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Individual health plans sold on Michigan's Affordable Care Act exchange will jump 16.7% next year
This is wild, totally wild, so many of the usual tropes and allegations about ACA, listed now, without any specifics, yet at the same time strongly advocating for the poor, whom ACA actually helps just enormously.
(And yet again --- this is like asking for the Trump tax returns --- without any thought content to it, suggestions of what to do instead.)
So do you instead mean the nonpoor group just above poverty ?
Lots of problems here, lots of fixes needed, mostly tweaks, we hope, yet much of them contained in the thoughtful and sophisticated discussions given in my and others' links.
But if you simply must rely on these assertions and on anecdote rather than larger sets of data, go ahead, give your own anecdotes. msf did.
You noted: "---Had their non-Obamacare health insurance canceled ---Could not keep their doctor ---Are paying more for health insurance now; then before Obamacare ---Are paying more for products and services because the increases in Obamacare it passed along to the consumer. ---Are struggling financially because of the cost of Obamacare"
The above items you noted have traveled to more health consumers than just the poorer citizens. Agreed?
I'll add this again from my earlier post:
A quick check with real human beings in the neighborhood regarding pricing changes for a few health plans going into 2017. ---teen healthcare private plan (they don't qualify for the ACA state exchange) BCBS, Premier Value monthly from $103 to $117 (+13.6% increase) and annual deductible going up from $6,750 to $7,150 (+4.4% increase) >>>The above is related to a household teen, but the price changes are similar for those having to purchase private plans (not exchange/tax credit qualified). Per 2015 Kaiser Foundation info (my recall), about 15% of the U.S. healthcare plans are "private", as these folks do not have group plans available via employers and are "too" rich, stuck somewhere in the middle class and having their healthcare costs becoming a too large portion of their net income. The best they may hope for with a form of "cost relief" is that their costs are high enough to qualify for some pricing relief; if they qualify to file long form 1040 and the medical expenses are also above the medical deduction floor. They still won't find much pricing relief with this method.
I don't recall this link here, but it is for "2015 Employer Health Benefits Survey" from about 1 year ago. I assume that the company costs of their portion of healthcare plans is a deductible cost on company taxes. One will find numerous charts/graphs with cost information, as well as text.
Lastly, my most favorite regarding the whole ACA song and dance for a "I am a politician and I'm here to help you"; is this Nancy Pelosi quote when she was "Speaker of the House". "We Have to Pass the Bill So That You Can Find Out What Is In It." Past all of the political crap I have observed since the Vietnam war era, Ms. Pelosi became the poster kid for the political machines. What a joke ('cept it was not, eh?).
Ultimately, what we are discussing is the concept of pooled risk. The smaller and more sickly the pool of patients insured, the more expensive it will be to insure them. The larger and less sickly the pool, the cheaper it will be to insure. One reason insurance premiums are going up is so many more people who were previously uninsurable as they had chronic illnesses or pre-existing conditions are now eligible for insurance. Thanks to the law, insurers can also no longer jack up their rates selectively on those sick patients any more than the rest of their customers. So rates rise together on the entire pool to cover more people, actual sick people, which is who insurers are really supposed to cover--actual sick people--not deny you coverage when you need it most.
The desire of profit-seeking insurers is always to have a large healthy pool of customers paying their premiums and not getting sick. They want to avoid small sickly pools. That's one reason they historically have charged the self-insured and small businesses so much more than big companies. There can be added risk if just one or two people get a chronic illness in a small pool. Also, they charge more because they can. Small businesses and individuals just have less negotiating power with insurers. This is why I think we need single payer ultimately. It creates the largest possible pool of insured people, more negotiating power with healthcare providers--Medicare routinely pays lower rates for medical procedures than private insurers--and eliminates the profit motive of insurance--the desire by insurers to collect premiums only from healthy people while denying sick people coverage to maximize their profits.
All of that said, Obamacare still did the right thing by forcing insurers to cover people with pre-existing conditions and not allowing them to jack up your premiums when you get sick. It forces insurers to actually insure sick people--the whole point of health insurance. This is why creating some separate system for young people or allowing them to opt out is a mistake. We need to create the largest pool possible for the system to work, and it must have healthy as well as sick people in it.
@catch22 - I'm somewhat unclear on your terminology, and at a loss as to the point you're trying to make.
All insurance plans (outside of original Medicare, VA, etc.) would appear to be "private", i.e. not public options offered by a government. It doesn't matter whether we're talking about Medicare Part C (Medicare Advantage), a BC/BS plan offered on an exchange, or a BC/BS plan offered off-exchange.
There's not much difference between on-exchange and off-exchange plans in the sense that they must all meet ACA requirements. Admittedly the states are free to set additional requirements for plans to qualify for inclusion in the exchanges. Not surprisingly, these plans are called Qualified Health Plans (QHP).
As that webpage notes, sometimes off-exchange plans are less expensive, sometimes more. So without more info, I don't get what difference it makes that this is an off-exchange plan.
Maybe you're trying to illustrate that there exists a plan off-exchange with a rate increase a bit under the Michigan average. Okay, but so what? By definition of average, there are on-exchange plans as well that have below average rate increases. (They can't all have above average increases.)
