Skip to main content
Message Font: Serif | Sans-Serif
 
No. of Recommendations: 45
...story doesn't hold up under scrutiny:

'I Would Jump At It'
The media labeled her an Obamacare victim. Here's what she really thinks.

http://www.newrepublic.com/article/115457/obamacare-victim-f...
Print the post Back To Top
No. of Recommendations: 1
Here's what she really thinks.

I read that article, and it doesn't really say much about what she really thinks. It has a lot about what Jonathan Cohn has guessed about her insurance options, but not a lot of actual discussion from Ms. Barrette thinks. There's only one real quote on her decision-making, which is here:

When I gave her a broad description of the plans available, she seemed interested. I noted that she’d be paying $100 or $150 extra a month for policies that still had high cost-sharing, so that she would still be a lot of money out of her own pocket. (I also made very clear that I’m not an insurance agent or broker—that, when she finally goes shopping for insurance, she should talk to a real expert for advice.) Here was her response: "I would jump at it," she said. "With my age, things can happen. I don’t want to have bills that could make me bankrupt. I don’t want to lose my house.

That's a strong quote, but based only on Cohn's estimates of the policy coverage and pricing. Look at the only other full quote in the article from her:

Most everyone I talked to said they were paying thousands more to get hospital coverage," she told me, "so I took my chances with what I have now."

So I would be rather surprised if Ms. Barrette actually signed up for insurance under the ACA. Given her income of $30K, and her price sensitivity, she doesn't strike me as someone who has an extra $1,200 to $1,800 in her annual budget to start paying for better health insurance. Nor, to be honest, is it likely that Cohn's noodling around the website is getting her all that accurate a read on the numbers - she's 57, not the 50 years old that the website uses to generate the "browsing" prices.

Maybe she will choose to buy coverage - and the exchanges are premised on the hope that people like Ms. Barrette will voluntarily pay more money if they can get the government to pick up most of the cost of a full plan. I'm skeptical, but one can only hope that she (and millions like her) are willing to pay a little more in order to get that government subsidy.

Albaby
Print the post Back To Top
No. of Recommendations: 19
Reading about the junk plan that she was paying $650 a year for infuriates me. She would have been better off banking the $650 and self-insuring instead of flushing her money down the toilet with that plan. States should have gone after companies selling crap policies like that.
Print the post Back To Top
No. of Recommendations: 2
"For some, this will seem like a good deal. For others, it will not. As Larry Levitt, senior vice president at the Kaiser Foundation, puts it:

Not everyone buying their own insurance today will perceive themselves as better off under the Affordable Care Act, but many will, once they come to understand what's available to them and what kind of tax credit they may be eligible for. Of course, this is not really easy to explain in a soundbite."

http://www.newrepublic.com/article/115457/obamacare-victim-f...
Print the post Back To Top
No. of Recommendations: 9


I read that article, and it doesn't really say much about what she really thinks.


Fair enough, we don't really know what she thinks. What the article does tell us is that what the media is calling health care insurance policy cancellations are not health care insurance policies at all. This is what most people have thought all along. When someone calls me on the phone and says they have a health care policy for $50 a month, I just hang up the phone. What this woman had didn't protect her at all, that's the whole idea behind the word "insurance."
I can go on about what this 57 year-old woman didn't have with her fake insurance policy, but suffice it to remain, there are not millions of insurance policies being canceled.
Print the post Back To Top
No. of Recommendations: 2
I can go on about what this 57 year-old woman didn't have with her fake insurance policy, but suffice it to remain, there are not millions of insurance policies being canceled.

I think this is also whistling past the graveyard. Certainly there are junk policies out there in the individual market. But the average per person premium in the individual market is $215 per month, which translates into a $2,500 annual premium for a single person, and a $10,000 annual premium for a family of four:

http://kff.org/other/state-indicator/individual-premiums/

You're not getting great coverage for $2.5K per year, but we're getting into real insurance policies here. And note that's the average. For every $50 per month high-deductible "junk" plan that's out there, there's someone paying $350 per month. AHIP (an industry trade group) did a survey in 2009, and about 2/3 of the people covered in the individual market weren't in high-deductible plans:

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&a...

