Can someone explain to me the 20 million?

This is a serious question. I'm asking because I respect your perspective. Please don't berkeley it up or flounder this thread.

As discussions of the Affordable Care Act continue, I keep hearing that 20 million more people are insured. That's important.

I have no knowledge on the subject other than the anecdotal- my own experience and my friends, but I'd like to be educated.

My perception is that the ACA bundled together people who are insured with people who are covered by Medicaid, and now reports them both as "insured". My perception is also that insurance coverage for middle class and upper middle class people has decreased significantly under the ACA, while Medicaid coverage for poor people expanded dramatically, creating a net increase in "insurance" coverage.

Am I wrong? A few facts would be helpful.

Keep it clean, boys. Thanks.

I don't know that the coverage for the middle and upper class decreased. It just got significantly more expensive. You can still buy whatever coverage you want, as long as you can afford it.

My coverage decreased because I could no longer afford the insurance I had.

In reply to Toyman01:

By "coverage" I meant number of people covered.

I don't know about anyone else, but last year was the first time I went without health coverage, ever. I had signed up for a plan, the insurance company changed the rates on me but did not notify me until after open enrollment had ended, so I had to cancel my plan and go with a catastrophic plan that didn't meet the qualifications for coverage. This means I was still paying an insurance premium every month but I also get the pleasure of paying the penalty to the government for not having qualifying coverage.

In reply to Toyman01 and EastCoastMojo:

Sounds like your anecdotal experience is similar to mine.

I'm still trying to understand if the 20 million represents a real expansion in people covered, or a shift in how we tally the numbers.

My sister's family moved back in with my parents and my brother's family moved in with his in laws so they could afford to keep their kids insured as their premiums climbed dramatically for similar coverage to what the previously had.

I'm fortunate enough to have coverage mostly covered by my employer, while paycheck withholdings cover the rest. In previous years, we could choose from a plan with a $3000 deductible, or a plan with a $1500 deductible. This year, both plans saw deductibles nearly double, and the amount being withheld has gone up accordingly as well. Employer still pays the same percentage of the cost, it's just that the total cost has gone up substantially.

The cost increases have caused the employer to look at other alternatives, such as heavily funding a "wellness center" for employees, so they can try and prevent chronic issues before they start.

My heath insurance hasn't changed much in the past 10 years. Our premiums have gone up, but my company has absorbed most of it. I've had a high deductible plan for awhile combined with a Health Savings Account. I have nearly the maximum contribution into the HSA that I can, essentially treating it like another retirement account. It helps to be single and relatively young (46 & healthy, so I don't use the Dr very much.

I don't know of anyone who has used the ACA system.

If you look at the way the subsidies work it only makes sense that lower income earners have disproportionally "gained". Insurance is very affordable the closer to the poverty level you are, it's a bargain, go buy it. If you make more but haven't built in a spare $1k a month (and very few people have an unsigned $1k a month) then ACA insurance is unaffordable. I'm not sure what the inflection point is, but it's there.
Go to the exchanges online and put in yourself at $30k a year and $80k a year. The difference in premium is staggering.
I recently did this with our family of six because there is a chance we'll have to start paying in the next little bit. It was interesting. If I had the time and motivation I'd enter my data over and over at varying income levels and graph it. I'm sure someone has done this.

I cannot explain the 20 million and what the number represents. Not sure if they are actual people or just a made up statistic.

SVreX wrote: I'm still trying to understand if the 20 million represents a real expansion in people covered, or a shift in how we tally the numbers.

The govt would never do something like that

Be careful with the "I don't know them so they must not be real" fallacy. I don't personally know any long haul truckers.

If your household income is below 400% of the federal poverty line, then you get a federal subsidy for your insurance plan through the marketplace. At the lower levels the subsidy is pretty dang big. The insurance companies are also required to cover you without any consideration to health issues. Both of those are where the additional insured have come from and that's who the aca was intend to help. The second point is at least part of why the premiums have gone up because they now have to cover people with major medial problems with no exclusion period or anything.

STM317 wrote: The cost increases have caused the employer to look at other alternatives, such as heavily funding a "wellness center" for employees, so they can try and prevent chronic issues before they start.

This is the goal of increased health care coverage, prevention is always cheaper than damage control. Most (poorer) people don't visit hospitals until they require the ER, because they can't afford it. The ER is vastly more expensive and a lot of times the hospital/taxpayer eats the expense anyway.

dculberson wrote: Both of those are where the additional insured have come from and that's who the aca was intend to help. The second point is at least part of why the premiums have gone up because they now have to cover people with major medial problems with no exclusion period or anything.

And there's the big question. It was intended to help those people, and let's say it really, truly did. Net benefit to society?

Certainly not a benefit to me directly as coverage is down and rates are up. If I had to pay the $700 per month through the marketplace for minimal coverage I would be really cranky. (FYI politically I would have voted for the ACA) Thankfully my employer absorbs most of the cost, however new this year they have tacked on $200/month or more (sliding scale) to those of us on salary so that they don't have to tack anything extra onto the hourly guys scraping by on $30k to begin with. The company is paying the same $ amount per month, $500 per employee or something, but rates have soared.

Medicaid used to cover people at 100% of the poverty line. The ACA incentivized states to increase that to 150% of the poverty line to get more people insured through Medicaid. Most states did this since it was 90% paid for by the Federal gov but some did not. So that's a pretty big increase in insured right there - people that were 50% above poverty line very rarely were insured.

Then you have the exchanges. The health care exchanges were set up for people that are above 150% of poverty line, and has a graduated federal subsidy to help make the coverage more attractive to people with lower incomes. Many people did end up buying through the exchanges for the first time, and many companies that previously did not offer insurance put their employees through the exchange.