I get that there is this one plan, it's off exchange, it's going up 13.6%. I don't know if you're presenting that because it's high, it's lower than average, because it exists off the exchange or what. Please clarify.
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Regarding the plan itself - you've selected a catastrophic care plan. I looked up on-exchange plans in Flint (if one wants to talk about people harmed, that seemed like a "good" place to start).
The BC/BS Premier Value plan for an 18 year old male does cost $117.32 with a $7150 deductible, as you wrote. (Its out of pocket cap is $7150.) It's the 2nd most expensive catastrophic plan on the market, out of seven. The highest costs only $2 more per month. All the others cost under $100 (lower by 15% or more).
This particular plan is not competitive on price with other BC/BS plans. BC/BS offers one of those five cheaper catastrophic plans. In addition, it sells two HSA plans that step up to Bronze for virtually the same price - HSA plans for $111.02 ($6550 deductible/$6550 cap) and $117.93 ($5950 deductible/$6350 cap).
There's even a Silver plan offered by another insurer for less ($117.29).
All of that said, Obamacare still did the right thing by forcing insurers to cover people with pre-existing conditions and not allowing them to jack up your premiums when you get sick. It forces insurers to actually insure sick people--the whole point of health insurance.
In addition, it addresses the free ride that healthy people were getting. Heads - they don't get sick - they win (cheap policy). Tails - they get very sick and their insurance is inadequate - we (the taxpayer) lose by picking up the tab.
Black swans do happen, they are extremely costly. It's not just coverage of pre-existing conditions that was expanded. As you wrote, now one won't lose coverage because one got too sick. Not only because rates might be jacked up, but because plans used to have annual and/or lifetime caps. The ACA eliminated those, too.
ACA made changes not just for people who are sick (using the absurdly broad insurers' definition of "sick"), but for healthy people who might actually get sick.
... is there a more free-market, more privatized system that could replace the Affordable Care Act without causing the number of uninsured to soar? No. ... Once again: a useful starting point is the problem of people with preexisting conditions. How can they be offered affordable insurance? You can prohibit insurers from discriminating on the basis of medical history — community rating. But if that’s all you do, only sicker people will sign up; many will wait until they get sick to buy insurance; and so costs will be high due to a bad risk pool. So nondiscrimination must be combined with an individual mandate, the requirement that everyone get insurance. But what about people who can’t afford it? There must be subsidies to lower-income families, so that they can. What you end up with, then, is community rating + individual mandate + subsidies — that is, with Obamacare. There’s nothing arbitrary about it, and you can’t pick and choose from the elements: it’s a three-legged stool that needs all three legs to stand. And it can’t be made cheaper, either — the subsidies are already on the low end, requiring that the allowed policies can involve higher deductibles than they really should. And all this, in turn, is the reason Republicans haven’t come up with an alternative. It’s not because they’re timid, or lazy, or stupid (they may be all these things, but that’s not why they’ve come up short). It’s because there is no alternative [other than single-payer / socialized a la UK NHS] that wouldn’t involve taking coverage away from tens of millions.
BC/BS offers one of those five cheaper catastrophic plans. In addition, it sells two HSA plans that step up to Bronze for virtually the same price - HSA plans for $111.02 ($6550 deductible/$6550 cap) and $117.93 ($5950 deductible/$6350 cap).
I believe the main difference between these two closely priced plans is that one is a PPO and the other an HMO. If you are referring to BCBS Bronze (PPO or HMO) Standard Pathway X for HSA, I opted for the PPO plan option which, I believe, allows for a wider range of care provider choices.
The two HSA plans are both HMOs - Blue Cross Select Bronze Saver HSA ($111) and Blue Cross Select Bronze HSA ($118). The only differences that pops out when I do a side by side comparison are the deductibles and caps (already noted above).
For $84 extra/year, one starts getting coverage (albeit with copays/coinsurance) at $5950, rather than at $6550. If you think there's a reasonable shot at paying that much (including drugs) for care in a year, go for it. Otherwise, that's just $84 down the drain.
The only Michigan BCBS Bronze PPO HSA I can find is Blue Cross Premier PPO Bronze HSA. It's got the same $6550 deductible and cap as the Premier HMO Bronze Saver HSA, but costs $152 ($41 more/mo).
This does not appear to be the plan you're describing. BCBS uses the moniker "Pathway" to denote its narrow ACA networks. The PPO plan I'm describing supposedly provides access to the broader BCBS national network.
A quick check with real human beings in the neighborhood regarding pricing changes for a few health plans going into 2017. And if it is snowing in your neighborhood then it must be snowing in Key West Florida."
>>>I suppose I could have stated, folks I have queried, asked, real world or whatever words you would find appropriate. I intended to reference data that was more than data from the internet. Not sure what to imply from the snowing statement. All in all, IMHO; the thread discussion for this very complex subject area has been very civil, in spite of differing views and/or experiences. A salute to MFO members.
Lastly, although this topic is subject to political decisions and ramifications; the topic also may cause changes in decision making for investors, as the costs of healthcare for all variety of reasons may have a substantial impact upon household budgets that may be reflected in abilities to save for retirement, college saving plans and other related investments.
