Insurance cost and the Affordable Care Act

Type 1 and LADA
1

In 2013 I become an independent contractor after 10 years with the same employer. We always had good health insurance through the company sponsored plan. The company subsidized the insurance plan so our premiums was barely $200 out of pocket. The plan covered 90% of costs. My CGMS was fully covered. So was my insulin pump.

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After I left, I kept the insurance plan, paying about $1900 through COBRA for a family of four. Then in 2014, COBRA expired and we found insurance through the exchange. Almost $2000/month for a family of four. But the top tier Platinum plan covered only 90% of dr visits and only 50% of equipment costs. I pay $996 every four months for CGMS sensors.

Then in 2015, the insurance company raised the premium to $2230/month. Exact same plan, save coverage, same deductible, same family of four. So I paid over $250 per month extra for the same insurance product.

From what I have read, the insurance company has petition the State of New Jersey for an increase in premiums. Same product, same coverage.

It’s not yet clear how much the marketplace premiums will increase since any increases must undergo state regulatory scrutiny before they’re finalized. However, four of the six marketplace insurers have proposed double-digit premium increases: Aetna, 30.3 percent; Health Republic of New Jersey, 17.99 percent; Horizon Blue Cross Blue Shield of New Jersey, 10.8 percent; and UnitedHealthcare, 15.65 percent. The other insurers – AmeriHealth New Jersey and Oscar Health Insurance – are proposing increases of less than 10 percent, the threshold for reporting the proposals to the federal government in June. ~ HEALTH INSURANCE SIGN-UPS HOLD STEADY, BUT MORE FAIL TO KEEP UP WITH PREMIUMS

Someone please explain to me how the Affordable Care Act is affordable?

NOTE: The fines for non having insurance have been raise to 2.5% of income.

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For most workers the system was not broken, but now it’s reversed and is slowly breaking down for those that work. I have a small business with 30 employees. I pay 100% of my employees premium and about 60% of the dependent cost. My cost has doubled in the past 4 years and my employees are direct labors and will never be able to pay for insurance. A small company like mine cannot generate enough direct labor profit hours to cover the high cost of health insurance today…Something has to change Americans cannot work any more hours, that’s how we always did it in the past…“Want a better life just work more hours”…Now when my employees work overtime my insurance company’s charge me a higher premium. They say longer workdays = poor health and more accidents… If these trends stay the same I will have to stop paying by 2017 or 2018.

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Sigh.

I know of a few former colleagues that have, because of increased costs, dropped the company sponsored plans and switched to the other spousal plan. Their spouses have state jobs.

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I have insurance through my work place. I have a $2600 deductible that I have to meet before I can get anything covered, including prescriptions, Dr. visits, medical devices, et.c. Once I hit the deductible I have to pay co-pays for medication. I’ve spent about 15% of my yearly income on health care this year (out of my own pocket). But, hey! The premiums are low.

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Question was, the quote thing isn’t working, was explain how ACA is affordable. ACA is a name. We can all think of names that are deceptive. I don’t believe ACA is a deceptive name. The goal of the legislation is to make care affordable. And that is how the ACA is affordable. Let’s put the question this way “how is any complex legislation with a name affordable?” Obvious answer is it’s not affordable. Things that are affordable are things that are bought and sold. Legislation, laws are not bought and sold in the sense of my use of those terms. Of course we know the rich buy laws and that should not happen and it’s is a grave injustice. My congress person, Duke had a sales price list for military contracts and he went to and died in prison for that.

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My deductible is $5000.

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my fiancee works in the health insurance industry.she will tell you there is nothing affordable about aca. she works for a third party administrator that specializes in contracted self funded employer groups through major insurance companies.
the insurance through her work is near impossible to use. They have domestic partner coverage so that is how I’m covered.
I’m an independent private contractor, so I would have to purchase insurance privately if I couldn’t be on her insurance privately.
I have been trying for a week to get my clinic to make an appointment or write a script. It’s getting to the point where it is kicking dead horse.
I called the clinic numerous times and have at one point showed in person to present my insurance cards. The insurance utilizes cigna PPO networks. The clinic seems to make one excuse after another and avoid answering certain questions.
I had to go to urgent care and get scripts for R and NPH. IThe bottom line is they don’t like the fact I do not have Medicaid now and they catered to me when I had Medicaid.

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@Khurt_Williams I believe it! I was trying to find a better plan than the one I have through work and I literally can not afford it. I mean, I don’t make enough money to cover the insurance, my rent, groceries, gas, et.c. (and I DO NOT live an extravagant lifestyle). And here’s the kicker: I don’t qualify for any help!

I thought this whole reform act was going to help people with disabilities and I have searched far and wide and found NOTHING that will help me. I’ve had meeting with job and family services who basically told me that to get help for a disability I have to be on disability. I’m still very capable of working and bust my behind 40+ hours a week and literally could not afford to keep myself alive if I had to buy insurance through the marketplace. The system is clearly broken.

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Well the original plan was for single payer, i.e. tax funded system for the affordable part… Insurance co’s wanted nothing to do with that as that money always went to their pockets and they made sure it and even more still does. (as everyone is required to carry “their” insurance plans.)

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The only part that works for people with disabilities is the part where an insurance co cannot deny you getting on board because of your pre-exhisting condition… It did nothing to change the fact that while they take your money they will not cover what you need.

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Which I had never had a problem with before. Maybe it was a big problem and I just never saw it, though.

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I never had either but for the fact that I had to make sure I sought employment with companies large enough to cover insurance otherwise it would be a problem.

