Affordable Care Act--what will it mean for us as consumers?

[SoonerTexan]

I actually don't mean to start much of a debate about this, but this section seemed safest.

I'm truly trying to understand what the immediate, short range (1-3 years) and long range (3+ years) impacts are going to be for us as consumers of health insurance. I figured I'd focus on that aspect even though I know it is going to mean A LOT of change for doctors.

These are a few of the things I'm confused about:

• So as of 2014, everyone will be required to have health insurance or pay a fine, correct? I know those in lower income groups will get assistance, but man, even some of the estimates of what I've been seeing of health care bought through the exchanges seems pretty high for the income bracket!
• All employers will be required to offer health insurance? Or just some? What are the limits?
• What exactly counts as a Cadillac plan? I know the "tax" doesn't hit until 2018, but I cant figure out if my current plan would even be one based on the limits published (I don't know how much my employer contributes to my premium). How can you know?
• Do you think premiums will rise? My gut says yes for just about everyone no matter what the first year, but I have no idea beyond that.

[GrayMatterWife]

Less choice, higher premiums, and longer waits.

If we're lucky.

If we're unlucky, we'll look like Ireland. BTDT

Whether you have to offer insurance relates to: (1) how many EEs you have and (2) how many hours they work. It incentivizes fewer EEs and fewer full-time EEs. Hence, why several major corporations are cutting back on low-level full-time positions.

The goal here is not to have everyone covered by insurance. The goal is to have as many people covered by the government programs as possible.

The next step from here will be employers dropping any type of spousal coverage. The law does not require spousal coverage, only dependent coverage. Already, we're seeing companies drop spousal coverage for any spouse that already has a job and can get insurance. They are just biding time, though. Eventually, it will be too expensive to cover any spouse, and non-working spouses or spouses that work part-time will be forced onto the government's programs.

Like Majority Leader Harry Reid said last week, the ultimate goal is a one-payer system. Apparently in an effort to make sure everyone shares in misery, rather than anyone rise above it.

I am endlessly shocked (I don't know why) at my Obama-supportive friends who are confused as to why their premiums will be going up. I guess they thought someone else would be paying for this.

[poky]

If the alternative to everyone sharing in "misery" is one person rising above it and 10 people going bankrupt because of medical bills, I'll share in "misery", because I'd prefer to not support a system that decides that people who don't have enough money (even if that's because of health care bills or loss of job due to illness) don't deserve health care.
Interestingly, my premiums went DOWN last year, after I had heart surgery, and aren't rising this year, afaik.
The ACA means that if I didn't have a job, I would be ABLE to get individual insurance, which until it took effect, I couldn't, because of my heart (and believe me I tried, when I was out of work for a while several years ago. I just. plain. couldn't).
Part of the ACA means that if insurance companies spend less than 80 or 85% of the premiums they collect on actual health care, they have to issue refunds for the amount over, and I just read a thing that said in Texas half a million families got an average of $100 back because of that provision this year (or last year?). So not everyone's premiums are going up.
I'm hopeful that once more people actually HAVE insurance, EDs will see a higher percentage of users who actually NEED the ED, and the percentage of people using them for primary care will go down, but we won't know that for a while. Seems a probable outcome, though.

[SoonerTexan]

Yep, definitely put this in the right place

There are some things I really like about it and some I hate (I wont go into that discussion here again and would prefer not to), but mostly I don't really understand it all! That's what I'm getting at.

[GrayMatterWife]

Not me. I would gladly support (voluntarily) charities that help the indigent, or provide assistance to those in need. But I have absolutely no desire to pay hire premiums for lesser care so that other people can afford health insurance. I've been dead-ass broke and struggled with insurance, because the government tells me it's my moral obligation. I work for the government. I cannot conceive of a less-qualified institution to be doling out morality. And it's not about morality, anyway. It's about power. This is an effort to make the federal government more powerful.

I am laughing at Ohio. That state voted for Obama. Insurance rates they are projected to skyrocket. Enjoy your vote, Ohio.

