Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
Support MFO
Donate through PayPal
...Med Ins.: ...And it DOESN'T help to get 6 different answers to the same question, either.
Obamacare was and is a positive step. But the last time I tried to inquire about getting a policy through the exchange, I was treated in one case over the phone as if I were a piece of fecal matter by the bitch at the other end of the line. My last call to MassHealth was very negative, too. I felt like I was being PRESSURED to get in. And, as this thread's title expresses, it's NOT helpful to get squishy, incomplete, tentative and downright incorrect crapola answers to some important questions. So we still get med. ins. via wife's job. We are required to have it, and the provider knows it. So the deductibles are goddam CRIMINAL. And this is Massachusetts, which had the stupid individual-mandate before anyone else. I think it began in 2006, under uncle Mittens.
The first opinion piece (theweek.com) doesn't quite crunch its numbers well.
It talks about many liberals predicting a mass migration from employer plans to ACA plans. That's not what I remembered, so I went into the internet time machine and found this 2013 paper on HealthAffairs.org. Its Exhibit 4 shows predictions by the CBO/JCT, Rand, Urban Institute, Lewin Group(?), and CMS. In 2011, 58.3% of nonelderly were covered by employer plans. The predicted changes ranged from an increase of 2.9% (Rand) to a decrease of 1.8% (CBO). No massive shifts.
Maybe there were others making wild speculations. For example, the HA paper mentions that the American Action Forum predicted 43 million (out of 170 million) would be dropped from employer insurance. But this was was under the assumption that employers would "ignore federal nondiscrimination laws" or segregate workers who didn't want insurance into separate subsidiaries, or ...
The "theweek.com" piece says that the exchanges are "useful almost entirely for lower-income people who are eligible for subsidies". Subsidies go up to 400% of FPL (about $66K for a family of 2, $100K for a family of 4). Both are higher than the median household income of $59K. It seems the plans are useful for above average households as well as lower-income people.
It dismisses CSRs (cost sharing reductions) by saying tersely that the government subsidies for CSRs were terminated. What it doesn't say is that while the government terminated direct subsidies, it's still subsidizing them indirectly. That's because by law (that Congress was unable to change), people below 250% FPL have to get lower copays and deductibles on their silver plans, regardless.
So the insurers hiked their premium rates to cover the cost of reducing copays and deductibles. Since the government subsidizes most people's premiums, the government wound up increasing the premium subsidizes and thus indirectly paying for CSRs anyway.
Since the CSRs still exist, someone at 200% FPL (the example in the article) would not buy a bronze plan, but a silver plan (the only metal level with CSRs). So its a mistake to look at subsidized bronze plans with high deductibles. Rather, the writer should have looked at subsidized silver plans with subsidized (low) deductibles and copays.
Finally, it says that blue states are shifting the burden onto poor people. But it ignores the fact that part of the ACA is something called a Basic Health Program. This is for people earning up to 200% FPL, and costs them less than a silver plan with CSR. So far, two states, Minn. and NY, have implemented this. Last I checked, the land of HHH and Democratic Farmer Labor was still blue, as was New York (despite the best efforts of the Independent Democratic Council).
IMHO there are lots of significant problems with the ACA, and Medicare for All, or even a government option, would be a big improvement. Nevertheless, with appropriate (significant) tuning, it is workable.
Thanks for the work on that response. I dunno how workable any option is until it's made to be simple and uniform across the board: a truly universal plan. I am quite aware that when the government touches ANYTHING, they screw it up--- but it seems to me the reason is vested interests making sure they get "theirs" FIRST, while contributing to the whole as little as they can. I just watched "Sicko" again yesterday. We are just a baby-step beyond that, and the state of affairs is still a cluster-f***. ... And yes, the plan I get through my wife's job (she has it too, of course) is a "bronze" plan. I've seen it labelled that way. The only other option available to us through fabulous Health New England is an HSA. And how are we supposed to save enough for ANY kind of major medical expense??? It's a system rigged for the benefit of Big Insurance and Big Pharma, and the AMA. I have half a mind to inquire about stuff on a RETAIL basis when I visit Canada in May/June.
Interesting. If you've got a "metal level" plan through work, is that a SHOP plan? SHOP is Small business Health Option Program; ACA plans for smaller businesses.
