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View Diary: Confessions of an Obamacare advocate with cancelled policy, facing 38% premium hike (463 comments)

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  •  Probably didn't cover (20+ / 0-)

    maternity care or pediatric dental.

    Look, I tried to be reasonable...

    by campionrules on Mon Nov 11, 2013 at 01:12:27 PM PST

    [ Parent ]

    •  Didn't check on these (8+ / 0-)

      Granted, I did not check to see if it covered those things. I was speaking from my perspective.

      Ginny Mayer, Ph.D. Democrat CA State Senate Candidate - SD-35 (Orange County)

      by Ginny Mayer on Mon Nov 11, 2013 at 07:17:49 PM PST

      [ Parent ]

      •  Coverage limits? (5+ / 0-)

        Did your plan have a yearly or a lifetime limit?   You mentioned that in your diary, and this is indeed an extremely important point.  Many plans on the individual market had these limits and some were quite low - I've seen them as low as $150,000, which is a drop in the bucket for a major medical event.  Even a million dollar limit can be easily exceeded.  

        Under the old regime (I won't call it a "system" since there was nothing systematic about it), people who hit these limits were totally screwed, since they were then effectively uninsured for life - no chance of getting alternate coverage with a pre-existing condition.   That is one of the things that had to change.  


        •  If the bottom line (1+ / 0-)
          Recommended by:
          Historyofthe Future

          is that thousands of Americans will have to spend more on health care thanks to the ACA than they were before (other than the uber wealthy) the ACA WILL be seen as a "failure."

          The core impetus behind "health care reform" was to make it MORE AFFORDABLE, not arbitrarily "better" or MORE complicated and expensive.  

          Only the most myopic ACA cheerleaders are still denying the law will end up forcing thousands of Americans to spend more of their incomes each year on private, for-profit, corporate insurance plans.  It embeds the private, for-profit "health" system we have even deeper into society, and will financially penalize people who don't want to participate in it.

          This unfortunate (and counterproductive) fact is not something Progressives should be having to defend at the local or national levels during elections for the foreseeable future.  

          At some point, Progressives have to get back on the ethical side of the argument about making health care affordable and available to all Americans, not defending the rights of the Insurance Industry to make money, and control the experiences Americans have with medicine.  

          It is pretty apparent at this point that the ACA is not going to be what many Progressives imagined.  It is taking America down a road that leads further from a National Health Care system, and makes our ridiculously expensive, intentionally complicated, profit driven corporate "health care" even harder to get rid of.  

          Perhaps it is too late for this generation.  The Insurance Industry, with the help of well meaning (?) Democrats, has had itself mandated into law.  This diary is just another that reluctantly points that out.

        •  wvmci, this is so very important! I think that (0+ / 0-)

          because the language is so unfamiliar, many just do not grok the meaning or the nature of coverage limits.

          Using self as an example, we would be ruined completely if we had plan coverage limitations last year.  You are so correct:

          Many plans on the individual market had these limits and some were quite low - I've seen them as low as $150,000, which is a drop in the bucket for a major medical event.  Even a million dollar limit can be easily exceeded.

          Even with the ACA in place, folks need to be mindful about what is and is not covered (or how much) when choosing their insurance on the exchanges or elsewhere.

          This being human can be so hard.  We sometimes forget that it is not always ill health that can cause a catastrophic medical bill exceeding a million dollars.  A harmless looking cut, a medical error, an accidental fall or a tree limb falling can alter the landscape of a robustly healthy human in a nano second.

    •  Pediatric Dental is causing us headaches at Penn (18+ / 0-)

      I serve as a graduate student representative on the Student Health Insurance Advisory Committee (SHIAC) at the University of Pennsylvania.  We are tasked with coming up with the benefits and costs of the annual Penn Student Insurance Plan.

      Our population is entirely students.  Mostly grad students, but that means the overwhelming majority of us are mid-to-late 20s.  We now have to cover pediatric dental even though none of us are even eligible to use that benefit.  There aren't even that many grad students with young children (we see about ~100 dependent plans out of over 9,000 total enrollees).

      Our committee is quite progressive when it comes to benefits offered (full prosthesis replacement, gender reassignment surgery, etc.) and low deductible (we're at $300.  That's not a typo - three hundred).  And yet even for us, at least in the college health insurance market, the ACA has truly been the "law of unintended consequences".

      Health insurance is nuanced like crazy, and sadly most people don't have the time and/or capacity to really understand the gritty details.  Relying on marketing slogans, some of which turned out not to be so correct, is turning out to be problematic.

      I should write a diary about how the ACA is affected college health insurance market.  We're a unique situation since the overwhelming majority of our population is young and healthy.  Now that students can buy individual plans (or stay on their parents' insurance), we're likely going to be looking at serious adverse selection since our benefits are so great, so only students with known health issues will purchase our plan.

      "Give me a lever long enough... and I shall move the world." - Archimedes

      by mconvente on Mon Nov 11, 2013 at 08:20:48 PM PST

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      •  Since none of your population... (7+ / 0-)

        ...needs pediatric dental, the cost to provide it should be very low. Maybe even zero.

        •  But this is the world of the ACA (3+ / 0-)
          Recommended by:
          caul, auapplemac, Zornorph

          That kind of tuning is no longer allowed.  

          The extra money she spends for insurance she doesn't need goes to

          1. Higher profits for the insurance company, or
          2. to subsidize lower rates for others.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Mon Nov 11, 2013 at 11:33:57 PM PST

          [ Parent ]

          •  If she "doesn't need it" she can get a very cheap (2+ / 0-)
            Recommended by:
            Crabby Abbey, worldlotus

            bronze plan that's going to cover catastrophic. It's going to cost her in the $20-50/month range with the subsidies. So why complain about subsidizing others-- only idiot Republicans do that. She's getting better coverage than I could dream of before the ACA, and the bill will be less than her cell phone.