You noted to me: "I'm somewhat unclear on your terminology, and at a loss as to the point you're trying to make.
All insurance plans (outside of original Medicare, VA, etc.) would appear to be "private", i.e. not public options offered by a government. It doesn't matter whether we're talking about Medicare Part C (Medicare Advantage), a BC/BS plan offered on an exchange, or a BC/BS plan offered off-exchange.
>>>Thank you for digging through my words for proper context. The area of my intention related to healthcare costs was to be directed towards those who are not eligible for group plans, subsidized plan costs and similar. I can't recall at this time (perhaps within my Kaiser Foundation link in my recent post) that about 15% of the population must obtain health plans on the "open market" at a "retail" price. I would suspect that this about 15% of the population could be broadly categorized as "independent contractors, small business owners and related". I did a quick check for Oakland County in Michigan, which has a wide mix of income levels and found the following for a single mother (age 50) who is an independent contractor with an annual wage of $65,000 and a 16 year old daughter.
A BCBS, Bronze, Select HMO, Extra health plan for both indicated the following: ---$520/month plan cost ---$13,000 combined annual deductible ---$14,300 estimated annual MAXIMUM out of pocket expenses NOTE: similar costs were found from other vendors for a 'bronze" plan and the BCBS plan is only an example.
Now, the cost does not take into consideration what part of this would be a deduction for this household when filing taxes. Obviously, too many varying considerations for tax filing. But, the initial cost could be reduced by allowed deductions for tax filing purposes. Is this an improvement from my first attempt?
Thank you for your excellent input into this complex subject. Got to get outside here..........Sat. and Sun. weather is sun and low 60's temp. We don't have much of this weather, for this time of the year, in Michigan. Regards, Catch
Thanks Catch. Some people work best with concrete examples, so I appreciate your specific county/individual hypothetical. Now we're on exactly the same (web)page. I'll look at those policies in my next post.
Part of the difficulty in discussing figures is that terms are so muddy. You write (I'm not faulting you specifically here - you done good) about people who must buy on the "open market" at "retail".
"Retail" is clear - no subsidies. It is also pretty clear that by "open market" you mean just "on your own" (not through an employer). But when looking at statistics, often "on the market" is conflated with in the "Marketplace" (i.e. exchange), while ACA policies are also sold outside the "Marketplace", i.e. off exchange.
Also, do the various statistics limit themselves to individual ACA plans, or do they also count Medicaid plans, Basic Health Programs (technically not ACA plans, though included in ACA), etc?
"Must buy" is a bit vague, especially since no one "must" buy a plan. People are free to pay a penalty instead. So "must" buy could include all those eligible to buy an individual ACA plan, or it might include just those who actually do buy a plan. I've probably seen statistics that go either way on this.
Since it would take me hours to sort through various sources, to ensure that not only was I comparing apples to apples, but that I wasn't mixing Macs and Red Delicious, I'll let the 15% figure go for now.
I think we can all agree that there are several million people who are ineligible for subsidies and who are actually buying policies on their own. Some of those are well enough off that while they may not like the prices they can afford them. Others are barely over the 400% FPL threshold and thus significantly affected by large price increases.
FWIW, here are a few pages/statistics I came up with when I did a cursory search. Note that these are not Macs and Delicious, but apples, oranges and bananas; so don't try to mix and match. They're incompatible figures.
An excellent column on lots of the confusion in the exchange system. https://www.healthinsurance.org/blog/2016/09/15/7-reasons-for-ending-off-exchange-enrollment/ (Buried within are statistics such as: up to 3.5M people enrolled off-exchange would qualify for subsidies if enrolled on-exchange; 1.5M are paying for unsubsidized noncompliant policies while they could get virtually the same policies, subsidized.)
From the Post article: "The other — preventing insurance companies from denying covering because of pre-existing conditions — offers a perfect illustration of why Trump and most of the other Republicans critics of Obamacare don’t understand the health insurance market."
It goes on to say that you can't do this without mandates.
Trump sounds a lot like an earlier presidential candidate, who "demonized the idea of mandates", according to Paul Krugman.
Sometimes people learn. As usual, the devil is in the details.
The fact that the column could have been better written does not detract from the points it is making. The paragraph from which that sentence comes is clearly talking about maintaining coverage (protection) for people who develop an expensive medical condition. Somewhat similar to a clause in an auto policy saying "we cannot cancel your policy because you got into an accident/made a claim".
That's certainly necessary, but not sufficient. It excessively penalizes people who do not "act responsibly" by purchasing insurance from the start. Obama originally felt that people would "act responsibly" and buy insurance so long as it was made affordable (see the Krugman column I cited above). But we know people don't do that. This is why there are mandatory auto insurance laws. People are generally poor at math, and extremely poor in doing risk analysis. Why else would anyone buy flight insurance?
There are parts of the ACA meant to deal with this. You cannot wait until you get sick to purchase insurance; you may only purchase it during open windows. You do not have to buy insurance, but you will pay a penalty (or what the SC calls a tax), This affects people's cost/benefit calculation.
