Obamacare is becoming unaffordable

[SHRED]

Plans in the ACA are getting unaffordable while covering less and less. Especially for those of us in our 50's and 60's who are charged much more.

Assuming Hillary wins and the Senate flips what can be done with a Republican House assuming it doesn't flip.

What can be done to relieve us from these terrible plans at ridiculous prices that we are forced to buy?

For those of you in this market who haven't yet checked prices and coverage prior to open enrollment hang on...you're in for a shocker.

...

[Foggyhill]

1. with no aca, even worse plans and still expensive

Health care has been out of control for 20 years, it has nothing todo with aca

Other plans were cheaper because they had only catastrophic coverage with sky high deductible and did not cover pre existing conditions

Enabling younger people to get on Medicare may be the way to go

[SHRED]

2. I understand that

The ACA is the vehicle.

But what can be done with that vehicle if we do not sweep Congress?

[Laura PourMeADrink]

11. What is 100% ironic is that Trump is questioning the laws that prevent

interstate competition among insurance companies - don't think anyone on our side is.

Bottom line, we are all fucked. The insurance companies are so rooted into healthcare it's a sin. Making millions upon millions for middle man status. I truly think that 30 years ago a bunch of fucking republicans sat in a room and said "OK...think !! What do all the people spend a lot of money on and how can we capitalize on that and share the wealth?" And then, they came up with HMOs.

Why we need middlemen is a mystery.

The only hope we all have is for Hillary to actually listen to it all. For us to have a Dem House and Senate. To actually curb/stop the corporate insanity.

[SHRED]

12. 1971

February 17, 1971
5:26 pm - 5:53 pm
Oval Office
Conversation 450-23

John D. Ehrlichman: On the—on the health business—

President Nixon: Yeah.

Ehrlichman: —we have now narrowed down the vice president's problems on this thing to one issue and that is whether we should include these health maintenance organizations like Edgar Kaiser's Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, “Well, I don't think they'll work, but if the president thinks it's a good idea, I'll support him a hundred percent.”

President Nixon: Well, what's—what's the judgment?

Ehrlichman: Well, everybody else's judgment very strongly is that we go with it.

President Nixon: All right.

Ehrlichman: And, uh, uh, he's the one holdout that we have in the whole office.

President Nixon: Say that I—I—I'd tell him I have doubts about it, but I think that it's, uh, now let me ask you, now you give me your judgment. You know I'm not to keen on any of these damn medical programs.

Ehrlichman: This, uh, let me, let me tell you how I am—

President Nixon: [Unclear.]

Ehrlichman: This—this is a—

President Nixon: I don't [unclear]—

Ehrlichman: —private enterprise one.

President Nixon: Well, that appeals to me.

Ehrlichman: Edgar Kaiser is running his Permanente deal for profit. And the reason that he can—the reason he can do it—I had Edgar Kaiser come in—talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because—

President Nixon: [Unclear.]

Ehrlichman: —the less care they give them, the more money they make.

President Nixon: Fine. [Unclear.]

Ehrlichman: [Unclear] and the incentives run the right way.

President Nixon: Not bad.

http://businesspractices.kaiserpapers.org/nixononkaiser.html

[Laura PourMeADrink]

15. Thanks, you just made me sick (no pun intended). Geez, we need a really

good story teller to dumb this all down for the masses. On the other hand, they employ millions. I wonder how it would happen....universal care implementation...all these companies tanking. It is almost like you need to factor that in to costs/impediments to moving toward UHC

[SHRED]

14. And here is a prophetic article from 2007

Kaiser wants to require that everyone must purchase a health plan as a matter of law. Although the government should offer a bottom-of-the-barrel medical plan, most of the health business should go to private insurers and HMOs.

http://mrzine.monthlyreview.org/2007/andrews050907.html


...

[Algernon Moncrieff]

3. There's a bunch that could be done. What will be done is anyone's guess

One solution for 50/60 somethings that has been widely suggested is some kind of early Medicare buy-in with some income-related subsidy.