Ultimately, this is an empirical test for the ACA. If the individual insurance market was as horrible as the Administration is now claiming and the offerings in the exchanges are pretty good, then reaction will be muted (if/when people can start getting exchange coverage). But if the exchange offerings compare unfavorably with the individual market coverage for a non-trivial number of people, it's going to be rough political seas.

Albaby
Print the post Back To Top
No. of Recommendations: 0


You're not getting great coverage for $2.5K per year, but we're getting into real insurance policies here.


First, no you are not "covered" You have no "insurance" if your health fails. What you have, or I should say, what she has here is pre-paid doctor visits and pre-paid prescription medications. That is all. As I said, I don't want to go into all that she does not have. Insurance premiums provide contractual agreements that your insurance companies have with doctors, hospitals, care centers, clinics... etc. without these reduced rates that insurance companies have with hospitals you are subject to anything the hospital master-charge says you have to pay often 10 times the contracted rates that insurers agree to. Second, these are under the current law "Not real insurance policies." The ACA and the federal government has now written into law what can pass as health-care coverage and finally someone has come out and said, "no this is not health-care insurance coverage." These policies are at best pre-paid doctor office visits.
According to your link the average individual policy in the United States is 300% more than what this woman "thought" was health care coverage.





this is an empirical test for the ACA. If the individual insurance market was as horrible as the Administration is now claiming and the offerings in the exchanges are pretty good, then reaction will be muted (if/when people can start getting exchange coverage). But if the exchange offerings compare unfavorably with the individual market coverage for a non-trivial number of people, it's going to be rough political seas.


Sounds good, but you're leaving out all the benefits that the ACA brings to the market, as if they have been there all along. In the past, you go into the hospital with a serious respiratory failure, for example. You wind up in ICU. After a week or ten days of hospitalization your insurance company says you had asthma as a child. Due to the pre-existing condition you get to keep the entire $480,000 bill for hospitals and doctors.
These conditions no longer prevail under the ACA, and before you point to one specific aspect of the ACA as "The Empiric Test," you have to go back and assess all the benefits afforded through the ACA.
Print the post Back To Top
No. of Recommendations: 2
According to your link the average individual policy in the United States is 300% more than what this woman "thought" was health care coverage.

That was my point. I was responding to your suggestion that millions of people aren't losing coverage, because policies like the one that Ms. Barrette had aren't coverage. That latter point might be true - but policies like the one Ms. Barrette had aren't the entirety of the individual market. The typical policy isn't a $50 per month 'prepaid doctor visit' plan.

These conditions no longer prevail under the ACA, and before you point to one specific aspect of the ACA as "The Empiric Test," you have to go back and assess all the benefits afforded through the ACA.

I didn't say it was "The Empiric Test." I said it was an empiric test - it's an instance where one of the things that the ACA does is now directly being tested in the real world. The ACA has de facto eliminated about a third to half of the individual insurance market, and those millions and millions of people are now going to have to look to the exchanges to replace their policies. So now the rubber meets the road - do the exchange policies end up offering comparable (or better) insurance to those people that aren't subsidized? If the answer to that is "no," then there will be a fair amount of political pain.

Albaby
Print the post Back To Top
No. of Recommendations: 0



policies like the one Ms. Barrette had aren't the entirety of the individual market. The typical policy isn't a $50 per month 'prepaid doctor visit' plan.



Ok, not everyone on the individual (current) market has a plan like the one described here with Barrette, but on the other hand you don't have an inventory of all the plans currently being canceled. Further, it could be that 40% of plans being canceled meet the requirements of the ACA. Companies are merely canceling policies. Most importantly, the point I made, the media has run many stories about people losing their current insurance, like this story, and having to pay 300% more under the individual mandated ACA. These same stories have been brought up before:

http://boards.fool.com/californians-not-liking-aca-rate-incr...

http://boards.fool.com/aca-is-pretty-expensive-30941190.aspx...