Permanently barring people from insurance (by eliminating guarantee issue for anyone not renewing) would be too harsh a penalty, and people wouldn't incorporate this into their risk assessments anyway.
But this doesn't mean there aren't other approaches. Single payer could also ensure universal participation. This is supposedly even supported by the writers. They say that "Congress should consider allowing states to develop different approaches in how to do this—allowing for the diversity and learning that comes from true federalism." Under ACA, states are already allowed to substitute a single payer system for the default system of mandates, tax credits, and guarantee issue.
Okay, forget about auto insurance being mandatory; that was perfunctory. The main point was about guaranteed renewal. That's what the paragraph in the article was talking about - if you act responsibility and buy insurance on day one, then insurance companies should not be able to cancel you if you get sick.
Putting that too succinctly, if you act responsibly you will be protected from getting sick.
This is one of many things that a health insurance system should provide. The wording is bad but the objective is right. My points were:
a) This is insufficient. People will "misunderestimate" their risk, and not act responsibly by buying insurance on day one. Subjecting them to a potential lifetime ban (well, to age 65) from insurance because of poor understanding of risks is too harsh a penalty. What the ACA does is subject people to a partial year ban (until the next enrollment period comes along).
(Guarantee issue without guaranteed affordability is tantamount to a lifetime ban.)
b) Obama similarly got it wrong. He originally assumed that people would naturally act responsibly - that they would buy insurance without a mandate. Given that thinking, it really wouldn't matter if people couldn't buy in later, since they'd have bought in from the start.
c) The article advocates a federal system that enables experimentation. Done. The ACA provides a lot of flexibility, including allowing single payer systems that could obviate mandates.
One other note on your most recent Vox link - Better Way suggests a 5:1 premium ratio based on age (as opposed to the current 3:1). There are real issues with compressing premiums. It is a transfer from young to old, which young will naturally reject if they have the option. (People often forget that they too will become older; at least that's the better of the two alternatives )
Even your cite to a Vox column from the White House perspective talks about going to a 4:1 ratio.
Yeah How much any of this matters is moot now (dictionary def of moot = 'only arguable') since ACA is in for major wrenchings, it seems. I like this sort of mooting better than reading articles about the details of the alternatives. Klein's Vox sure does good work, though.
Just a wee interruption. The simple fact that folks may lose a limb or their sight or even their life because they cannot afford the treatment . . . is an obscenity beyond words. The fact that we have allowed the health care system to become profit oriented is a reason to go and pee on Adam Smith's grave.
The simple fact that we now have a shorter lifespan and greater percentage of infant mortality than Canada or Britain tells a tale. Not a problem if you can afford high quality care but if not . . .
The problem with the ACA was that it didn't go nearly far enough.
The simple fact that we now have a shorter lifespan and greater percentage of infant mortality than Canada or Britain tells a tale. Not a problem if you can afford high quality care but if not . . .
Yes it does - the USA has a larger population, that is more diverse ethnically/racially, more affluent, with more roads/cars etc.
In short, if you are going to make such a comparison you need to look at the causes. If you do that you will find the differences have little if anything to do with health insurance.
The importance of doing such an analysis is that you can focus attention on addressing the causes.
Take a look at diabetes for example, the USA ranks high in that area. Addressing the cause of that will improve the lifespan and health of the USA better then anything you can do with health insurance.
I agree that HSAs as originally conceived did largely favor the better off - since they could use these for tax-sheltered savings, and because the tax deductions HSAs provide are more valuable to those in higher tax brackets. In contrast, the ACA provides tax credits; the dollar value of a credit does not vary based on tax bracket.
In addition, HSA wrappers (accounts) are not cheap. (This could be because of the reporting requirements, or because there are relatively few providers, or ...). By "not cheap" I mean that most come with monthly fees or four figure bank balance requirements - you can't invest you HSA money without keeping a significant part of your HSA in a low interest bearing account. This favors more affluent people who can maintain larger HSAs (thus reducing the cost as a percentage of account size).
But as things stand how, HSAs can be pretty useful for the average worker (over 250% of poverty level, i.e. fully responsible for deductibles). This is not to say that HSAs have gotten better, but that under the ACA, virtually all lower premium plans (bronze, let alone "catastrophic") have high deductibles.
Likewise, the ACA "fixes" the bifurcation (adverse selection) problem mentioned. That's where healthier people abandon traditional plans for low cost high deductible plans, thus causing premiums to rise. The plans from a given provider at a given metal level tend to have similar prices, regardless of whether they're HSA-qualified.
HSA-qualified plans may not force you to take even slightly higher deductibles or caps. Sometimes the opposite. HSA-qualified plans cap out of pocket expenses at $6550 (individual) or less. Other ACA plans allow expenses up to $7,150. These are 2017 figures.
For example, looking again at Flint plans for a 25 year old single male earning $30K, there are three BC/BS bronze plans: - Premier PPO HSA ($240 premium, $6550 ded, $6550 cap) - Premier PPO Saver ($224 premium, $7150 ded, $7150 cap) - Premier PPO Extra ($250 premium, $6650 ded, $7150 cap)
The only differences between the first two are the lower caps/deductibles for the HSA plan and its higher premium. The Extra plan adds generic drugs and PCP visits for just copays (before meeting deductible).
