Affordable Care Act Scare!

http://vitals.nbcnews.com/_news/2013/05/24/18470487-california-reveals-prices-for-health-insurance-under-obamacare?lite

Lol, who could have guessed that? Guess everyone's premiums won't be going down as promised

wait, you mean we were misled?

shocking.

Well from my perspective this is actually a much larger systemic question. Insurance companies work out rates individually with every provider in the area currently. If there are universal rates, or rates based on quality of service, then that would impact the cost of coverage just as much if not more than the quantity of services provided.

Really there is no easy answer how to pay for high risk individuals, but should they not have to pay more since they are higher risk? Insurance pools risk, the most risky should have to pay more vs having a universal rate.

-In 2002, the 5 percent of people with the greatest health care expenses in the U.S. population spent 49 percent of the overall health care dollar.
-The lower 50 percent of spenders accounted for 3 percent of the total national health care dollar.
-The proportion of spenders who remained among the top 1% of spenders for two years in a row doubled between 1996-97 and 2002-03.
-The five most expensive health conditions are heart disease, cancer, trauma, mental disorders, and pulmonary disorders.
(Source: http://www.ahrq.gov/research/findings/factsheets/costs/expriach/index.html)

The belief is that providing people with comprehensive health coverage many of these conditions can be caught earlier, allowing for treatment and lower overall costs. When things like (some) mental disorders, cancer, and heart disease are caught in the early stages they can be largely prevented from advancing to the advanced stages that send people out on disability and compounding into larger health problems.
For example, catching early high blood pressure and pairing it with case management can help someone get it under control with inexpensive medication and lifestyle changes before it becomes a chronic problem that leads to expensive surgeries.

http://vitals.nbcnews.com/_news/2013/05/24/18470487-california-reveals-prices-for-health-insurance-under-obamacare?lite

From the article:
*************
In California, a 40-year-old who makes less than four times the federal poverty level - that is, $95,000 for a family of four or $46,000 for an individual - would pay as little as $40 per month for a mid-level plan in which about 70 percent of medical costs and all preventive care is covered. This excludes additional costs to cover children or a spouse.

The same plan for a person who makes too much to qualify for a subsidy would run about $300 per month on average, the state said. In addition, the total amount consumers would have to pay each year for co-payments and other out of pocket costs would be limited to $6,350 or less, depending on income.

Patients could choose plans that offer lower co-pays if they wished, but would pay higher premiums. In some cases, particularly for low and moderate income workers in their 20s, the premiums are free once a federal subsidy is factored in.
*****************

Maybe you need to move to super expensive CA?

I think we would be better off doing the following:

1) Securing the border
2) Auditing all forms of current government health care (Medicaid, Medicare, etc.) for fraud, waste, and abuse.
3) Limiting lawsuits

It seems the AHCA is more about governmental control than any real health care reform.


Remember, "we have to pass it to find out what's in it."

The more we find out, the more we need a do-over.

You're a second grade teacher. That is a great profession (that I wouldn't have the patience for). So what experience do you have to say "the AHCA is more about governmental control than any real health care reform."?
Have you spent hours reading the ACA? Have you spoken to politicians or asked questions of your lawmakers?
Have you read fearmongering blogs and message boards like this one?

Well from my perspective this is actually a much larger systemic question. Insurance companies work out rates individually with every provider in the area currently. If there are universal rates, or rates based on quality of service, then that would impact the cost of coverage just as much if not more than the quantity of services provided.

Really there is no easy answer how to pay for high risk individuals, but should they not have to pay more since they are higher risk? Insurance pools risk, the most risky should have to pay more vs having a universal rate.

