The ACA: Unable to Meet the Deductible or the Doctor

[cali]

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

<snip>

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

<snip>

Deductibles for the most popular health plans sold through the new marketplaces are higher than those commonly found in employer-sponsored health plans, according to Margaret A. Nowak, the research director of Breakaway Policy Strategies, a health care consulting company. A survey by the Kaiser Family Foundation found that the average deductible for individual coverage in employer-sponsored plans was $1,217 this year.

In comparison, the average deductible for a bronze plan on the exchange — the least expensive coverage — was $5,081 for an individual and $10,386 for a family, according to HealthPocket, a consulting firm. Silver plans, which were the most popular option this year, had average deductibles of $2,907 for an individual and $6,078 for a family.

<snip>

http://www.nytimes.com/2014/10/18/us/unable-to-meet-the-deductible-or-the-doctor.html?_r=0

[egduj]

1. This was predicted by both sides of the argument on ACA,

but was determined to be an acceptable consequence by proponents, in order to avoid lifetime debt for catastrophic medical circumstances.

[dixiegrrrrl]

4. Wonder if was predicted that docs would would double their rates under the new law?

I have the bills to prove it.

The annual routine lab test rate doubled.
The Dr.routine Dr. office visit doubled.
Immediately after the law passed.
Luckily I have Medicare B, but my co-pay of course did increase.

[SheilaT]

76. I'm on Medicare,

with a Part B and Part D that are subsumed under an Advantage plan.

My relatively trivial costs have gone down. I'm now getting my two prescriptions with no co-pay as I elect to have a 90 day supply mailed to me. I have zero co-pay for a regular doctor visit. So far have paid nothing out of pocket for blood tests.

[zipplewrath]

48. And existed prior to the ACA

This problem predated the ACA, people with insurance that still couldn't afford health CARE. It was one of the reasons I found the ACA to be such a disappointment. It left one of the larger problems completely unaddressed and in fact expanded it by forcing people to purchase insurance they'd never be able to afford to use.

[LWolf]

53. I see.

Not getting care for possible catastrophic medical circumstances, like brain hemorrhages or aneurysms, because one can't afford the deductible or copay, is certainly one way to avoid lifetime debt for care for those circumstances.

[hobbit709]

2. My housemate has that problem. A $6000 deductible when you make $9.75/hr

Means you don't have diddly squat left over pay check to paycheck.

[scarystuffyo]

9. What's going to happen is there will be a lot of medical bankrupties with people who have

Affordable insurance under the Affordable Care Act

[hobbit709]

11. If you're barely scraping by, you won't have the money to file bankruptcy.

[scarystuffyo]

13. True

Average cost is $1500 to $2000

[Algernon Moncrieff]

20. You are right, but you miss the point

OK, owing $6K is bad, but it's a lot better than owing $20K or $50K or $100K, which is what was happening before. Before the ACA was passed, there were countless cases of people with no coverage, no hope of paying, and they system passing on the billions in unpaid debt onto those who could pay, which has been a big component of the medical inflation spiral. Mitigating that condition should, long run, help med inflation.

Also, $6K won't drive even the poorest into bonafide bankruptcy. It's an amount that the courts would have worked out through a long term payment plan, and that the provider could comfortably eat, if need be.

[Fumesucker]

25. People with chronic persistent conditions though will get hit with that $6,000 deductible every year

Unless they are quite well off they'll never get caught up.

This system might as well have been custom designed to get government premium support to the companies and make sure they don't have to pay out much on the poorer clients.

[IronLionZion]

34. Which is exactly why GOP cut the budget and blocked any attempt to advise or help people

choose plans. People with chronic conditions who use health providers regularly should get lower deductible plans, and there are options for that if someone had advised them and helped them find a plan based on their needs. Don't you remember red state governors actively blocking organizations from helping people?


The high deductible plans are closer to the catastrophic plans for healthy people who only want coverage for the big stuff. Most of them are usually paired with a health savings account. These plans were for those healthy folks who would try to go without insurance before, but will sign up for an affordable plan just in case something major happens.

