Since I'm getting killed on the 'maternity' thread...

[B2G]

Will just post one thought and then leave it alone.

The reason I asked, is because it seems to me, there are a significant number of people who will fall through the cracks.

For those who don't qualify for subsidies and can't afford the bronze plan and don't qualify for Medicaid. There are a lot of them. And it seems to me that this makes a whole lot more sense than forcing them to do without becase they can't afford it.

ACA was supposed to fix this issue...folks who aren't insured because they can't afford it. So fix it. If it means a skinnied down coverage plan, so be it. It's better than being unisured.

That was my main reason for asking. Later.

[uppityperson]

1. Is your point that each person should be insured only for those things they can get or already have?

I agree that the ACA isn't good enough. Not sure what your reason is, would like to clarify.

[B2G]

3. I'm saying there should be a 'catastrophic' option of some sort

Something that people can choose rather than doing without insurance at all. I thought I made the reasons clear in my first post.

I've seen posts here from members who don't qualify for medicaid or subsidies yet still can't afford the Bronze plan. That's wrong and one way to fix it would be to offer a low cost, '
skinnied down' coverage plan that could be purchased based on a means test.

[Cerridwen]

7. Kinda like this?

Note: If you get an exemption because coverage is unaffordable based on your expected income, you may also qualify to buy catastrophic coverage through the Marketplace. This may be more affordable than your other options.

edit to add link at which I found the above: https://www.healthcare.gov/exemptions/

[hlthe2b]

9. There is for those very young (under thirty, I think)--it is the cheapest plan for that age group

[Cerridwen]

10. or low income.

Marketplace catastrophic plans cover prevention

In the Marketplace, catastrophic policies cover 3 primary care visits per year at no cost. They also cover free preventive benefits.

If you have a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or on out-of-pocket costs based on your income.
Catastrophic plans for people with limited incomes

People 30 and over with low incomes for whom other insurance is not considered affordable or who have received a hardship exemption from the fee may be able to buy these catastrophic plans in the Marketplace.
Learn if you qualify in the Marketplace

When you fill out a Marketplace application you'll see catastrophic plans listed as options if you qualify for them. If you don’t qualify for a catastrophic plan, you won’t see them as an option.

https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/

[B2G]

14. Thank you~! I hadn't seen that before

or seen it discussed here. I though it was Bronze or nothing. Will take a look...

Adding:

That would be a good thread. There might be folks who aren't aware either.

[Cerridwen]

23. Made OP. Go kick it. And read it. n/t

[hlthe2b]

2. Sorry, but IMO there is a reason that you are being excoriated on that thread...

If you honestly know nothing about insurance and how it works, please say so and perhaps others will take the time to educate you. But as it is, your posts are (unfortunately) incredibly aligned with RW anti-Obamacare talking points.

You do have a point on there being more room for savings--had we had the public option or single payer.... On that, I totally would agree. But, this is, hopefully a starting point..

[DURHAM D]

5. B-I-N-G-O !

[B2G]

6. I do know about insurance and how it works

I know that up until now, you could purchase insurance without materinity coverage, and it was a lot cheaper. Now you can't.

How is that statement wrong?

[Recursion]

8. *some people* could purchase it without maternity coverage. Others couldn't get it at all

As a consequence of everybody being able to get it, everybody has to pay for some things they aren't liable to ever use.

[B2G]

11. I'm talking about the people who can't afford

to kick in for the common good, much less afford their own insurance. I'm talking about them, not me.

I can and I will, but what about them?

[Recursion]

13. Let me see if I get your hypothetical

You're wondering about people who are:

1. Too poor to afford unsubsidized coverage, while also being
2. Too rich to get subsidized coverage, and
3. Unwilling to enroll in catastrophic coverage, and
4. Living in states where they aren't eligible for Medicaid, whose
5. Price sensitivity is less than the cost differential between the bronze plan and a similar plan without maternity coverage?

Well, I'm sure both of the people who meet all five of those criteria are screwed.

[B2G]

17. Exactly.

I've seen the mythical beast right here on DU.

[dsc]

20. well glad you admit that

The fact is that is likely to be a pretty decent number of people if maternity coverage is as expensive as I have been lead to believe it is. Over half the states didn't expand Medicaid including such large ones as Texas, Florida, Georgia, North Carolina, Virginia, and PA. I would imagine that a woman with cancer who is say age 29 might, just might, fit that bill if she were making say 15k a year. Saving 50% on the bronze plan might be the difference between her living and dying.

[Recursion]

21. So what other treatments should people be able to opt out of?

Cancer? Car crashes?

