O-Bummer Care Question (Costco, moving, medical, plan)

[Weichert]

Originally Posted by Robyn55

No - I don't know the answer. Because it varies from person to person - so there are lots of "working parts" to the answer. So who's going to pay for the subsidies in your opinion? Robyn

Like you I am not even eligible for ACA. My primary interest in it is because my daughter is eligible and will be signing up for it before the end of the year. As far as subsidies are concerned I have no idea whether she will receive them or not (as I have no idea what her income is).

As far as who pays for subsidies, I'm sure that you've read as much (and likely a whole lot more) on the subject than I have. I do recognize that it is an issue but I've just not got that far yet.

As you say lots of "working parts" and variability. After this all settles down (after the enrollment period ends) it'll be an interesting subject to review (for me anyway).

[markg91359]

However, it does not prevent insurance companies from raising prices across the board. So "the same premium healthy people pay" is not likely to be the same premium healthy people paid before the ACA, meaning people who already had insurance before the ACA are likely to see premium increases.

Yes, but its better than the alternative of basically throwing people with pre-existing conditions to the wolves. I don't think I'm alone in a belief that if people truly have a condition that is akin to a chronic illness (not something you can say they had a role in causing) that the cost of the illness should be borne by society at large.

Precisely because many of those buying through the exchanges will have pre-existing conditions, their utilization will be higher.

I tend to agree.

The question is whether enough healthy people will buy insurance to offset that. The young and healthy who do not perceive they need insurance often did not buy it even when they could get it cheaply through an employer. Will they see opting out as the cheaper way to go now?

Its no exaggeration to say that the success or failure of the ACA will depend on the ability of the government to get get younger healthy people to sign up. I think a combination of the "carrot and the stick" will likely be required.

I have my doubts that enough in premiums will be collected from the newly insured to pay for the health care the newly insured will be receiving. The money to subsidize premiums for those who cannot pay them also has to come from somewhere, and if the people who are eligible for subsidies also cannot (or just do not) pay their deductibles and copayments, good luck getting doctors to see them. It does no good to have insurance if you cannot find someone to see you.

We'll see. Undoubtedly there will be problems. There already have been problems with the exchange and computer website. No one should lose sight of the fact that we had lots of problems under the old system too which included getting doctors to see some groups of patients. Even a 20% improvement is still an improvement over what we had.

[Robyn55]

Originally Posted by markg91359

Complain all you want to about the ACA. What you aren't getting is that the problems under the old system are what brought it about. Let's talk about some of those problems and how the ACA fixed them.

1. People with pre-existing health conditions couldn't get insurance. This was a huge problem...

...I'm not convinced the exchange, in and of itself, is a sufficient mechanism to contain prices...

I don't know if it was a "huge" problem nationally - but it sure was a headache for me and my husband before we went on Medicare.

But here's where the "don't you care?" stuff comes in. I never saw anyone clamoring to make insurance available/affordable for people like us. Most people kind of understood somewhere deep in their brains that they would have to pay more for their insurance if we were able to get "affordable" insurance too (just like people in Iowa understand that if we get a national windstorm insurance pool - they're going to be paying to subsidize people in Florida). And you can be sure that large numbers of people who have MS (which my husband has) are going to sign up for this.

Now I don't know the economics of most diseases - but I have a general grasp of MS economics. In a nutshell - it is for many people a super expensive disease. And I think many people who were basically sold a bill of goods when it comes to the ACA (the "you can keep your plan if you like it stuff") are slowly waking up to the fact that they will wind up paying more - perhaps a lot more - to cover previously uninsurable people. They're not being asked to "care" in some vague amorphous theoretical "feel good way". They're just having their wallets emptied to pay the bills. Which is a lot tougher to swallow than simply writing "I care" on a message board.

If this is what people bargained for - fine. I suspect it isn't what many people were expecting.

FWIW - I think the number of previously uninsurable expensive people who sign up will wind up costing a lot more than any younger/healthier previously uninsured people who sign up pay into the system. But that of course remains to be seen. Robyn

[Robyn55]

Originally Posted by Weichert

Like you I am not even eligible for ACA. My primary interest in it is because my daughter is eligible and will be signing up for it before the end of the year. As far as subsidies are concerned I have no idea whether she will receive them or not (as I have no idea what her income is).

As far as who pays for subsidies, I'm sure that you've read as much (and likely a whole lot more) on the subject than I have. I do recognize that it is an issue but I've just not got that far yet.

As you say lots of "working parts" and variability. After this all settles down (after the enrollment period ends) it'll be an interesting subject to review (for me anyway).