The point, Ms Barrette never had coverage for a health care need, and cp her "coverage" with real coverage is a joke, and further creates public perceptions that are false.


then there will be a fair amount of political pain.

True, and there will be some pain, esp for people caught in the so-called gap.
Print the post Back To Top
No. of Recommendations: 2
The point, Ms Barrette never had coverage for a health care need, and cp her "coverage" with real coverage is a joke, and further creates public perceptions that are false.

Perhaps - but if she can't find one or two thousand dollars extra in her annual budget (not easy for someone making $30K per year), she's not going to have coverage for a health care need under the new system either.

True, and there will be some pain, esp for people caught in the so-called gap.

At least those folks won't have their situation changed from the status quo - they lack insurance today, and will continue to lack insurance. The ones who will be really howling are any who have insurance today - legitimate individual market policies - who are uninsured come January 1. The Administration had better make sure that there are very few of those people. Bear in mind that now the exchanges have to sign up something like 4 million people who had policies just to break even.

Albaby
Print the post Back To Top
No. of Recommendations: 0



Perhaps - but if she can't find one or two thousand dollars extra in her annual budget (not easy for someone making $30K per year), she's not going to have coverage for a health care need under the new system either.


She will have to pay a hundred dollars more a month "to have coverage for a health care need." Under the new plan she gets two doctor visits a year paid for, rather than having something like a one hundred Co-pay under her old plan.

The ones who will be really howling are any who have insurance today - legitimate individual market policies - who are uninsured come January 1

As I pointed out, you don't have an inventory of those plan specifics. We've heard a lot about the "fake" plan cancellations, but not much information about the real policies that are converting to the ACA. In may cases, private insurance companies are doing the conversions for policyholders. As your link points out, the current family of four plan averages $10,000 a month, that might go as high as $12,500 or drop to $8,500. A family of four where Ms. Barrette lives with a household income of 65k would see their $10,000 policy drop to $5,700. This is part of the aggregate "rubber meets the road test" that will establish the ACA.
Print the post Back To Top
No. of Recommendations: 1
Basically everyone from (solid middle class level and the young even with subsidy) will be paying close to double over what they were previously.

Everyone below this line will have modest increases all the way down to darn near free because they will qualify for a subsidy.

ACA is the largest tax increase on the middle class in our history.
Print the post Back To Top
No. of Recommendations: 3



Basically everyone from (solid middle class level and the young even with subsidy) will be paying close to double over what they were previously.

- SGIZ1

Too bad you can't stick with the evidence, just regurgitating PoxNews propaganda. The current average family of four policy is $10,000 a year.


Here are facts:

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

Double the current average is $7,300 more than that. Good thing you don't run your own business, your workers would rob you blind; but you can always take a sixth-grade math course refresher.
Print the post Back To Top
No. of Recommendations: 2
Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

Double the current average is $7,300 more than that. Good thing you don't run your own business, your workers would rob you blind; but you can always take a sixth-grade math course refresher.


Rightime, the $12.7K limit does not include the premium.

Albaby
Print the post Back To Top
No. of Recommendations: 0



does not include the premium.



But the current premium is Already $1700 Less than the current average Family of Four
Print the post Back To Top
No. of Recommendations: 0
"does not include the premium.


But the current premium is Already $1700 Less than the current average Family of Four "

but.. but.. but...
lol...
You are on a roll
Print the post Back To Top
No. of Recommendations: 2
But the current premium is Already $1700 Less than the current average Family of Four.

That wasn't the point you were making in your post. You were claiming that "double the current average" was $7,300 more than the max required under the exchanges. That's not correct. The $12,700 cap is in addition to the premium.

I should note that using the Kaiser calculator, the estimated premium for second-lowest silver coverage nationwide for a family of four - without subsidy - is about $8.3K:

http://kff.org/interactive/subsidy-calculator/#state=&zi...

Albaby
Print the post Back To Top
No. of Recommendations: 0



I should note that using the Kaiser calculator, the estimated premium for second-lowest silver coverage nationwide for a family of four - without subsidy - is about $8.3K:


And that's $1700 Less than the current average family of four per your link.
Print the post Back To Top
No. of Recommendations: 2
And that's $1700 Less than the current average family of four per your link.