          •  There is a cap on insurance company profits now (4+ / 0-)

            that didn't exist before. That is why so many people and companies got rebates the last couple of years.
            Premiums don't subsidize other people's rates any more than they would in a big company with employer provided insurance. (Except in exchanges rates do go up with age. However this is limited from what it use to be in individual policies. The rate for the oldest can be up to 2.5 times as much as for youngest. Many states had no limits and in almost all cases it was much higher)

            •  No, there isn't. That is a popular misconception (1+ / 0-)
              Recommended by:

              You are thinking about the medical loss ration requirement.
              It says that:

              1. For insurance to individuals and small businesses,  80% of premiums must be spent on health care, ie: Doctor's visits, prescriptions, etc.

              2. For insurance to larger groups, 85% must be spent.

              You may have gotten a rebate check last year if your company spent a higher ratio than  that. We did -- about $100, which was more than 1% of our premiums.

              Those aren't very strict limits, but, in the past, some insurance companies have exceeded them, by quite a bit in some cases.

              One problem with a percentage based rule like that, and one familiar to utility regulators everywhere, is that higher costs = higher profits. Insurers can make more money if health care costs go up.  This will be interesting to see.

              LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

              by dinotrac on Tue Nov 12, 2013 at 06:15:33 AM PST

              [ Parent ]

              •  Thank God someone finally said it! (1+ / 0-)
                Recommended by:

                My first thought when hearing about this was that the military called it "cost plus contracting" - where a subsidiary of Halliburton charged Halliburton $150 a gallon for gasoline so that Halliburton could charge the Pentagon $165.
                You think a hospital charging $35 for an aspirin is bad? Wait till the insurance companies point out that thanks to the ACA they want to be charged $1000 for an aspirin.

                •  It will be interesting to see. (0+ / 0-)

                  I'm not aware of -- and I mean it exactly that way as I have not pored over every bit of the act -- anything in ACA that puts hard limits on what hospitals, doctors, therapists, pharmacies, etc, can charge.

                  LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                  by dinotrac on Tue Nov 12, 2013 at 08:38:51 AM PST

                  [ Parent ]

          •  "Subsidizing" others (5+ / 0-)

            Insurance by its very nature consists of the majority of people who are fortunate enough not to have bad things happen to them "subsidizing" the relatively small number that do have bad things happen to them.  Take fire insurance - all of us who never have our houses burn down are "subsidizing" those who have this misfortune  - in return we are protected in case it happens to us.

            Insurance is NOT an investment! You do not want to make money on insurance.   The best possible outcome is that you pay for insurance you entire life and never use it because nothing bad ever happens to you.  

          •  Uh... Your Point #2 (0+ / 0-)

            Is what "insurance" is.

      •  It doesn't seem like you've explored your options (5+ / 0-)

        Instead of complaining about items you don't want, when there's a legal baseline now that applies to all plans. NOw, no plans can cheat you on a lifetime cap, or preventive care. Parity for mental health with medical visits and services. So what if each person covered doesn't use one element or another, in the long run everyone is getting a basic set of items in the plans gauranteed, good garauntees. Republicans hit up the refrain, waah I don't want to pay for your abortion or your pediatric dental. That's just being stupid.

        A basic set of required items makes it so that no one can get screwed. People who don't get that cherry pick out the stuff they don't need and complain even though they are light years better off. We just went through an era of bankruptcy where if you got a cancer diagnosis and if you need Medicaid when you have cancer, you have to liquidate all your assets to qualify and get the expensive treatments paid for. I had a friend who went through that a couple years ago. I NEVER WANT TO GO BANKRUPT due to a major illness. THAT's OVER, folks, and people should celebrate this new found security which was denied us during my entire lifetime.

        I could go on, but this one illustration of how everyone's getting a set of basic benefits, very good and useful ones, along with some you'll never need nor use, but no need to cherry pick that out and complain. Just get the best plan for yourself and don't sweat it. If you're making under $15,000 a year, you automatically now are covered by Medicaid, if you earn above that up to $45,000, you get the subsidies, and you choose the plan for you, and believe me those plans are affordable-- they are not what you see on the so called free market where such plans would cost up to a 1000 a month for my age group and didn't deliver basic benefits. The ACA is a huge advance forward. Do we want to make it better, yeah.

        I can understand the frustration for college official looking for plans. What I don't get is, most of your students are going to be on their parents plans until they are 26. This can't be that hard to figure out-- couldn't you get a bunch of colleges banding together and trying to get a good group plan for those kids not on their parents plans. I know it's tough, but that's your damn job.

      •  Everybody needs better dental coverage and the (0+ / 0-)

        pediatric is a start, by 2016 Dems will propose dental and vision coverage be added to the ACA. You can either figure out how to thrive in the new system or be nostalgic for the bad old system and grind your teeth, complain and dig your heels in, your choice.

      •  Clarification to my above comments (0+ / 0-)

        The issues that I mentioned in my comment are a slight annoyance, however our committee has full confidence that we will solve them without any problems.  Overall, I enthusiastically support the Affordable Care Act and its mission to ensure that all Americans have access to affordable, quality health care.

        I wish the Republican party would work with Democrats to fix any issues that are commonplace with new legislation, rather than repeatedly try to dismantle the entire law.

        "Give me a lever long enough... and I shall move the world." - Archimedes

        by mconvente on Tue Nov 19, 2013 at 04:39:41 PM PST

        [ Parent ]

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