The Dismantling of ObamaCare - Ongoing Updates.

[HoosierLife]

Perhaps I misunderstood what you posted.

You are saying there are 2 different options she can choose from her employer.
1. Co-Pay Plan with no HSA
2. High Deductible with HSA

You used to be on #1. Now you are on #2.
On Plan #1, you paid $30 or $50 when going to the doctor.
On Plan #2, you now pay $100 when going to the doctor.

Is all that correct?

No. Yeah you are misunderstanding me. Two years ago when we first started the HSA plan the doctor visits were ~$30/$50. That was while we have the HSA plan. Before that it was $20/$40 every time because of the co-pay under plan number one.

It's just the adjusted cost with the HSA plan would get the PCP visit down to around $30 and now the adjusted cost is around $100.

 

[Yagents]

Your carrier changed, or network changed, or contracts changed.

If your high income, after tax deductions and lower premiums, you may come out ahead. Compare total out of pocket after taxes.

 

[junkman]

Not all poor can get Medicaid. Have you forgotten about the states that did not expand Medicaid?

And now, even the middle are being priced out. TN did not expand Medicaid and all buy either direct from the carrier or off the Federal exchange. I had a reason to look at options for friends in CA and DC. Both of those areas have higher medical costs than does TN. Both expanded Medicaid and both have lower unsubsidized premiums than does TN.

Our wonderfully caring, intelligent conservative, Christian-promoting, right-wing state legislature has shot themselves in the foot. Well, actually their constituents that have to buy coverage. The politicians have coverage that we pay for.

@Hoosier: service costs have generally not doubled. It is time to start pushing the doc on his prices. Have them give you a network price and a self-pay price. Always ask for a "prompt pay discount" even after the fact even if you haven't paid in a year. Most of the time you can get 10 to 20% off the network price. The only exception I've seen is Quest Labs. They over charge non-network payers, don't discount and I string them out as long as possible.

I don't have a discretionary service performed without knowing a price first. Ex: I went to talk to a doc about a significant procedure. Their SOP was to automatically take x-rays but couldn't tell me what the charge was. I told the nurse "tell the Doc I want to talk to him 1st and if I like him, I'll hire him."

He ended up being a great Doc but after we talked asked me "how do you feel about 1 x-ray?" I had money and got the x-ray and paid for the office visit. The main procedure was going to be pushed into the next year when I'd hit the OOP so I was simply minimizing cost in the current year.

Of course, this is one of the cost drivers. I didn't care about cost in the year of the main procedure, only OOP. It is also why I consider the Repubs mouthing about "market forces" to be disingenuine. There ain't no market forces at the provider level when we pay for healthcare with insurance.

 

[evoxse]

...High risk pools with tax payer funding and allowing insurance companies to underwrite and sell insurance is the answer.

I don't see how this is any different from what we have now. The burden of funding high risk patients will still be placed on the general population. Only difference being it's now in the form of taxes instead of mandatory coverage.

 

[nylife11023]

I don't see how this is any different from what we have now.

From what I've read, Trumpcare is just Obamacare without a personal mandate.

It will also fail.

Let me ask this. How many of you (or your clients... especially FE clients) would buy auto or home insurance if you/they were not required by the state (to register car) or the bank (to get a loan) to do so?

Therein lies your answer of why a mandated system of either 'forced premiums' like the current system or one based on mandated higher payroll/income taxes will be required.

Good luck getting those who are 35 and under to buy a health insurance policy if they don't have to.

 

[AgentOrange]

I don't see how this is any different from what we have now. The burden of funding high risk patients will still be placed on the general population. Only difference being it's now in the form of taxes instead of mandatory coverage.

Generally speaking, It will be very different if you are in the high risk pool or trying to get into the high risk pool. These things are chronically underfunded and typically get capped when a certain number of people are enrolled. So many people will be without coverage that desperately need it. Who remembers those calls? Additionally, the pool will be extraordinarily expensive to cover. Think dialysis, cancer, Alzheimer's etc. something like 25% of all Americans under 65 have a pre-x, so if you lose coverage there's a 1 in 4 chance you're uninsurable. Even if states cover large portions of the premiums many of those people will still be priced out because they are so expensive and because HRPs are designed to take losses many states impose a fee on private health insurance to cover the cost. So we'll not only be paying for these things from our state and fed taxes, but also our insurance premiums.

The cost savings is really had by capping the people in the pools. And that's the trade off back to sick people going bankrupt and the excluded either not getting any care or getting dodgy care. And as a country we go right back to square one with the only affordable comprehensive coverage being done through group and health insurance is coupled to employment.

 

[HoosierLife]

Generally speaking, It will be very different if you are in the high risk pool or trying to get into the high risk pool. These things are chronically underfunded and typically get capped when a certain number of people are enrolled. So many people will be without coverage that desperately need it. Who remembers those calls? Additionally, the pool will be extraordinarily expensive to cover. Think dialysis, cancer, Alzheimer's etc. something like 25% of all Americans under 65 have a pre-x, so if you lose coverage there's a 1 in 4 chance you're uninsurable. Even if states cover large portions of the premiums many of those people will still be priced out because they are so expensive and because HRPs are designed to take losses many states impose a fee on private health insurance to cover the cost. So we'll not only be paying for these things from our state and fed taxes, but also our insurance premiums.

The cost savings is really had by capping the people in the pools. And that's the trade off back to sick people going bankrupt and the excluded either not getting any care or getting dodgy care. And as a country we go right back to square one with the only affordable comprehensive coverage being done through group and health insurance is coupled to employment.

How big is this pool really? We're not counting the 90% of the country that are on employer plans, Medicaid, medicare or VA.

I think I'm one to be concerned as this will directly affect me. I have a wife with a Pre-X and will soon have to get coverage on the open market. But I can afford to pay the premiums.

It can't be worse than the $15-25,000 in annual premiums I would have to pay under the current system?

Time will tell.

 

[AgentOrange]

How big is this pool really? We're not counting the 90% of the country that are on employer plans, Medicaid, medicare or VA.

I think I'm one to be concerned as this will directly affect me. I have a wife with a Pre-X and will soon have to get coverage on the open market. But I can afford to pay the premiums.

It can't be worse than the $15-25,000 in annual premiums I would have to pay under the current system?

Time will tell.

Here's a pretty even handed look at HRPs:

High-Risk Pools For Uninsurable Individuals | The Henry J. Kaiser Family Foundation

 

[SamIam]

Here's a pretty even handed look at HRPs:

High-Risk Pools For Uninsurable Individuals | The Henry J. Kaiser Family Foundation

I don't think it will be bad because these people from my understanding will only be in the pool for one year if they didn't have continuous coverage.

 

[AgentOrange]

I don't think it will be bad because these people from my understanding will only be in the pool for one year if they didn't have continuous coverage.

I saw that one year stipulation floated around, where did you get that from? If that is true, then after one year where do they go? Back into regular individual underwriting? That would be even worse off.