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There are 100's of studies out there that do show that getting preventive care is actually less expensive in the long run, thus the coverage under the ACA. If you can catch someone's high blood pressure before they have a heart attack and stroke will cost far, far less than the care for either of those. Taking a $4/month pill is way better than paying for 6 weeks in the ICU.
The issue isn't getting the care you want/need, the issue is no one wants to pay for it. The high deductible plans address this and are doing their "job" helping to control costs. As more and more companies and individuals move to these plans, you will see costs go down. I'm already seeing that with my corporate accounts. Every single company I work with that has elected to go primarily or totally to tax qualified HD plans, has seen their premiums level off over the past few years and a good portion of those are seeing premium decreases as their claims experience improves. Everyone hates the plans at first, but as they build up funds in their HSA's and use their plans more wisely they slowly come around. So now, instead of running to the ER every time their child coughs, they give it a day or two and see what happens. Usually it's a cold and they don't need medical care. That first $1500 bill for going to the ER with a sinus infection usually is a reality check for them as well.
I don't know anyone that understands how insurance works that though that the ACA would provide care at a lower cost. That was really not the point of the ACA anyway. The point was to get everyone on an insurance plan so they are not sucking up resources by not having coverage and providers having to write off huge medical bills. The problem was the pricing of the ACA plans from the start. If insurance companies priced the plans out according to what the actuarial tables really said, well.....we are now seeing the consequences of that--with the co-ops going out of business because they did not plan ahead or just flat out competition and market conditions forcing other companies out. United Health Care took a 700,000,000 loss last year because of the pricing model for their Marketplace plans. That's just not sustainable. So, either the user cost share goes up or companies pull out. People whining about a $5000 deductible, well, you do have a choice and can take a higher cost plan for a lower deductible...but those usually end up costing more in the long run, not to mention, how often do you REALLY spend that much on medical care in a year....
I was just talking to someone yesterday, she was trying to figure out which insurance plan she should take. Her company offered 3 different plans. She was leaning toward the plan with the lower deductible, but at a much higher premium. We did the math and the "lower cost" plan in her mind, the one with the lower deductible, really would cost her $1500/year more....not including the tax savings she would have gotten on the higher deductible plan. The overall out of pocket max on that plan was only $500 LESS than the higher deductible plan too but the premiums were $2000 more. She was willing to spend $1500/year more, so her deductible was lower...still makes NO sense to me at all, but I see this line of thought every single day...
The President indeed told us that the cost of insurance would be less. Anyone with a grain of sense knew that was a lie. It does not take a genius to know that insuring the formerly uninsurable - those who had chronic illnesses that meant they could not get insurance at all or only at outrageous rates - would not be cheap. Those are not people who are only going to have one wellness visit a year. They had problems that had not been addressed over long periods of time.
High deductibles do discourage utilization, but sometimes that keeps sick people from seeing a doctor. They work great for people who never even see a doctor, though, or only get the "free" visits. We are not just seeing $5000 deductibles, we are seeing $10K deductibles - and those do not come with cheap premiums, either. For some people, that is totally unaffordable. The option of a low premium with a high deductible for catastrophic coverage pretty much does not exist any more. There are people willing to pay for preventive care and routine office visits out of pocket.
In addition, young healthy people are still not buying insurance. They would rather pay the penalty. Those were the premiums the insurance companies needed to offset the increased utilization by new enrollees with problems and high utilization.
Suzy and Qwerty - Thank you both for this sober intelligent assessment of the situation - free of name calling or rants. I find it very refreshing.
On my part - I don't understand why insurance companies like UHC seem to have been blind-sided. Especially by the previously uninsurable becoming insured. Had I been in their shoes - I would have taken a hard look at the history of state high-risk health insurance pools. I'm not familiar with all of them - but I'm very familiar with the one in Florida. Because my husband and I were in it for 15+ years.
One could join the pool if 2 regular insurance companies turned you down. Premiums were based on 3 risk classes. The "healthiest" members paid 125% of premiums people their age paid. Next tier was 150%. Third was 175%. The lowest deductible was never less than $1k - and rose to $5k at some point (our deductible was always $10k). I don't recall exactly when the pool was started. The 1970's IIRC. But it was in deep trouble by the early 1990's. Because - even with the relatively high deductibles - and the relatively high premiums (ours were on the order of about $400/month) - the insureds were costing much more than they paid in in premiums.
In Florida - these losses were passed on to health insurance companies doing business in the state. Which - in turn - passed them on to their customers. Which - in turn - raised the cost of insurance for everyone. Various groups - especially the Chamber of Commerce - objected. And - in the 1990's - got legislation passed that closed the pool to new enrollment.