Sure - but I (like I imagine you did) left the default age setting at 21. If the adults are 42 years old, the second-lowest silver plan for the family of four is also $10K per year:

http://kff.org/interactive/subsidy-calculator/#state=&zi...

As you might guess from that coincidence, 42 years old is the 'equivalence' age.

Note that the second-lowest silver plan cost for a 35-year-old individual is about $500 higher than that national average in the insurance market:

http://kff.org/interactive/subsidy-calculator/#state=&zi...

...and individuals generally fare worse under that calculator.

Finally, it should be noted that the second lowest (or lowest) silver plan may not be anywhere close to the coverage of any given individual market plan - in either direction. As you've pointed out, some individual plans are junk. As others have pointed out, some exchange plans are Exclusive Provider Organizations with very narrow networks, and silver plans have deductibles going up from about $1,500 to $5,000:

http://www.forbes.com/sites/danmunro/2013/09/29/average-cost...

...so these types of comparisons based on premiums alone can be inaccurate.

Albaby
Print the post Back To Top
No. of Recommendations: 0



...so these types of comparisons based on premiums alone can be inaccurate.


There are a lot of variables. Comparing people who buy health insurance through their employer to people buying healthcare insurance for a family on the current (Pre-ACA) is not applicable. Insuring a family of four on the Pre-ACA policy market, say Kaiser California, carries between a $2000 deductible and $6500 deductible; with Co-pays and Caps.
Deductibles are not new to the individual exchange market, and the ACA provides insurance at high-end. If you start comparing weeks of hospitalization with the ACA to the old individual exchange market of coverage you see the difference in terms up to 10 times the coverage under the ACA.

You have to compare the same things, and simply saying that all Americans that are not subsidized will pay double for healthcare is an absolute fabrication. I make mistakes, but at least I present evidence.
Print the post Back To Top
No. of Recommendations: 1
You have to compare the same things, and simply saying that all Americans that are not subsidized will pay double for healthcare is an absolute fabrication.

Oh, I agree - that's just nonsense. But the fact that the above claim is nonsense does not mean that less overwrought claims about the negative impacts of the ACA are nonsense as well.

Albaby
Print the post Back To Top
No. of Recommendations: 1



the fact that the above claim is nonsense does not mean that less overwrought claims about the negative impacts of the ACA are nonsense as well.



I agree and I’ve said that there are pitfall. As I pointed out, the lower end of the subsidy cutoffs. I agree with your assessment, steeper deductibles/Co-pays with the low end plans. I don’t know if you’ll agree, but the ACA has addressed the astronomical end of health care costs; that is the starting point for what I understand is the concept of insurance. Correct me, but I have not seen a supporter of the ACA claim that there are no the negative impacts of the ACA. Conversely, I have read time and again extreme claims that the ACA is all being paid for by the unsubsidized recipients. There is a lot of polemicizing without the use of facts, as was the above statement about doubling premiums. The ironic aspect to all these polemics is that everyone is being forced to pay “something.” There are many conservatives here constantly complaining that 49% pay no federal income tax, and have no “skin-in-the-game.” Now, here’s a program that forces 89% of Americans to have “skin-in-the-healthcare-coverage-game” and it’s too liberal because wealthier people will not be subsidized.
I know that you don’t like the concept of younger, healthier people subsiding older, possibly sicker people, but I never got a Pell-Grant, my kids don’t receive Pell Grants. I subsidize some young healthy people and then they subsidize some older unhealthy people. It all works out.

Cheers
Print the post Back To Top
No. of Recommendations: 1
The ironic aspect to all these polemics is that everyone is being forced to pay “something.” There are many conservatives here constantly complaining that 49% pay no federal income tax, and have no “skin-in-the-game.” Now, here’s a program that forces 89% of Americans to have “skin-in-the-healthcare-coverage-game” and it’s too liberal because wealthier people will not be subsidized.