People are nuts if they think this is going to equalize health care and be cost-efficient. At what point has the government ever made anything cost-efficient. It will just become a bloated system. People like me--people with the means to do it--will just find their health care elsewhere, and everyone else--the people who really desperately need the access and advocacy--will be screwed in long lines. It is headed down the road to what we see in Ireland and England or worse. A bifurcated system of the haves and have-nots, and a system that does not attract the best and the brightest to enter the field.

And, for whatever it's worth, the argument that ACA will reduce bankruptcies due to health care costs is incorrect. People don't go BK because they don't have health insurance. The vast majority of people who go BK because of medical costs do so because they cannot pay what they owe even with insurance. I see this every day in my job. Yes, some people lose their job and lose coverage and get sick, but a sh*tload of people have insurance and just cannot keep up with the out-of-scale charges for medical costs. That isn't going to be solved with the ACA. Billing will not be better trued-up to real costs and people will still owe outrageous amounts. This was never about lowering medical costs. It isn't even about lower insurance costs.

[Sheherezade]

My premiums are down too. And both poky and I are in Ohio.

I think no one really knows what's going to happen. It's a very complex system. Everyone is playing the projection game to benefit their own politics. http://economix.blogs.nytimes.com/20...care-act/?_r=0

One hopeful spot: health care costs are no longer rising so quickly.

[BonBon]

Our premiums go up year after year, even though we buy only catastrophic insurance.

I used to have happy feelings that a single payor system was the way to go. Working at ECMC in Buffalo changed that. We got scads of Canadians coming in because the wait times there were so bad. I'm not sure what the solutions are, but the government in charge of health care is not it.

ETA: sorry this did not answer your original questions, ST.

[samssugarmomma]

Good questions ST. I wish I knew even 1 of those answers. I've tried to read about it but it is very confusing!

[GrayMatterWife]

I'm talking about people who have to independently purchase insurance. The people who need reasonable rates the most but have no ability to negotiate. The ones who just get f**ked in the system. nThere is no dispute that their premiums are going through the roof--Ohio was one of the states where it is predicted to happen at the steepest rate. It has been well-covered in the news, although occasionally the news tries to cheerlead for the administration by comparing apples to oranges. If your rates did not go up, count yourself lucky. Most people's will, within the next few years. This isn't really a point of contention: the administration has conceded it.

And don't think you can keep your plan, like promised. Employers are dropping plan, dropping full-time employees so they don't have to cover, and who they are willing to cover, like spouses.

Yay government. Which cannot learn the lesson of unintended consequences.

[PrincessFiona]

I have mixed feelings about the changes coming. I think things are intentionally confusing so that we all don't know what the real problems/pitfalls/advantages are.
I've lived in 2 different countries with mixed forms of healthcare. In Germany, there was a robust private program as well as a more common public health program. Both required insurance premiums and had different advantages. All were initiated at the start of a job, with the employer paying a certain percentage of the plan as well. In the UK, we had govt. insurance, but could pay privately for a consultant to provide care. This was available to anyone, but obviously limited those who had less money.

Here is what people don't understand. In countries with robust public health care plans there is NO MONEY. There are no hospitals with marble pillars and private rooms unless you pay extra out-of-pocket. It just doesn't happen. In Germany, I labored in a room with the other wives and their husbands. In the UK, there were 12 women in the 'room' after giving birth. Americans have come to expect a standard of care that is luxurious and unaffordable. That will have to change. There is no way around it. I'm not saying that's a bad thing, but it is a real truth.

In the UK, people all had access to the same care. It meant no choice in healthcare providers. You went to the clinic in your neighborhood. If you didn't connect with your doc, tough shit. If your kid needed speech therapy, the wait list was 1.5 years. Suck it and don't complain. I have a very good friend there who could not get a consult with a pediatric nephrologist or even pediatrician. She had to see an FP. By the time her daughter was finally seen by a consultant, she had almost no kidney function in one kidney and damage to the other....for reflux. It was preventable damage and a real shame. She has come to the US and has paid out-of-pocket here to be seen by doctors to get the care for her kids/herself that she needs and is always amazed at how well she is treated and how good the care is. Her son has suffered harm at waiting so long for speech therapy and then having a speech therapist who was from India and spoke poor English. She could NOT get a different provider. What do they teach the kid in the Montessori school? "you get what you get and you don't throw a fit." Think of that on a larger scale.