My husband and I stayed in the pool until we went on Medicare. And watched the number of plan participants dwindle over the years. By the time we left - there were only a few hundred people left in the plan. Who were costing an average of $10k more/person than they were paying in premiums. This certainly isn't a large enough sample to reach a positive conclusion about anything - but it sure is a big yellow light IMO.
BTW - I'm in the middle of watching a panel discussion about UHC/the ACA on CNBC now. And the panel members are making a few points. First is that getting those young healthy people into the pools is absolutely essential. OTOH - no one mentioned that the penalties have no teeth in terms of enforcement (they can only be taken out of income tax refunds). So - to make any progress in this area - the enforcement mechanisms have to be beefed up. Second is that the health care model that seems to be working better than others is the Medicaid HMO model. Very limited networks - limited drug formularies - etc. Being forced into a health care system like this will - IMO - be a rude shock for people who are used to more conventional systems - like regular PPOs.
I don't have any great solutions to these problems. But - on my part - suspect that some of the issues we're seeing when it comes to people who aren't on Medicare will start appearing in/affecting the Medicare arena too. I also think that whatever those retirement calculators tell us about retirement health care costs - they are probably underestimating what we'll be paying down the road. Robyn
The President indeed told us that the cost of insurance would be less. Anyone with a grain of sense knew that was a lie. It does not take a genius to know that insuring the formerly uninsurable - those who had chronic illnesses that meant they could not get insurance at all or only at outrageous rates - would not be cheap. Those are not people who are only going to have one wellness visit a year. They had problems that had not been addressed over long periods of time.
High deductibles do discourage utilization, but sometimes that keeps sick people from seeing a doctor. They work great for people who never even see a doctor, though, or only get the "free" visits. We are not just seeing $5000 deductibles, we are seeing $10K deductibles - and those do not come with cheap premiums, either. For some people, that is totally unaffordable. The option of a low premium with a high deductible for catastrophic coverage pretty much does not exist any more. There are people willing to pay for preventive care and routine office visits out of pocket.
In addition, young healthy people are still not buying insurance. They would rather pay the penalty. Those were the premiums the insurance companies needed to offset the increased utilization by new enrollees with problems and high utilization.
I'm really sick of people saying that Obama lied. He didn't lie. Yes, he was misinformed and should not have said that but it's not the same as lying. The entire insurance industry took a collective gasp when he said that.....just like when Bush said they were at war with terrorist after 9/11....because that would free insurance companies from having to pay death benefits on life insurance policies because they don't cover acts of war...which did not happen, but we were not officially at war so did Bush lie too???
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Originally Posted by Robyn55
Suzy and Qwerty - Thank you both for this sober intelligent assessment of the situation - free of name calling or rants. I find it very refreshing.
On my part - I don't understand why insurance companies like UHC seem to have been blind-sided. Especially by the previously uninsurable becoming insured. Had I been in their shoes - I would have taken a hard look at the history of state high-risk health insurance pools. I'm not familiar with all of them - but I'm very familiar with the one in Florida. Because my husband and I were in it for 15+ years.
One could join the pool if 2 regular insurance companies turned you down. Premiums were based on 3 risk classes. The "healthiest" members paid 125% of premiums people their age paid. Next tier was 150%. Third was 175%. The lowest deductible was never less than $1k - and rose to $5k at some point (our deductible was always $10k). I don't recall exactly when the pool was started. The 1970's IIRC. But it was in deep trouble by the early 1990's. Because - even with the relatively high deductibles - and the relatively high premiums (ours were on the order of about $400/month) - the insureds were costing much more than they paid in in premiums.
In Florida - these losses were passed on to health insurance companies doing business in the state. Which - in turn - passed them on to their customers. Which - in turn - raised the cost of insurance for everyone. Various groups - especially the Chamber of Commerce - objected. And - in the 1990's - got legislation passed that closed the pool to new enrollment.
My husband and I stayed in the pool until we went on Medicare. And watched the number of plan participants dwindle over the years. By the time we left - there were only a few hundred people left in the plan. Who were costing an average of $10k more/person than they were paying in premiums. This certainly isn't a large enough sample to reach a positive conclusion about anything - but it sure is a big yellow light IMO.
BTW - I'm in the middle of watching a panel discussion about UHC/the ACA on CNBC now. And the panel members are making a few points. First is that getting those young healthy people into the pools is absolutely essential. OTOH - no one mentioned that the penalties have no teeth in terms of enforcement (they can only be taken out of income tax refunds). So - to make any progress in this area - the enforcement mechanisms have to be beefed up. Second is that the health care model that seems to be working better than others is the Medicaid HMO model. Very limited networks - limited drug formularies - etc. Being forced into a health care system like this will - IMO - be a rude shock for people who are used to more conventional systems - like regular PPOs.
I don't have any great solutions to these problems. But - on my part - suspect that some of the issues we're seeing when it comes to people who aren't on Medicare will start appearing in/affecting the Medicare arena too. I also think that whatever those retirement calculators tell us about retirement health care costs - they are probably underestimating what we'll be paying down the road. Robyn
I don't know that UHC was blindsided.....