>> Addressing the cause of that will improve the lifespan and health of the US better than anything you can do with health insurance.
Surely you know that some health insurance (Medicare e.g.) seriously addresses causes, or attempts to --- incentivizing preventive OVs, counseling, self-care, personal responsibility, earlier PCP involvement, non-MD activities, etc.
Comments
(And yet again --- this is like asking for the Trump tax returns --- without any thought content to it, suggestions of what to do instead.)
So do you instead mean the nonpoor group just above poverty ?
Lots of problems here, lots of fixes needed, mostly tweaks, we hope, yet much of them contained in the thoughtful and sophisticated discussions given in my and others' links.
But if you simply must rely on these assertions and on anecdote rather than larger sets of data, go ahead, give your own anecdotes. msf did.
You noted:
"---Had their non-Obamacare health insurance canceled
---Could not keep their doctor
---Are paying more for health insurance now; then before Obamacare
---Are paying more for products and services because the increases in Obamacare it passed along to the consumer.
---Are struggling financially because of the cost of Obamacare"
The above items you noted have traveled to more health consumers than just the poorer citizens. Agreed?
I'll add this again from my earlier post:
A quick check with real human beings in the neighborhood regarding pricing changes for a few health plans going into 2017.
---teen healthcare private plan (they don't qualify for the ACA state exchange)
BCBS, Premier Value monthly from $103 to $117 (+13.6% increase) and annual deductible going up from $6,750 to $7,150 (+4.4% increase)
>>>The above is related to a household teen, but the price changes are similar for those having to purchase private plans (not exchange/tax credit qualified). Per 2015 Kaiser Foundation info (my recall), about 15% of the U.S. healthcare plans are "private", as these folks do not have group plans available via employers and are "too" rich, stuck somewhere in the middle class and having their healthcare costs becoming a too large portion of their net income. The best they may hope for with a form of "cost relief" is that their costs are high enough to qualify for some pricing relief; if they qualify to file long form 1040 and the medical expenses are also above the medical deduction floor. They still won't find much pricing relief with this method.
Regards,
Catch
I assume that the company costs of their portion of healthcare plans is a deductible cost on company taxes.
One will find numerous charts/graphs with cost information, as well as text.
http://kff.org/report-section/ehbs-2015-summary-of-findings/
Lastly, my most favorite regarding the whole ACA song and dance for a "I am a politician and I'm here to help you"; is this Nancy Pelosi quote when she was "Speaker of the House".
"We Have to Pass the Bill So That You Can Find Out What Is In It."
Past all of the political crap I have observed since the Vietnam war era, Ms. Pelosi became the poster kid for the political machines. What a joke ('cept it was not, eh?).
Regards,
Catch
http://m.sfgate.com/bayarea/article/Pelosi-s-new-office-is-House-s-costliest-by-far-3261615.php
The desire of profit-seeking insurers is always to have a large healthy pool of customers paying their premiums and not getting sick. They want to avoid small sickly pools. That's one reason they historically have charged the self-insured and small businesses so much more than big companies. There can be added risk if just one or two people get a chronic illness in a small pool. Also, they charge more because they can. Small businesses and individuals just have less negotiating power with insurers. This is why I think we need single payer ultimately. It creates the largest possible pool of insured people, more negotiating power with healthcare providers--Medicare routinely pays lower rates for medical procedures than private insurers--and eliminates the profit motive of insurance--the desire by insurers to collect premiums only from healthy people while denying sick people coverage to maximize their profits.
All of that said, Obamacare still did the right thing by forcing insurers to cover people with pre-existing conditions and not allowing them to jack up your premiums when you get sick. It forces insurers to actually insure sick people--the whole point of health insurance. This is why creating some separate system for young people or allowing them to opt out is a mistake. We need to create the largest pool possible for the system to work, and it must have healthy as well as sick people in it.
All insurance plans (outside of original Medicare, VA, etc.) would appear to be "private", i.e. not public options offered by a government. It doesn't matter whether we're talking about Medicare Part C (Medicare Advantage), a BC/BS plan offered on an exchange, or a BC/BS plan offered off-exchange.
There's not much difference between on-exchange and off-exchange plans in the sense that they must all meet ACA requirements. Admittedly the states are free to set additional requirements for plans to qualify for inclusion in the exchanges. Not surprisingly, these plans are called Qualified Health Plans (QHP).
To get a sense of what sort of requirements might be added, here are a few (5) slides from Connecticut on what that state requires for a plan to be offered on its exchange: http://www.ct.gov/hix/lib/hix/043014_final_Plan_Management_Update_BOD_Slides_v2.pdf
See here for a more complete explanation of on exchange vs. off exchange:
https://www.healthinsurance.org/obamacare/off-exchange-plans/
As that webpage notes, sometimes off-exchange plans are less expensive, sometimes more. So without more info, I don't get what difference it makes that this is an off-exchange plan.
Maybe you're trying to illustrate that there exists a plan off-exchange with a rate increase a bit under the Michigan average. Okay, but so what? By definition of average, there are on-exchange plans as well that have below average rate increases. (They can't all have above average increases.)
