(06-12-2015 07:22 PM)dawgitall Wrote: (06-12-2015 06:21 PM)Hambone10 Wrote: (06-12-2015 03:08 PM)Redwingtom Wrote: Just a point of clarification: The $2,500 comments from Obama were made WAY before the ACA took final shape and was based on stuff that didn't come anywhere close to what was in the final bill.
These were made back in 2008 before he was even president...and on most occasions, he said up to or as much as $2,500 per year. In a few, he did say an average of $2,500. I know I read how they were calculating that amount at one point, but I can't find the story as of yet.
Okay Gunga Din.
I mean seriously, this is laughable. He certainly didn't negotiate with Republicans, so the only ones he can blame for any 'changes' from his plan are in his own party.
Now, if you mean that he lied to get elected and then stopped telling the lies once in office, I might agree with that. That's essentially been my point all along.
Can you tell me one single thing that was in his original plan that didn't make it to the final bill that would have been responsible for this sort of a change? Please provide a link to the financial analysis.
(06-12-2015 05:51 PM)dawgitall Wrote: The anti-ACA spin is that all that are out there are high out of pocket policies and now you are saying that what Kaiser considers for the purposes of their survey to be high deductible policies aren't high at all! If that is the case it serves to dispute that claim. That means that less than 40% of the people buying individual policies (grandfathered and ACA compliant) are buying high deductible plans. That is certainly a positive.
None of this is really pertinent to anything anyone else is saying. It's like you're talking to yourself and ignoring us.
By definition, nobody is buying a grandfathered plan who didn't already have that plan. Yes, we all know that a large number of Americans already had good insurance that they were happy with. That was the whole point. How is this a positive? If you mean that most Americans work and have jobs and buy insurance... then yes, I suppose it's a positive... yet I somehow think that you're trying to claim that this is a positive aspect of the ACA. I suspect before the ACA, this number was even better.
Quote:Here are some averages regarding deductibles and OOP maximums for various plans.
For group / employer plans deductibles average 1.2K, out of pocket maximums average 3k, PCP visits $24, and specialists $36. Hospital visits average $280.
For ACA Platinum plans deductibles average $400, out of pocket maximums average 2k, PCP visits $18, and specialists $29. Hospital visits average $330.
For ACA Gold plans deductibles average 1.4k, out of pocket maximums average 4.5k, PCP visits $22, and specialists $44. Hospital visits average $330.
For ACA Silver plans deductibles average 3.4k, out of pocket maximums average 5.8k, PCP visits $28, and specialists $56. Hospital visits average $500.
For ACA Bronze plans deductibles average 6k, out of pocket maximums average 6.6k, PCP visits $38, and specialists $65. Hospital visits average $450.
Yet earlier you pulled out the KFF numbers that referred to 1500 individual and 3k family as 'high deductible'.... By that defintion EVERY SINGLE ONE OF THESE is at or nearly a high deductible plan.
Most importantly, those receiving subsidies are most likely to get the bronze because they are fully paid. More often, they have to contribute to the other plans. Seriously, what difference does it make if you pay no premium and have to pay 6k out of pocket... pay 1k in premiums and have to pay 5k oop, or pay 2k in premiums on top of the subsidy but then only have a 4kOOP? Obviously I'm rounding... but the difference in the plans is simple math... It's not magic.
You're actually proving our points.
What I was doing was offering some points of reference. Forgive me for posting factual information that helps to paint a clearer picture for all of us.
The most popular plans are the silver plans, not the bronze plans. In 2014 65% of the people that bought on the exchange got a silver plan and only 20% got a bronze plan. The percent of buyers on the exchange that got tax credits was 85. Even if the only people that got bronze plans were those that got tax credits (and that is very unlikely) that would leave a majority of them signing up for something else.
See, here is an example of how you CLAIM to be trying to offer clarity, but you actually intentionally mislead....
First, you try and differentiate between what Candidate Obama said and what President Obama signed... negotiating only with his own party. As I said, if you'd like to admit that it was the entire PARTY who lied and Obama is merely impotent and is now taking the fall for them, I guess you can. In any event, it's still worth noting that THE PEOPLE didn't vote for the ACA. They may or may not have voted for what Candidate Obama and the Democratic party sold them... and now we know better, since nobody can claim that they did it because Republicans made them do it to let it pass.
Second, you said that 1500 individual and 3000 family was a 'high deductible/OOP plan'. Then you actually LIST the plans you're talking about and we see that only ACA platinum plans are actually below $1500/3000... group employer plans are +/- right at that level... and gold silver and bronze plans are all 'high' by your definition. my point being that you can change the percentages merely by redefining the word 'high'. Pre ACA, $3,000 wouldn't have been considered high for an OOP max. Most people wouldn't have even considered 5k particularly high. $10k would have been high. It is these ACTUAL high deductible 'catastrophic' plans with things like FSAs for the minor ailments that the right and many centrists have specifically complained about losing... and the sort of plan IMO that our systems should be designed around... which is (imo) why the left wants to 'reclassify' the term 'high' so as to subvert the discussion. The primary advantage of a truly high catastrophic type policy is that it is less expensive overall because MANY people would never use it... It can still cover (for little or no cost) all the preventative care that pundits say we need to fund, and we not only protect people from financial catastrophe's, but we offer what is in effect a financial incentive to live more healthy/make better choices.