[Algernon Moncrieff]

47. Exactly!

...or people with lots of cash laying around, or people who choose to use HSAs to cover routine doctor and dentist visits.

For the $6K per year difference, even with a preexisting, you can probably find a lower deductible plan. Also, look t play the other angles-- see if assistance is available for drug costs.

[Chuuku Davis]

50. Pretty sure the insurance companies

DID design a lot of the ACA

[IronLionZion]

66. They just love paying out more money, covering more treatments,

and no longer being able to turn away the more costly patients because of pre-existing conditions and lifetime caps or charge more for women. They would have done it on their own but were just waiting patiently for someone to sign that into law.

[IronLionZion]

37. What already happened is people had nothing before

and now they have something. It has to start somewhere.

[Skink]

59. That deductible plan enabled me to

Sign up for affordable dental coverage.

Hopefully the medical becomes affordable in the future.

[treestar]

38. The subsidy makes that person eligible

for a better plan than that. This is precisely the situation where the ACA helps - people not so poor they qualify for Medicaid but not making enough for a policy or having a job that provides one.

[hobbit709]

39. Not here in TX

And he still wouldn't have the cash for a copay.

[davekriss]

60. Hold on now!

Someone making $20,000 a year or less (your $9.75 per hour example) would hit the maximum allowable out of pocket limit long, long before having to pay $6,000.

Go to the kaiser foundation subsidy calculator. A 30 year old making $20k has a MAXIMUM out of pocket expense - which covers deductibles and co pays - of $2,250. That's still a desperately high chunk of change for $9.75, but way short of the policy's $6,000 deductible. Once your friend paid that amount, the ACA pays 100% of charges thereafter.

[hobbit709]

61. Not here in TX.

[Roselma]

62. Help your housemate with this suggestion.

Go to www.healthsherpa.com. Put in the zip code, then answer all questions (takes 10 seconds or so). I put in for a Dallas-area zipcode (I am from another state and don't know where you are from). I put in for a 61 year old smoker who earned $20,280 ($9.75/hr/40 hr wk/52 wk/year). I found 2 silver level HMO Blue Cross plans with low deductibles (one was $500 and one was $1500). Both had annual maximum out-of-pockets of $1500 with low doctor copays and zero cost ($.0) for generic prescriptions. These amounts would be different in other areas of the state as they are based on available providers in a market. I think your friend may have erred in 1) entering data, or 2) understanding the resultant information. Your housemate likely is unaware of subsidies PLUS for low-income individuals like him/herself, the ADDITIONAL "cost sharing" provided by the federal government. Yes, the max out-of-pocket is much lower than your housemate was able to discern for him/herself due to the ADDITIONAL "cost sharing" for low income people.

[GummyBearz]

3. Great...

Big insurance wins again!

If only I could place bets on them in Vegas, I might be able to pay their ridiculous fees

[Control-Z]

5. These deductibles do not apply

for doctor's visits, mosts tests, prescription coverage, specialty doctors, Urgent Cares, ER visits and numerous other things. There is no required expense to use most benefits.

It is applied for surgeries, hospital stays, extensive procedures and tests like MRIs.

[Cal Carpenter]

6. In other words, they apply to various important medical services, and are unaffordable to many.

Insurance isn't very helpful if you can't afford to use it when you need it.

[hobbit709]

7. Depends on where and what you have.

My housemate's employer supplied policy covers diddly squat until the deductible is met.
A $50 copay is out of reach for someone living paycheck to paycheck
Of course here in TX you get the shaft no matter what.

[kcr]

73. Ours doesn't cover anything. Not even prescriptions.

It's a high deductible, too.

[scarystuffyo]

8. The important stuff

[davidn3600]

10. So in other words the poor can't have access to the same kind of medical testing the rich get

MRIs, colonoscopies, lab work, etc... those wont be covered until a deductible is met.

You have any idea how much those tests cost?

