Affordable Care Act tore me up

[Rukh]

I'll sit here and hold my breath while the healthcare industry lowers their rates because of an influx of money.

Truth is, cost reduction will never happen unless it is legislated.

Edit: I'm all for everyone being covered, I just don't feel the ACA was the right solution.

There were a couple of mechanisms that were supposed to help lower costs. One, having to compete against a public option, didn't make it in to the bill. It was an important part. The other hope though is that if the price to actually insure people goes down, i.e. healthy and younger people also paying in, than market competition will cause prices to go down though natural means. This requires some regulation such as insurance companies not cooperating on setting prices, and I don't know if that has happened or not. In general such a thing is already illegal through antitrust laws, but some industries to get some rights for price setting. I know for instance, west coast fisheries. Fishermen do have some ability to negotiate for an overall price to the processors.

[taliey]

I'm talking about people like the OP who can't afford to not have insurance but refuses to get it anyway.

Say what you like about "free riders/welfare leechers", statistical data on welfare recipients show that most people on government assistance are old people and children, and estimates of welfare fraud are below 3 percent.

I was making a tongue in cheek reference to welfare queens. Sorry, I should have been more blatant in my sarcasm.

[breadisfunny]

I was talking about celista's implied uncompensated care and going on to describe the people who do such actions. So, no, I'm not calling you anything but a Draenei hater.

those draenei get what they got's coming to them. bam! pow!

[drwelfare]

You talking about free riders/welfare leechers?

Dont have coverage, dont incur costs, and pay your fine, does not sound like leeching the system. Actually supporting it, even if its not voluntary.

The able-bodied person who gets subsidized coverage is the one doing that, or the illegal who just shows up at the ER.

[Celista]

I don't have a choice sadly. I go though my school, and they use Aetna. It's cheaper that way

Do you NEED to go through your school? :/ Seems strange that they don't allow you to participate in the marketplace. I was able to opt out of our school insurance when I was in law school and get independent coverage, school insurance plans tend to be pretty crap.

[breadisfunny]

I'm talking about people like the OP who can't afford to not have insurance but refuses to get it anyway.

Say what you like about "free riders/welfare leechers", statistical data on welfare recipients show that most people on government assistance are old people and children, and estimates of welfare fraud are below 3 percent.

gee celista a lot of the people in my area on welfare or welfare programs are actually around my age or slightly older.

[Crissi]

Do you NEED to go through your school? :/ Seems strange that they don't allow you to participate in the marketplace. I was able to opt out of our school insurance when I was in law school and get independent coverage, school insurance plans tend to be pretty crap.

Nah, they only require I have any insurance. Unfortunately, getting insurance direct from companies cost me about 100 a month more due to pre existing conditions jacking the price (anxiety and burst ovarian cyst history)m
And mine is actually pretty good, but USC is a private university so *shrug*

[Ahovv]

A lot do, yes. They never can seem to explain why private is "fundamentally" more efficient than public, they just "know" it is.

I've exhausted myself in explaining why health insurance is a scam in previous threads, and how a true free market would not have rampant health insurance.

[taliey]

Dont have coverage, dont incur costs, and pay your fine, does not sound like leeching the system. Actually supporting it, even if its not voluntary.

The able-bodied person who gets subsidized coverage is the one doing that, or the illegal who just shows up at the ER.

The subsidy is meant to maintain a certain level of coverage. And also, if you look on a form 8962, you have to repay your subsidy (if you receive advance payment of the subsidy when you purchase your plan, otherwise its what you're entitled to).

[drwelfare]

gee celista a lot of the people in my area on welfare or welfare programs are actually around my age or slightly older.

You didn't even mention the ones who work under the table, or the guy on disability who picks up old appliances and sells them for scrap/

[Renathras]

And that's a temporary fact. The reason insurance rates are so high is because hospitals charge a ton. The reason hospitals charge a ton is because some people don't pay and hospitals still need to make their money. With many more people having insurance, hospitals receive their money more reliably and can then lower the rates they charge to insurance, who should then lower the rates they charge to consumers.

Actually, it seems the opposite is true.

I've said for a while the ACA was a bad law/bill because it has all the wrong incentives. For example - the ACA was supposed to make health care costs go down by having people get preventative care, which is cheaper. Sounds like a good plan...except because of all the mandates, premiums went up and deductibles went up, so a lot of people try eking out every cent they can in a single year and then not using any the next year. Additionally, in an effort to keep people from going to the doctor for every stubbed toe - which would drive costs up more - the law increased out of pocket and copay costs.

...as you might guess, this resulted directly in people getting LESS, not MORE, preventative care, which will drive costs UP, not DOWN, in the long run.