It's not really all that ironic. As I've mentioned from time to time, most of the people who get insurance under the ACA will get it for free - the majority of people will be put on Medicaid. They have no skin in the game.

The next biggest batch will be those getting subsidies - but they're no more likely to have much more skin in the health care game than previously. On average, the uninsured paid about 30% of their own health care costs out of pocket:

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/74...

...which is pretty decent "skin in the game" already. They'll now have insurance, and likely end up paying about the same or less of their health care costs going forward - while consuming more health care. And since the subsidies go all the way up to people earning nearly $100K, you're talking about the taxpayers picking up expenses for people that are making twice the median household income - something that is very inconsistent with conservative principles.

Albaby
Print the post Back To Top
No. of Recommendations: 0



most of the people who get insurance under the ACA will get it for free

more in the range of 38% of the current uninsured. you just got done telling me that millions and millions of the currently insured are being diverted to ACA plans, so which is it?



As I've mentioned from time to time, most of the people who get insurance under the ACA will get it for free - the majority of people will be put on Medicaid. They have no skin in the game.


currently this is $15,856 for a household of one or $32,499 for a household of four. This represents the vast majority of Americans?
Currently people in this income range get healthcare for free already, it's just screwed up how they get it through emergency rooms. someone earning even $200 over this level still has to pay something... it might be $200 a year or $65 a month depending on the deductibles, but they are in the game. Do you really expect this segment of the population to pay for the greater part of health care insurance?



The next biggest batch will be those getting subsidies - but they're no more likely to have much more skin in the health care game than previously. On average, the uninsured paid about 30% of their own health care costs out of pocket

But Ms Barrette represents exactly this segment and she will be paying up front 185% more for coverage. She represents 185% more skin-in-the-game.

Young adults are the largest segment of uninsured. It's estimated that 60% of this population of uninsured (those over 26 or w/o parents coverage) will pay at least $100 a month. Now you're talking about billions of dollars of skin in the game that didn't exist previously.

subsidies go all the way up to people earning nearly $100K, you're talking about the taxpayers picking up expenses for people that are making twice the median household income - something that is very inconsistent with conservative principles.

Paulson wrote a 300 billion dollar blank check to the wealthiest people on earth, placed into office by a conservative House, Senate, and President.
Print the post Back To Top
No. of Recommendations: 1
more in the range of 38% of the current uninsured. you just got done telling me that millions and millions of the currently insured are being diverted to ACA plans, so which is it?

They're the same. Medicaid is 38% of the uninsured, but not all of the uninsured are expected to get insurance under the ACA. Longterm, the CBO estimates that the ACA reduce the uninsured by about 25 million people - of which 13 million will be put onto Medicaid:

http://www.cbo.gov/sites/default/files/cbofiles/attachments/...

But Ms Barrette represents exactly this segment and she will be paying up front 185% more for coverage. She represents 185% more skin-in-the-game.

Young adults are the largest segment of uninsured. It's estimated that 60% of this population of uninsured (those over 26 or w/o parents coverage) will pay at least $100 a month. Now you're talking about billions of dollars of skin in the game that didn't exist previously.


No - because lack of insurance does not mean lack of skin in the game. As I pointed out upthread, the uninsured pay for a non-trivial amount of their own health care - they just do it out-of-pocket. When they have to go to the doctor, they pay for it. When they need to buy medicine, they pay for it. They have skin in the game, because they have to cover their own health care costs. When the government comes in and basically buys them a free health care plan:

http://www.nytimes.com/2013/11/04/business/under-health-care...

...they can end up with less skin in the game.

You have one person that pays for a big chunk of their own health care out of their own pocket (either because they're uninsured or have a high-deductible plan), while a second person gets health care provided to them for free at the public's expense - and the former person is the free rider?

Albaby
Print the post Back To Top
No. of Recommendations: 0



the uninsured pay for a non-trivial amount of their own health care - they just do it out-of-pocket.