I get that there is this one plan, it's off exchange, it's going up 13.6%. I don't know if you're presenting that because it's high, it's lower than average, because it exists off the exchange or what. Please clarify.
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Regarding the plan itself - you've selected a catastrophic care plan. I looked up on-exchange plans in Flint (if one wants to talk about people harmed, that seemed like a "good" place to start).
The BC/BS Premier Value plan for an 18 year old male does cost $117.32 with a $7150 deductible, as you wrote. (Its out of pocket cap is $7150.) It's the 2nd most expensive catastrophic plan on the market, out of seven. The highest costs only $2 more per month. All the others cost under $100 (lower by 15% or more).
This particular plan is not competitive on price with other BC/BS plans. BC/BS offers one of those five cheaper catastrophic plans. In addition, it sells two HSA plans that step up to Bronze for virtually the same price - HSA plans for $111.02 ($6550 deductible/$6550 cap) and $117.93 ($5950 deductible/$6350 cap).
There's even a Silver plan offered by another insurer for less ($117.29).
Black swans do happen, they are extremely costly. It's not just coverage of pre-existing conditions that was expanded. As you wrote, now one won't lose coverage because one got too sick. Not only because rates might be jacked up, but because plans used to have annual and/or lifetime caps. The ACA eliminated those, too.
ACA made changes not just for people who are sick (using the absurdly broad insurers' definition of "sick"), but for healthy people who might actually get sick.
https://www.yahoo.com/news/why-health-care-eats-more-152811297.html
... is there a more free-market, more privatized system that could replace the Affordable Care Act without causing the number of uninsured to soar? No. ...
Once again: a useful starting point is the problem of people with preexisting conditions. How can they be offered affordable insurance? You can prohibit insurers from discriminating on the basis of medical history — community rating. But if that’s all you do, only sicker people will sign up; many will wait until they get sick to buy insurance; and so costs will be high due to a bad risk pool.
So nondiscrimination must be combined with an individual mandate, the requirement that everyone get insurance. But what about people who can’t afford it? There must be subsidies to lower-income families, so that they can.
What you end up with, then, is community rating + individual mandate + subsidies — that is, with Obamacare. There’s nothing arbitrary about it, and you can’t pick and choose from the elements: it’s a three-legged stool that needs all three legs to stand. And it can’t be made cheaper, either — the subsidies are already on the low end, requiring that the allowed policies can involve higher deductibles than they really should.
And all this, in turn, is the reason Republicans haven’t come up with an alternative. It’s not because they’re timid, or lazy, or stupid (they may be all these things, but that’s not why they’ve come up short). It’s because there is no alternative [other than single-payer / socialized a la UK NHS] that wouldn’t involve taking coverage away from tens of millions.
http://krugman.blogs.nytimes.com/2016/04/11/the-obamacare-replacement-mirage/
For $84 extra/year, one starts getting coverage (albeit with copays/coinsurance) at $5950, rather than at $6550. If you think there's a reasonable shot at paying that much (including drugs) for care in a year, go for it. Otherwise, that's just $84 down the drain.
The only Michigan BCBS Bronze PPO HSA I can find is Blue Cross Premier PPO Bronze HSA. It's got the same $6550 deductible and cap as the Premier HMO Bronze Saver HSA, but costs $152 ($41 more/mo).
This does not appear to be the plan you're describing. BCBS uses the moniker "Pathway" to denote its narrow ACA networks. The PPO plan I'm describing supposedly provides access to the broader BCBS national network.
Here's a page that seems to summarize the BCBS plans available in Michigan:
http://www.bcbsm.com/index/plans/michigan-health-insurance/2017.html
You noted to me:
"catch22 said:
A quick check with real human beings in the neighborhood regarding pricing changes for a few health plans going into 2017.
And if it is snowing in your neighborhood then it must be snowing in Key West Florida."
>>>I suppose I could have stated, folks I have queried, asked, real world or whatever words you would find appropriate. I intended to reference data that was more than data from the internet.
Not sure what to imply from the snowing statement.
All in all, IMHO; the thread discussion for this very complex subject area has been very civil, in spite of differing views and/or experiences. A salute to MFO members.
Lastly, although this topic is subject to political decisions and ramifications; the topic also may cause changes in decision making for investors, as the costs of healthcare for all variety of reasons may have a substantial impact upon household budgets that may be reflected in abilities to save for retirement, college saving plans and other related investments.
Regards,
Catch
You noted to me:
"I'm somewhat unclear on your terminology, and at a loss as to the point you're trying to make.
All insurance plans (outside of original Medicare, VA, etc.) would appear to be "private", i.e. not public options offered by a government. It doesn't matter whether we're talking about Medicare Part C (Medicare Advantage), a BC/BS plan offered on an exchange, or a BC/BS plan offered off-exchange.
>>>Thank you for digging through my words for proper context.
The area of my intention related to healthcare costs was to be directed towards those who are not eligible for group plans, subsidized plan costs and similar. I can't recall at this time (perhaps within my Kaiser Foundation link in my recent post) that about 15% of the population must obtain health plans on the "open market" at a "retail" price. I would suspect that this about 15% of the population could be broadly categorized as "independent contractors, small business owners and related".