For the private carriers, to me the obvious solution it that the Feds could create a reinsurance mechanism and offer excess-of-loss coverage on the ACA policies. It would work like this: the carriers would hand over a portion of written premiums to the Feds. The Feds, in turn, would be on the hook for losses over some agreed-upon figure. This would help mitigate some of the claims for expensive pre-existing conditions.

[dflprincess]

4. The only answer I see is expanding Medicare

I am in my 60s and work for one of the non-profit health insurers in Minnesota (as a disclaimer) I'm fortunate that my employer offers a reasonably priced plan with no deductible and a low out of pocket max for copays, etc. to employees though I haven't heard what's going to happen with 2017 benefits.

That said, a couple of my cousins who retired pre-Medicare age have had policies through the company I work for I just heard recently what they're paying - I don't know how they manage it. One of them and hear husband just found out that their premium is going from $1500 to $1700 for 2017 (which sadly, is not a bad increase for individual plan); their deductible will stay the same at $3500 apiece but to add insult to injury the hospital/clinic system their doctor is with is being dropped from the network for individuals. I did some snooping around at work and supposedly narrowing the network can help control costs. I have no idea of how much truth there is in that. I know in my cousins' cases that it isn't true as they are both healthy and so far my employer would have found them to be the kind of people they like to insure.

Anyone the family members will be looking for a new insurer that covers their doctor and they'll have to move fast because all the carriers around here who offer individual coverage are capping how many of those policies they'll write next year.

Lowering the Medicare age really is the only answer for some; maybe a buy in of some kind for younger ones.

[mahina]

16. Is that 1500, 1700 and 3500 a month?

How is that even possible?

[dflprincess]

43. The premium is going from $1,500 to $1,700/month

Plus a $3,500 ($7,000 for the two of them) annual deductible.

[Princess Turandot]

19. Regarding lowering costs...

It's really the insurance company costs that it might lower. As one example: By limiting the number of hospitals included in their network, the insurance company will try to get the remaining network hospitals to accept lower payment rates from them, in exchange for their getting potentially more patients, because the patients will have fewer hospitals to choose from.

Whether that actually lower the patients' premium is anyone's guess.

[Hassin Bin Sober]

48. I saw an infomercial the other day for "Cancer loans"

WTF

[LuvLoogie]

5. Much depends on the state, your level of income, plans that participate.

The larger, general question can only be dealt with in terms of long-game politics. Where your individual needs are concerned, you might have to dig deeper into what exists for you now. For instance, do you have to any employment options where employer-based insurance is available? Are there subsidies available? Do you qualify for Medicaid, etc.

[central scrutinizer]

6. Without the ACA

Ms. central scrutinizer and I would be facing bankruptcy and homelessnes. She was diagnosed with pancreatic cancer a few months ago. Our choices would have been eschew treatment and die painfully and quickly or eat up all our assets to buy her a few extra months.

[SHRED]

7. It was a positive step forward for sure

But we need more steps forward soon.

[kacekwl]

9. Very soon . I will have only

One insurance provider to "chose" from in 2017 and I'm sure my doctors and hospital will not be an option. Cost also will rise ,I'm afraid of how much I hope Hillary is serious about fixing the ACA and quickly.

[frazzled]

8. Without ACa most people in their 50s and 60s would be

Denied insurance altogether. Just from my tiny circle, before ACA, I recall one relative, then in his late 50s, who was denied insurance because of slightly elevated blood pressure, for which he took medication. Another friend told me she was turned down for a finger injury she'd had in the previous year! My sister, who never had an illness in her life, was turned down for reasons unknown.

If you recall, they just wouldn't sell insurance to people over 50 in most cases, and if they did, it was sky high.

[SHRED]

13. I am not questioning the benefits of the ACA

I am asking, with the House of Representatives in Republicans hands, how can we improve it so we are not priced out?

