Home Forums Discussions General Discussion "Affordable" Healthcare Plans

I have finally seen a few ACA patients.

My patients are discouraged: Their Obama plans are neither Affordable, nor can they get care. They have huge deductibles meaning their care is not covered and they have premiums on top of this they cannot afford. One was in tears: the government is requiring them to do something they feel the cannot afford, and will take 1% of their income if they do not comply.

One guy told me he is getting subsidized 10,000 per year for his plan from the taxpayers, but he still has to pay 290 dollars per month. He wanted to get some care, but he has $5000 deductible to pay before he gets a cent. So he has to pay over $8000 per year before he gets any help for this taxpayer investment. When he is done with this, he has a 60/40 split! Taxpayers are getting screwed, the patient has no affordable care, the doctor isn't going to get paid, and the insurance corporation goes home with a bunch of money. When will our country wake up to the government/corporate corruption?

Wish there were a "like" button

Any physician CME instructor or scientist with the remotest connection to a drug company has to 'disclose' their conflict to the audience or reader. That is our standard in healthcare.

However, the government is rife with corruption. Executives from Monsanto sit on the board of the USDA. Government officials hold positions on Wall Street and with major corporations who receive government funding. Examples abound of corruption. It is not even hidden anymore, but well-known and obvious. If we ever want to take our country back, we will have to start with the corruption.

It's more complicated than 1 example, isn't it?

What were the patient's options prior to Obamacare? Probably no better unless he is young and healthy.

Insurance is not for smaller bills (like we docs generate) only for hospital/procedures/surgeries. That's not necessarily bad. One can pay more in premium and then have no deductible. Take your pick. If he makes less than 200% poverty then the deductibles go down significantly.

Any proposed better alternatives? We could keep having a large uninsured population, or single payer government system, or cut enough hospital/procedure cost fat so the cost of healthcare isn't so damn high;)

One of my personal friends had been buying health insurance for himself and his wife. He is in his late 40's, was paying $450/month, had a $30 co-pay to go to the doctor and a $2000 deductible. He received a letter stating that his insurance was not compliant with the ACA and they were cancelling his policy (so much for the "If you like your insurance, you can keep it".

The cheapest he was able to find to replace it now costs him $750/month and he has an $8000 deductible.

The ACA plans are essentially catastrophic plans, at least the "bronze" plans that most will choose due to lower premiums are. So, now instead of collecting from insurances we will be collecting from individuals. Good luck with that. It does keep people from being saddled with a life time of debt due to a big medical bill but it does not make access for non-preventive care any better than having no insurance. This is a great deal for the insurance companies. Just watch the executives take home big pay days over the next few years.

Two years ago I was paying 600 per month for a plan for 6 people with a 2500 deductible. Our old plan was canceled because of ACA (Liar liar Mr. Obama)Now I'm paying $1200+ per month with a 2750 deductible. In 5 years, that's 72,000 dollars in premiums in 5 years, and I'm thinking about self-insuring - but this would be against the law and they would take 1% of my income. All the regulations that came with the ACA have made it the opposite: UNaffordable. I looked on the exchange and there are no better plans and many have $12,500 dollar deductibles.

So far in my office the ACA has essentially been the Medicaid expansion act. Many new Medicaid patients but not many through private insurers. I think for many people the new plans are still just too expensive.

For the people that had catastrophic plans before, the new catastrophic plans are often more expensive since they are filled with the mandatory health maintenance and other provisions. We can debate whether that's good or not but the bottom line is that for many patients the Affordable care act is less affordable.

It's what happens when the insurance lobby gets to write the bill.

Life would sure be easier if everyone understood this. Of course, it is not looked at as "insurance" any more but as an entitlement. Witness the "wellness" benefits. Thus, the more of it you use, the more you "get" from your entitlement. "You don't really need an MRI for your headaches" "Oh, don't worry, Doc, I've got good insurance and it costs a lot of money..."

Years ago, I heard a talk by an insurance group, that started by a gentleman reminding us how insurance started. In the days of sail, oceanic shipping had a very high loss rate, so merchants agreed to put some of their cargo on each other's ships, so at least some would get through. That story has stuck with me. I don't know what we have now, but it sure isn't insurance.

Oh you hit the nail on the head. Insurance is(or at least was) to ensure you against ruin in the case of a crisis. Unfortunately, it his human nature to misuse that in which you have no stake. I fear that people will not ask the right questions from their doctors and insurance companies, that they will become less active participants in the management of their health.

