Seriously? (Health Ins. Rant)

Flight Service wrote: Your employer does not mandate you buy insurance from them. That has never been part of any program. If you refuse the benefit of the group rate and the smaller and smaller subsidy they offer, you can shop on your own. Edit: Oh yeah and your penalty for not having insurance is $50. Less than what you would pay for any plan.

But you're NOT free to NOT have insurance. You may be able to choose where you buy it - which is a Hobson's choice - but you're not free to buy catastrophic-care-only plans, or even forgo insurance if you wish. That is a fact.

First off, it's theoretically NOT a penalty - it's called the Individual Shared Responsibility Payment, which kind of flies in the face of any assertion that this is not a redistribution of wealth scheme. And, remember the whole "it's not a tax, it's a penalty, because a tax would be illegal" farce with the Supreme Court a few years ago? Yeah, so there's that.

Second off, I've been through the IRS calculator, and several others. I'm truly not sure where you're coming up with that "the penalty is only $50" stuff. $50 per person per month, maybe. For my family of 4, the results are this:

• 2014 - $1347
• 2015 - $2750
• 2016 - $3504

Note that the CAP for the penalty goes from about $9800 per year up to almost $11,000 per year for a family of 4.

In reply to Duke:

At what point is it catatrophic only? $5000 deductable? Just because they have to pay for you to get a check up and can't say they won't cover you if you are in the hospital for a heart attack because you have a heart murmur doesn't mean they aren't catastrophic. At this point we are arguing semantics over what amount of money is deemed catastrophic. My old insurance was pretty catastrophic because they covered nothing. It is called a High Deductible plan.

Don't get me started on that Supreme Court bullE36 M3.

Yes you have to be covered. That is accurate. But you have to have insurance to have a car on the road. I am confused to the difference.

If you live in a state that actually implemented the ACA, the Medicaid expansion would have covered most. Do you live in a state that accepted the ACA?

From the IRS website.

For 2014, the annual payment amount is: The greater of: 1 percent of your household income that is above the tax return filing threshold for your filing status, or Your family’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285

and if you make real money and refuse... Your payment amount is capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in 2014. For 2014, the annual national average premium for a bronze level health plan available through the Marketplace is $2,448 per individual ($204 per month per individual), but $12,240 for a family with five or more members ($1,020 per month for a family with five or more members).

Mind you in all of this, my own opinion is the insurance companies, administrators and lawyers are the problem. Take it back old school. No Mr. Insurance man you do not get to talk to my medical provider. You are a gambler. You take my money and play the market with it and bet that you can make more money than I will cost you. I bet that my insurance premiums will be more than my medical costs are. You do not get to rig the rules in your favor or fight me when you have to pay. That is reneging on your obligation. If you did that on a regular bet your bookie would break your knees. I will do much worse.

Facts are the point of my arguments here. Not my opinion of the current state of healthcare.

In reply to Flight Service:

So you are saying I shouldn't like Taylor Swift? Is it still okay to watch her sing her songs with the volume off?

All I know is that I could not afford insurance before, and now its even more expensive. However, I get to pay a penalty because I don't have money.

Nick_Comstock wrote: In reply to Flight Service: So you are saying I shouldn't like Taylor Swift? Is it still okay to watch her sing her songs with the volume off?

Completely acceptable and encouraged, the same goes for Pre-Federline Brittney Spears.

Knurled wrote:

pinchvalve wrote: Yeah, I just found out that Obama thinks that my health insurance is too good, and is forcing my company to reduce the level of services it provides and increases our payments. Thanks a lot...affordable healthcare my butt.

Your company is the one screwing you.

How is that? Our healthcare coverage is so good, the government says that we can't have it. We are being forced to downgrade to the Gold plan or be in violation of the AHCA and deal with whatever repercussions that entails. And there was no offer to pay a "cadillac tax" or any other way of keeping what we have. It is falling on my company to make up the difference in benefits and increased fees that this new regulation has imposed.

Flight Service wrote: In reply to Duke: Yes you have to be covered. That is accurate. But you have to have insurance to have a car on the road. I am confused to the difference.

When driving a car, I am required to have insurance that covers MY LIABILITY TO OTHERS in case I cause them damage or injury. I am not in any way required to have insurance that covers my car for damage at all. That is entirely optional and at my own discretion.

The ACA, however, requires ME to have insurance that covers ME, even if I don't want it at all, or want less than what they consider minimum.

Other than being about insurance, they are not the same thing at all. But I suspect you knew that.