[ohnoyoudidnt]

44. It will be tough without enough votes in the house.

Maybe incrementally starting with a bill to lower the age for Medicare eligibility to somewhere in the 50s. This is a group insurance companies don't seem to want and a group that is more likely to vote.

[thucythucy]

27. I'm so sorry to hear about your news.

My partner is also battling cancer. Our lives completely changed after her diagnosis. I don't know that anyone not living through this can truly understand what we're going through.

Best of luck to you and yours, and again, you have my deepest sympathy.

[central scrutinizer]

42. Fortunately ms. cs is stronger than me

She is not afraid and is keeping all of us from hovering. We are arranging a green burial which has been a cathartic process for us. Her friends are knitting a burial shroud, her brothers (who are carpenters) are building the shrouding board. She helped pick out the burial plot. Her wishes: don't mourn, organize.

[A HERETIC I AM]

10. They could start with removing the profit motive from the process of paying for health care.

Why the ever living hell is there a for profit corporation standing between me and my doctor(s)?

Go to a single payer system and be done with it. If people want to purchase further health insurance, let them, but having a company that needs to make a profit involved is counterproductive.

[mahina]

18. Word.

[BainsBane]

17. It's time to revisit the public option

and do away with the insanity of the government and exchanges not being able to negotiate group prices on medication.

[DemonGoddess]

20. The increase in premiums even WITH

the government help to pay them has made it so I can't make my payments, which means I face a penalty for the next tax year. Which goes to show that HRC pushing a public option as she has, is the right way to go, I'm thinking.

[duncang]

21. GOTV and get rid of the repub's

They worked hard to poison it as much as they could. Changes to big pharma to help lower the inflated prices of drugs.

[One_Life_To_Give]

22. Transfer the Seriously and Chronically Ill to a Taxpayer funded Public Health.

Half of what we pay in health insurance goes to cover the couple percent of serious and chronically ill patients. About 5% of people account for 50% of healthcare spending. We really should move them from the regular ACA to a progressively funded Public Health Pool. It puts to much of a regressive load on low income families to lump them in with everyone else. Single Payer Tax funded chronic health coverage for those in the top few percent of healthcare spending and such chronic conditions.

[leftyladyfrommo]

23. Everybody needs to be on Medicare.

It is wonderful. I just don't worry about insurance any more. Was in the hospital overnite for heart tests. Total bill was $11,000. I paid $119.

Doesn't cover ambulance but most people don't need one.

[LWolf]

24. The only change

I've experienced since the ACA is even higher premiums, deductibles and copays, and they are still going up every year.

What can be done?

Universal single-payer not-for-profit.

[vlyons]

26. Problem with the ACA

is that it still revolves around the for profit insurance industry. When we go to single payer system, like the rest of the world, things will get better. So we have to keep working at taking back the house and senate.

[Dem2]

28. It has nothing to do with the ACA

What we need to do is grab our pitchforks and go to the insurance companies and tell them you need to fix this or we're going to destroy you.

[bighart]

29. I think your theard title is causing this to be passed by.

This is a huge problem and will it only grow bigger in the future unless something is done about it.

[SHRED]

30. I changed it.

[Exilednight]

31. The failure was the lack of a national exchange.

The one thing I do criticise Obama on in his first term is starting out from a weak negotiating stance. He offered up compromise in lieu of getting a bill with teeth to it.

Allowing the states to run their own exchanges put many in financial risk of not carrying insurance. The mandate didn't help any. He ran to the left of Hillary in '08 on HCR, and we ended up with Hillary's version.

The only thing that can be done is a true national exchange with no state opt-out clause.

[tonyt53]

32. Make it so when a person hits 50, they can stay with what they have or buy into Medicare.

This is a stop gap until we can move to single payer, which will take a few years and a willing electorate voting in people to office that work for the people instead of the corporations or megadonors.

[edhopper]

33. Looking at the numbers

costs seem to be rising slightly less than before the ACA, but still rising. Obamacare got more people insured and helped in other areas, like pre-existing conditions, but didn't help much with costs.