The insurance I can buy as an individual through the marketplace now is more expensive than the one I had before. The coverage is different. I preferred my previous one. The marketplace insurance that we might get through the business looks better(price and quality) than both tough.

Who said this?

We can all hope for upcoming elections...

My 2 cents. My wife and I had a family policy through Blue Cross of TN, got grandfathered in. Monthly premium $1,200. With the marketplace we got a better BCBS policy, better drug coverage, premium $995 a month. I guess the "silent majority" of satisfied users of ACA should add our voice to the people who are not happy.

I just talked to a friend high up in a big insurance company. The rates on the exchange are to be set for 2015 by April 15/2014. Expect a 20 percent rise at least......great

Well, the Republican Party has been going to great lengths to find people who will take interviews saying how dissatisfied they are. Interestingly, many of those seem to be bogus. When a reporter discovers this and publishes about it, they then attack the reporter. See my link below.

http://nymag.com/daily/intelligencer/2014/02/it-mean-to-debunk-lies-about-obamacare.html

Also, President Obama is apparently up to more evil. See the link below.

http://nymag.com/daily/intelligencer/2014/02/obama-has-released-homo-demons-church-sign.html

But seriously, I do wish people with experiences like yourself would send letters to the newpaper editors, and the White House, documenting the benefits that you have seen from the ACA. It's not that I am necessarily for or against the ACA. I just happen to be sick and tired of the shrill yelling about the horrible ACA that is harming so many patients, and then the examples are seemingly bogus but there are no reports from patients who publicly state that they are benefiting from the ACA. I would like to see some balance and verifiable truth out there.

It's like when they pulled out that Joe the Plumber BS when it turned out Joe wasn't even a licensed plumber! I don't even think he was an apprentice. Just a plumber's helper.So he is never ever gonna be getting a plumbing business because at least in NY/NJ you need to do a 5 year apprenticeship to get your license. Interestingly, the actual licensed plumber that Joe helped was not up on stage at the Republican Convention. Just this unqualified, uncredentialed Bozo. Why is that??? Sorry, a little old and off topic.

Just please go ahead and send your letter in, but be aware you may be asked to do an interview on TV or something. Well, based on who has been chosen to be reported on when it comes to the ACA, you actually have little chance of being asked to do that.

At least in Oregon it looks like the "Insurance" companies collude to ratchet up the rates. They take turns increasing rates each year (and we have to scramble to get a slightly lower rate from a "competing" company). Rinse and repeat the next year.

That way they can get major rate increases over a three year period, where it would be very difficult to sell the same increase to the "publicly accountable" Insurance Commission who oversees all this monkey business on a year by yer basis.

How much taxpayer subsidy does this include? I ask this because, granted, some people will have lower rates with heavy subsidies. This is part of Obama 'spreading the wealth' - taking it from the upper middle class and giving it to the lower.

And how much is your deductible? And co-insurance? Apples to apples.

The insurance rates on the exchange are heavily "doctored" by subsidies, huge deductibles and co-pays.

Wayne...not to jump the post, but Joe the Plumber now works at the local Jeep Plant in Toledo, Ohio....and yes doing maintenance as...you guessed it...plumbing and electrical...he needed to get this job so he could get benefits as his cost on the exchange was too expensive...he gave an interview on this..it was great...

Well, it is good that he went out and found employment that would provide health insurance. I'm happy for him. But I bet the exchanges have a lower cost than he could get individually before they came about.

Many people don't really understand how expensive health insurance is, and they make alot of noise when the exhcanges are offering plans at $100/month for "full coverage."Because "affordable" translates to different numbers depending upon who is listening.

It is wild, I priced group coverage this year for the practice and it has tripled. So instead I'm giving the employees a healthcare stipend they can use on the exchange.

Wow! Now, that is definitely an increase. And that's from your state exchange? Now it would be interesting to take a closer look at what happened in your case. But I think it's safe to assume that wouldn't result in finding out that you never looked at the exchanges.

Wayne, that was for a group plan for my office so it was through an agent, not the exchange. Last year the monthly rate for an employee and spouse with a 2000 deductible was around 400 now it's a 3000 deductible and 1150 per month.

Now, let me add this. Since I can't afford to offer a group plan, one of my employees went to the exchange and was able to get a plan with a 6000 deductible for 250 a month since she qualifies for the income redistribution.