Moreover, as more people are seeing that the insurance is worse than what was available before the ACA (higher premiums, deductibles, and copays with narrower doctor networks), many people who are healthy and young have opted instead to pay the fines and forego health insurance that they generally do not need, which has resulted in the costs going up more - a lite version of the "death spiral" that some predicted. Indeed, I was reading an article last week where insurance companies are saying yet again they're going to have to have a steep rate hike this year because the pool of people wanting insurance is sicker and older than they forecast for the 3rd year running.

On top of that, it's worse in many states. While liberal leaning states already had fairly expensive insurance with lots of mandates, less progressive ones tended not to. So when the Federal government made one-size-fits-all mandates, they didn't spike the costs much in the "blue" states, but sent them up by rather large factors (sometimes more than 100%) in "red" states. And this is before adding the issue that, while the mandates are nation wide, the law DIDN'T make insurance buyable across state lines to increase competition. And what makes all this even WORSE is that many of these mandates don't apply to most people - literally, you are paying for/buying insurance with components you CANNOT use. For example, childcare for people without children and pregnancy care for men, elderly women, and lesbians (or any women, really) who have decided not to have any children.

And this is before getting to the fact that half the states didn't expand Medicaid (including still having the old rules where, for example, a single male can't get on it), meaning if you're "too rich" for the subsidies you may still not have viable insurance options, but if you're also TOO POOR for the subsidies - where the law expected you'd be shunted to Medicaid instead (even though it's worse all around, I guess the writers thought it was okay to give poor people sub-par insurance?), in all those states that didn't expand Medicaid, you can't get on IT. So you can't get on Medicaid, but you're not RICH enough to get a subsidy, so there's NO WAY you can actually afford insurance...but to add taxes to injury, you get the tax/fine for not having insurance! You're LITERALLY penalizing people for being poor by making them pay a "poor tax", which is the absolutely most regressive taxation schema possible!

And, all the while, the law never addressed the actual problems - torts and a lack of supply of doctors, particularly the less lucrative general care practitioners and nurses/physician assistants, that our population, living longer lives, is desperately in need of.

.

So as the law didn't address basically any of the reasons costs have gone up, doesn't address the supply side issues or the legal/bureaucratic issues, and instead provided ample mandates to drive up costs, it seems HIGHLY likely that we're going to continue to NOT bend down the cost curve (recent data suggests the cost curve is unchanged from the pre-ACA rate of cost increases, and even moreso in many states), and people are losing more and more money on health insurance policies that are worse than the ones before the ACA.

In short, it's going to continue to be plagued with problems year over year, and, at least right now, there's no end in sight. The issue you call temporary isn't likely to go away as more people are priced OUT OF, not IN to, the insurance pools. And that's before even addressing issues like illegal immigrants who go to hospitals and still leave them without paying the bill. So even the problem you mention that the ACA was supposed to fix, it does not. And, indeed, it may be making that problem worse.

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Don't get me wrong, it does a few good things - like lifetime cap removal and people with preexisting conditions getting insurance. But, ultimately, I sad in 2009 and I hold to it now, we could have achieved the SAME THING if the Federal government simply expanded Medicaid to all Americans regardless of health status and simply charged a rate based on income (with it being free for people below a certain amount). Doing so would have covered all uninsured, allowed any American to get some form of insurance for a price they could afford (or free if they were poor), and the government, if it felt all those mandates were good, could just have applied them to the national Medicaid insurance.

It would have been a more elegant solution that wouldn't have caused all the problems of tinkering with 1/6th the economy and placing government bureaucrats between patients and their doctors for three times the price and one fifth the value.

[Ryzek]

My family has had a shit ton to f billing and admin issues with all sorts of health insurance. Better does not mean good, and my poor by is that people that think probably care must be better than gov aren't necessarily right.

The amount of misbillings is too damn high!

This is very true, I work as a Medical Biller. A big problem with private insurances is they each want things filled out their own way so its a pain in the ass because how you bill something to Aetna will not work the same way you bill something to Blue Cross Blue Shield. Also a lot offices and facilities also don't require any type of certification from billers. Example, I work for a pediatrician and we see about 80-100 patients a day, although most are medicaid each have different medicaid (Yay for Texas allowing MCOs into the mix) each MCO and private insurances have their own set of rules, so I have to follow a different set of rules for each insurance. That's just claims, not to mention authorizations and other stuff.

[Renathras]

People who say they're paying more I have sympathy for. People who say they need medical help who don't have insurance and who complain they can't pay for the medical help they need because they're getting fined for not having insurance... I hope the irony doesn't make your headache worse.

Not sure I get you.