We need the public option.

[SHRED]

34. Our premiums went...

...from $638 per month this year (two of us) to over $800 for 2017.

Same plan with less coverage.

We will have to take our chances on a Bronze level plan. Fortunately we live in California where the exchange has more choices than most states.

[edhopper]

35. And there were plenty of stories of premiunms doubling

before Obamacare, or deductibles tripling. But the overall statistics is they rose at at slightly lower rate.
But this doesn't mean they won't rise more in the future. The ACA did not address costs, as it should have.
Medicare for all would be a big help.

[SHRED]

36. Yes it would

[haele]

37. I know. But in 2007, my family premium on supposedly good employer insurance went

from $250 a month to $495 a month. And my disabled spouse was half-way to being kicked off my employer's plan - he'd already reached $600K with the $1 Million lifetime cap they had in place, along with a yearly cap on the amount of overall "therapy" - 40 hours worth in a max of 20 visits, no matter if it was physical or mental - that he was allowed during the period of benefits.
It was already getting difficult with the insurance company deciding not to cover some of his tests and therapies before the ACA came along. Another thing with the prescription tiers going from $5/$10/$25 on a generous formulary to $10/$25/$50 with a significantly reduced formulary, with 40% responsibility for non-formulary and compounded prescriptions on a pre-approval basis.
I can understand that the ACA is difficult for people who didn't really need to visit the doctor more than for general check-ups and immunizations. And for people who are in the income-based "doughnut" - making too much for subsidies, but too little to afford what's available without subsidies, it's a worse situation than they had before, when they were able to save money by gambling that whatever medical issues may arise are covered by other insurance policies (someone else's auto or home insurance, worker's compensation, etc...) until they reached the age they could get on to Medicare.
I know what that's like, I used to be in that situation during the 1990's after my stint of active duty before I got married and had dependents that needed regular care; I went with minimum/catastrophic health coverage (and no dental) to save money for "the real world" bills, and hoped if I got sick or injured, it would be during a reservist drill period or at work, where I would have full coverage.
I'm paying for it now with bad teeth.
But for people not in the doughnut who have disabilities, a catastrophic injury, or chronic illnesses, it's better than what we had before.

Haele

[SHRED]

39. Yes it is better than before...

...but we are at a point now where it needs improvement and soon.

[AngryAmish]

38. I blame Trump

[PasadenaTrudy]

40. Mine is going up about 9% next year

I'm 52, live in CA. I'll be paying $542 a month. That's a lot.

[SHRED]

41. There is a dramatic age discrimination built in

The older you are the more you pay no matter how healthy you are. No matter how well you've taken care of yourself. Zero reward for a preventive lifestyle.

[JSA944]

45. We need single-payer ASAP!

There's no excuse for the world's most powerful country to not have universal health insurance, and I hope HRC recognizes this. Until all Americans are covered, we do NOT deserve to be called a "developed" nation.

[Atman]

46. No denying it...I can't afford to get sick.

I can get my "free" check up, but I pay $12,000 a year for it. If they find anything wrong, then I'm really fucked, because I have to come up with at least $6000 to cover the next test.

Sorry. This has been a disaster.

Let's look at WHY. For-Profit insurance companies were encouraged to focus on PROFITS. A single-payer or public option would take the onus off of the board room, off of the bean counters. No on is saying a health care CEO shouldn't be paid a salary...but when that salary could pay for another ten thousand people, something is seriously wrong. There is no reason, absolutely no reason, that a health care provider CEO cannot live comfortably on a couple hundred grand a year while still providing a needed service. It shouldn't even be up for discussion.

PUBLIC OPTION or SINGLE PAYER. Otherwise, more of the same. We're fucked.

[roamer65]

47. Make Medicare the single-payor. No private health insurance. Include dental as well. N/t

[lumberjack_jeff]

49. So long as the system guarantees profit, nothing.

It's not really the insurance companies fault. They don't have the clout that the government as single payer would have.