I have tried to figure out whether to drop the employer insurance I offer and let employees get their own. We have one employee who previously would have had problems getting private insurance, so we have kept our group plan out of a sense of social conscience. I cannot figure out what is available for how much, and what are the "catches". And of course our insurance agent, who stands to lose a commission, keeps filling us with horror stories. I am totally lost.

I have been thinking of replacing my present employer-sponsored plan with:
-- an HSA covering each employee's deductible (part funded by our practice), plus
-- a fixed contribution to their premium for a plan chosen from the healthcare.gov exchange.
Many of our lower paid employees have kids, so using the subsidy calculator it seems that our employees total contribution could be kept from rising, or even decline.

You all might want to at least check the exchanges for plans for small businesses and see what rates they offer. Your insurance agent will probably actively discourage you from this, but as they say "Knowledge IS Power."

Wayne, you buying what Harry Reid is saying? ACA is a joke built out by CPA's rather than MD's. The results of the roll out are reflective of the thoughts going into it. Plan and simple. As we stand right now, the WH states that 4 million have signed up. Same group who lied about ACA to get it passed and to get the occupant of the WH elected. We have no idea how many have actually paid rather than just signed up, but that is another investigation. Right now 6 million have lost their coverage. So the net right now (not later in the year when millions more lose coverage) is that 2 million have lost their coverage due to ACA and we have spent ungodly amounts of money to launch this disaster to what effect? We would have been better off just placing the 30 million onto Medicare/Medicaid because we all know how wonderful that insurance is.

Dusting off Joe the Plumber? Next it is Bush's fault. Some point the party that passed ACA will need to own it as they are wholly responsible for it and the agony that it has placed untold millions of american's through. They rammed it through, now pay the price in the mid terms and in 2016.

Why, are you buying whatever Mitch McConnell or Karl Rove says? It's not whether or not I believe what Reid says. It's that whenever someone is trotted out in the media spotlight for interviews to prove how they have been hurt by ACA, it turns out to be bogus. At least the examples that I've seen. I just find it odd that they can't seem to find one of these cases that, when examined, it turns out to be true. And their response is to attack the person who uncovered the falsehood. So based on these actions I'd be more likely to believe Reid.

You can't blame the capricious and malevolent actions of some insurance companies on the ACA. Those are actions of the companies in question and you can depend on them to do that just as you can depend on a honey badger to bite you if you take its food. And sit down and really examine what happened with the rollout, which is simply that the GOP had been attempting to sabotage things from the beginning and finally one of their tactics worked.

And Joe? He is just another example in a pattern of behavior. Again, a big mouthed example trotted out that turned out to be bogus.

Look, I'm not going to turn the AC board into a venue for political debates and arguments. My position is just that I want to see real, truthful examples for and against the issue. But examples I've seen against the ACA all turn out to be tainted when closely examined. Frankly, what happens is that these guys run around and cherry pick 4 or 5 cases that support their version of the truth and try to ignore the other several million cases, or act as if their 4 cases are the "typical" cases. It's just not true. What they should be doing is trying to make the law a success, and if in spite of those efforts it isn't then say "I told you so." Instead , they try to obstruct everything, and when they succeed in causing a problem they say " See, I told you so."

I think the ironic title of this thread ("Affordable" in quotes) says it all. A cheap premium is trumped by a huge deductible -- not for us business owners but for the average person who thought they would be able to buy healthcare coverage, not a catastrophic plan. There is a little bit of benefit from paying an insurance rate instead of "no-insurance", but I am out of network for almost half the ACA plans in my area because of the narrow panels created by the insurance companies. Patients don't get it -- yet.

I was expecting much more from ACA after all the talk from VP Biden "we're going to tell the insurance companies what to provide". Obviously we have to move forward with the reality of the law and disregard the demagogues, but what I am looking at on the healthcare.gov exchange is not "Joe the Plumber" propaganda. It's just not right what people are getting for their money, and what taxpayers are getting for their subsidies.

Instead of Biden, Reid & the Republicans posturing, they should hold insurance companies responsible for their end. But I'm not seeing that, now or ever. Our national government is too poisoned by ideology and choked by PAC & corporate money.

Wayne, then keep politics out of your comments. Your first sentence brought it up and now you want to end it when there is push back. Sorry, but I grew up in Chicago and had BO pegged from the start.

