Premiums Unveiled For Health Overhaul Plans

[Tiddlywinks]

Originally Posted by Orruar [You must be logged in to view images. Log in or Register.]

Over the past 6 years, I've paid probably $11k in premiums and I've received no more than maybe $2k in benefit from it... I really just keep it because I'd hate to be financially ruined by a stroke of bad luck. What really sucks is I know my employer has also probably paid about $11k towards the insurance as well. If it wasn't for the insane marriage of employment and health insurance, I would have received a good chunk of that in compensation instead.

That's the give and take of insurance in general really. For every story like yours though there are people like me. I'll give you mine really quick:

I began working for my company a little over a year ago, and they require that I carry health insurance as part of the terms of my employment. It's only around $56 a month, but were it elective, being under 30 and in relatively decent health I probably would not have opted in. This past february I messed my knee up pretty bad, and ended up with a patella sublexation.

That night I went to the ER and had an x-ray. Were I not insured that would have wound up costing me $900. Later that week I went to an ortho and he had me get an MRI. I honestly don't even remember what that cost, but I think ballparking it around $1500 is more than fair. After that I went through 2 months of Physical therapy. Out of pocket that would have cost me $1900, my insurance covers 90% of PT costs, I payed $94. The MRI I paid a $600 deductible for. The ER visit ended up costing me about $300.

All told this cost me under a grand. Without insurance I would have been looking at about $4,500-$5,000. I also pay around $4 a month for dental insurance that offers a max coverage of $1,000 per year, and I've used that for a year.

In the last year and a half I've gotten ~$6,000 worth of medical expenses taken care of for $1500 + ~$60 a month for 18 months.

Now obviously my plans aren't terrible, and my employer covers a good chunk of the monthly costs.. but my injury was nowhere near "catastrophic" and aside from my dental (I really let my teeth go throughout college), being young and healthy absolutely none of this was expected. Without insurance it would have sucked. A lot. I can't even imagine what a large injury, or even something more common such as a pregnancy would wind up costing somebody who was uninsured.

I don't relay the story to say "Obama care is awesome!" but rather to point out that for every story like yours, there are probably a pretty decent amount that are just like mine. I'm the same as you with my car insurance. I live in a state that does not require it, however I've paid in my entire driving-aged life because if I hit somebody I sure as fuck don't want to be sued for an insane amount of money.

I'm not entirely sure I agree with saying that the amount our employers end up paying in to our insurances would wind up in our paychecks. It would be nice, but there is just no way that I believe I would see much, if any of that money as direct-pay compensation.

Anyway, I'm off-topic, and rambling, but just wanted to say, that for everyone that pays in and doesn't use it, there are those that do. Personally, I don't think it's worth the gamble, even at a young age.

That's at least kind of why I enjoy the notion of those that are going to gamble paying SOMETHING into the system regardless on the off chance that something terrible does happen to 1/10000 that do and the rest of us get stuck with the costs.

[Lojik]

Originally Posted by runlvlzero [You must be logged in to view images. Log in or Register.]

And how exactly are we racist if we don't believe in being forced to pay for subsidizing the U.S. medical industry? This won't help poor families of black children with 6 people. They will just end up paying a tax penalty on everyone in their family and still have to go to the ER uninsured AFAIK.

ACA has a lot of new legislation including an expansion of Medicaid in addition to the individual mandate, penalties for being uninsured, pay or play, and these new exchanges. Also the penalty is capped at 3x the flat rate per family, but if they make below a certain threshold they are exempt.

[Orruar]

Originally Posted by Tiddlywinks [You must be logged in to view images. Log in or Register.]

"
Catastrophic insurance covers three doctor visits per year at no cost and preventive care such as screenings and vaccines. This plan will carry a higher deductible.
All plans bought through the exchanges must offer the same coverage benefits. All offer free preventive care. Nearly all cap out-of-pocket costs to $6,350 and $12,700 per family. No one can be turned away. No one will be penalized because of their gender (women often paid more in the old insurance system). Only smokers may be penalized in some plans and some older people may pay more.
"

They're essentially targeted at young individuals who don't need to spend thousands of dollars a year for health insurance they may, or most likely will NOT need to use.

