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The others that are "subsidized" are all the state, local, and federal employees that have absolutely no empathy with those who are paying their way in total! They also see no need to change a system that is benevolent to them.
I don't know what you're basing this on, but I live in New York, a blue state if ever there was one, and here all state, and many county and municipal employees are unionized. Many of these workers get their health coverage through their unions, not their employer. Unions have increasingly viewed health benefits as the cash cow. Limited drug benefits, narrow lists of providers, those were true of some union plans far before the ACA. Many union plans are "grandfathered" so they were able to keep their limited drug benefits even though the ACA brought broader protections for those getting their coverage through the exchange.
I regularly see and help state and city workers who turn down their union-provided plans to get better coverage through the exchange, even though it means that they will not be eligible for subsidies. Don't think they'd be doing that if their coverage was as good as you perceive it to be.
He can stay healthy and still have huge medical bills...fall down the stairs will cost more than the $1000 difference just to put a cast on your broken arm....
Having a kidney stone made me realize anything can happen at anytime, no matter how healthy you think you are. A lithotripsy treatment alone can cost more than a couple of years worth of premiums.
While there are many factors that contribute to the high cost, I would contend that the lack of "real" competition is one of the major reasons. The ACA will not change this. As an owner of multiple businesses in different economic sectors the cost of insurance was always an issue. We often had to switch providers every year or two to contain costs. However, with the advent of the ACA my costs have skyrocketed and I've been left with fewer alternatives/choices.
Now for those who believe that not having insurance is an option, that is nothing more than foolishnes. My daughter was between jobs a few years back and only had a couple weeks gap in insurance coverage. She decided to risk it. During that time, her 4 year old son came down with viral encephalitis. The bill was way into 6 figures. Now she is lucky from the standpoint that she is a very high earner, nonetheless she had to pay for this out of pocket, something that would have financially ruined most people.
I appreciate you understanding the importance of having health insurance. However, I think as long as we on things like "competition" and "market forces" we will never solve the dilemma with health care costs and health insurance. Insurance company profits are one factor in increasing the cost of health insurance, but the one I have alluded to over and over again is simply the fact that health care itself in this country is too damn expensive. There are a lot of reasons for it: 1. The fact that when we need medical care we are not in a position to bargain for it or to shop with different providers; 2. The fact that health care options in many communities in this country are limited to one or two hospitals and a small group of physicians; 3. The fact that the technology going into medicine is the latest and greatest (and therefore the most expensive); 4. Unrealistic expectations on the part of the public to receive perfect, or near perfect care; and 5. High salaries among all those who work in the health care field.
A competitive economic model works fine when it comes to buying groceries or automobiles when we have time and plenty of options to choose from. It works poorly in the health care field has failed to much in terms of reducing costs for a 100 years or more.
What is really needed is a model like that of public utilities. We should recognize that conditions for effective competition don't work in the health care field and instead create a body like the Public Utilities Commission to regulate prices and services within the health care field. Ideally, this would cover everyone--most particularly pharmaceutical companies. We may have to accept the fact that this slow medical innovation. However, I think we have reached a point where this is inevitable. There is much more I could say on this subject, but the gist of it is whenever someone starts trying to say that "all we need is more competition" in healthcare, I perceive them as being poorly informed about the problem.
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Originally Posted by echo99
So you feel that 10% of gross income (if 100K) is a reasonable amount to pay for insurance premiums (not healthcare). If that person is in a 30% bracket then they are paying 14% of net income for premiums. Note this is not healthcare. They still have to get past the deductible to begin enjoying any type of "coverage".
How do people make gross generalization such as you did ===>
"group of independent self-employed people who did their best to not think about health insurance much at all. Whether they will realize it or not, they were part of the problem that lead to the ACA."
I don't think 10% is unreasonable for people with a good income for health insurance. The 10% figure only applies to those with an income in the range we have discussed. Ordinarily, people who earn good incomes are not young. People in their middle ages are precisely those who begin needing real medical care. Young people often don't need more than checkups and occasional treatment for a strep throat. It is appropriate that those who are more likely to need care--and can afford it--pay more for it.