You may have pointed it out, but the majority of uninsured are young adults who don't pay "out of pocket." Once in a while one of them dives headfirst into the ocean and hits a sand bank. After he becomes a paraplegic, you pay his healthcare bill anyway. If 60% of this group pays $100 a month, that's 600 million month more or less skin-in-the-game rather than surfing for free.
The 60 year-old couple earning $24k between them is the minuscule minority, and in a couple years they get Medicare anyway. They will be converted over to a Medicare for under 65.

You have one person that pays for a big chunk of their own health care out of their own pocket (either because they're uninsured or have a high-deductible plan), while a second person gets health care provided to them for free at the public's expense

About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost.

Out of 46 million? You’re the one that pointed out that a family of four earning $46K pays $233 a month. So which is it, is it for free or do they have $233 a month skin in the game.
You suggesting that if someone's insurance is subsidized, then they don't have skin in the game.
Print the post Back To Top
No. of Recommendations: 2
You may have pointed it out, but the majority of uninsured are young adults who don't pay "out of pocket." Once in a while one of them dives headfirst into the ocean and hits a sand bank. After he becomes a paraplegic, you pay his healthcare bill anyway. If 60% of this group pays $100 a month, that's 600 million month more or less skin-in-the-game rather than surfing for free.

Why don't they pay out of pocket? Far more often than becoming a paraplegic, they might sprain an ankle or come down with mono - and they pay for their doctor visits and medications out-of-pocket. They'll pay for wound care and illnesses and injuries and a host of things - uninsured people paid $30 billion of their own health care last year.

And why would I pay his healthcare bill anyway? I might have to pay for the emergency room treatment, but only to stabilize his condition. The years of therapy, any subsequent reconstructive surgery he might need....those aren't going to be done in the emergency room.

Out of 46 million? You’re the one that pointed out that a family of four earning $46K pays $233 a month. So which is it, is it for free or do they have $233 a month skin in the game.

You suggesting that if someone's insurance is subsidized, then they don't have skin in the game.


That family of four has skin in the game...since they're not the ones getting fully subsidized coverage. The ones who get shifted into Medicaid or get a zero-premium policy are the ones who don't have skin in the game....or rather, have far less skin in the game than they did before and less than even the uninsured person.

And even that family of four might have less skin in the game than before the ACA - because the public is picking up a non-trivial portion of their premiums.

Albaby
Print the post Back To Top
No. of Recommendations: 0



- uninsured people paid $30 billion of their own health care last year.


No way, uninsured people were Charged $30 billion for health care last year.

The ones who get shifted into Medicaid or get a zero-premium policy are the ones who don't have skin in the game....

Which is the minority of uninsured.
Print the post Back To Top
No. of Recommendations: 0



And why would I pay his healthcare bill anyway? I might have to pay for the emergency room treatment, but only to stabilize his condition.


Not true, once he becomes indigent he's on Medicaid, which is the vast majority of current Medicaid recipients.
Print the post Back To Top
No. of Recommendations: 2
No way, uninsured people were Charged $30 billion for health care last year.

No, they paid $30 billion for health care last year:

People without health coverage spend less than half of what those with coverage spend on health care, but they pay for a much larger portion of their care out-of-pocket. In 2008, the average person who was uninsured for a full-year incurred $1,686 in total health care costs compared to $4,463 for the nonelderly with coverage. However, these averages are affected by the high number of uninsured individuals that do not seek health care at all. The uninsured pay for about a third of this care out-of-pocket, totaling $30 billion in 2008. This total included the health care costs for those uninsured all year and the costs incurred during the months the part-year uninsured have no health coverage.

The remaining costs of their care, the uncompensated costs for the uninsured, amounted to about $57 billion in 2008. About 75% of this total ($42.9 billion) was paid by federal, state, and local funds appropriated for care of the uninsured population.


http://kaiserfamilyfoundation.files.wordpress.com/2013/10/74...

The ones who get shifted into Medicaid or get a zero-premium policy are the ones who don't have skin in the game....

Which is the minority of uninsured.


....but the majority of people who gain insurance under the ACA. That's because the majority of folks that are currently uninsured will remain uninsured.

Albaby
Print the post Back To Top