[scarystuffyo]

15. I remeber reading something about colonoscopies

that most of the cost is covered until they find a polyp and it's removed during the exam.

Then it becomes a procedure and you get billed out the ass ( pardon the pun) for the deductible .

It's all bullshit

[LeftOfWest]

31. post the link fot this. n/t

[scarystuffyo]

45. here

http://www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/42779

[justice1]

78. Interesting reference

Medpage Today, powered by Everyday Health Inc., is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

[Mariana]

49. That's exactly what happened

when my husband has a colonoscopy. He called the insurance company and they told him exactly that - when they removed the polyps it became a treatment instead of a screening. Slimy bastards.

[Roselma]

63. Thankfully, that has changed just recently. Here is a

link: http://www.dol.gov/ebsa/faqs/faq-aca12.html

Here is the q/a wording:

"""""Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy?

No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service."""""

[PeoViejo]

71. My Wife's employer paid 100% because they had an arrangement

with a local hospital run by Nuns. Last Year, I had a Colonoscopy with 6 Polyps removed. The total charge to the Insurance was under $400 with no co-pay.
That gives you an idea of what the real costs are when one takes away the profit motive.

[Habibi]

12. I don't believe that is correct.

From looking over plans available in my area last enrollment period, the deductible applies to just about everything, with minor differences between plans.

Then there's the issue of "coinsurance" for, say, hospitalization, which several of the plans I looked at had. That means you pay a premium, a deductible, and if you're hospitalized, a percentage of the costs of that as well.

[WillowTree]

21. For the most part, that's just not true.

Deductibles and copays don't apply to routine well care visits and tests, but they most certainly can apply to treatment of illnesses, and definitely to specialist care. "There is no required expense to use most benefits" is just not so under most plans.

[LWolf]

54. The only thing

I've seen a doctor for that my deductible did not apply for in the last 10 years, pre- and post-ACA, is my annual flu shot.

And there are a bunch of things I haven't seen a doctor for simply because of that fact. I can't afford the fucking deductible after paying the premium.

[KG]

14. can't be true, ACA is most wonderfullest thing ever, because obama!

i'm sure a loyalist will be along shortly to straighten it all out for us.

[scarystuffyo]

16. There's no shortage of those here

[840high]

17. Yeah, right.

[woo me with science]

18. Huge K&R. I made an angry post yesterday or the day before,

after seeing yet another person struggling to afford health insurance receive a letter from the ACA provider notifying them of their impending twenty percent rate increase.

*Twenty percent.* Exactly as high as they can go....EVERY SINGLE DAMNED YEAR.

Actually, it's 19.67 percent. And they didn't even give the poor sap an entire year at the old rate before jacking it up. This will mean either going to a lower tier with even more exorbitant deductible, or more likely not being able to afford insurance at all...since Third Way governor Terry McAuliffe broke his Medicaid expansion promises and this person does not make *enough* to qualify for subsidies.

What an amazing coincidence, that the rate hike determined to be justified just *happens* to round up to the ACA-enshrined maximum!

Woo hoo for corporate health insurance. What a vicious scam.

_________________________________________________
*Remember, the ACA doesn't even require the company vultures to justify a hike until it goes over *ten* percent...When was the last time your salary increased by even half that much?

[woo me with science]

19. How bad is it?

Medical Debt: A Curable Affliction Health Reform Won’t Fix
http://www.pnhp.org/news/2013/june/medical-debt-a-curable-affliction-health-reform-won%E2%80%99t-fix

The high frequency of medical bankruptcy was often cited by advocates of health reform during the debate over the ACA. Yet the debate largely ignored the fact that most medical debtors actually have coverage. In order to protect Americans from bankruptcy, coverage must be truly comprehensive, that is, it must cover virtually 100 percent of all needed medical care. Unfortunately, the insurance policies mandated under ACA are required to cover only 60 percent of expected health-care costs.

http://www.nerdwallet.com/blog/health/2014/03/26/medical-bankruptcy/

56 MILLION Americans under age 65 will have trouble paying medical bills.

Over 35 MILLION American adults (ages 19-64) will be contacted by collections agencies for unpaid medical bills.