Finally as to your claim of whom is buying what.... my comment about subsidies obviously didn't mean those with partial subsidies, since a partial subsidy by definition wouldn't be 'fully paid'... This is a reading comprehension issue. but as i said, the differences in the plans are all math, not magic, so it really doesn't matter on average.... but someone getting a full subsidy probably can't afford to contribute to a silver or gold plan. They don't get the bronze because it offers the best combination of coverage for them, they get it because it's all they feel they can comfortably afford.
Let me say it differently... throwing in some numbers.
Bronze COSTS 500/month... 6k deductible
Silver costs 600/month...3.4k deduct
Gold costs 700/mo... 1400 deduct
Note I'm talking about how much they actually cost... clarity... because it is math, not magic.
For sake of the conversation, lets say 100% of the FLP is 1k/mo and the 'full' subsidy is paid to people who earn up to $1500/mo.
If the 'subsidy' is worth $500, then the premiums (after the subsidies) for the policies are zero, 100 and 200. That's zero, 1200 and 2400 per year... PLUS the deductibles.... or UP TO 6k, 5k and 4k. If you make $1000/mo, you're probably taking the zero. If you make $1500, $100-200/mo is still a lot. If you make 3k/mo, which is 300% of my FPL and subsidies go to 400%, you're probably taking the silver... so yes... It does not surprise me at all that MOST people choose 'the middle' one. There are actually lots of studies that show that people do this all the time... and not just with insurance.
Those aren't real examples, but it's not that far off from how it works. You guarantee the 'payor' more income and he limits your possible downside in return.... but since the coverages are all ultimately the same (what is covered and what is not)... then these are the only differences in the policies.... is how much 'downside' you are buying.
If you're healthy, your actual cheapest option IS the bronze plan (subsidy or not)... since you're not likely to use up the deductible every year. If you're sickly, your actual cheapest option is the Gold, even if you really don't think you can afford it.... because the chances that you owe 'the max' is almost 100%. That is true regardless of HOW much you earn or HOW much your subsidy is.
but few people, especially few poor people look at insurance this way. They should. Farmers does a commercial where they talk about you THINK you're insured for this, but you're really insured for that... and you THINK you're paying for this, when you're really paying for that. I know it's not healthcare, but it's a perfect example of how people don't really understand what insurance is or how it works.
Insurers/Payors don't really care of you pay your copay or deductible. That is between you and the doctor or hospital. They got their money and they've paid what they're supposed to pay. They're out.
I understand that the ACA keeps a very small number of people from owing $100,000 from heart bypass and that is worthwhile... But it also likely increases the number of people (exponentially) who owe $6,000 (per year) for a chronic disease like diabetes and 5 years later with 30k in debt, they stop getting the preventative care they need because they don't want to run up more debt.
The ACA was correct to focus on primary care... but if it really cared about poor people and wellness, unless it was actually going to reduce everyone's deductibles to something like the $3,000 OOP max you suggest is the lower bound of 'high' (which would have been FAR more costly)... then it should have left strategic holes in the coverage rather than leaving generic holes in the finances.
As an example... You break your leg in a car accident, low deductible. You break your leg 'ghosting' in your car, high deductible. You get hospitalized because you stop taking your prescribed and paid for medication without instructions to do so? High deductible. If you're on drugs, you get rehab paid for... low deductible. You leave AMA, high deductible. Hospitalization for hep from illegal drug use? High deduct. hep from something else, low. Use 'coverage' to encourage healthy behaviors. If you want to smoke crack or hang glide or snort cinnamon for youtube, that's fine... and we won't let you kill yourself doing it... but we're also going to make you bear a higher portion of the cost.
Am I being clear enough? Use the rules to encourage good behavior and choices. Instead we're essentially encouraging bad behavior and choices. It's essentially the same finances... we're just being smarter about how we allocate it. I can't give you a good example, but at the risk of giving a bad one... We've already established that the poor can't afford their deductibles anyway... if they're poor and you have dm2 from poor diet and exercise and you have no insurance... even though you know what to do they don't do it... so we buy them a policy with a 6k deductible they still can't afford, so they still don't do it. So we eventually spend $1000 more and buy them a policy with a 2k deductible... now they might do it, or not. What if with that same money we offered them a $250/yr gym membership and $250 in cooking tips or maybe even $500 in free vegetables to eat better and exercise... What if all that were 'free' and the risk to you of non-compliance was $10,000 in copays or that you lost some of your subsidy? are you more, or less likely to do it?
People don't value what they don't sacrifice for as much as they value what they do. People who have been fat and lost weight tend to value their physique far more than those who were simply born skinny. People who have illnesses or injuries of choice aren;t compelled to make different choices if you take away the consequences of those poor choices. I'm not talking about DM1, and yes... ICD-10 has more specificity in 'how it happened' than you can possibly imagine.