I think there were some issues across the board when so many states opted not to expand Medicaid, that did hurt some projections. Also, I think there were some miscalculations on how many healthy people would forgo insurance totally.
I'm really sick of people saying that Obama lied. He didn't lie. Yes, he was misinformed and should not have said that but it's not the same as lying.
That is the big problem with the ACA. The people who passed it did not know what was in it. It is the responsibility of the President to be informed before he opens his mouth.
Quote:
The entire insurance industry took a collective gasp when he said that.....just like when Bush said they were at war with terrorist after 9/11....because that would free insurance companies from having to pay death benefits on life insurance policies because they don't cover acts of war...which did not happen, but we were not officially at war so did Bush lie too???
I believe we are at war with terrorism. Do you not think so? I take it in the metaphorical sense that I believe Bush intended.
Quote:
I don't know that UHC was blindsided.....
I think there were some issues across the board when so many states opted not to expand Medicaid, that did hurt some projections. Also, I think there were some miscalculations on how many healthy people would forgo insurance totally.
Yes, the ACA created lots of unintended consequences. I do think that many were predictable. The states that decided not to expand Medicaid were concerned about the costs down the road. I think they are being proved right to have those concerns.
Many of the people who are not buying insurance are in the same demographic as those who could have bought it before the ACA and chose not to do so: young folks who feel invulnerable.
...Yes, the ACA created lots of unintended consequences. I do think that many were predictable. The states that decided not to expand Medicaid were concerned about the costs down the road. I think they are being proved right to have those concerns.
Florida was one of the states that rejected Medicaid expansion. Even with that rejection - Medicaid now accounts for over 30% of all state spending. It is the #1 expenditure in the state (education used to be #1 and is now #2). Robyn
That is the big problem with the ACA. The people who passed it did not know what was in it. It is the responsibility of the President to be informed before he opens his mouth.
I believe we are at war with terrorism. Do you not think so? I take it in the metaphorical sense that I believe Bush intended.
Yes, the ACA created lots of unintended consequences. I do think that many were predictable. The states that decided not to expand Medicaid were concerned about the costs down the road. I think they are being proved right to have those concerns.
Many of the people who are not buying insurance are in the same demographic as those who could have bought it before the ACA and chose not to do so: young folks who feel invulnerable.
The point you missed was that if the President declares war (which really takes an act of congress...) deaths as a result of that war are no longer covered under any life insurance policy--so, in this case the 9000 people that died as a result of the 9/11 attacks no long had life insurance....again, Bush misspoke. He can't declare war, it's not a lie, just a statement, just like Obama and what he said about health insurance.....and keep in mind, health insurance IS costing most people less....even if you don't happen to be one of those people...
The point you missed was that if the President declares war (which really takes an act of congress...) deaths as a result of that war are no longer covered under any life insurance policy--so, in this case the 9000 people that died as a result of the 9/11 attacks no long had life insurance....again, Bush misspoke. He can't declare war, it's not a lie, just a statement, just like Obama and what he said about health insurance.....and keep in mind, health insurance IS costing most people less....even if you don't happen to be one of those people...
I know what you meant. Obama had ample opportunity to inform himself about the ACA and did not. That means he was either incompetent or deliberately misleading.
I do not think Bush misspoke. He was not referring to a declared war. What he meant was akin to the "war on drugs." I really doubt the insurance industry thought differently.
The ACA is costing some people less, but not most of them. Those with employer group plans are hurting less, but those who are not eligible for subsidies and who were buying individual plans before are now having to buy individual plans with features they do not need and are seeing higher premiums and deductibles.
I know what you meant. Obama had ample opportunity to inform himself about the ACA and did not. That means he was either incompetent or deliberately misleading.
I do not think Bush misspoke. He was not referring to a declared war. What he meant was akin to the "war on drugs." I really doubt the insurance industry thought differently.
The ACA is costing some people less, but not most of them. Those with employer group plans are hurting less, but those who are not eligible for subsidies and who were buying individual plans before are now having to buy individual plans with features they do not need and are seeing higher premiums and deductibles.
Ok ,so Bush can talk off the cuff, but Obama can not....hummmm.
Overall insurance premiums have go up FAR less than they were going up pre ACA, historical rates have been referenced before. Up until the adoption of the ACA and really up until the widespread use of tax qualified HD plan, premiums were going up by double digits every year. I think if you really look at the data, SOME plans have gone up by more than 10% but MOST plans have had single digit increases or LESS. Even those plans that have had larger increases are STILL lower cost than most plans nationally.
Ok ,so Bush can talk off the cuff, but Obama can not....hummmm.
