So, What Happens to Everyone Who Loses Their Insurance & Can't Buy It Anymore?


#21

Just another thought-- of the 3% or so on exchange plans now In California-- how many of them are on those plans (which they can’t afford, and are getting worse) that would have instead been on medical? Perhaps their needs would have been better met with medi-cal than with a worthless insurance plan they can’t afford and can never even reach the deductible with? Just food for thought.


#22

I can’t speak to the exact number, but I know a fair number of professionals on the exchanges. This is an expensive city. (I mean, really expensive). If you are a “creative professional” or self-employed, to just survive here you likely would never have qualified for MediCal, even under expanded income requirements in California. Also, I’ve also seen a lot of people who have said they really like the insurance (these are people I don’t know personally, who are just expressing their opinion on parenting list-serves).


#23

Although I know SF is pretty pricey… I’d suspect there are TONS of people on medical there… (or were) not sure what happens to them after the exchanges opened… not only the self employed are required to have coverage now… the unemployed, the mentally ill, the homeless, etc are all as well… not sure to what extent “subsidies” have replaced just good old fashioned public assistance like Medicaid in the past couple years


#24

Yes! MediCal is still in place and I suspect somewhere between 10 and 30 percent of the SF population receives it. It’s just that the income limit is about 40k for a family of four, which isn’t even enough to afford a 1-bedroom apartment in today’s market. So most of the people who I see asking about the exchanges are probably earning more than that. Median income is about $84,000 in the city.


#25

I don’t know how people survive there even on 84k even without substantial medical expenses…


#26

Dr. Frankenstein: “What a nasty, filthy job!” (as they exhume the soon-to-be monster’s body)

Igor: “It could be worse.”

Dr. Frankenstein: “How could it POSSIBLY be worse?!!”

Igor: “It could be raining.”

Lightning flashes, thunder booms and torrents of rain begin to drench them. Dr. Frankenstein’s eyes blaze in fury at Igor.

…and scene.


#27

No one gives a damn about anything but taking whatever money they can get off me. Apparently my taxes are just rent money - we have no voice.


#28

The one thing that I take comfort in right now is that all of us have a community here that is caring and engaged. We know the shock of the diagnosis, we know what it’s like to have to deal with the D. You don’t have to explain many of your frustrations in detail: we “get” each other.

Because we’ve been there or are there, we also really want to help others here do the best they possibly can or a least learn from our mistakes and avoid them if at all possible. I don’t know of many spaces or places that are so helpful and encouraging.


#29

I am self employed, micro business owner, 3 employees. My insurance company stopped Health insurance effective Jan 1, 2016 d/t UnAffordable Health Care Act. All options were minimum of 33% higher cost than what we lost. I elected to join a Christian Plan which avoids penalties. This is similar to a Catastrophic Plan whereas I pay out of pocket BUT my maximum OOP is limited for every medical condition. Worst part is that pharmacy expenses are not covered. When I calculated expensive insurance premiums + deductibles + OOPs versus a small donation each month + Dexcom + insulin, I was financially equal or better off with the Christian Plan. I used a spreadsheet to estimate total costs of known and potential conditions. Other than T1D I am reasonably healthy. Your conditions may warrant finding a typical insurance plan.


#30

I believe that both sides agree that a) pre-existing conditions not being a factor in insurance coverage, b) children being able to stay on their parents insurance until they are 26 and c) no Lifetime max caps are things that both Republicans and Democrats agree on…at least enough that I think any legislation passed would have to include these 3 things still.

The major differences and disagreements come when we get into the COST and premiums that members are currently forced to pay. Some are saving, but figures show many are paying more than I would want to pay if I were in the market…and I have to agree with them.

My hope is that they don’t repeal the ACA; rather, work in a bi-partisan manner (not a familiar concept over the past 8 years in the Senate and House…but mostly the Senate) to work out mutually agreeable terms that keep the 3 things everyone knows should be kept in there while also addressing the rising costs.