From your comments, you are stating that everyone who shared in this string how their insurance has been canceled or how their costs have gone up dramatically are lying. I trust their stories because it is what I have heard from many others from many different sources. To have the leader of the Senate call Americans that disagree with or illustrate how Obamacare is a disaster LIARS at the top of his voice on the floor of the Senate is unbelievable and shows how disturbed he & his party have become. The rammed it through without a single vote from the opposing party and now they own 100% of the disaster it has become. How afraid they have become since buyers remorse is settling in ever where and the mid-terms look bleak for them. You can lie until the cows come home but you cannot hide the impacts to every American when they open that cancellation letter, or when they have to write that monthly check, or struggle to find a doctor that will treat them. Those that rammed this through are struggling to deflect the disaster away from them and all they can come up with is LIARs. How pathetic and empty.

I also noticed that the fact that we now have at least 2 MILLION fewer on insurance than when this disaster started is not discussed. I find it intriguing that the Government will not share how many have actually paid for insurance out of the 4 million which makes me think that much less than the 4 mill actually paid for insurance. Seems to me that there is much that the owners of this disaster are afraid to share.

I do not buy for a second that Obsamacare is good, well thought out, or that we should sit idly by when lies that would make Nixon blush continue to be made by the WH and BO. Obamacare is a disaster on all accounts, plain and simple. To the general public, healthcare, and to the democratic party. Obamacare is reflective of catering to the smallest minority at the forced sacrifice of the majority. I believe in helping the minority but not catering to them. I trust that Obamacare will be gutted and that our healthcare system will survive until then.

If this ACA was so good for the American people ,how is it that the President, the members of the Senate and the Congress want no part of it if I understand it correctly.
In this whole debate about the ACA and the blame game from the Democrats and the Republicans, the physicians and the working class have to bear the brunt of the ACA.
I can only speak for my family and my staff. Our premiums have increased as well as the deductible anywhere from $2500 to $ 5000.
So my question to the insurance agent was : "What's the point of paying my monthly insurance premium when I have such a high deductible?"
Their answer was that the ACA covers maternity benefits, pre existing conditions ....!! Even if you dont need it you have to take it.
So in other words you spread the risk and spread the wealth around.
The Insurance companies are laughing all the way to the bank with peoples monthly premiums as most will not meet their deductibles.
Beware of the Insurance exchanges- patients have 90 days to change their mind if I understand it correctly.You may be left holding the bag if the patient changes plans.
Unfortunately we have no legitimate body to represent our interests as we get steam rolled by the Senate, Congress, the Insurance companies, Lawyers,Certified Chartered Accountants who seem to know what is best for the physicians and the medical community.

My point is not to coop the AC board into such. You can send me a private message. Sorry, I grew up in DC and have lived for over 20 years in NYC.

I didn't state that anyone who shared in this string was lying. I said that the examples trotted out into the media tend to be those who are lying. I specifically said state I'd like to see actual, legitimate examples in the media and those could be positive or negative. If you happen be an example of one, either positive or negative,then write a letter to the editor, the GOP, Dems, the White or something and be profiled. Then people will have real information and examples, instead of the stupid shrilling that is going on currently. I notice

There are some Americans that had their policies cancelled. Was that really the fault of the ACA, or just pernicious actions by insurance companies? Or is it pernicious behavior by many employers? You can't just look at the resulting numbers, you have to look at the process by which those numbers come about. Many others have access to insurance that didn't before. I personally know people that were making $2K or $3K too much to get Medicade, but whose employer didn't offer health insurance and they really couldn't afford the rates they were quoted. A few I know got sick, and were told to quit their job so they could get Medicade (and a couple did). Now they can at least get Medicaid or possibly catastrophic if the companies in their state and

You cannot make a change this big and not have some who effectively "lose." It's gonna happen, can't avoid it but it doesn't mean the thing is bad. There is no perfect legislation. It will need to be tweaked, but there are many for whom "tweaking" it means "making it unworkable."

Do I think the ACA is perfect? Heck no! But if it isn't well thought out, it partly the GOP to blame since they have worked so hard to derail it instead of truly trying to provide suggestions to actually make it work.

Again,just shrilly saying they are Liars does not help a discussion. Frankly, that doesn't help on either side of discussion, which tends to be my problem.

I think overall the people of Kentucky think Obamacare is a good think so far. At least their governor believes that they do.

John, I agree in that people may not be getting enough for their money. I hoped for more (not quite sure what I expected). But we were seeing the lower premiums with high deductibles before ACA. They had coined the term "Consumer Driven Health Care".