Without people paying in and having those hated "cadillac plans" there are no super-facilities...no private rooms...no excellent access to care. I think it's hard to imagine the scenarios that I've laid out happening, but they do.

We live in MN. Thomas has multiple patients from Canada whom he regularly sees for care. The waits are too long for them to get into the specialist.

When we say that we want this .... in order to have "fair" and equal access to care, we're fooling ourselves. I've seen it.

But I digress.

In MN, there is an insurance plan for the poor called MNCare. MN ranks as one of the states with the highest number of insured and lowest health care costs. I believe we are in the top 5. There are income requirements to get into MNCare and I know a family on it. They have excellent healthcare coverage for next-to-nothing. I pay outrageous premiums for our plan. They don't. I'd argue they have better access to care than we do. In our state, there are a lot of people with private insurance... Access to this care is a lifesaver and I 'm not sure how changing this in our state to meet the requirements of Obamacare will be an improvement.

I am skeptical about how this will all work out for America, having been down the road of public healthcare. Americans will need to change their expectations (not necessarily a bad thing).

Like I said, I'm on the fence. I truly believe that every hard-working American should have access to a health insurance plan to protect themselves and their families and to take care of their healthcare needs. It's ridiculous that we don't have a better system in place for middle and lower class americans. At the same time, I don't think the current plan will be the answer. I'm very skeptical. I will say though that some of our friends who are big supporters of this plan are the biggest hypocrits. (I'm not saying all supporters are). They are physicians and use every avenue to get their kids in ahead of the line, use the doctor card in the ER, reject public education for private schools, plan ways to get out of paying as much in taxes as they can ... and it bothers me. Again ... not all supporters of the plan are like this obviously ... just those we know in medicine who believe they are different and belong in a different class because they are doctors/doctor spouses.

Anyway...I'm on the fence about the plan. It isn't what I would have chosen to do, but I feel some changes needed to happen.

My fear is that this will have a large negative effect on physician incomes and will hurt us personally .... and that it will create access and quality of care issues.

As an additional FYI, physicians in countries with more socialized medical plans are earning well under 100,000. How will decreased physician salaries work here in the US with the issue of student loans. In the UK, I believe average salary is at 70k. That's not enough to pay off 200k in loans.

Reimbursements are already falling, and they will continue to fall. There just won't be money.

Kris

ETA: I have no idea how the healthcare exchange thing will end up playing a role in the increase in costs and the future development of a public health care plan. I feel like we are headed in the direction of a govt. plan. I also believe that many employers are going to make changes to decrease the number of hours an employee works in order to ensure that they don't have to provide them with health insurance. This game has been going on way too long anyway. It's old hat...but it will make life even harder for individuals with low income jobs.

It is good that pre-existing conditions will be covered. I don't know the limitations on that.

Our healthcare plan offered us a startling increase in our premium this year ($1500 more). We have the threat of being taxed on this policy held over our head. If this counts as income, we will likely be forced to take a cheaper and less comprehensive plan. I will be really discouraged about that. We have already passed the limit at which we are willing or able to pay more taxes. We have 5 kids. Life is expensive. Increasing taxes takes money away from our children's educations ... and now possibly their healthcare plans.

There is a feeling that we have that we are being punished for working hard to be more successful. That's all a different issue though.

I'm just babbling.

[diggitydot]

Falling reimbursements aren't necessarily because of the ACA. They've been steadily falling for decades.

[PrincessFiona]

Falling reimbursements aren't necessarily because of the ACA. They've been steadily falling for decades.

That is absolutely true. We've see this happen without ACA. I think ACA has the potential to accelerate this.

The thing is ... we're all in now. It's happening. So ... maybe the doomsday forecasts won't happen and it will turn out to be the best thing for this country. I truly, truly hope it is.

There were too many people who could not afford healthcare insurance. I hope that the ACA will make healthcare affordable to them without having a huge negative impact on the rest of us. Time will tell.