A good site with comparison info to the other lowest plan (the bronze tier) can be found here:

http://health.usnews.com/health-news...alth-insurance

Except that covering 3 doctors visits per year is not what I'd call catastrophic. Also, they are required to cover a whole range of things related to maternity and pediatric care that I don't want in a health insurance plan as it only increases premiums with no benefit for me. I'm basically paying for other peoples' kids at that point. Real catastrophic coverage plans were the norm back in the day, but in the past few decades, they have been slowly regulated out of existence. And due to the various tax benefits of receiving insurance through my employer, the insurance closest to catastrophic coverage is not even competitive with my more luxurious plan. I'm paying for it in hidden costs (reduced compensation) that I cannot recoup by switching to one of the Obamacare plans.

[runlvlzero]

Originally Posted by Lojik [You must be logged in to view images. Log in or Register.]

ACA has a lot of new legislation including an expansion of Medicaid in addition to the individual mandate, penalties for being uninsured, pay or play, and these new exchanges. Also the penalty is capped at 3x the flat rate per family, but if they make below a certain threshold they are exempt.

Thanks for the clarification. If they had good legislation they shouldn't have put it in an unpopular and controversial bill if they wanted it passed easily. Its not a good way to do politics if you care about your people.

That being said. I can see how this could maybe be potentially helpful to middle class or lower middle class people.

In fact I'm all for taking money out of the NSA's pockets and giving it to Not for Profit hospitals to take care of the underprivileged. =)

How much might 10 billion out of 53.4 billion do? I wager quite a bit without further burdening the lower classes.

It would also allow for many more jobs for doctors and nurses. Perhaps we could you know give out a few tuitions for people who want to work in those places?

I dunno =)

I don't think disliking the current legislation is racist.

[Orruar]

Originally Posted by Tiddlywinks [You must be logged in to view images. Log in or Register.]

too long to quote

You really think that for every story like mine, there are more like yours? You think spending $5k+ a year on health needs is a highly probable thing? I doubt it. Also, you have to keep in mind that the various costs your insurance "paid" were highly inflated due to our insane health insurance scheme. If people paid out of pocket for more things, competition would drive prices way down. Not to mention the greatly reduced costs to health care providers when they don't need a team of people just to file all the insurance paperwork. I mean, the doctor to paper pusher ratio at most doctors offices must be about 1:5.

Also, keep in mind that I could afford a $5k injury like yours every 18 months or so and still only break even with my insurance. It's pretty insane really. I know there are a lot of people who like to go to the doctors office for every little issue, and that's fine. I just shouldn't have to subsidize these peoples' hypochondria.

As for the employer compensation part.. Any employer looks at the total cost of employing someone, and that includes the health care portion. If you removed all employer health care tomorrow, employers would suddenly have a windfall of extra profits. If you think this would just go on forever, you don't know the first thing about business. People would begin to demand more actual compensation, and this would lead to much more room to poach talented individuals and compensation would rise until it's near where it is it with the health care included. There are probably better ways (other than a sudden 100% shift to no employer based insurance) to make sure this process is as smooth as possible. Also, you should understand just where the marriage of employment and health insurance began. It started in WW2 when FDR had placed various wage controls on industry. Industry then began to offer health insurance as a backdoor compensation, and they eventually got this written off on their taxes as well.

[Tiddlywinks]

Originally Posted by Orruar [You must be logged in to view images. Log in or Register.]

Except that covering 3 doctors visits per year is not what I'd call catastrophic. Also, they are required to cover a whole range of things related to maternity and pediatric care that I don't want in a health insurance plan as it only increases premiums with no benefit for me. I'm basically paying for other peoples' kids at that point. Real catastrophic coverage plans were the norm back in the day, but in the past few decades, they have been slowly regulated out of existence. And due to the various tax benefits of receiving insurance through my employer, the insurance closest to catastrophic coverage is not even competitive with my more luxurious plan. I'm paying for it in hidden costs (reduced compensation) that I cannot recoup by switching to one of the Obamacare plans.