You ask how I could make the generalization that I did. its really quite simple. The group that I primarily am around are self-employed people because I am self-employed myself. I'm telling you that I used to constantly hear colleagues say their health insurance was so bad it wouldn't pay for anything. So, the alternative was either plan on paying in cash or if your medical condition was bad enough you either: (1) argue for a discount; or (2) file bankruptcy. I wish I had a quarter for every time I heard someone say that to me. I make this generalization because I saw it and heard it many times.
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Originally Posted by KathrynAragon
OK, I'll give you my self employed perspective. We've been self employed and buying our own health insurance for five years now.
Prior to the ACA going into effect, we had BCBS insurance with a deductible of I believe $1500 and otherwise decent coverage. It cost us around $575 a month (this was for two adults in their early 50s). Now it's up to over $1000 a month - every year it has jumped in price, except this year, when it didn't increase in price but the benefits were slashed to the bone. Deductibles raised, doctors limited (we're having to change doctors, hospitals, dentists, etc), co pays increased, and no more PPO option unless we pay about $500 MORE PER MONTH. So there you have it.
We don't qualify for any subsidies. Oh but guess what - we have maternity coverage - WOOOHOOO! (I have had a hysterectomy so I doubt we'll be using that). We have pediatric dental coverage! (All our kids are grown but hey, we've got that coverage!).
We also have mental healthcare coverage now, which I may actually use to work through my angst regarding the ACA.
First of all, there would have been increases in your health insurance without an ACA because medical costs steadily increase. Second, your health insurance has gone up because the benefits provided under the coverage have increased as well. Third, I believe you live in Texas from other things I have read. My understanding is TX has a particularly high percentage of uninsured people. That's bound to make health insurance premiums go up in and of itself.
I support making certain things--maternity coverage--mandatory as part of health insurance. It is in everyone's interest that mothers receive good prenatal care and proper care during the labor and delivery of a child. That way, babies are born healthy and require less medical care down the road. I suspect that such care would literally pay for itself over time.
One of the points that many of those who continually oppose the ACA make is that they don't personally need this part of coverage or that part. My point is that the whole reason for a law like the ACA was to guarantee everyone certain basic benefits. It wasn't about giving every single individual total freedom of choice over what would be in a health insurance policy. Law are not written with just one group of people in mind. Some people never seem to quite understand that. You can take that up with Congress if you wish. Perhaps, the ACA will be repealed in 2017 after the Presidential election. However, one thing is for certain even if it is repealed this problem isn't going to go away. There is going to be reckoning one way or another with the whole issue and there will be winners and losers no matter what is done.
My understanding is that you qualify for a subsidy if your family income is less than about $90,000 a year. I assume your business income is more than this? In essence you complain about having to pay about $9,600 a year for decent health insurance which covers more than your old plan would have.
One of the problems we have in this country is that a lot of people who were self-employed chose--prior to the ACA--to either have no insurance or bare bones policies that didn't cover much of anything. They simply planned on paying cash--or filing bankruptcy if they got sick. The people who seem to be most upset by the ACA here on this forum are self-employed types. I'd honestly like to know what their insurance arrangement was before the ACA. I bet I am right.
Right about what? I'm one of those self-employed types.
Before the ACA we paid about $500-650 a month for health insurance for 3 of us. We had free preventative care, colonoscopies, annual physicals, gyn visits, etc. Our deductible started high and was reduced each year based on our good health. The amount of the deductible didn't affect us because we never needed any medical care.
During a short period of time years ago when we were uninsured, my daughter had a medical issue and we paid all the bills.
Am I upset that our plan was deemed unacceptable under the ACA and the least expensive plan for us was over $1000 a month for just 2 of us? I was, but have switched to a healthcare sharing ministry, which is more in line with our beliefs and our budget.
First of all, there would have been increases in your health insurance without an ACA because medical costs steadily increase. Second, your health insurance has gone up because the benefits provided under the coverage have increased as well. Third, I believe you live in Texas from other things I have read. My understanding is TX has a particularly high percentage of uninsured people. That's bound to make health insurance premiums go up in and of itself.
First, of course my health insurance costs would have gone up a bit over time - they always do. But ours have more than DOUBLED in cost in the past three years. That is a ridiculous jump. Couple that with the double whammy of our actual benefits being significantly reduced. So the actual cost to me is even higher. Now on top of the CRUSHING premium - which is about the same as my mortgage payment - I now have a huge deductible - and I have to pay every single stinking bit of that before any insurance payment comes into play. It's a joke when it comes to insurance. It's insane actually.