[WolfpackWife]

I find the whole damn thing so confusing and it worries me. Obviously most of my worries are selfish and for that I'm somewhat embarrassed: what does the ACA mean for my husband's career/our future livelihood? With COL and student loans and someday possibly wanting a family it's even more frustrating to not fully understand the whole plan and it's implications. I'm responding so I can follow the updates and information.

[Sheherezade]

Affordable Care Act--what will it mean for us as consumers?

The best explanation for what's predicted and why I can find:

"The Society of Actuaries projects that the number of individuals insured in that market will increase from the pre-A.C.A. level of 415,000 to the post-A.C.A. level of one million. Many of these newly insured are projected to be relatively sicker individuals who had been excluded from Ohio’s nongroup market, either because they could not afford the high premiums they were quoted, based as these were on the individual’s health status; or because insurers had refused them coverage outright; or because they were in the state’s high-risk pool.

Just last week Julie Appleby of the Kaiser News Network reported on the tribulations that individuals had routinely experienced in the current, pre-A.C.A. nongroup market.

The proponents of the Affordable Care Act should not deny that with this simulated change in the risk profile of Ohio’s nongroup insurance market — which may or may not come about — a switch from medically underwritten premiums to community-rated premiums, coupled with a richer benefit package, could significantly raise premiums for healthy individuals with higher incomes who are not entitled to substantial federal subsidies or any at all. The Ohio Insurance Department’s news release certainly drives home that point.

On the other hand, for projected new entrants into Ohio’s nongroup market who are relatively less healthy, the community-rated premiums even before federal subsidies are most likely to be significantly lower than their medically underwritten pre-A.C.A. premiums — if they had been offered coverage at all. A forthright news release would have mentioned that positive outcome as well.

From the “fact sheet” that the Department of Insurance appended to its news release, one gathers that Ohio’s lieutenant governor, Mary Taylor, who also acts as director of the Department of Insurance, opposes the Affordable Care Act and supports its repeal. In the fact sheet, her department notes:

Health insurance today is priced based on individual characteristics. Those with healthier lifestyles are rewarded with more affordable options. Under the A.C.A., all Ohioans will be lumped together for the purposes of pricing thereby eliminating the benefits of healthier choices. This method of rating is commonly known as “community rating. … Because Ohio is being forced into this type of pricing, health insurance costs are increasing in 2014.
I can understand how community rating violates the theory of justice espoused by libertarians. In fact, I have proposed a way to accommodate their preferred social ethic. The department’s rationale for opposing what it calls “one-size-fits-all pricing,” however, astonishes me.

One can agree that an individual’s choice of an unhealthy lifestyle can reduce her or his health status and increase that person’s use of health care. Community rating gives such people a financial break we would rather not give them.

But many serious and often devastating illnesses afflicting individuals are a result of accidents, or genetic or environmental factors that have little to do with lifestyle choices. The many victims of such illnesses, in Ohio as elsewhere, might interpret the Ohio Insurance Department’s rather crudely put theory of the causation of illness as an insult added to injury."



So there's the debate over whether we all - most of us here at least are healthier, wealthier people - should pay higher rates so that those that have less healthy less wealthy existences can pay lower rates.

As for hospital reimbursements, who knows? I know that the hospitals agreed to the ACA because get felt getting paid for previously unpaid charity work would offset lower reimbursement overall. I think it's all theoretical though.

It's one hell of a math problem for the actuaries.

[SoonerTexan]

Very good points Kris. I thought it was interesting about all the coverage about the luxurious and expensive Lindo Wing when Kate Middleton was giving birth--I looked it up. It's crap compared to the average private hospital experience (in Texas at least). Steak and lobster dinner anyone? (Yes, I'm dead serious) Obviously a wee bit over the top.

I definitely think it will be a hard thing to get used to. We do have a lot of luxury in our system--honestly I could care less about some of it, but I'm going to be honest, I really don't want to give birth in a room with other women or share one in recovery. (If that becomes the norm, then sign me up for a homebirth or birthing center ASAP!)

Sorry, that's my only reference point for care right now