OT: Obamacare… Don’t say we didn’t warn you…

[no_such_reality]

If you’re under 400% FPL in SoCal, age doesn’t matter much, ACA tax credits, drive your cost for coverage to a common point.

San Diego has an anomaly, in that the HealthNet plans for older people actually have a premium that is below the ACA credit level which is determined by taking (I think) the average of the three lowest plans and calculating a max percentage of income to purchase health coverage.

In other words, whether you are 20, 40 or 60, at a certain income level, ACA credits push your net cost for coverage to ~4% (at $18K single) range and I think 10% at 400% FPL. It doesn’t matter how much the average premium costs, the tax credits push it to same level.

[FlyerInHi]

Honestly, I don’t know much about the details of Obamacare. My insurance is great so doing the research is useless to me.

I don’t however see how anyone can be against the concept of getting everyone covered with the goal of a healthier population.

Premiums may vary between different employers and individuals, but total health care costs are born by the whole country. Under the status quo, for decades, health care has been eating up a bigger and bigger percentage of our national wealth. We need to stop escalating costs and such things as the use of the emergency room by the uninsured population. Is sounds to me like Obamacare is designed to do that. There may be some transition pains but as the population is covered, costs will come down.

[citydweller]

I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?

[scaredyclassic]

this is so complex.

can we just have something simple?

[spdrun]

Sure. Public option, but nooooooo, we’d have death panels if this were ever implemented. Right.

[livinincali]

[quote=FlyerInHi]Honestly, I don’t know much about the details of Obamacare. My insurance is great so doing the research is useless to me.

I don’t however see how anyone can be against the concept of getting everyone covered with the goal of a healthier population.

Premiums may vary between different employers and individuals, but total health care costs are born by the whole country. Under the status quo, for decades, health care has been eating up a bigger and bigger percentage of our national wealth. We need to stop escalating costs and such things as the use of the emergency room by the uninsured population. Is sounds to me like Obamacare is designed to do that. There may be some transition pains but as the population is covered, costs will come down.[/quote]

What makes you think costs will come down. Say there’s a 20% reduction in emergency rooms visits because patients go see the doctor before they end up in the emergency room. Are some emergency rooms going to close? Are some emergency rooms going to downsize? What if instead the emergency rooms jack up the prices on their remaining patients to make up for the decrease in the number of patients they see. Does that lower the cost of healthcare in this country?

Obamacare is likely adding 30 million people to the demand side of the equation and it will likely take years for the supply side of the equation (more doctors, nurses, and clinics) to catch up. What’s likely to happen to the costs if demand goes up a bunch and it takes a while for supply to show up. Will the costs go up or down?

[SK in CV]

[quote=livinincali]
What makes you think costs will come down. Say there’s a 20% reduction in emergency rooms visits because patients go see the doctor before they end up in the emergency room. Are some emergency rooms going to close? Are some emergency rooms going to downsize? What if instead the emergency rooms jack up the prices on their remaining patients to make up for the decrease in the number of patients they see. Does that lower the cost of healthcare in this country?

[/quote]

You have this kind of backwards. Reductions of ER visits are much more likely to be from patients that previously had no coverage and weren’t paying. That won’t reduce ERs viability, it will increase it. They’ll be servicing a higher percentage of paying patients, so if anything, they can decrease prices. And those patients who were previously getting free ER treatment, are more likely to see non-ER providers, with treatment at a much lower cost. So yes, it will lower the overall cost of healthcare.

[bearishgurl]

[quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]

citydweller, I haven’t had the chance to look at CoveredCa’s charts on your behalf, but would surmise you are a “boomer.”

Do you have an HSA at present? That “Kaiser Bronze 60 HSA HMO” is nowhere near equivalent to your present coverage, IMHO. Not only do you currently have a much better carrier, your deductible is much lower than the Bronze plan (lowest, cheapest plan on the exchange). You also likely have a PPO with a large choice of providers. As a “boomer,” you’re likely not going to want to go from “choice” to “locked into an HMO.”

An HSA makes the most sense if you know you will have W-2 or taxable self-employed income to fund it going forward.

What is troubling to me, though is that you stated your present out-of-pocket maximum is $11,810, which is a typical out-of-pocket cost for a family plan, not an individual plan.

Was your policy “grandfathered” by Anthem/Blue Cross, citydweller? In other words, was your policy already in effect in March 2010, when the HCRA was signed into law? Something doesn’t seem right with you having a (very reasonable) $2950 deductible and a soaring $11,810 maximum out of pocket requirement. That is, in effect, an $8,860 annual coinsurance requirement!

In all of the plans I’ve ever seen offered on paper, the coinsurance requirement was 75% or LESS of the deductible.

Is your coverage part of a family plan, citydweller? And how are you figuring out your current out-of-pocket maximum expense?

In the absence of the answers to those questions, I think you should leave well enough alone for now, citydweller. ESPecially if you have a “grandfathered” plan and are 55+ years of age. There are worlds of difference between a Kaiser HMO (ESP a 60% one that needs the infusion of MSA $$) and an Anthem/Blue Cross PPO.

“Open enrollment” for CoveredCA runs though March 2014, IIRC. Your coverage is not going away so you have plenty of time to make a decision for 2014. And of course, there’s always 2015.