I understand that we have more coverage - more useless coverage, such as coverage for maternity care and pediatric dentistry just to name a few things. In the past, those were considered riders that one could opt in or out of - and we opted out, which kept our premiums lower. Now we don't have that option.
And yes, Texas does have a lot of uninsured people, but I've never been one of them. What you don't hear mentioned is how many of those uninsured residents are here illegally.
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I support making certain things--maternity coverage--mandatory as part of health insurance. It is in everyone's interest that mothers receive good prenatal care and proper care during the labor and delivery of a child. That way, babies are born healthy and require less medical care down the road. I suspect that such care would literally pay for itself over time.
What you're really supporting is that I pay for maternity care for other people. I will never need maternity care for myself. I should be able to opt out of it in exchange for a lower premium. I used to be able to do that, but of course I can't do that now.
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One of the points that many of those who continually oppose the ACA make is that they don't personally need this part of coverage or that part. My point is that the whole reason for a law like the ACA was to guarantee everyone certain basic benefits. It wasn't about giving every single individual total freedom of choice over what would be in a health insurance policy. Law are not written with just one group of people in mind.
So in other words, rob Peter to pay Paul. And when you're doing that, you can always count on Paul's vote. And when you create more Pauls than Peters, Peter is always screwed.
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Some people never seem to quite understand that.
It's not a matter of not understanding it - it's a matter of not agreeing with being forced to subsidize situations that I will NEVER experience.
We moved a couple of years ago, to a county that has a higher incidence of wind damage than the county we were previously living in. Our home owner's insurance went up, because our risk went up. Now - I may never file a claim and yet I've paid insurance all these years - but I don't have a problem with that because it's true that there's a higher risk of wind damage in my county - so it COULD happen. My house is at a higher risk than my former house. I get that.
But there is absolutely zero risk of me getting pregnant. Zero. I will never get pregnant. Four years ago I could purchase health insurance that did not include maternity care. It cost less. My insurance company was still making a profit on my insurance plan. Everyone was happy.
So what you're really saying is that I should be forced to pay for other peoples' maternity care.
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You can take that up with Congress if you wish.
Thanks for this "helpful" advice. I've already done so - repeatedly.
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Perhaps, the ACA will be repealed in 2017 after the Presidential election. However, one thing is for certain even if it is repealed this problem isn't going to go away. There is going to be reckoning one way or another with the whole issue and there will be winners and losers no matter what is done.
There are more people receiving subsidies (out of my pocket and the pockets of others) than there are people paying subsidies, so I "get it." I'm screwed. That doesn't mean I have to enjoy the experience - and it doesn't mean I'll put up with it without a fight.
It's pretty strange when someone who makes $150K per year and enjoys excellent health benefits through his wife's government employer lectures the self employed about "paying their fair share". The self employed see their premiums double, their deductibles dramatically rise all for narrower and narrower networks and we are just supposed to shut up and be happy?
It's pretty strange when someone who makes $150K per year and enjoys excellent health benefits through his wife's government employer lectures the self employed about "paying their fair share". The self employed see their premiums double, their deductibles dramatically rise all for narrower and narrower networks and we are just supposed to shut up and be happy?
Hence the reason the Cadillac tax is being delayed. All those fine folks who pushed heavily for Obamacare all of a sudden don't want to help pay for it. It is the same old it is good for thee but not for me mentality.
As an aside, it will also be the reason why single payer won't be enacted. Those getting good bennies won't want a 20% increase in taxes to get the same crappy plans as the rest of the unwashed masses. The 1 percenters of health insurance don't want to share their "wealth" with others.
First, of course my health insurance costs would have gone up a bit over time - they always do. But ours have more than DOUBLED in cost in the past three years. That is a ridiculous jump. Couple that with the double whammy of our actual benefits being significantly reduced. So the actual cost to me is even higher. Now on top of the CRUSHING premium - which is about the same as my mortgage payment - I now have a huge deductible - and I have to pay every single stinking bit of that before any insurance payment comes into play. It's a joke when it comes to insurance. It's insane actually.
I understand that we have more coverage - more useless coverage, such as coverage for maternity care and pediatric dentistry just to name a few things. In the past, those were considered riders that one could opt in or out of - and we opted out, which kept our premiums lower. Now we don't have that option.