Nearly 17 MILLION American adults (ages 19-64) will receive a lower credit rating on account of their high medical bills.

Over 15 MILLION American adults (ages 19-64) will use up all their savings to pay medical bills.

Over 11 MILLION American adults (ages 19-64) will take on credit card debt to pay off their hospital bills.

Nearly 10 MILLION American adults (ages 19-64) will be unable to pay for basic necessities like rent, food, and heat due to their medical bills.

Over 16 MILLION children live in households struggling with medical bills.

Despite having year-round insurance coverage, 10 MILLION insured Americans ages 19-64 will face bills they are unable to pay.

1.7 MILLION Americans live in households that will declare bankruptcy due to their inability to pay their medical bills.

Three states will account for over one-quarter of those living in medical-related bankruptcy: California (248,002), Illinois (113,524), and Florida (99,780).

To save costs, over 25 MILLION adults (ages 19-64) will not take their prescription drugs as indicated, including skipping doses, taking less medicine than prescribed or delaying a refill.

[nationalize the fed]

22. +56 million

This whole "deductible" thing hasn't even begun to sink in. Because the ACA was the grand savior of Those In Need.

People have to now pay a monthly bill AND everything but catastrophic care. Most people won't even use what they are now required to buy.

I've been trying to find another nation that both requires insurance or a contribution to a government plan (like Germany) and still sticks the poor citizen with having to pay for medical care and so far I haven't found one.

Meanwhile, the Democrat who had single payer advocates arrested at a hearing is the new Ambassador to China. He's probably looking for ways to further help the middle class.

[Fumesucker]

23. That was the entire point of it

The poor have to pay insurance that they for the most part can't use if they actually get sick.

A huge windfall for the insurance companies.

[leftstreet]

43. +1

[woo me with science]

64. +2

[slipslidingaway]

85. Check or working on a number of items on this list n/t

[Zorra]

24. We need to put a stake through the evil rotten hearts of private insurance companies.

I just went through my own new miserable experience with this deranged healthcare system, and ended up not getting the surgery I needed because of companies playing money games with my health.

Medicare for all.

Bernie Sanders for President.

[Live and Learn]

26. Then again, under the previous system

she couldn't have gotten coverage at all.

So the ACA helped a lot of people but more still needs to be done.

We all know single payer is the ultimate goal but Obama deserves accolades for what he was able to accomplish.

[Fumesucker]

27. If single payer is the ultimate goal perhaps arresting single payer advocates was suboptimal?

[Live and Learn]

28. Arresting single payer advocates?

Do you mean stopping them? I don't think Obama had a chance of getting single payer through or he would have. Getting anything though was quite miraculous and the first time it has been done.

I don't see what blaming him for not getting single payer through will accomplish now. Except maybe getting everything he did accomplish wiped out. Is that what you guys really want?

Why not just work on improving it by getting single payer as the next objective.

[Fumesucker]

29. Because the objective has already been reached

Mandatory private insurance which many of the working poor cannot afford to actually use.

Nov 19, 2008.. After Obama was elected and before he took office I predicted mandatory private insurance would be the final plan despite the fact that Obama went so far as to mock the idea of mandatory insurance during the campaign.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=4494168&mesg_id=4494251

[Live and Learn]

30. Only if we stop fighting.

And don't forget that many want to completely annihilate the gains that were made.

Important gains were made. People with previous conditions can now get insurance. And is many states, people that can't afford insurance can get Medicaid.

These are important milestones that we shouldn't let be irradiated due to our (perfectly righteous) demands for more.

[Nuclear Unicorn]

32. Except, we are now in the position of having to defend the ACA. When will we have a

chance to work towards an actual health CARE system (as opposed to merely health insurance) if we are backed into the corner defending the taste of a crap sandwich with a smile on our faces while the stories of people such as in the OP stack up at our feet?