[dsc]

24. ideally none

but should people die for the ideal? Maternity care is apparently a large part of a policy's cost for those who are in their 20's and early 30's. Those people are also, far and away, the most likely to be in the income situation where they can't get subsidies (too poor) but can't qualify for Medicaid in their states which refuse to expand (too rich). You will wind up having people die due to this, I have no idea how many, but there will be some. If that is OK with you, then so be it. No other aspect of medical care is as expensive relative to a policy's total cost as maternity is to people in that age cohort.

[Barack_America]

18. And because of that, most people who wanted maternity coverage couldn't afford it.

And the tax payers ended up footing the bill in Medicaid costs. Or, for those with more money, but not enough to spend $8-10K on a birth, insurance companies decided their family planning for them.

All to increase insurance company profit margins. Have you ever been a part of a group plan before? Risks (including maternity) are shared in group plans. We are now basically being treated as one big group.

[kcr]

22. The fact you asked that question shows quite clearly that you don't

Or you would know that tailoring everyone's plans to cover only what they need would not lead to lower premiums for anyone. Those people you worry about falling through the cracks? If insurance worked the way you want it to, those cracks would get even bigger.

[Recursion]

4. Say we had Medicare for All. What would happen with people who can't pay the premiums?

ACA is a (small) move towards a uniform universal coverage system: everyone can get insurance, everyone has to get insurance. It's provided by multiple providers, which has pro's and con's, it's state by state, which is problematic, and the providers are insufficiently regulated (but regulated much more than they were last year).

The way that kind of thing works, mathematically, is that people who aren't using many medical services have to end up paying the premiums that cover those who do. That's the entire point of the system. Take away all the flaws in ACA I mentioned above, and have a literal single payer model, and it still has the feature that you are calling a flaw. In fact in some ways it has it even more plainly.

[Rex]

12. This is not about you personally.

So the why will not make rational sense.

[HockeyMom]

15. They penalized women, and even men, of childbearing age

at my former job at a self-insured public school in Florida. Since the AMA "recommends" that women have their first child before age 30 (????) for health reasons, do you, or your SPOUSE if male employee, plan on getting pregnant with your first child following AMA guidelines?

Female staff was horrified with this question on their "health profile". Married male staff, who didn't insure their wives, were very perplexed. If they weren't covering their wives (TOO EXPENSIVE) under their plan, why the hell did the school district CARE when they were having children??? YOU aren't paying for it? Duh?

Yes, they were SELF-INSURING so they could do, and discriminate and penalize, according to want they wanted. Last I heard, female staff was refusing to answer these pregnancy questions.

[tiredtoo]

16. Having a difficult time

understanding your premise of someone not qualifying for subsidies or Medicaid still not being able to afford the bronze plan. the income levels to qualify for expanded medicaid are something like 4 times the poverty rate. Do not know at what income level subsidies drop off but it seems those who make enough to not qualify for either of these would be making enough money to buy a bronze plan. Has anyone documented their results after going to the site and applying? Sounds like just opinions based on what rwnjs are telling the public.

[B2G]

19. Maybe you missed this thread

http://www.democraticunderground.com/10023787462

[tiredtoo]

31. Yes i did miss that thread

could not find it. It appears the poster lives in S.Carolina, a state that does not give a damn about the poor people. Also saw where he will not be subject to penalty based on his income. So basically he is no better and no worse since the law's inception. Must be hell to be poor in S.Carolina.

[surrealAmerican]

25. You are right about some people "falling through the cracks".

Most of them will be in states that refused to expand Medicaid. They will be no better off, but no worse off either - if they genuinely can't afford coverage, they will not be subject to fines.

[Bernardo de La Paz]

26. Please think to link to the thread you refer to. You can edit your post to do so. Context helps. nt

[redstatebluegirl]

27. Well I do not have children but

I have never voted against a school referendum. I do not understand your reasoning..

[frazzled]

28. The ACA DID fix it: The Supreme Court undid it

Medicaid was supposed to be expanded to people earning 138% of poverty level in all states, or the states would lose their Medicaid funding. Some time after the bill was passed, it was brought to the Supreme Court, which supported it all, except for the compulsory Medicaid expansion. Now a whole bunch of Republican states have opted out, leaving their poorest non-insured citizens without means to get insurance.

This will certainly be fixed in the near future. We'll have to amend the ACA to cover these people whose states won't let them into Medicaid (which is a state-run program).

To reiterate, however: the ACA would have covered all these people, had the Supreme Court not made Medicaid expansion optional for the states. The bill could not have foreseen that outcome.

[on point]

29. What you really need is single payer and eliminate the insurance companies

That's how you really get the cost down.

[NoOneMan]

30. Your copayment for starting this thread is $563 dollars