-In 2002, the 5 percent of people with the greatest health care expenses in the U.S. population spent 49 percent of the overall health care dollar.
-The lower 50 percent of spenders accounted for 3 percent of the total national health care dollar.
-The proportion of spenders who remained among the top 1% of spenders for two years in a row doubled between 1996-97 and 2002-03.
-The five most expensive health conditions are heart disease, cancer, trauma, mental disorders, and pulmonary disorders.
(Source: http://www.ahrq.gov/research/findings/factsheets/costs/expriach/index.html)

The belief is that providing people with comprehensive health coverage many of these conditions can be caught earlier, allowing for treatment and lower overall costs. When things like (some) mental disorders, cancer, and heart disease are caught in the early stages they can be largely prevented from advancing to the advanced stages that send people out on disability and compounding into larger health problems.
For example, catching early high blood pressure and pairing it with case management can help someone get it under control with inexpensive medication and lifestyle changes before it becomes a chronic problem that leads to expensive surgeries.

There is a lot of merit to that argument of prevention and early detection saving money in the long term, but also what do you think of the moral hazard of having more people covered?

There is always a moral hazard, and that will have to be accounted for. Once again, I think that may be a larger question, and I really don't have a good answer for that one off the top of my head.

IBTL!










Because this won't end well.

Right there with ya

This whole healthcare debate is so flawed. People confuse health INSURANCE for health CARE. They are NOT the same. Many people, especially in the US, receive excellent health CARE without the benefit of health INSURANCE. An insurance card does not heal you when you are sick - doctors and medicine do that. Insurance is merely a means of payment for care that has been received.

The US has by far the most cutting edge medicine and medical technologies, and the most well-trained physicians in the world, particularly with regard to specialists. The majority of the most highly-regarded hospitals in almost every specialty are in the US. The US is responsible for the majority of the miracles of modern medicine that benefit the entire world, even though the US only comprises only 5% of the world's total population. There is no question that the health CARE in the US is the best.

Now with regard to health INSURANCE, which is an absolute DEBACLE in the US, there are tons of things that could be done to make the system better, but the "Affordable Care Act" did almost NONE of them.

I agree with you 100%

I am shocked that anyone thought this was going to be "affordable". Think about it.

Actually I live in MA, we've had to have insurance for years and, though there are some flaws, overall it has lead to a higher quality of health and availability of care to residents.

I agree that quality of health has likely improved for the general population and availability of care, but then there are the folks (like me) who are stuck in the middle.

Health Insurance is still not affordable to me. In fact, since the MA Health Reform has gone into effect I have barely had health insurance. I got insurance when I was under 26 because it was $100/mo (when I was pregnant I also had HI.) After my son was born I lost my insurance because I couldn't afford the premiums. I have also not been penalized for not having insurance, as they fine come tax time if you don't have it. This is because they acknowledge the fact that I am unable to afford health insurance on my own but also that I make too much money to qualify for subsidized insurance through the state. I feel as if I'm in a loophole of "It's okay if YOU don't have insurance, but all these other people have to have it."

Believe me, I would like to have affordable health insurance for me and my family. My son goes to doctor's visits on schedule for which I pay out of pocket. And yes, I pay all my medical bills. Thankfully we haven't had any serious problems healthwise, but if we did, I would be lost. Sadly, I've had to convince myself that paying for 2 dentist visits and 1 well child visit for him is much better than 10% of my salary going to (possibly unused) health insurance instead of food, nice housing, etc.

I agree with the poster above- Yes we have great health care, but our health insurance system is seriously flawed.

End rant I suppose.

This is nothing new. Back in 2007, if we wanted health insurance - both hubby and I were 1099 - we would have had to pay over $1000/mo. After they denied a $3000 surgery, we opted out of health insurance. Why would we pay $10,000 per year to have them deny a $3,000 surgery?

I gave up being a 1099 so I could have health insurance, life insurance and retirement. Sometimes the "dream" of being self employed is actually a nightmare.

And that's what's even worse, say I have insurance, they can still deny coverage of certain treatment. If they don't cover services I need, what am I paying these premiums for? That's too bad you had to give up being self employed.