[geek tragedy]

67. the ACA did not prevent single payer from becoming a reality

Do people seriously still believe otherwise?

[nationalize the fed]

35. No. Arresting single payer advocates means ARRESTING them. You don't remember this?

Not surprising, most Democrats don't. Or, they have deliberately "forgotten" it. Because it's hard to blame the "Rethugs" for lack of single payer when the lead Democrat in charge of the hearings has them ARRESTED.

as in ARRESTED. Police. Mug shot. ARRESTED. Jeezus. WTF? There is no hope when people deny reality.

Uploaded on May 5, 2009

On May 5, 2009, eight activists were arrested at a health care hearing of the Senate Finance Committee, in the Dirksen Office Building, Room 106. As soon as the Committee Chair, Sen. Max Baucus (D-MT), opened the proceedings, the activists began in turns to stand and to make comments, like: "Why isnt a single payer at the table?" They were immediately "escorted" out of the room by the Capitol Hill police and placed under arrest.
The demonstrators' press release underscored "how 22,000 people die in the U.S. every year due to a lack of health insurance." This is seven times the number of victims that perished in the 9/11 tragedy.
Dr. Margaret Flowers, one of the eight arrested, added in the press release: "Health insurance administrators are practicing medicine without a license. The result is the suffering and death of thousands of patients for the sake of private profit. The private insurance industry has a solid grip on patients, providers and legislators. It is time to stand up and declare that health care is a human right." The activists are supporting HR 676 and S 703. For background and any updates, see: http://www.healthcare-now.org and
http://singlepayeraction.org and http://md.pnhp.org and
http://www.prosperityagenda.us/ and http://freshaircleanpolitics.net.

Any idea where this Democrat that had single payer advocates *ARRESTED* is now? He's the Ambassador to China. Rewarded for a job well done. No doubt trying to further his work for the middle class.

It's amazing that people would think that mandating the purchase of corporate insurance would make single payer more attainable.

Baucus’s Raucous Caucus: Doctors, Nurses and Activists Arrested Again for Protesting Exclusion of Single-Payer Advocates at Senate Hearing on Healthcare

Advocates of single-payer universal healthcare — the system favored by most Americans — continue to protest their exclusion from discussions on healthcare reform. On Tuesday, five doctors, nurses and single-payer advocates were arrested at a Senate Finance Committee hearing, bringing the total number of arrests in less than a week to thirteen. We speak with two of those arrested: Single Payer Action founder Russell Mokhiber and Dr. Margaret Flowers of Physicians for a National Health Program. [includes rush transcript]
Transcript

This is a rush transcript. Copy may not be in its final form.
http://www.democracynow.org/2009/5/13/baucus_raucus_caucus_doctors_nurses_and

I can't wait for the next person to call me a "racist" for opposing the mandated purchase of corporate insurance when there is no public option as promised by Senator Reid and Barack Obama:

[woo me with science]

46. Thank you.

No more pretending about what we are really facing here.

Report Details How Counter Terrorism Apparatus Was Used to Monitor Occupy Movement Nationwide
http://www.democraticunderground.com/12527647

Whoop, There It Is... 'Evidence Homeland Security Coordinated Occupy Crackdown' -
http://www.democraticunderground.com/1002462465

ACLU discovers FBI is labeling peace activists as 'potential terrorists'
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=104x4500788

Protestors against Energy Company charged with terrorism
http://www.democraticunderground.com/10024175848

DOJ's outrageously aggressive prosecution of internet activist, Aaron Swartz
http://www.huffingtonpost.com/2013/03/22/al-franken-eric-holder_n_2934627.html

Bradley Birkenfeld, UBS Whistleblower, Finds Himself in Federal Prison
http://www.cnbc.com//id/41257962

Holder/DOJ sided with Rove in politically motivated prosecution of fr. AL governor, Don Siegelman,
Then, the person who handled the paperwork, got onto the Supreme Court.
http://www.opednews.com/articles/Elena-Kagan--Willing-Acco-by-Michael-Collins-100622-971.html

