantime I lost a lot of time at work due to a car accident this year.  Even if I had insurance I couldn't have afforded to go to the doctor, mine didn't pay for shit until you pay out $6000 or thereabouts.  Even with the insurance, I still would have been stuck going to the ER for a neck sprain from the car accident, because it's the only place that doesn't make you pay out of pocket.  What good is insurance that only kicks in after you spend $6000 out of pocket?  I guess it's good for preventing bankruptcy, but that's about it.  In the meantime it's just an extra kick in the balls.

So for the last 18 months I've been uninsured.  Honestly the ACA might be the thing that makes me go work for someone else, it's pretty much impossible to afford insurance and be self-employed and making under $30k.  There's just no room for anything to go wrong.  

Depending on your income and number of dependents, its possible the silver-level plan (the one above the bronze-level plans you were looking at) actually would've been cheaper than what you saw. In addition to the subsidies people get directly, there's a separate subsidy, only for silver level plans and only for people with incomes up to 250% of the federal poverty level that goes directly to the insurer to further lower premiums. Also, I'm fairly certain that there's a process to adjust your subsidy amount in advance if you anticipate your annual income to be significantly lower (or higher) than it was the previous year.

[Ser Scot A Ellison]

BBW,

Indeed.  Which is another reason why I have never liked the sop to the Insurance industry that is called the "ACA".

[TrackerNeil]

Tracker,

Which is why it's just wonderful to face a 7.5% average premimum jump in a year because Health care costs are well under control.

Scot, health insurance premiums have always gone up yearly, and the ACA has not accelerated that. Again, more needs to be done, but if you're suggesting that nothing has been done to contain costs, I think you've just got your facts wrong.

[Fez]

Tracker,

Which is why it's just wonderful to face a 7.5% average premimum jump in a year because Health care costs are well under control.

Except premiums didn't go up 7.5% across the board. They went up that amount for people in Obamacare coverage for the very specific reason of those insurers not having the risk pools they thought they would have.

But there's only a small fraction of people actually in Obamacare coverage. Most people are either in employer-sponsored coverage or Medicare or Medicaid. Medicare premiums are flat, Medicaid either doesn't have premiums or its a flat percentage of income (depending on the state), and employer-sponsored premiums only went up 4% on average.

As for overall health care costs, there's a year lag in that. But the 2014 numbers just came out, and they that per capita health care spending increased 4.5% that year; primarily because prescription drug costs (a costs specifically not addressed by Obamacare) increased 12.2%.

[Ser Scot A Ellison]

Tracker,

That's not what I said.  I said costs aren't contained not that nothing has been done to attempt to contain them.  The primary purpose of the ACA is to force people to buy insurance or face penalties.  That, doesn't contain costs and based on increasing premiums it is safe to say the other "cost saving measures" are not working to contain costs.

[TrackerNeil]

Tracker,

That's not what I said.  I said costs aren't contained not that nothing has been done to attempt to contain them.  The primary purpose of the ACA is to force people to buy insurance or face penalties.  That, doesn't contain costs and based on increasing premiums it is safe to say the other "cost saving measures" are not working to contain costs.

There we disagree, but there we'll have to leave it. I'm not defending the ACA to those who just don't like it despite the tons of good it has done, and that's where I think we are now. 

[A Horse Named Stranger]

Well, the problem in the US are sky high prices the health providers in the US charge. 

You want the Affordable healthcare act to be affordable long term. That's where regulating should start.

Though this is more anecdotable, but small story of where the money goes.

 

http://en.chessbase.com/post/astana-salome-melia-a-player-in-need-270313

 

http://en.chessbase.com/post/ketevan-to-be-operated-in-berlin-in-april-310313

 

and conclusion: spoiler happy ending.

 

http://en.chessbase.com/post/ketevan-is-in-great-shape-260813

 

Bottom line is: same procedure performed in Germany costs 60.000 € , performed in the US it costs between 500.000 € up to a milion €.

[NestorMakhnosLovechild]

There we disagree, but there we'll have to leave it. I'm not defending the ACA to those who don't like it despite the tons of good it has done, and that's where I think we are now. 

Of course, what you actually said was that the people who claimed that the ACA would raise premiums were wrong - when in fact they were correct, and premiums are set to increase dramatically in 2016. This isn't about "liking" or "defending" Obamacare. This is about having the intellectual honesty to admit when the real world doesn't conform neatly to hyper-partisan narratives.

Sarah Kliff is a huge booster for Obamacare and has been for years. But at least she has the honesty to admit what's going on, not only with the dramatic rise in insurance premiums under the ACA, but also that overall health insurance plans are getting worse because of it and employees are paying increasingly greater shares of their own health insurance coverage, largely through increases in their deductibles (or at her Vox headline puts it - "health insurance plans are getting crummier.")

Sarah Kliff, Matt Yglesias, and Ezra Klein do a very interesting, very intelligent policy-based podcast through Vox called "The Weeds." Any self respecting liberal should listen to it.They recently did an episode tackling the rise in health insurance premiums as a result of Obamacare, and anyone who is really interested in discussing the issue should listen to it. It's turning out that many of the people signing up for insurance under Obamacare are sicker than anticipated, and have much higher health care utilization than anticipated. Participation in the health care exchanges has already proven to be so bad for UnitedHealth, the nation's largest health insurer, that it is probably going to end up pulling out of them, potentially forcing half a million people to get new coverage.

Now, none of this is necessarily "fatal" to the idea of Obamacare. If you believe that getting health insurance to poor and sick people is a priority, and understand that this comes with sacrifices for everyone else, then fine. But that's NOT the "story" of Obamacare that was sold to the American people. They were not sold Obamacare along with the understanding that, for many of them, their premiums would increase, their deductibles would rise, and they would end up paying MORE of their own insurance costs - not only in absolute terms, but also as a proportion of overall health care spending. Ie: they would pay more for slightly worse plans. Now maybe that's a trade off that we SHOULD be making as a society - but that's not the debate we had. 

[Mr. Chatywin et al.]

BBW,

Indeed.  Which is another reason why I have never liked the sop to the Insurance industry that is called the "ACA".

Agreed. A single payer system with some tort reform would have worked much better.

That said, the real problem with the ACA is Congress. If they could act in a traditional bipartisan way and try to fix the ACA's problems, we would get much better results.

[NestorMakhnosLovechild]

Agreed. A single payer system with some tort reform would have worked much better.

That said, the real problem with the ACA is Congress. If they could act in a traditional bipartisan way and try to fix the ACA's problems, we would get much better results.

The Affordable Care Act is not bipartisan legislation and there is no bipartisan agreement as to how to "fix" it.