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Old 11-05-2013, 05:11 AM
 
Location: Inactive Account
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We've got a few other health insurance threads around, but let's just zero in on this topic. Some people, who are healthy, that had individual catastrophic coverage in 2013 with high deductibles, will probably rationalize along these lines:

"I was paying $zzz a month for something I never planned to use (that is why it is *insurance* after all) and can cover my out of pocket costs. The fine is $yyyy which is much less than [$zzz * 12] per year, so I'll just pay the fine."

At what stage does paying the fine become punitive enough that it no longer makes sense? I'll make a guess that it is about 3 or 4 times the monthly cost of buying new comprehensive coverage.

For example, someone facing a jump in 2014 of $200 to $400 a month on taxable income $50,000 a year a few years from now, when the fine is 3% would either pay a $1500 fine or $4800 a year for insurance. The decision is basically whether to pay $3300 above the $1500 and get insurance or continue going bare.

It's hard to forecast what fraction of the individual market will remain "holdouts" in 2015 and 2016 etc. But I suspect it will be higher than the ACA writers anticipated.
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Old 11-05-2013, 05:17 AM
 
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Going without health insurance is only an option for those who have no assets. If you are "healthy" that can change at any time. I would never go without health insurance as that could be financially devastating to my family.
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Old 11-05-2013, 08:12 AM
 
Location: Containment Area for Relocated Yankees
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You're missing a variable in your calculation. How much are your average out of pocket costs (that you say you can cover)?
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Old 11-05-2013, 09:07 AM
 
Location: Wake Forest, NY
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Amazing. To avoid a fine you have to prove you have insurance. But when voter ID is mentioned to prove you're a legal voter certain groups go nuts.
I had an HSA and a savings account to back it up. I liked the plan I had chosen. Going away. Now I will have maternity coverage and much higher premiums. Awful.
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Old 11-05-2013, 10:09 AM
 
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Quote:
Originally Posted by MB1972 View Post
Going without health insurance is only an option for those who have no assets. If you are "healthy" that can change at any time. I would never go without health insurance as that could be financially devastating to my family.
Well that may be your logic. That may be my logic. But it certainly isn't the logic of a lot of people I know. I worked for a guy that flat said he wouldn't offer health insurance for any of his employees because he and his family were healthy and if we wanted insurance we should marry someone that had it.

And that was a high tech job and he certainly had assets. He liked to bicycle tour Italy while calling us daily to push billables.

I also know people that won't take anything that isn't "natural". One has a bi-polar kid which some would argue is impossible. He is far more likely to kill himself because they won't take him to a medical doctor for the condition (he's 16) nor will they allow treatment with anything that isn't "organic" and btw pretty much believe it's a problem with his faith and not his brain. They have three kids and live in a 2 million dollar house on the beach in Orange County CA.

My point is, there is a lot of logic issues to go around when it comes to health care.
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Old 11-05-2013, 10:45 AM
 
Location: Inactive Account
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There was probably an assumption when the ACA was written, that the individual market is made up of a crowd of people who all lament "If only I could get group, comprehensive insurance". What we're learning now from the various blog post responses, etc is just how varied this market is.

Yes there were some people "trapped" on indivudal plans. But many of these folks were minor entrepreneurs, running fledgeling businesses. They are venting about being punished by the system.

There are people who work in artistic or holistic fields that don't fit neatly into major employment. Ironically many Obama voters would be in that demographic.

I think overall, there are more people in the indivudal market who would rationalize that "Life is inherently a gamble anyway". IE, choosing to run a small independent business is a risk. Choosing to be a photographer or massage therapist is a risk. You know going into those things that they're hard choices, and you could be making financial sacrifices anyway just to persue the occupantion that you want.

People with these mindsets, could have their own "logic" that defies what was expected in the next few years.
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Old 11-05-2013, 11:53 AM
 
Location: Containment Area for Relocated Yankees
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Quote:
Originally Posted by Sean_CLT View Post
There was probably an assumption when the ACA was written, that the individual market is made up of a crowd of people who all lament "If only I could get group, comprehensive insurance". What we're learning now from the various blog post responses, etc is just how varied this market is.

Yes there were some people "trapped" on indivudal plans. But many of these folks were minor entrepreneurs, running fledgeling businesses. They are venting about being punished by the system.

There are people who work in artistic or holistic fields that don't fit neatly into major employment. Ironically many Obama voters would be in that demographic.

I think overall, there are more people in the indivudal market who would rationalize that "Life is inherently a gamble anyway". IE, choosing to run a small independent business is a risk. Choosing to be a photographer or massage therapist is a risk. You know going into those things that they're hard choices, and you could be making financial sacrifices anyway just to persue the occupantion that you want.

People with these mindsets, could have their own "logic" that defies what was expected in the next few years.
Actually, I think the assumption was that the majority of the uninsured population wished to be insured, but they couldn't get insurance due either to cost or pre-existing conditions. So the ACA solved that for them. However, it also had to account for the (larger than they may have expected) population of uninsured who are healthy enough (and young enough) to voluntarily go without insurance. Unfortunately, an unhealthy risk pool generally yields higher costs/premiums. So if you only have the majority (the cost/pre-existing conditions crowd) signing up, your risk pool will suck and costs will remain high for everyone. So you need to force the healthy/young to join the risk pool to bring the costs down. Problem is that they didn't make the penalty high enough to achieve their objective.*

Back to my previous question -- what do you budget for out of pocket costs? Because you need to factor that into your equation to really be able to do a risk analysis.

*I am arguing neither for nor against the ACA. Merely stating how it works.
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Old 11-05-2013, 01:13 PM
 
5,150 posts, read 6,639,298 times
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Originally Posted by WorkingMomof2 View Post
Back to my previous question -- what do you budget for out of pocket costs? Because you need to factor that into your equation to really be able to do a risk analysis.
Which is a good question with the reports about limited hospital access in some states. We don't have that problem here in NC because we have a limited ACA choice to begin with. Certainly nothing to brag about ours being better when the effect is still the same. Only a couple of companies can give you broad access because we only have two companies and less in some situations.

Big Pharama also seemed to have been in play regarding costs. They fought pretty hard to make sure more branded drugs were available and according to reports a lot of the staffers now work for them.

I think I would have liked to seen something inbetween. More than just catastrophic coverage but less as far as what you have to have.

Ugh, I haven't checked the other thread to see if real world examples are coming in for NC since it started to go political. I guess I need to.
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Old 11-05-2013, 03:40 PM
Status: "On The Lookout" (set 23 days ago)
 
Location: The Triad (NC)
28,396 posts, read 61,765,972 times
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Quote:
Originally Posted by WorkingMomof2 View Post
Back to my previous question -- what do you budget for out of pocket costs?
Exclusive of dental and optical (where most actually have treatment and Rx costs)...
unless you have a condition of some sort most people won't have ANY out of pocket costs.

eg: In the last 5 years I've had a grand total of $200 in medical costs.
(and I'm not an invincible 20 something by a long shot)
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Old 11-05-2013, 04:38 PM
 
Location: Inactive Account
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Well I'd admit not knowing much about individual plans. In my life I was always either full time employed and covered, or part-time employed/unemployed and going bare.

Just seems to me there are many untested assumptions in the ACA. Economics is the "dismal science" because people don't make *predictable* decisions.

Some will say "Oh what a horrible waste of money to pay the fine and get nothing for it; I guess I'll have buy the insurance, like it or not..." Others will say "Insurance is such a racket, they always find a way to deny claims, why bother with the charade of paying in at all..."

As time ticks down, we'll start seeing more ancedotes though.
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