[scarystuffyo]

51. It's called being bought out

[TheKentuckian]

57. They remember, they just pretend not to for nefarious purposes.

[geek tragedy]

68. no one with a triple digit IQ thought single payer had a chance of passing Congress. nt

[hobbit709]

79. And no one with a triple digit IQ thought the ACA was anything but a sop to the insurance companies

[geek tragedy]

80. That is an incredibly false and ignorant claim.

For one, thousands of lives will be saved because people are getting treatment. Because they have coverage. Along with MILLIONS of other people who were excluded before.

Not to mention the removal of pre-existing condition exclusions, lifetime caps, imposition of medical loss ratios upon insurance companies, expansion of Medicaid, etc etc etc.

Sorry that reality does not agree with your cartoonish view of the ACA, just as it fails to agree with the cartoonish view held of the ACA by the Tea partiers.

[hobbit709]

81. Rah, rah, rah! Siss, boom bah!

Coverage you can't afford to use as is pointed out repeatedly in this thread is as useless as no coverage at all.

But then you never fail to apologize for the establishment.

[geek tragedy]

82. you realize you are bashing Medicaid expansion and trashing it as worthless, right?

Also, no one is making the factual argument that it is impossible to use coverage one pays for under the ACA. Indeed, that would be a shockingly ignorant and false and stupid thing to argue, as many, many people do use the coverage they get under the ACA.

What people are arguing is that there are still instances where the coverage is less than ideal. This is undoubtedly true.

But it is a silly logical fallacy to claim that because not everyone's problems have been solved that no one's problems have been addressed.

You can have the last word. Maybe you can even provide an actual fact or something. It would be a refreshing break from the reflexive bashing.

[hobbit709]

83. Two different things there

goodbye, I don't waste my time trying to teach pigs to sing.

[slipslidingaway]

84. Exactly and excluding them from discussions really helped advance the issue ...

We cannot blame the repubs for every evil

[magical thyme]

33. Which is why I will pay the penalty this year and next, too

If I get seriously ill, I will get care out-of-pocket/credit card or I will die.

When I had the "best" HMO in Massachusetts and I got seriously ill, I was told my dramatic weight loss (110 to 84 in weeks), night sweats, severe insomnia, fever/chills, recurring lump under one arm, afternoon blurred vision, exhaustion to the point that I had to lie down to rest before I could drive home from work, were "all in my head" by the HMO doc (who was being paid bonuses to not run tests).

A CBC would have told him I was seriously ill. My dentist put me on prophylactic antibiotics and saved my life.

My choice last year was to pay that same fucking insurance company $2,000/year that I don't have...or pay the penalty. I opted for the penalty. As a result, I have $2,000 sitting in my bank account right now -- the first real cushion I've had since 2008-2009 -- that I can use if I need antibiotics again.

[Travis_0004]

41. Don't pay the penalty

The IRS has no enforcement powers to collect it other than holding your tax refund. Adjust your withholding so you don't get a refund and tell the IRS to piss off.

[magical thyme]

42. I'm not risking having it taken from SS or something else if that blows up in my face. nt

[treestar]

36. I don't get it

Maybe it's the state? I have a really low deductible and low out of pocket maximum.

I talked to people on the phone and they guided me to the best plan. The value of the plan is way greater than what I pay due to the subsidies.

I had one med recently, a one shot deal, that was applied to the deductible, and that was expensive. But now there is not much left towards the deductible.

I went to the doctor and had a small co-pay. Small co-pay on my regular prescriptions.

These people may make a lot of money relative to me and so don't want to pay their share of the premium and so they pick a plan with a high deductible. I had that before the ACA and kept kicking up the deductible because they kept raising the premium. The ACA has solved that exact problem.

Maybe this is the red state phenomenon too, where they would otherwise get Medicaid. Quit blaming the ACA and blame the Republican majorities in their states and get out and vote in their state elections this year.