Medium and large businesses continue to buy insurance directly from insurers (or self-insure). However:
The offered insurance must meet the minimum essential coverage (MEC) requirement, defined as "Bronze level" where the health insurer plan will pay at least 60 percent of the cost of each health service or treatment; higher levels of coverage include "Silver" with 70% insurer payment, "Gold" at 80% insurer payment and "Platinum" at 90%, and are permitted
So it may be that your plan really is bronze, or it could be that your plan just meets the minimum coverage requirements of a bronze plan.
All that HSA-eligible means is that a plan (such as a bronze, silver, or gold) meets high deductible health plan (HDHP) requirements - that except for preventive care, it pay for nothing until you meet a deductible, that deductible has to be within certain ranges, etc.
These days, I refuse to call the HDHP deductible requirement "high", when bronze and even silver plans have deductibles that are higher than this requirement.
Last year I had an HSA-eligible bronze plan. But my insurer closed up shop. Now only the two most expensive insurers (BCBS and UnitedHealthcare) offer HSA plans in my area. Their cheapest bronze HSA plans cost about $2K/year more than my 2018 non-HSA silver plan from a nonprofit insurer. So I know whereof you speak, or in Clintonese, I feel your pain.
Comments
https://www.nytimes.com/2018/04/09/opinion/obamacare-trump.html
It talks about many liberals predicting a mass migration from employer plans to ACA plans. That's not what I remembered, so I went into the internet time machine and found this 2013 paper on HealthAffairs.org. Its Exhibit 4 shows predictions by the CBO/JCT, Rand, Urban Institute, Lewin Group(?), and CMS. In 2011, 58.3% of nonelderly were covered by employer plans. The predicted changes ranged from an increase of 2.9% (Rand) to a decrease of 1.8% (CBO). No massive shifts.
Maybe there were others making wild speculations. For example, the HA paper mentions that the American Action Forum predicted 43 million (out of 170 million) would be dropped from employer insurance. But this was was under the assumption that employers would "ignore federal nondiscrimination laws" or segregate workers who didn't want insurance into separate subsidiaries, or ...
The "theweek.com" piece says that the exchanges are "useful almost entirely for lower-income people who are eligible for subsidies". Subsidies go up to 400% of FPL (about $66K for a family of 2, $100K for a family of 4). Both are higher than the median household income of $59K. It seems the plans are useful for above average households as well as lower-income people.
It dismisses CSRs (cost sharing reductions) by saying tersely that the government subsidies for CSRs were terminated. What it doesn't say is that while the government terminated direct subsidies, it's still subsidizing them indirectly. That's because by law (that Congress was unable to change), people below 250% FPL have to get lower copays and deductibles on their silver plans, regardless.
So the insurers hiked their premium rates to cover the cost of reducing copays and deductibles. Since the government subsidizes most people's premiums, the government wound up increasing the premium subsidizes and thus indirectly paying for CSRs anyway.
Since the CSRs still exist, someone at 200% FPL (the example in the article) would not buy a bronze plan, but a silver plan (the only metal level with CSRs). So its a mistake to look at subsidized bronze plans with high deductibles. Rather, the writer should have looked at subsidized silver plans with subsidized (low) deductibles and copays.
Finally, it says that blue states are shifting the burden onto poor people. But it ignores the fact that part of the ACA is something called a Basic Health Program. This is for people earning up to 200% FPL, and costs them less than a silver plan with CSR. So far, two states, Minn. and NY, have implemented this. Last I checked, the land of HHH and Democratic Farmer Labor was still blue, as was New York (despite the best efforts of the Independent Democratic Council).
IMHO there are lots of significant problems with the ACA, and Medicare for All, or even a government option, would be a big improvement. Nevertheless, with appropriate (significant) tuning, it is workable.
Medium and large businesses continue to buy insurance directly from insurers (or self-insure). However:http://www.ncsl.org/documents/health/aca_requirements_for_employers.pdf
So it may be that your plan really is bronze, or it could be that your plan just meets the minimum coverage requirements of a bronze plan.
All that HSA-eligible means is that a plan (such as a bronze, silver, or gold) meets high deductible health plan (HDHP) requirements - that except for preventive care, it pay for nothing until you meet a deductible, that deductible has to be within certain ranges, etc.
These days, I refuse to call the HDHP deductible requirement "high", when bronze and even silver plans have deductibles that are higher than this requirement.
Last year I had an HSA-eligible bronze plan. But my insurer closed up shop. Now only the two most expensive insurers (BCBS and UnitedHealthcare) offer HSA plans in my area. Their cheapest bronze HSA plans cost about $2K/year more than my 2018 non-HSA silver plan from a nonprofit insurer. So I know whereof you speak, or in Clintonese, I feel your pain.