Flight Service wrote: From the IRS website. For 2014, the annual payment amount is: The greater of: 1 percent of your household income that is above the tax return filing threshold for your filing status, or Your family’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285 and if you make real money and refuse... Your payment amount is capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in 2014. For 2014, the annual national average premium for a bronze level health plan available through the Marketplace is $2,448 per individual ($204 per month per individual), but $12,240 for a family with five or more members ($1,020 per month for a family with five or more members).

...which about lines up with the numbers I gave in my personal example. My wife and I both work full time and we definitely make a comfortable living. But it is far from what I would consider "serious money". We are not starving or getting evicted, and we can afford to send our 2 kids to the local state university (though not both at the same time, and not anywhere more expensive). We ain't po'. But we ain't rich, either.

Facts are the point of my arguments here. Not my opinion of the current state of healthcare.

So where are you getting your "$50 penalty" number from?

In reply to Duke:

I think if it's an entire family of pre-teens that work 10 hours a week at McDonald's. The number work, then.

Datsun1500 wrote: I love the "My employer is screwing me" attitude. If You work for me, and your premiums are $300 a month, of which we can pay $200 to help you out, that's fair. If your premiums jump to $750 a month and I say we can only still pay the $200, then I am the bad guy? That's why the employee contribution has gone up, because the cost has gone up. Put it in car terms. As part of your salary I give you $300 a month as a car allowance and you buy a car for $400 a month for the first 3 years so I am covering 75%. On year 4 you buy a more expensive car for $600 and complain that I am only covering 50%..... seems fair.

In my business that's why the insurance gets changed every year or two. When premiums go up, there's a three pronged choice for the business: 1) absorb the increase, not always possible 2) raise the employee's contribution which can lead to the loss of good employees or 3) drop insurance entirely (only possible under certain circumstances) which again means good employees will leave. That's a tough set of choices and every company I have worked for has, once they have a contract in place, immediately start shopping for another plan because they know there's an increase coming.

Also on this subject: my new chemo is much more toxic (the doc's term) than the stuff I was on last year. It has made it pretty much impossible for me to work so I had to resign in mid December. My employer chose to: 1) keep me on the payroll through December 31 2) carry me on the company insurance at no cost to me through March 31. That is to give me enough time to go on disability.

So no not all employers are out to screw their people. This next might get this post edited or deleted by the mods, but if anyone around Columbia SC needs wheels please check out jtscars.com ,that is my old employer. I can't say enough good about these people.

Next target: what I see as the artificial inflation of medical costs. The oncology office I go to bills BCBS for my care, I get EOB's (explanation of benefits) which cover that. So the oncologist bills BCBS $2,112.00 for a chemo, BCBS 'discounts' that to $183.75. I don't pay any part of that because I have hit my max out of pocket. So here is my question: SCOA obviously makes a reasonable profit at $183.75 or they wouldn't accept that amount, yet they would bill a slob off the street $2,112.00 for the exact same thing. How is this justifiable?

I just got back from my neurologist's office after having an MRI. I paid a $60 co pay. I will get an EOB soon showing the numbers for this particular visit, recently down here a hospital maybe 500 yards from the neurologist's office charged an uninsured patient something like $5400.00 for an MRI. I will be interested to see what BCBS pays vs. what the neurologist billed then also compare that number to what the hospital billed that poor slob.

There is also the matter of SCOA (my oncology office) billing my dad $48,000.00 for approximately 5 weeks of chemo, then accepting $1600.00 to settle that bill. I know this because as an executor of my dad's estate I was deeply involved in that.

Picking on the insurance company again: my new oncologist prescribed a series of shots to bring my white cell count up; it dropped as a result of the chemo. I already described how they were 'closed for training' but I also found out later that they were balking at paying for this treatment. Waitadamnminnit: my doc prescribed the shots as necessary to ensure my survival. So why is the insurance company balking? It's not like it's some nebulous unproven BS, this shot series is a PROVEN treatment for this. The doc can't continue chemo if the white cell count is low. Is BCBS willing to let me die over this?

Im sure once the politicians see how it effects their plans, they will fix the issues.

Curmudgeon wrote: Picking on the insurance company again: my new oncologist prescribed a series of shots to bring my white cell count up; it dropped as a result of the chemo. I already described how they were 'closed for training' but I also found out later that they were balking at paying for this treatment. Waitadamnminnit: my doc prescribed the shots as necessary to ensure my survival. So why is the insurance company balking? It's not like it's some nebulous unproven BS, this shot series is a PROVEN treatment for this. The doc can't continue chemo if the white cell count is low. Is BCBS willing to let me die over this?