[hobbit709]

40. Delaware isn't run by teabagging loons.

[leftstreet]

44. Yay for the Insurance and Big Pharma Profitability Act !!

[LWolf]

52. I've been saying this for at least a decade.

Insurance is not the answer. If you can afford the premium, you often cannot afford to get actual care because of copays and deductibles.

This is why I did not welcome the ACA as the answer to getting actual health CARE.

[sendero]

55. Is everyone here living under a rock?

ALL health insurance plans are heading this direction. My company, involved in the health care world, offers ONLY HSA type plans with high deductibles, and has done so for several years now. I'm given to understand that in a matter of years that is what most companies will offer by way of health care benefit.

Why is this happening? Two reasons. The usual, greed, letting companies spend less on health care. But there is another reason, companies want to force the pain of these costs on to their consumers in the belief that many people use health services on a whim since it costed them nothing in the old way.

Do I like this or am I defending it? No. I'd prefer single payer. You know, what Obama promised us before the election and did not lift a finger to make happen afterward.

But if I have to choose between the ACA and nothing, well the ACA is clearly better than nothing.

[scarystuffyo]

58. So I guess this is the Legacy of Obama and the ACA ....it's better than nothing

That should work well

[geek tragedy]

69. the legacy is thousands of people living who would otherwise have died

millions with insurance coverage.

and a stop to out of control cost increases.

it didn't solve every problem, but guess what no legislation could have solved all the problems.

[sendero]

74. I'm not defending Obama..

... on anything, look at my posting history if you don't believe me.

I share your disgust that no matter who we elect and what we are promised we get crap.

That said, the ACA is truly better than nothing for the majority of Americans, and that is just a fact. And the latest polls show people warming up to the ACA once they realize that the liars on the right are, uh, liars.

[Kingofalldems]

75. Not fooled in the least.

[Tweedy]

65. Something wrong here

You have a deductible and a co-pay. Sometimes, you have co-insurance. There is no ACA compliant plan I have seen where you have to exhaust your deductible before you get coverage. That is the old catastrophic care coverage model. What are her co-pays to see the doctor? This is what matters.

[alarimer]

70. A longstanding problem.

I suspect those plans just barely passed muster with the ACA, but were cheap enough that people bought into them.

I can sympathize. I can't afford the usual copayments for doctor's appoints. I have a flexible spending account for that, but can't afford much more than $20 a month to put into or $240 per year. The last two years, I've used it for glasses (the first time I've had to have them). So any appointments have to wait until January.

[justice1]

72. The New York Times writer should be fired, for being a hack

Patricia Wanderlich does have a part time job as the office manager at Infinity Lawn and Landscape, which she started in March of this year. She also has a full time job, which she has held for the last 12 years, as an Administrator, for the Institute of Medicine of Chicago. She resides in a neighborhood, where the average household income is over $85,000, and she pays taxes of over $4000 on her home.

[SheilaT]

77. So what was her coverage before this?

Since I have not had to negotiate the world of health coverage under the ACA, I can't say too much, other than I've heard that a lot of people would be better off getting something other than the cheapest plan, because a better plan covers more tests, procedures, doctor visits, whatever, and in the long run costs a lot less.

I know I researched Advantage plans as carefully as I could when I went on Medicare earlier this year, and I'm extremely happy with what I have.

[woo me with science]

86. kick

[NCTraveler]

87. You can't be serious.

You are acting like we are being forced to buy a product from a private company and can only use that product if we can afford to do so after gaining membership into the club. So, I have been told more and more that the clubs(private insurers) membership is skyrocketing and that is the point of it all. What is this healthcare you are talking about. This club is about insurance, not care.

The "You can't be serious" was light hearted.

You know how happy insurance companies are with this "new" revelation. They collect monthly premiums and don't have to pay out claims. Who in the government do I have to pay to get on their good side? I want some of this "tough love" that they dish out to massive corporations.