Overall insurance premiums have go up FAR less than they were going up pre ACA, historical rates have been referenced before. Up until the adoption of the ACA and really up until the widespread use of tax qualified HD plan, premiums were going up by double digits every year. I think if you really look at the data, SOME plans have gone up by more than 10% but MOST plans have had single digit increases or LESS. Even those plans that have had larger increases are STILL lower cost than most plans nationally.
No, Bush never said that the US had formally declared war on anyone. Any assumption on the part of life insurance companies that he meant that the US had formally declared war was wishful thinking on the part of their execs. Obama stated that we could keep our old insurance plans if we wanted to (We could not, because they were non-compliant with the ACA) and that insurance would be cheaper (It's not, when you factor in 5 digit deductibles for some families). The two situations are not analagous. Obama either knew what he said was not true or he did not do his due diligence before he said what he did. Either reveals his incompetence as far as the ACA is concerned.
Your link does not factor in deductibles.
Prior to the ACA the people with high deductibles were mainly those with HSAs. Now pretty much everyone has deductibles much, much higher than before. That is in addition to co-payments for office visits. To get "low" premiums, you have to accept those very high deductibles. The total out of pocket for many families is much higher than it was before the ACA. People are skipping care because of high deductibles.
No, Bush never said that the US had formally declared war on anyone. Any assumption on the part of life insurance companies that he meant that the US had formally declared war was wishful thinking on the part of their execs. Obama stated that we could keep our old insurance plans if we wanted to (We could not, because they were non-compliant with the ACA) and that insurance would be cheaper (It's not, when you factor in 5 digit deductibles for some families). The two situations are not analagous. Obama either knew what he said was not true or he did not do his due diligence before he said what he did. Either reveals his incompetence as far as the ACA is concerned.
Your link does not factor in deductibles.
Prior to the ACA the people with high deductibles were mainly those with HSAs. Now pretty much everyone has deductibles much, much higher than before. That is in addition to co-payments for office visits. To get "low" premiums, you have to accept those very high deductibles. The total out of pocket for many families is much higher than it was before the ACA. People are skipping care because of high deductibles.
That is absolutely NOT true at all. Very few private plans, pre ACA, were HSA qualified plans. In my state, those OOP max, pre ACA, for many of the low cost individual plans were in the $35,000 range. There were NO limits on how much that could be and they all had $1,000,000 lifetime limits. Have cancer, your bills are $2,000,000..sorry you get $1,000,000 of BILLED expenses covered, the rest is on you, after your OOP max and deductible, which usually meant you paid $12,000 and then another $35,000. Sure, your premium might have been $70/month, but you also had a $12,000 deductible and a $35,000 OOP max.....so, tell me again how this cost less???? Yes, you could pay more for a plan with lower deductibles, but that is not what we are talking about, right?
I'm working with a group right now, they offer a minimal essential plan, first group I've worked with that has a plan like this. We tried to council them out of doing this but their employees want a "cheap" plan...well, they got it, for $40/month/individual they get their annual physical and a list of preventive screenings..and that is it. If they go into the hospital, they pay 100% of the cost, if they go to the doctor for a broken arm, 100% of the cost. Now they can upgrade this plan and get 3 office visits covered at 100% and emergency only hospital care covered with a $4000 deductible, but that is only for defined emergencies, heart attack, stroke, etc., need your gall bladder out, sorry going to cost you 100% of the charges. So, if your plan pays for any more than these basics, you are paying for extra coverage.....
Also keep in mind, RARELY do people reach their OOP max. It is meant as a stop gap, not to be "cheap".
As for your article--"people are skipping check ups"...annual physicals are covered at 100%, families making $70,000/year but can't save money for out of pocket medical costs. The average middle class person is making 53K but has less than 6000 in savings....this is not the fault of insurance or the ACA......not to mention that the drop of using the hospitals is a goal and cost contaiment...you don't need to go to the hospital (ER) for an ear infection, same with office visits, many of those visits were unnecessary visits for things like the common cold. It's a good thing....One woman that didn't get her blood pressure medicine for 3 months because of her deductible--how about talking to your dr about alternative meds that are generic that will work...and cost you $10 for those 3 months???? You can twist the numbers any way you want I guess though. You would be surprised at how many people think that if you have a $2500 deductible think they have to pay $2500 before they get ANY care....and don't understand that if you have a co-pay, that is all you pay for that medicine or that if the medicine only costs $10 that is all you pay. A LOT of people think that if they have a $2500 deductible that they will pay the pharmacist $2500 for that medication....seriously....I talk with people every day that think that...and people that have posted here with the same question.
I love the quote about the dr that runs a free medical clinic stating that since the ACA, most of his patients are on Medicaid...well, surprise, surprise, the ACA allowed them to get low cost insurance through Medicaid in many states. The article is just......not very well researched.
Last edited by Qwerty; 11-23-2015 at 03:58 AM..
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