For some people on Medicare - one interesting "side effect" of the ACA will be its impact on Medicare Advantage plans (the ACA reduces funding in that area). People with MA plans might follow this by following news on one of the big MA companies (like UHC). Robyn

[Robyn55]

Originally Posted by markg91359

Yes, but its better than the alternative of basically throwing people with pre-existing conditions to the wolves. I don't think I'm alone in a belief that if people truly have a condition that is akin to a chronic illness (not something you can say they had a role in causing) that the cost of the illness should be borne by society at large.

Mark - this is a totally slippery slope - the concept of the "innocent sick" versus the "guilty sick". One you should never get on (it's like coming from Miami for your twice a year 1 week ski trip to Utah - and trying to do powder above your knees on black runs ). I mean it's health care acceptable to diss people who smoke (ACA plans are free to charge them up to 50% more than non-smokers). But not alcoholics or drug addicts (the ACA mandates "substance abuse coverage" and they pay the same premiums as everyone else). Note that many alcoholics and drug addicts tend to smoke. Doesn't quite make sense .

And what about if 2 people have a gene that practically insures that their kids will wind up with a super bad disease - and they have kids anyway. Many Rabbis will refuse to sanction a marriage between 2 Jewish people whose kids are likely to have Tay Sachs due to genetic defects. But - if they ignore the Rabbi - is the Tay Sachs kid "guilty" or "innocent"? We could probably wipe out some diseases - like CF - in a couple of generations if people whose genetic make-ups almost guaranteed defective kids. But our society isn't willing to do this (not that people who engage in casual sexual encounters are likely to ask about genes).

Which leads me to STDs. Are people with AIDs "innocent" sick or "guilty" sick. Does it matter whether they got AIDs through a blood transfusion - or they had marital/partner sex with a "steady" who lied to them - or they got AIDs as a result of having unprotected anal sex with 50 different anonymous partners in a "bath house" setting?

Then again - there's obesity - perhaps our most common health problem today. Are these hippos that you see everywhere (at least where I live) today "innocent" sick or "guilty" sick? Whatever - I find them visually revolting.

It's funny - gay people smoke a lot more than straight people (I only realize this because people on the Florida forums complain about not being able to find non-smoking gay bars):

Gays and lesbians more likely to smoke (by quite a bit), study shows | Booster Shots | Los Angeles Times

You can't charge a gay guy who engages in casual anonymous sex more than someone who's monogamous - but you can charge him up to 50% more under the ACA if he smokes. Wonder when I'll see the first lawsuit about that (probably when the first ACA insurance company seeks to rescind an insurance policy based on someone lying on the smoking question)?

Mark - believe me - stay off this slippery slope - it won't get you anywhere. As a smoker who's not an alcoholic or a drug addict or gay - I am vilified - but people who do worse than smoking (at least IMO) are treated like saints. I got used to it a long time ago - and have no personal feelings about it. I just find the hypocrisy amusing at times.

We'll see. Undoubtedly there will be problems. There already have been problems with the exchange and computer website. No one should lose sight of the fact that we had lots of problems under the old system too which included getting doctors to see some groups of patients. Even a 20% improvement is still an improvement over what we had.

Just curious - did *you/family/close friends* have any problems under the old system? My husband and I did to the extent that we paid a lot of money (that we could - knock wood - afford to pay). And we uninsurables would have been delighted to have someone subsidize our health care/insurance more than we were subsidized through our state high risk pool. Although we graciously accepted the subsidies we did receive.

FWIW - the way our state high risk pool worked in later years. Insureds paid 125-150-175% of the average individual policy premiums in our geographical areas - depending on specific diseases/diagnoses/past claims. For excellent PPO coverage (every excellent medical institution in the county and all the mediocre ones too) with a $5 million lifetime limit (hard to get over $5 million without being dead). There were various deductible and co-pay plans. We took the highest - which was basically max $13k/out of pocket per person per year ($10k deductible and 20% co-pays). I left this plan about a year ago - and was paying $600/month.

When I look at the 2014 non-Medicare plans for older people today - well it seems like what I was getting was a relative bargain. In terms of costs and especially in terms of provider network (don't think I could get anywhere near the same benefits/provider network for what I was paying in 2012 when I was 64 if I was 64 in 2014). I do know that our plan ran an annual loss of $5k per plan participant. But still - I assume there are at least some healthy 60 somethings out there who won't be as expensive as the average older person in a high risk pool. Or maybe there aren't? Like I've said - I think I got old in the nick of time <sigh>. Robyn

[Robyn55]

Originally Posted by suzy_q2010

However, it does not prevent insurance companies from raising prices across the board. So "the same premium healthy people pay" is not likely to be the same premium healthy people paid before the ACA, meaning people who already had insurance before the ACA are likely to see premium increases.