I did a quick check for Oakland County in Michigan, which has a wide mix of income levels and found the following for a single mother (age 50) who is an independent contractor with an annual wage of $65,000 and a 16 year old daughter.
A BCBS, Bronze, Select HMO, Extra health plan for both indicated the following:
---$520/month plan cost
---$13,000 combined annual deductible
---$14,300 estimated annual MAXIMUM out of pocket expenses
NOTE: similar costs were found from other vendors for a 'bronze" plan and the BCBS plan is only an example.
Now, the cost does not take into consideration what part of this would be a deduction for this household when filing taxes. Obviously, too many varying considerations for tax filing. But, the initial cost could be reduced by allowed deductions for tax filing purposes.
Is this an improvement from my first attempt?
This link is the starting point used for the above numbers...
https://www.healthcare.gov/see-plans/#/
Thank you for your excellent input into this complex subject.
Got to get outside here..........Sat. and Sun. weather is sun and low 60's temp. We don't have much of this weather, for this time of the year, in Michigan.
Regards,
Catch
I found the more current (2016) version of the KFF study you cited. It really wasn't too hard - just change the 2015 in your URL to 2016
http://kff.org/report-section/ehbs-2016-summary-of-findings/
Part of the difficulty in discussing figures is that terms are so muddy. You write (I'm not faulting you specifically here - you done good) about people who must buy on the "open market" at "retail".
"Retail" is clear - no subsidies. It is also pretty clear that by "open market" you mean just "on your own" (not through an employer). But when looking at statistics, often "on the market" is conflated with in the "Marketplace" (i.e. exchange), while ACA policies are also sold outside the "Marketplace", i.e. off exchange.
Also, do the various statistics limit themselves to individual ACA plans, or do they also count Medicaid plans, Basic Health Programs (technically not ACA plans, though included in ACA), etc?
"Must buy" is a bit vague, especially since no one "must" buy a plan. People are free to pay a penalty instead. So "must" buy could include all those eligible to buy an individual ACA plan, or it might include just those who actually do buy a plan. I've probably seen statistics that go either way on this.
Since it would take me hours to sort through various sources, to ensure that not only was I comparing apples to apples, but that I wasn't mixing Macs and Red Delicious, I'll let the 15% figure go for now.
I think we can all agree that there are several million people who are ineligible for subsidies and who are actually buying policies on their own. Some of those are well enough off that while they may not like the prices they can afford them. Others are barely over the 400% FPL threshold and thus significantly affected by large price increases.
FWIW, here are a few pages/statistics I came up with when I did a cursory search. Note that these are not Macs and Delicious, but apples, oranges and bananas; so don't try to mix and match. They're incompatible figures.
16M eligible to enroll in Marketplace plans, 12M eligible for subsidies:
http://kff.org/health-reform/state-indicator/state-marketplace-statistics/?currentTimeframe=0&sortModel={"colId":"Location","sort":"asc"}
12.7M (Marketplace), 20M total enrolled
http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/
8M-12M enrolled off exchange (thus unsubisized), 2M unsubsidized on exchange
https://www.healthpocket.com/healthcare-research/infostat/unsubsidized-health-insurance-market
(FWIW, that 2M figure is about 15%-20% of the 12M on-exchange figure, if one wants to try blending the apples and bananas)
An excellent column on lots of the confusion in the exchange system.
https://www.healthinsurance.org/blog/2016/09/15/7-reasons-for-ending-off-exchange-enrollment/
(Buried within are statistics such as: up to 3.5M people enrolled off-exchange would qualify for subsidies if enrolled on-exchange; 1.5M are paying for unsubsidized noncompliant policies while they could get virtually the same policies, subsidized.)
https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/
It goes on to say that you can't do this without mandates.
Trump sounds a lot like an earlier presidential candidate, who "demonized the idea of mandates", according to Paul Krugman.
Sometimes people learn. As usual, the devil is in the details.
http://www.politico.com/agenda/story/2016/11/repeal-obamacare-roadmap-republicans-000230
and thought perhaps that others might do the same, although who knows, maybe some will find it worth offering suggestions to
That's certainly necessary, but not sufficient. It excessively penalizes people who do not "act responsibly" by purchasing insurance from the start. Obama originally felt that people would "act responsibly" and buy insurance so long as it was made affordable (see the Krugman column I cited above). But we know people don't do that. This is why there are mandatory auto insurance laws. People are generally poor at math, and extremely poor in doing risk analysis. Why else would anyone buy flight insurance?
There are parts of the ACA meant to deal with this. You cannot wait until you get sick to purchase insurance; you may only purchase it during open windows. You do not have to buy insurance, but you will pay a penalty (or what the SC calls a tax), This affects people's cost/benefit calculation.
Permanently barring people from insurance (by eliminating guarantee issue for anyone not renewing) would be too harsh a penalty, and people wouldn't incorporate this into their risk assessments anyway.