The catastropic plans also cap a max out of pocket expenses per year. Meaning that anything truly catastrophic is going to be covered at that point.

I mean, I don't want to pay extra for pregnancy covereage or shit I don't need either. Nobody does, but that's just the way it is. You don't get to pick and choose every little thing you want in your coverage. If you could it would probably be even more expensive. Again, I disagree with the hidden cost factor, because I highly doubt someone like you or I would see much of what our employers are currently paying wind up in our direct compensation if they didn't have to pay it.

[Tiddlywinks]

Originally Posted by Orruar [You must be logged in to view images. Log in or Register.]

You really think that for every story like mine, there are more like yours? You think spending $5k+ a year on health needs is a highly probable thing? I doubt it.

Umm.. ya. Not only is it probable, it's fact that we spend MORE than that on average. The average healthcare cost per citizen is over 8k per year. While that's high compared to other countries, even in a lot of those the average cost is over 5k per year.

http://www.pbs.org/newshour/rundown/...countries.html

http://www.forbes.com/sites/carolynm...e-big-picture/

As for the employer compensation part.. Any employer looks at the total cost of employing someone, and that includes the health care portion. If you removed all employer health care tomorrow, employers would suddenly have a windfall of extra profits. If you think this would just go on forever, you don't know the first thing about business. People would begin to demand more actual compensation, and this would lead to much more room to poach talented individuals and compensation would rise until it's near where it is it with the health care included. There are probably better ways (other than a sudden 100% shift to no employer based insurance) to make sure this process is as smooth as possible. Also, you should understand just where the marriage of employment and health insurance began. It started in WW2 when FDR had placed various wage controls on industry. Industry then began to offer health insurance as a backdoor compensation, and they eventually got this written off on their taxes as well.

I disagree. Compensation structures in places such as where I work (and I'm guessing you work in a similar environment) are generally based off of the compensation structures of other similar businesses so that they remain competitive in the job market. The ONLY reason I am offered benefits such as health insurance, and any form of indirect compensation (which accounts for 20% of my total comp) is due to the fact that this is the standard within my industry, and my company does it to remain competitive when recruiting new talent. That is why we are given what we are.

Companies are greedy. Employees ALWAYS want more compensation. As you mentioned, if they were to stop contributing to employee health plans, the company would instantly have much more profits. The only thing that would make those companies interested in putting that money into direct compensation for their employees would be to stay competitive when recruiting talent (you mentioned this also).

I don't think there is any reason to assume that this would be the case. All of the companies in the industry already have a good amount of talent. The proverbial "line" regarding compensation has already been drawn. The benchmark is there. One company may use some of it's new profits to raise it slightly, but there is no way that they are going to use 100% of their new saved money to directly compensate employees in an attempt to get more talent.

A slight raise (2%-5%) industry wide would still not account for nearly what the employer was paying in the first place to cover their employees.

[Millburn]

I don't know about you guys but I'm fucking STOKED for this shit.

I've had type 1 diabetes for 24 years now and the shit it's done to my savings account is ridiculous. I have to maintain health insurance even if it doesn't do anything for me so that I can keep a certificate of credible insurability which would guarantee that going forward I wouldn't be denied coverage due to my pre-existing condition. Most (read: 99%) of plans don't cover anything that I need and the ones that do are split between both prescription insurance and health insurance due to diabetic supplies being a medical supply and insulin being a medication. So that's two things that sap my income without providing any benefit.

All in all my monthly expenses are about $300 for insulin, $100 for strips, $75 for syringes and pen needles. That's almost $500 a month and that's the BARE necessity of what I need. That is essentially a second apartment lease and that's just to survive.

The affordable care act is pretty much a dream come true if I understand it correctly.

[Orruar]

Originally Posted by Tiddlywinks [You must be logged in to view images. Log in or Register.]

The catastropic plans also cap a max out of pocket expenses per year. Meaning that anything truly catastrophic is going to be covered at that point.