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It almost encourages people to earn less money. I’m probably going to allow my current contract to expire and not renew it.
With only my fiancee’s income, we’ll qualify for Medicaid amongst other things.
I would prefer to work and provide an income for my family, but I think I will adjust to my new role as Mr. Mom

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@AARON10, I’ll change the question to How does the Affordable Care Plan help make medical insurance more affordable?. :smile:

ACA may have made healthcare more affordable for some of the population who maybe couldn’t afford it before, done nothing for many more, and increased expenses for some. I don’t think it has done anything for the vast majority it was meant to help.

And words do matter. It’s called the Affordable Care Act. Affordable was the main goal. I posted a link above that illustrates my point. It’s written by and for a New Jersey audience.

It’s not yet clear how much the marketplace premiums will increase since any increases must undergo state regulatory scrutiny before they’re finalized. However, four of the six marketplace insurers have proposed double-digit premium increases: Aetna, 30.3 percent; Health Republic of New Jersey, 17.99 percent; Horizon Blue Cross Blue Shield of New Jersey, 10.8 percent; and UnitedHealthcare, 15.65 percent. The other insurers – AmeriHealth New Jersey and Oscar Health Insurance – are proposing increases of less than 10 percent, the threshold for reporting the proposals to the federal government in June. ~ HEALTH INSURANCE SIGN-UPS HOLD STEADY, BUT MORE FAIL TO KEEP UP WITH PREMIUMS

I have only done a back-of-the-envelope calculation but I think I would actually save money paying out of pocket for my medical expenses (for my whole family). I can’t do that now, because ACA requires the purchase of at least a catastrophic plan which only covers emergency room visits and, in New Jersey, costs about $6000/year.

Here’s what a colleague of mine wrote in 2013:

So the math then tells me that, in those aforementioned states (like New Hampshire, but not New York*), the ObamaCare plans will only be used by those who previously couldn’t get insurance, effectively making those plans high-risk plans, and raising those premiums up to the roof (just like they were for pre-ObamaCare high risk plans).

Right?

If correct, then what’s the point? If we’re going to do this, we can’t split the baby and expect it to still be “affordable” for everyone. At least not according to my math. Am I wrong? ~ Dave Hamilton

I don’t qualify for any help either @MissMargie. :sob:

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And therein lies the real issue with this whole plan. The only way to make ACA work for everyone is to have everyone in it. Employers sponsored insurance plans skew the numbers. ACA should have banned the use of employer sponsored plans, forcing everyone into the free market and hence open up opportunity for both insurance companies and the populace. I personally think that would have worked better.

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Well this was even long before ACA, here in MA, we would stay on parents insurance until 22 (basically out of college) Employer insurance plans have been around for my whole life after that but small employer plans say 10 people suffered greatly by hiring a DIABETIC… Every co-workers rate went up and if employer could not absorb that increase it came down to passing it on to each worker. In a much larger company the increase is absorbed much more easily. The health industry has always had a circle jerk way of pointing to the right at their problems. I’s the doctor says the insurance co, doctor points to pharma, they point at ins. and around goes the blame. At this point I think most of the blame is insurance co’s and next pharmaceutical co’s dancing with them, taking our money and paying out as little as possible.

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I agree it is a total circle jerk. I see the ACA as a band-aid that can only do so much with the profit-driven US health care system. It does subsidize and make insurance accessible to those with low incomes. It does limit the profit-gouging (to I think 20%, the rest has to go back into treating patients). It does close the convenient pre-existing condition loop hole that companies loved to exploit. What we are seeing is not the fault of ACA. Some of the negative opinions about ACA is really more about the scales falling from people’s eyes as the realize how outrageous the corporate-driven health care system which has been running a muck for years before the ACA. I have watched my premiums go up significantly every year for many years. I watched my DME increase from 30% to 50%. Some employers take on so much of the cost that the employees can remain blissfully unaware of the outrageous costs, especially if they do not suffer a chronic disease like diabetes. Some employers subsidize much more coverage than others and some of us PWD’s have been very fortunate to have access to pumps and CGM.

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I don’t blame the pharmaceutical companies. I worked in the IT department of a big pharma for 10 years. I had the opportunity to be part of a group that followed the path of a drug – I think it was an oncology drug for people who did not respond well to other oncology drugs – from inception (discovery of a promising compound), through non-human primate lab test, through clinical trials, through FDA submission and final approval, through product development and delivery. It took about 7 years before the drug hit the market. When I saw the balance sheet for the cost of all of the expenses related to developing and manufacturing that drug, my jaw dropped. It was in the billions.

Given that the company had a limited market for the drug – I think the numbers were in the single digit millions – and has to make enough money to cover cost plus profit and stay solvent, you begin to understand why some drugs cost $90/does. Then take into account the cost of R&D on the drugs that don’t ever get approved or aren’t effective in clinical trials. The successful ones have to pay for the failures. Sometimes a drug gets all the way through clinical trials but a competitor brings a similar drugs to market first. Maybe there isn’t enough market demand to support two drugs. So you cut your losses and shelve that drug.

An older article form Scientific American suggest that the Cost to Develop New Pharmaceutical Drug Now Exceeds $2.5B.

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My COBRA costs were $500 less and the plan covered more than what the ACA plan provisioned through Amerihealth of New Jersey. One may assume that when I was paying COBRA I was paying the full cost of my plan.

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A dear type one friend has had to take employment instead of self employed just to get better health insurance. Health care in the USA has prompted one self employed friend from high school to emigrate to Canada. It is a disaster. Let’s not understate the achievement of allowing many people to access health care, of passing a law over the unanimous objection of one of the two parties even though the whole law was a concession to them and could not more embody their own stated principles. But it is horrid what we with chronic illness endure being unprofitable in a for profit industry. Advances in our treatments are making us poorer and the rich richer. Yes the health care system in the USA is abysmal. The ACA is a step forward that left the self employed hanging. I hope another step can be taken but if the majority party can’t even choose a house speaker what hope is there?

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