If my old, “grandfathered” coverage wasn’t “going away” on 12/31/13 (my carrier, Aetna is leaving the state), I wouldn’t even be remotely interested in signing up on the exchange.

[no_such_reality]

[quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]

Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.

As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.

[bearishgurl]

[quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]

Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.

As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]

nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.

If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.

But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.

[citydweller]

Thanks for all the comments. Yes my current policy is grandfathered in from way back. I was only looking at Kaiser because a friend of mine recently got coverage there and said she was happy with it, but I would hate to switch based on one persons experience.

Thanks to your feedback I took another look at CoveredCA and the “Anthem Multi State Plan Silver 70 EPO” looks better and cheaper than what I have now. $520 month premium, $2,000 deductible, $6,350 max out of pocket, also copays that are not subject to deductible.

I’m assuming that “Multi State” means I would be covered in other states, I’ll have to do some more research.

[livinincali]

[quote=SK in CV]
You have this kind of backwards. Reductions of ER visits are much more likely to be from patients that previously had no coverage and weren’t paying. That won’t reduce ERs viability, it will increase it. They’ll be servicing a higher percentage of paying patients, so if anything, they can decrease prices. And those patients who were previously getting free ER treatment, are more likely to see non-ER providers, with treatment at a much lower cost. So yes, it will lower the overall cost of healthcare.[/quote]

How do figure that it will lower the total cost of health care. Look at it from the vantage point of the ER. They have x amount of staff to pay, y amount of fixed costs, and some profit margin. Whether they charge 10 patients $1 million each and get paid on 30% of them or they charge $300K each and get paid on all of them doesn’t change the total cost of health care at all. Those 10 patients brought in 3 million dollars to the ER. It just changes who’s paying for it. Suppose this scenario.

The ER sees 7 patients cuts the $1 million charge to $500K and gets paid on all of them. The ER just made an addition $500K and total health care costs went up even though each individual patient was charged less.

Now if the ER responds by cutting their workforce (costs) because they see less patients the total costs could go down but nothing in Obamacare makes them do that.

[FlyerInHi]

We are spending more as share of national wealth than older healthier societies. Something is screwed up. Something needed to be done.

Everything is a process, not a be-all-end-all solution. ObamaCare is the beginning of reform.

I think a lot of the visceral opposition is emotional rather than rational.

Obamacare will be helpful to independent business people such as family farmers, electricians, plumbers, actors, writers, etc who currently go without health insurance.

[livinincali]

[quote=FlyerInHi]We are spending more as share of national wealth than older healthier societies. Something is screwed up. Something needed to be done.

Everything is a process, not a be-all-end-all solution. ObamaCare is the beginning of reform.

I think a lot of the visceral opposition is emotional rather than rational.
[/quote]

I think emotion rather than rational thinking gave us ObamaCare. The first question to ask would have been why do we spend more as a share of national wealth than the rest of the world. Is it because we subsidize the rest of the world with R&D spending on medical research? Is it because we support small rural emergency rooms that are under utilized? Is it because of illegal immigrants using up resources? Is it because we’re a nation that insists that we’re all entitled to the best care regardless of cost and we don’t want to wait for said care.

I will agree that other nations do spend less on medical care for a variety of reasons, but I will argue that the solution isn’t pumping another couple hundred billion into the medical insurance industry. I’m willing to bet that after ObamaCare goes into effect at less half of the total premiums collected as will be an increase to the total medical spending in this nation. The reason is fairly simple. The new money that is collected is going to go somewhere and likely be counted as medical spending.

[SK in CV]

[quote=livinincali]

How do figure that it will lower the total cost of health care. Look at it from the vantage point of the ER. They have x amount of staff to pay, y amount of fixed costs, and some profit margin. Whether they charge 10 patients $1 million each and get paid on 30% of them or they charge $300K each and get paid on all of them doesn’t change the total cost of health care at all. Those 10 patients brought in 3 million dollars to the ER. It just changes who’s paying for it. Suppose this scenario.

The ER sees 7 patients cuts the $1 million charge to $500K and gets paid on all of them. The ER just made an addition $500K and total health care costs went up even though each individual patient was charged less.

Now if the ER responds by cutting their workforce (costs) because they see less patients the total costs could go down but nothing in Obamacare makes them do that.[/quote]

Ignoring professional staff for the moment, there are other marginal costs for running an ER. Drugs, consumables, DME, admin costs and salaries. Using the beginning of your example, instead of 10 pts with 8 paying, they may only have 9 pts with all of them paying. Some ER visits for formerly uninsured will remain, but some will entirely disappear as covered patients see non-ER physicians with a much lower cost, and some visits entirely disappear as a result of preventive care.

The cost savings in having more people covered (as specifically related to ER’s only) will come from two areas. First, preventive care is less expensive than acute care. (e.g., successfully treating for hypertension is significantly less expensive than treating for a heart attack.) Second, treating in a non-emergency clinical setting is significantly less expensive than treating in an ER.

One of the by-products will be a reduction in cost-shifting. Currently non-profit hospitals that are required by law to treat indigent patients (where zero-pay patients often reach 20%, in some hospitals much higher) must charge insured patients to cover the cost of their zero-pay patients. With a reduction in indigent patients, that cost-shifting will be reduced.

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