I mean, I don't want to pay extra for pregnancy covereage or shit I don't need either. Nobody does, but that's just the way it is. You don't get to pick and choose every little thing you want in your coverage. If you could it would probably be even more expensive. Again, I disagree with the hidden cost factor, because I highly doubt someone like you or I would see much of what our employers are currently paying wind up in our direct compensation if they didn't have to pay it.

Well, of course all insurance is going to cover catastrophes. That's the original point of insurance. And that's ALL I want covered. I don't want my regular checkups covered, because by definition insurance is for unexpected events.

"that's just the way it is"

lol... That's exactly my point. It's not that way because of some underlying economic reason. It's that way because the government mandates it, and has for quite a while. We force people who are in groups that use the health system less to subsidize those who use it more. Clearly it's wrong on moral grounds, but it's also fucked up on utilitarian grounds. I mean, we're basically encouraging people to be unhealthy.

And if you think we wouldn't get all or most of the hidden costs that our employers pay in the form of compensation, you're wrong. Economists from pretty much every diverse school of thought would agree on this. I bet you also think the minimum wage is the only reason we're not all being paid 5 cents an hour?

[Orruar]

Originally Posted by Tiddlywinks [You must be logged in to view images. Log in or Register.]

Umm.. ya. Not only is it probable, it's fact that we spend MORE than that on average. The average healthcare cost per citizen is over 8k per year. While that's high compared to other countries, even in a lot of those the average cost is over 5k per year.

http://www.pbs.org/newshour/rundown/...countries.html

http://www.forbes.com/sites/carolynm...e-big-picture/

Ah, I was speaking of people our age. Old folks use a lot of health care, but not necessarily for insurable events, just "getting older" problems. This chart kind of shows what I'm talking about.

[You must be logged in to view images. Log in or Register.]

I disagree. Compensation structures in places such as where I work (and I'm guessing you work in a similar environment) are generally based off of the compensation structures of other similar businesses so that they remain competitive in the job market. The ONLY reason I am offered benefits such as health insurance, and any form of indirect compensation (which accounts for 20% of my total comp) is due to the fact that this is the standard within my industry, and my company does it to remain competitive when recruiting new talent. That is why we are given what we are.

Your understanding of history and economics is sorely lacking. Companies don't offer health insurance "based on compensation structures of other similar businesses" just for that reason. They structure it like they do because government regulations make the current structure most effective in giving the employee the maximum amount of compensation for the least amount of cost to the business owner. They could offer us 100% pay and no benefits, but then the employer would have to pay more money overall to get the same bang for their buck. If we removed all tax incentives, you would see many more companies with no health insurance, giving their employees cash instead. You don't buy your car insurance, food, housing, or any other goods through your employer. Why don't you do these things? For economic reasons, and the same economic reasons would encourage you to buy health insurance on the open market absent government influence is keeping our health insurance tied to our job.

Companies are greedy. Employees ALWAYS want more compensation. As you mentioned, if they were to stop contributing to employee health plans, the company would instantly have much more profits. The only thing that would make those companies interested in putting that money into direct compensation for their employees would be to stay competitive when recruiting talent (you mentioned this also).

I don't think there is any reason to assume that this would be the case. All of the companies in the industry already have a good amount of talent. The proverbial "line" regarding compensation has already been drawn. The benchmark is there. One company may use some of it's new profits to raise it slightly, but there is no way that they are going to use 100% of their new saved money to directly compensate employees in an attempt to get more talent.

A slight raise (2%-5%) industry wide would still not account for nearly what the employer was paying in the first place to cover their employees.

You seem to agree with me at first, but then only to a degree. It seems you understand that people are just as greedy as the employers. And you have to realize that people aren't stupid. If they were suddenly without health insurance through the employer and needed to pay another $5k a year on insurance, they would ask their employer for nearly all of that in increased compensation. In fact, I bet this process would happen automatically for most companies, as employees would be incredibly unhappy to suddenly lose such a big chunk of compensation. Companies that don't immediately increase compensation when the health coverage goes away would lose a lot of people. You have to remember that people who run businesses aren't as economically ignorant as you. And lucky for you many of us employees aren't either, and we'd make sure our (and by extension your) compensation rises as it should in this case.