But think about some things we've seen. For example (before ACA), someone gets laid off but has COBRA. They may not feel they can afford COBRA, but compare the rate they would get under COBRA to the rate they would pay if they didn't have COBRA, especially if the had a medical condition. Even just allergic rhinitis. Now compare those rates with what they can get now on some of the Exchanges. If the rate on the plans on the Exchanges is lower, that shows some progress on the issue. Now, maybe some will say it's not low enough to be "affordable." Now, that result can be either being unrealistic expectations, lack of competition in the insurance market, or just pernicious behavior on part of the insurance companies (I say it's a combo of all three, but mainly 2 & 3 but unfortunately I have no data to prove it one way or another).

Yes, there is a lot of postering on both sides out there. Frustrates the heck out of me, since what I (and I think most people) want is good, unbiased information so that they can make proper decisions.

Not exactly. Senator Grassly attached some language to a bill concerning Congress and its staff purchasing from the Exchange, but did not think it through. They are Federarl Employess and are covered by Federal Employees Health Benefits Plan (FEHBP). So, well alot of stuff is going on and it is still in dispute. See the link.

http://politicalticker.blogs.cnn.co...empt-members-of-congress-from-obamacare/

Wow, your premiums AND your deductible increased. Now that does seem bad.

As far as the explanation. Well that is what the insurance company would say, but again it could just be pernicious behavior on their part to get a rate increase. Fertile females, yeah maternity benefits. 50 year old female...no. Unmarried male...no maternity benefits. The companies have the ability to adjust rates based on specific data. They may not want to, but I contend that its them, not the ACA. But perhaps the law could be tweaked to fix this. And yes, all the "rich" pcps are getting slammed on this. It's one of my issues with the ACA.

I think if we want to bash insurance companies, then we just need to ask this: do most people expect to get back more from insurance than they pay over the time they have insurance? If not, then why not just self insure, and leave the horrid insurance companies in the lurch? As to the "1% of their income" as a penalty, anyone of us who is even vaguely affluent took a much bigger increase in tax hit than that, and mostly just grumbled about it. As I said earlier, this is not about shared risk, it is about entitlement. Paying for healthcare is not "fun". You don't get to look through color catalogs and go window shopping for that nice shiny new snow machine or whatever. So, when you find that you have a bill for about 30% of what a Skidoo Skandik snow machine costs because you need to get that screening colonoscopy or MRI for your headaches, or whatever, there is a great hue and cry. But no one goes to the snow machine dealer and expect them to sell a machine for 30% of the going rate because they are over 65, or have 5 kids, or dropped out of school and have a lousy job.
Yes, insurance companies are making a killing over this law. If the population did not insist that every twinge get a full workup by a cardiologist, every ache and pain the full head to toe workup, or that little Susie should get the costs of travel to Geneva for treatment of her sadly incurable illness, the problem would not exist.
My attitude is simple and hard: You want it, you pay for it, either up front or in installments through an "insurance" program. Suck it up. Stop whining.

dgrauman
sounds like you want to go back to the days before insurance and healthcare in general, was an entitlement! All in favor, say Aye!!
Aye!!

1. In my practice most people who have insurance do not abuse it.
2. I agree with your view about "entitlements" if you mean - The people who have free insurance "MEDICAID". As some of them in my practice are the ones that tend to abuse the system. They get free housing, free food stamps,free rides to the drs office and back and go the ER for any trivial reason. Most of them have no motivation to work as they feel that they are entitled to those priviliges.The more children you have the more benefits you get..there is no accountability.
3. If forcing the people to buy insurance who are above 26 yrs of age and below 65 yrs of age is not shared risk then what does one call it. The raise in the premiums and deductible by the insurance company to cater to the 1 % or 2 % of the population who have complications and overutilize the medical system from not taking care of themselves is indefensible. Hold them accountable and reward people who comply and take care of themselves.
4. Work ups to rule out cardiac problems or intracranial pathology even if 1 in a million chance of occurence is necessary, as much as I trust my judgement and my medical skills it stands no chance with a jury. Is it defensive medicine, maybe. At times I have been proven wrong when I thought it was defensive medicine and the patient did turn out to have a real problem. I have got burnt.

I'm not sure that I really care that much how it is done, as long as it is done honestly. If people want "panem et circunces", and a decision is made that all be entitled, then ALL should pay. That is called a tax. The entertainment itself is an entitlement. It is not shared risk, nor does it mean that someone who wants clowns on unicorns in their circus gets to demand it.