Precisely because many of those buying through the exchanges will have pre-existing conditions, their utilization will be higher.

The question is whether enough healthy people will buy insurance to offset that. The young and healthy who do not perceive they need insurance often did not buy it even when they could get it cheaply through an employer. Will they see opting out as the cheaper way to go now?

I have my doubts that enough in premiums will be collected from the newly insured to pay for the health care the newly insured will be receiving. The money to subsidize premiums for those who cannot pay them also has to come from somewhere, and if the people who are eligible for subsidies also cannot (or just do not) pay their deductibles and copayments, good luck getting doctors to see them. It does no good to have insurance if you cannot find someone to see you.

Most of this is just totally obvious to me too.

I think the issue of physician access will vary specialty by specialty - and may depend in part on where you live. Because there are more specialists in some areas of practice/particular places - fewer in others. For example - you can get a consult with the MS specialist here at Mayo JAX in a month or two (MS usually isn't an emergency) - so this is an ok waiting time. If you're trying to get into the "migraine clinic" (something no one in my family has ever had to deal with) - you'll probably be put on a waiting list for a year. My last specialist consult - colorectal surgery - I had to wait about a week or two. No big deal. Robyn

[CA4Now]

Originally Posted by Home_Kid

nobody is saving $$ with ACA. everyone who "can pay" is forced to fork out $$...

What Obamacare Will Cost You « The Dish

[Weichert]

Originally Posted by Robyn55

For some people on Medicare - one interesting "side effect" of the ACA will be its impact on Medicare Advantage plans (the ACA reduces funding in that area). People with MA plans might follow this by following news on one of the big MA companies (like UHC). Robyn

I'm not sure that UHC is a very reliable indicator of whats going on in the MA world. They are not particularly well liked.

Its hard to predict how the interactions of ACA and Advantage plans will play out.

Should MA plans deteriorate to the point that they are no longer an option a lot of people will be in serious trouble. Many retirees simply can not afford the Medigap + drug premiums. If it came to that, millions would only have original Medicare and nothing else. The zero premiums and low copays of the MA plans are what makes it possible for many retirees to have decent comprehensive insurance in many parts of the country.

[Robyn55]

Originally Posted by Weichert

I'm not sure that UHC is a very reliable indicator of whats going on in the MA world. They are not particularly well liked.

Its hard to predict how the interactions of ACA and Advantage plans will play out.

Should MA plans deteriorate to the point that they are no longer an option a lot of people will be in serious trouble. Many retirees simply can not afford the Medigap + drug premiums. If it came to that, millions would only have original Medicare and nothing else. The zero premiums and low copays of the MA plans are what makes it possible for many retirees to have decent comprehensive insurance in many parts of the country.

OTOH - UHC is big (and its Medigap policies seem be welll liked).

I understand what you're saying about MA plans - especially for lower income seniors. They're a good thing for a lot of people - no doubt about it.

Still - I am starting to get a kind of sick feeling in my tummy about the ACA. That one of the primary effects will be to push new ACA insured HMO people - MA advantage people - and Medicaid people - into the same low tier health care system.

So - my advice to seniors would be. Do traditional Medcare/Medigap if you can afford it - for as long as you can afford it. Even if it means giving up a vacation - or an RV - or Christmas presents for your grand kids. Robyn

[Weichert]

Originally Posted by Robyn55

OTOH - UHC is big (and its Medigap policies seem be welll liked).

I understand what you're saying about MA plans - especially for lower income seniors. They're a good thing for a lot of people - no doubt about it.

Still - I am starting to get a kind of sick feeling in my tummy about the ACA. That one of the primary effects will be to push new ACA insured HMO people - MA advantage people - and Medicaid people - into the same low tier health care system.

So - my advice to seniors would be. Do traditional Medcare/Medigap if you can afford it - for as long as you can afford it. Even if it means giving up a vacation - or an RV - or Christmas presents for your grand kids. Robyn

I know. The UHC Medigap is great. Thats what my sister switched to when she retired even though her employer (the state) offered UHC PPO to her with them paying half the copays. Her doctors and the hospital like the UHC Medigap but refuses to take their PPO.

Believe it or not, in some parts of the country Advantage is the plan of choice. There are some Advantage companies that have their regions sewn up (so to speak) completely, all the doctors and hospitals in those regions are in the Advantage HMOs. A far cry from where you live. But there are other places in addition to Jacksonville where Advantage plans just haven't caught on. I really don't know why there is such a diversion in attitude.