Federal government things. It sucks.

logdog wrote: Im sure once the politicians see how it effects their plans, they will fix the issues.

No, they won't. They quietly add language to some completely unrelated omnibus bill that will increase the amount of their plan that is paid for by taxpayers, so there is no net difference to them.

In reply to Duke:

exactly

In reply to Duke:

I'm pretty sure logdog's comment was dripping with sarcasm.

logdog wrote: Im sure once the politicians see how it effects their plans, they will fix the issues.

You’re being sarcastic – right?

You do know that they have a completely separate plan that totally insulates them from all of this – right?

In reply to SVreX:

Wups, my bad. It's a little hard to tell dripping sarcasm from the "like every other civilized nation already does" mentality, sometimes. That's probably enough two-dimensional marine fauna from me, anyway.

Here's the thing:

None of this is static. As soon as the gov't is the decider on what health care you get and when, then all care becomes political. You've already heard some of this with abortions and mammograms. Do you really want a bunch of lawyers with whitened teeth, hair plugs, and an obsession with being elected to power making these decisions? What's next? Sex changes? A "right" to poor people for plastic surgery? Don't laugh, it's coming.

Supposedly, everyone being insured brings down the cost of insurance for everyone, including those that were insured before. Therefore, your premium should be declining. So why are people reporting big increases in premiums, raising of deductibles, reductions of benefits and, in addition, increased costs in the form of a "Robin Hood" tax? Hmmm?

Remember, you can keep your policy if you like it. Well, guess what, you can keep it, but it won't be the same policy.

Don't be the flounder. Be the pufferfish.

iadr wrote: FIX YOUR GOVERNMENT! YOU need it (to work properly)!

That's very Utopian, but also very naive. It presupposes that the government CAN be fixed, and that fixing it is in someone's best interest. It also suggests that one person or group can offer a formula to fix it.

I've realized something in the last few years that has radically changed how I view government.

Government doesn't want to be fixed. Chaos is a candidate's best friend, and BOTH Republicans and Democrats are pursuing the same thing.

Chaos, anger, and righteous indignation drive voters to the polls. Peace and contentment do not.

It has become the job of the politician to rile up the masses. The more angry and worked up you can get one group of constituents, the better it is at the polls.

The only difference between Repubs and Dems is WHO they are good at pissing off. When they fight with each other, they are actually working together, because they both want chaos.

So, go ahead. Get pissed at your government. They LIKE it that way, and intend to keep it that way.

Gearheadotaku wrote: All I know is that I could not afford insurance before, and now its even more expensive. However, I get to pay a penalty because I don't have money.

And you think they didnt know that was in there BEFORE they passed the bill?

In reply to SVreX:

I had a supervisor who used to say "in chaos there is profit." More often than not that has been true.

Cone_Junkie wrote: The purpose of the chart was the disturbing trend of the employers shuffling more of the cost to the employees. Which explains why premiums are going up despite the fact that the current insurance plan met all the criteria of the ACA. .... Blaming ACA for every insurance problem from here on out is bad logic, and just getting old.

There's 2 problems with riding this train I see. It would be okay to be 'worried' about the cost of healthcare being shifted more toward employee if there was a direct correlation between employee pay and participation. There isn't. If you didn't elect to get health insurance thru your job, that portion that your employer was going to pay to the insurance company isn't going to be paid to your wallet instead. They keep that money. so who really beared the burden in the first place?

the second is that the ACA stands for the Affordable Care Act. the fact that a bill named for and tasked to address health care costs completely ignores one of the major pillars of that cost; the supply/demand cycle of medical care, certainly does open it up for blame and criticism when its features exacerbate an inequity that we knew about for 20 years before the bill passed... :(

I don't believe healthcare SHOULD be the responsibility of employers. Unfortunately we (collective) have decided that's how it works, so therefore that's how it is (for now).

it is important to note how we got to the point that it is this way because we didn't used to need an employer to manage our health care plan needs, and that was because of government interference. At one point, there was a law that restricted how much monetary compensation an employer could pay their workers. Thus, fringe benefits, including health care, became the domain of competing employers trying to get quality employees. It was that way for long enough that despite when said laws were lifted, the legacy of doing things that way continued to stick with us.

...

but back to the original post... I too find it really annoying that health care is one industry where almost every position other than doctor or nurse faces such ridiculous customer service deficiencies... it seems like only cable companies do consistently worse...