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View Diary: Overcoming discomfort with the ACA's Individual Mandate (28 comments)

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  •  here's my gripe------the mandates don't change the (1+ / 0-)
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    actual insurance that is available. And that insurance STILL does not allow poor people to see a doctor when they need to.

    Virtually all of the low-end plans in the ACA are shit insurance with high deductibles ($2-4000 seems to be typical). When you go through the policies listed for sale at all the ACA websites, take a gander at the deductible (the part that YOU have to pay, completely, before the insurance company gives you one thin dime) for all the policies that you can afford with your subsidy. Then picture yourself as a low-wage worker (either just above the Medicare cutoff or in a state with no Medicare expansion) who just broke her leg or just developed a persistent cough----and ask yourself how the hell you are going to pay that deductible.

    (And that leaves aside entirely the fact that most of the policies don't even pay the entire bill after the deductible--theyt pay 60% or 80% or whatever, up until you reach your "maximum out of pocket" for the year--which seems to range around $6-8k or so, an amount that is simply unaffordable for most.).

    Most of the insurance sold under ACA is still shit insurance, and it still guarantees that many people who need to see a doctor won't, because they still can't afford to pay the deductible. Even if we pay their premiums 100% for them, low-wage workers still won't be able to afford to pay the deductible. Which means they either don't get care when they need it, or they don't pay for it.

    That is NOT how insurance is supposed to work.

    If our goal is really to let people get care when they need it, then there are only two possible fixes--either we pay their deductible as well as their premiums, or we eliminate deductibles entirely in any insurance plan sold through ACA.

    •  There is no deductible (0+ / 0-)

      For regular Dr. Visits such as physicals.

      If you are against sane gun regulations then by definition you support 30,000 deaths a year by firearms.

      by jsfox on Tue Oct 29, 2013 at 02:42:32 PM PDT

      [ Parent ]

      •  so what. it's not "regular dr visits" that make (1+ / 0-)
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        people go broke---it's breaking your leg and not having the money to pay the deductible plus the 20-40% of the bill that your much-vaunted insurance doesn't cover.

        •  uh, you don't seem to really understand the (3+ / 0-)

          insurance policies or terminology that you are making an argument about.  Reasonable.  Most people who have health insurance coverage don't understand it.  But if you are going to make a claim about the horrible nature of a deductible, you ought to understand what a deductible pertains to and what it does not.  

          It's terribly arcane and people often conflate a required co-pay that is used toward a deductible as evidence of non-coverage, say for an ER visit that turns into an admitted hospital stay.  I have a $2K deductible but I paid only $300 for my entire event, including ER visit, overnight in the Cardiology unit, and the battery of cardio tests the following day. The actual cost of my event to my insurer was significantly higher than my out of pocket costs, even with my high deductible, since I paid only $300 toward my 2K deductible.

          You might wish to do a little more research before making as strong a statement about what isn't covered (before or after co-pay or deductible).  I agree with your lack of fondness for insurance companies but you ought to at least have your facts in order.

          ps. I live in Mass where we have an individual mandate and have had it for years.


          "Out of Many, One Nation." This is the great promise of the United States of America -9.75 -6.87

          by Uncle Moji on Tue Oct 29, 2013 at 05:34:29 PM PDT

          [ Parent ]

    •  Many plans are similiar to employer-offered plans (0+ / 0-)

      That deductible is often for major events, but not often for routine care. Very few plans on either the individual or the group (e.g. employer coverage) markets have zero deductibles for all services.

    •  You may wish to study the Massachusetts (3+ / 0-)

      mandate.   We have 97% coverage.  This includes the poor folks you write about.  

      I work in a business where most of us are paid minimum or near minimum wages.  All of us have health insurance coverage.  

      Many of my co-workers qualify for food stamps and fuel assistance and other government subsidies because our wages are so horrible.  And yet, we all have coverage.  And unlike my youth decades ago when I refused to buy health insurance, my young co-workers seem to see it as a normal part of life.  I remain surprised at how normalized the expectation that they pay for (at a subsidized rate) health insurance coverage and go and see the doctor when they are ill.  I would never have guess it, but it's happening.  And as a population, we are healthier for it.  

      I wrote farther down about your misunderstanding about what a deductible is, so I won't go into that, but I think you are wrong about one thing for sure and that is:

      That is NOT how insurance is supposed to work.
      It is, actually, how all insurance works, it is a for-profit ruthless business.  It's not how health care is supposed to work, I agree with that.  But that is not something that most of the country agrees with, yet.  

      "Out of Many, One Nation." This is the great promise of the United States of America -9.75 -6.87

      by Uncle Moji on Tue Oct 29, 2013 at 05:46:22 PM PDT

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