This person has the money to pay for his health care.
The government takes that money from him in the form of a fine.
This person now cannot afford the care they COULD HAVE AFFORDED without the fine.

That's not irony, that's government stupidity.

Think about it - what was the point of the Affordable CARE Act? Was it not to make health CARE affordable to people? But if you take people's money so that people who COULD afford their health CARE now cannot afford their health CARE because they're being fined for not having INSURANCE, then doesn't that defeat the purpose?

What's more, if he couldn't afford the insurance, then what makes you think he'd be able to afford the deductible if he had it? That is, imagine he had bought the insurance, so now he's got even LESS money than before the government fine. Now he goes to get his issue taken care of and has to pay a DEDUCTIBLE on top of it!

That's not irony, that's government/politician stupidity.

[Cthulhu 2020]

I was talking about celista's implied uncompensated care and going on to describe the people who do such actions. So, no, I'm not calling you anything but a Draenei hater.

The state loses a lot of money when idiots go without insurance then have huge medical bills and have to declare bankruptcy.

[Schattenlied]

I'm talking about people like the OP who can't afford to not have insurance but refuses to get it anyway.

The OP's point is: s/he would have been able to afford it if they didn't have to pay the ACA fee...

OP also said having the insurance would cost more than the fee, and s/he can't afford to pay the fee and $190 to get his/her teeth fixed, so what makes you think s/he would be able to afford the insurance?

You say s/he can't afford to not have insurance, to me it looks more like s/he can't afford to have insurance either.

[Renathras]

OP: You are exactly what is wrong with our insurance market. You believe it to be cheaper to pay the fine and out of pocket for dental work, so you don't get insurance. Now fast forward a few months, you are in a serious accident and are hospitalized. Congrats on life-crippling debt while the rest of us pay for you!

Man, YOU are exactly what's wrong with our insurance AND political market:

You and those who supported the ACA ran under the assumption that people WOULD be in accidents. To hear you talk, we all are spending 6 months out of the year in a hospital.

Personally, I'm a bit over 3 decades of life and I've never had a hospital stay, broken a bone, etc in my life.

Congrats on NON-life-crippling NON-debt while I get to pay for the rest of you to have cheaper insurance rates? That's what you should be saying...

[chazus]

Why didn't you get health insurance?

Why don't you have insurance? Anything requiring a hospital visit or god forbid a stay is going to kill you if the fine does.

I didn't have health care last year either. I had no illness and injuries, but it would have run me about 4000 for the cheapest plan available. So affordable!

It was that, or pay the $200 fine.

I have insurance now (which thank goodness, because I actually did have medical problems that would be in the 6-8 grand range now), but the fact of it is... Its hard to plunk down several hundred bucks a month for some people if nothing is wrong.

[breadisfunny]

Man, YOU are exactly what's wrong with our insurance AND political market:

You and those who supported the ACA ran under the assumption that people WOULD be in accidents. To hear you talk, we all are spending 6 months out of the year in a hospital.

Personally, I'm a bit over 3 decades of life and I've never had a hospital stay, broken a bone, etc in my life.

Congrats on NON-life-crippling NON-debt while I get to pay for the rest of you to have cheaper insurance rates? That's what you should be saying...

no the problem is that our healthcare system is treated as a for profit business with the shareholders being insurance companies.

[Ahovv]

I've exhausted myself in explaining why health insurance is a scam in previous threads, and how a true free market would not have rampant health insurance.

A short summary of my previous posts:

1) The concept of health insurance has been propped up and supported by government since the 20th century. This has climaxed with the ACA which further solidifies our nation in the health insurance scam. The new argument against reform is one promoted by Hillary Clinton: "Oh, we spent all this effort fighting for the ACA, do we really want to argue over this more?"

2) The third party of health insurance has removed all competition and pricing from the medical industry. Negotiations are never between consumer and product; instead, an overwhelming majority of all doctor's visits and surgeries are performed without a patient understanding the costs involved. The consumer doesn't care about the costs because many excess costs are deferred to the insurer. This endless cycle results in healthcare costs which outpace inflation.

3) A healthcare system with transparent pricing would result in more incentives for quality and value, with no requirement for health insurance. The poor could still be subsidized under this system while also resulting in substantial savings for all. Everyone wins.

[Renathras]

Why don't you act like a responsible adult and get health insurance. Or are you just going to claim bankruptcy if you get into an accident or are diagnosed with a serious illness?

Irresponsible. Grow up.

Why don't you act like a responsible adult and realize that different people can make responsible adult decisions like COST/BENEFIT analyses.

If he wasn't being fined by the government, he'd be able to afford his own heath CARE without the need for the overpriced, government mandated INSURANCE that wouldn't pay for it anyway if he didn't meat the deductible!