If the ACA wasn’t so expensive I don’t think any American nor any government official would have problems with it.

This is the hope that I hold on too anyway. Bi-partisanship is going to be crucial (as it has always been.)


#31

Interestingly, the insurance my family had from a state risk pool was cheaper and better than the Cobra insurance from a large company. Also, the state risk pool insurance was far more comprehensive and had amazingly low prescription drug prices. Wish we could go back to that. This was even though we didn’t qualify for any subsidy. We received it because we couldn’t get insured due to pre-existing conditions. Interestingly, this insurance was considerably cheaper than the current ACA policies even though we were paying the entire cost.


#32

Good luck to you, @JJM1. I’ve heard about Samaritan Ministries health sharing system, but unfortunately for vast majorities of us these are not an option. I’ve heard you have to take a pledge that you go to church at least weekly, get a sign-off from your pastor/religious leader, and promise to adhere to Christian values. If you develop a health condition that was caused by “un-Christian” behavior then treatment may not be covered and your insurance could be canceled. I’ve also heard that they do not pay for pre-existing conditions, which would be a total non-starter for most T1Ds, whose primary expense is their diabetes.


#33

An opinion article came out today about this: http://www.nationalreview.com/corner/442135/trump-obamacare

The writer thinks that coverage for pre-existing conditions is key to the whole thing, and I agree. It adds so much unpredictability to the cost and the insurance companies will fight like heck to add a bunch of loopholes that potentially could screw us PWDs. That is the part the govt. has to legislate correctly so the insurance companies aren’t allowed to shut us out or price us out. The lifetime cap and keeping coverage for young adults seem like they should be automatic as the actuaries will have an easier time calculating costs for those.


#34

Looks like Ryan is also talking about defunding Medicare…I can’t imagine that actually happening.


#35

They have total control (besides Filibuster abilities of the minority)…so anything’s possible, honestly.


#36

Regardless, it’s the right thing to do. Someone who was born with, say Diabetes, should not be penalized for having a disease that they did nothing to get. They should get, and be able to keep and pay the same amount for, the same insurance that someone who’s been more fortunate in their lives with zero medical conditions, can get.

The reason the ACA hasn’t worked thus far (one problem anyway), is that the ACA was designed to get EVERYONE (healthy and unhealthy) into the market to help offset those costs. This didn’t (or isn’t) happening at a fast enough pace to cover the costs of caring for those with health issues, who are in the market place. This is causing insurance companies to pull out of the market, creating a situation that, honestly, the congressional members should have predicted occurring, and writing legislation to prevent that from occurring.

There are a lot of flaws, but I hope at the end of the day (for my SONS and for everyone with a pre-existing condition) that when they get this resolved, that the 3 things we all think are important, are still included in the coverage. I have 3 sons with pre-existing conditions. One had cancer when he was 1 year old. One is autistic, and Liam has Diabetes.


#37

A recent study showed that over 50% of the adults in California either had been diagnosed with diabetes or met diagnostic criteria to be diagnosed for diabetes or prediabetes. If they exclude people with diabetes they’re ruling out over 50% of their profit base. I’m really not worried about it-- the vast vast majority of those people spend a lot more of their life paying into the insurance pool than they do receiving net payouts from it.

My insurance policy costs upwards of $2000/ month between my employers share and my own. My insulin costs (retail, which they pay nowhere near… that’s a whole different rant) maybe $150/ mo… and I buy my own test strips. If they really want to exclude people with diabetes they’ll soon be out of business.


#38

Seems like the “burn it all down” wing of the Republican party is warring with the “Just burn down the garage” portion and that Trump is giving mixed signals


#39

Hope the Tea Party is fully eliminated, or dealt with…they’ve been a disaster and how they were ever allowed to come into existence (and rise in power enough that they can stop any legislation from being passed) in the first place just amazes me…even the Republicans have problems with them. That’s part of the reason Boehner left (or was driven out).


#40

Boehner is probably sipping a martini somewhere with his great spray tan and laughing hysterically.