I say this as a Nurse and also as a Husband of a small business owner. I don't at all doubt that 20 million are now covered by the ACA changes that were not able to get insurance in the past.

Whether the ACA caused insurance rates to rise at a rate faster than previously is a different debate altogether with much hazier answer.

Knurled wrote:

STM317 wrote: The cost increases have caused the employer to look at other alternatives, such as heavily funding a "wellness center" for employees, so they can try and prevent chronic issues before they start.

This is the goal of increased health care coverage, prevention is always cheaper than damage control. Most (poorer) people don't visit hospitals until they require the ER, because they can't afford it. The ER is vastly more expensive and a lot of times the hospital/taxpayer eats the expense anyway.

I guess the next best thing now that more people are covered (assuming the numbers are correct) is to have fewer people need medical attention. Of course doing something about actually reducing the costs of healthcare would be the dream, but is probably too much to expect.

In reply to STM317:

I work in cancer research. With the prices of drugs set to skyrocket, I really think reducing costs of healthcare is a pipe dream. Some of the newer immunotherapies cost upwards of 1 million dollars a year per patient, and there are hundreds of thousands of patients a year that could benefit from these drugs. People will live longer right away, at great financial cost.

I have no idea what the answer is.

Your cost has gone up astronomically and your choice of doctors shrunk just as astronomically as well as your choice of insurance companies because most of the big companies have been pulling out.

Oh yeah, low deductibles are a thing of the past. So the ACA has really, really helped us all.

Our deductibles went up over 10X what we had and coincidentally so did our costs. We cannot use the doctor we want or even doctors near us. Finding a doctor took months. We couldn't find a doctor for the longest who would even add a new ACA patient. Heaven help you if you need any kind of specialist service because they don't want ACA people either.

I don't know of any level of income that healthcare now becomes "cheap", cheaper than someone who makes more maybe, but not cheap. What we had with ACA was what you used to call catastrophic coverage with you footing the bill except for catastrophic events.

What I'd been told was that the increased numbers came from number fudging and requiring more Medicaid #s.

Me and my family are not in the theoretical '20 million'. My congrats to the people who are; the rest of us are paying more to get less to cover your expenses.

Personally, the changeover from a copay-based system to a high (enormous?) deductible health plan has resulted in a health-roulette. Starting over Jan 1 each year every health issue has gone from "call for an appointment" to "can we really pay for this right now?" I have two procedures that I'm putting off indefinitely as I wait for enough funds to accrue in my HSA to pay for them. I never would have had to agonize over this before.

In reply to bastomatic:

It's depressing. I've personally seen issues of outright price gouging, with items as common as over the counter drugs. My father had cancer. He lived with my wife and I for a period during his treatment, and I saw what the hospice company was charging insurance for common over the counter drugs. Things like charging the insurance company $130 for a bottle of over the counter medication that I can get the exact same brand and size from my local pharmacy for $7. If I can buy it for $7, and in doing so the manufacturer and the retailer both make their acceptable profits, why is the insurance company being charged $130? The hospice company did it to justify their high costs (a rate of $90k/yr) to Medicare, who is funded by the taxpayer.

It seems like nobody even checks or second guesses the costs because they're medical, and it's easy for companies to take advantage of that. I'm typically a small government type, but I'd probably be ok with more oversight of health care in order to protect consumers from sheer corporate greed, and it all comes at the expense of the taxpayers.

Here's what I can't separate is that if we had no ACA, would the cost have gone up YOY for us at the same rate? I remember YOY cost increases for my health insurance and a reduction in coverage basically every year that I have been working... Seems like it has really escalated the past say.. 5. My gut feel is that these price hikes were inevitable, but I have no info.

I too am frustrated by the cost of healthcare. My personal belief is that it'll get worse before it gets better. We'll go through a few rounds of messing it up in various ways until everyone gets fed up and goes single payer. Just my thoughts.

In reply to Fueled by Caffeine:

I can't find a chart with the most recent years but my personal experience is that the pace of healthcare cost increases has mostly stayed static but has finally reached a pain point for the average American family.

Edit: Kaiser says that in 2016 the family contribution was $5277, with total costs being about $18k. So about the same growth.

carguy123 wrote: Your cost has gone up astronomically and your choice of doctors shrunk just as astronomically as well as your choice of insurance companies because most of the big companies have been pulling out.

All of that happened even before the ACA, so I'm not sure how you blame that. When I started work, we had a huge choice of who to be insured by, and the set of doctors. Over time, that reduced to 2 traditional plans and a single HMO, with the cost going up every time.

As far as I can see, for big employers, companies are not pulling out as much as customers are reducing what they want to look at- I used to have an HMO that my wife still has, but when it was reduced, I was forced to choose a specific company that begrudgingly added some doctors. But the company that "pulled out" still covers others, just not us.

What I don't get about all of this stuff is how there's such a profitable industry that all they do is launder my money for a fee, and it's about healthcare. It's one thing to have insurance for stuff where you can have basic coverage and make money doing it. But to have it where the goal is to keep people healthy, and business choices are made to prevent people from being actually healthy just for money, well... It's a moral grey area that I just don't understand why others are not questioning.

I don't know what the 20 million accounts for. I've been very fortunate that I've been on my parents plan, or my own plan that has been very affordable overall.

I was looking at the numbers though in November, after the election, and came to the conclusion that ACA may be the singular reason why the election went the way that it did. My wife and I make very good money combined--we're above the 400% level for a family of 4, maybe even 5 (and we're a family of 2). We would not be able to have bought our house and our car if we had to pay for insurance for more than the two of us.

And FWIW, my wife has used a lot of her benefits. I've used about $200 worth in the past 4 years.