But this doesn't mean there aren't other approaches. Single payer could also ensure universal participation. This is supposedly even supported by the writers. They say that "Congress should consider allowing states to develop different approaches in how to do this—allowing for the diversity and learning that comes from true federalism." Under ACA, states are already allowed to substitute a single payer system for the default system of mandates, tax credits, and guarantee issue.
Clearly I did not see the points you did in that screed.
Meanwhile,
http://www.vox.com/2016/11/17/13626438/obamacare-replacement-plans-comparison
(What a ton of journalistic work.)
Putting that too succinctly, if you act responsibly you will be protected from getting sick.
This is one of many things that a health insurance system should provide. The wording is bad but the objective is right. My points were:
a) This is insufficient. People will "misunderestimate" their risk, and not act responsibly by buying insurance on day one. Subjecting them to a potential lifetime ban (well, to age 65) from insurance because of poor understanding of risks is too harsh a penalty. What the ACA does is subject people to a partial year ban (until the next enrollment period comes along).
(Guarantee issue without guaranteed affordability is tantamount to a lifetime ban.)
b) Obama similarly got it wrong. He originally assumed that people would naturally act responsibly - that they would buy insurance without a mandate. Given that thinking, it really wouldn't matter if people couldn't buy in later, since they'd have bought in from the start.
c) The article advocates a federal system that enables experimentation. Done. The ACA provides a lot of flexibility, including allowing single payer systems that could obviate mandates.
One other note on your most recent Vox link - Better Way suggests a 5:1 premium ratio based on age (as opposed to the current 3:1). There are real issues with compressing premiums. It is a transfer from young to old, which young will naturally reject if they have the option. (People often forget that they too will become older; at least that's the better of the two alternatives
Even your cite to a Vox column from the White House perspective talks about going to a 4:1 ratio.
As a reminder, here are the links you gave:
http://www.vox.com/the-big-idea/2016/10/7/13192640/obamacare-exchanges-insurance-healthcare-fix (tweaks including going to 4:1)
http://www.vox.com/the-big-idea/2016/10/7/13191250/obamacare-exchanges-crisis-arrogant-progressives (Republican companion piece critical of the current 3:1 ratio)
How much any of this matters is moot now (dictionary def of moot = 'only arguable') since ACA is in for major wrenchings, it seems. I like this sort of mooting better than reading articles about the details of the alternatives. Klein's Vox sure does good work, though.
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-hsa-20161118-story.html
Just a wee interruption. The simple fact that folks may lose a limb or their sight or even their life because they cannot afford the treatment . . . is an obscenity beyond words. The fact that we have allowed the health care system to become profit oriented is a reason to go and pee on Adam Smith's grave.
The simple fact that we now have a shorter lifespan and greater percentage of infant mortality than Canada or Britain tells a tale. Not a problem if you can afford high quality care but if not . . .
The problem with the ACA was that it didn't go nearly far enough.
and so it goes,
peace,
rono
In short, if you are going to make such a comparison you need to look at the causes. If you do that you will find the differences have little if anything to do with health insurance.
The importance of doing such an analysis is that you can focus attention on addressing the causes.
Take a look at diabetes for example, the USA ranks high in that area. Addressing the cause of that will improve the lifespan and health of the USA better then anything you can do with health insurance.
In addition, HSA wrappers (accounts) are not cheap. (This could be because of the reporting requirements, or because there are relatively few providers, or ...). By "not cheap" I mean that most come with monthly fees or four figure bank balance requirements - you can't invest you HSA money without keeping a significant part of your HSA in a low interest bearing account. This favors more affluent people who can maintain larger HSAs (thus reducing the cost as a percentage of account size).
But as things stand how, HSAs can be pretty useful for the average worker (over 250% of poverty level, i.e. fully responsible for deductibles). This is not to say that HSAs have gotten better, but that under the ACA, virtually all lower premium plans (bronze, let alone "catastrophic") have high deductibles.
Likewise, the ACA "fixes" the bifurcation (adverse selection) problem mentioned. That's where healthier people abandon traditional plans for low cost high deductible plans, thus causing premiums to rise. The plans from a given provider at a given metal level tend to have similar prices, regardless of whether they're HSA-qualified.
HSA-qualified plans may not force you to take even slightly higher deductibles or caps. Sometimes the opposite. HSA-qualified plans cap out of pocket expenses at $6550 (individual) or less. Other ACA plans allow expenses up to $7,150. These are 2017 figures.
For example, looking again at Flint plans for a 25 year old single male earning $30K, there are three BC/BS bronze plans:
- Premier PPO HSA ($240 premium, $6550 ded, $6550 cap)
- Premier PPO Saver ($224 premium, $7150 ded, $7150 cap)
- Premier PPO Extra ($250 premium, $6650 ded, $7150 cap)
The only differences between the first two are the lower caps/deductibles for the HSA plan and its higher premium. The Extra plan adds generic drugs and PCP visits for just copays (before meeting deductible).
>> Addressing the cause of that will improve the lifespan and health of the US better than anything you can do with health insurance.
Surely you know that some health insurance (Medicare e.g.) seriously addresses causes, or attempts to --- incentivizing preventive OVs, counseling, self-care, personal responsibility, earlier PCP involvement, non-MD activities, etc.