And yes, Texas does have a lot of uninsured people, but I've never been one of them. What you don't hear mentioned is how many of those uninsured residents are here illegally.
What you're really supporting is that I pay for maternity care for other people. I will never need maternity care for myself. I should be able to opt out of it in exchange for a lower premium. I used to be able to do that, but of course I can't do that now.
So in other words, rob Peter to pay Paul. And when you're doing that, you can always count on Paul's vote. And when you create more Pauls than Peters, Peter is always screwed.
It's not a matter of not understanding it - it's a matter of not agreeing with being forced to subsidize situations that I will NEVER experience.
We moved a couple of years ago, to a county that has a higher incidence of wind damage than the county we were previously living in. Our home owner's insurance went up, because our risk went up. Now - I may never file a claim and yet I've paid insurance all these years - but I don't have a problem with that because it's true that there's a higher risk of wind damage in my county - so it COULD happen. My house is at a higher risk than my former house. I get that.
But there is absolutely zero risk of me getting pregnant. Zero. I will never get pregnant. Four years ago I could purchase health insurance that did not include maternity care. It cost less. My insurance company was still making a profit on my insurance plan. Everyone was happy.
So what you're really saying is that I should be forced to pay for other peoples' maternity care.
Thanks for this "helpful" advice. I've already done so - repeatedly.
There are more people receiving subsidies (out of my pocket and the pockets of others) than there are people paying subsidies, so I "get it." I'm screwed. That doesn't mean I have to enjoy the experience - and it doesn't mean I'll put up with it without a fight.
...pre ACA you were paying for a lot of things you would NEVER get too....testicular cancer, sickle cell or how about all the conditions you could have gotten but didn't. This is just a ridiculous argument all the way around. Do you have any clue how expensive your insurance would be if you got to pick ala carte??? It's very curious that you have no issues paying higher premiums for your house but not for your health . And, again, since you don't seem to get it, you are paying well under the average premium cost for a family plan, but since you are your own employer, you are paying both sides of your premiums....and all the tax breaks that go along with being self-employed.....and you have options you refuse to consider...and your tax breaks are coming out of MY pocket so how about we do away with all of the write-offs for businesses....not to mention, any time you file a claim against any insurance, that claim is coming out to of the pockets of everyone else on that plan...like you illustrated with your wind example. It's how insurance works....and how your health insurance was working WELL before the ACA. Get a real job, get a company plan, pay 1/2 or less of your premiums, simple solution....but then again, you would be subsidizing your co-workers then.
[quote=Qwerty;42499732]I think that if someone chooses not to have health insurance that they should just be turned away anywhere...sorry, but do you carry auto insurance, homeowners insurance? How about life insurance of any kind? I don't see people complaining about carrying those, and in most states auto insurance is required and no mortgage company is going to give you a loan without having homeowners insurance. In the 25+ years we have had homeowners insurance, we have used it twice, for hail damage to our roof and once for our auto insurance for hail damage to our car.
^^^This.
Fine, you Republican's don't want to carry health insurance, now you are on the hook financially for ALL of it. The $1200 MRI, the $5000 ED bill, no making financial arrangements with the hospital, no applying for Medicaid because you can't work now. Pay your bill, in full please. You like our capitalistic society so well, step up my friend, put your money where your mouth is all you rebels who want to elect out of health insurance.
5 weeks ago I received a kidney transplant from my husband, the bills have started rolling in, thank goodness we have some great insurance! Total cost thus far... almost 450K. My out of pocket so far $250.00. I hope y'all stay healthy, but one small setback will ruin you.
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. And, again, since you don't seem to get it, you are paying well under the average premium cost for a family plan, but since you are your own employer, you are paying both sides of your premiums....and all the tax breaks that go along with being self-employed.....and you have options you refuse to consider...and your tax breaks are coming out of MY pocket so how about we do away with all of the write-offs for businesses....not to mention, any time you file a claim against any insurance, that claim is coming out to of the pockets of everyone else on that plan...like you illustrated with your wind example. It's how insurance works....and how your health insurance was working WELL before the ACA. Get a real job, get a company plan, pay 1/2 or less of your premiums, simple solution....but then again, you would be subsidizing your co-workers then.
