"Cadillac" Health Care Plans and Obamacare

[Vertigo]

My sister and her husband will not receive any subsidies to offset their large premium increase because they don't qualify as low-income earners. Again, still waiting for someone to tell me when her family will see a $2500 decrease in their insurance costs...

So they make more than 400% of the poverty level for their family size? Assuming a family size of 4 that would be about $94K/yr.

If we really wanted to see a decrease we'd open up the exchanges nationwide for better competition.

[Hueypilot]

I posted this on another thread, but here are the premiums for the Blue Cross plans in Arkansas in black and white. There are two other insurance companies operating on the exchange in AR and while their prices will likely differ, they'll be in the same ballpark.

I put down the benefits of each plan, and included a non-Obamacare plan still being offered by Blue Cross as well (it's not eligible for subsidies and you will still have to pay the fine since its not an approved plan). That can give you an idea of the differences both in benefits and costs of the exchange plans versus a non-exchange plan. And I'll state this too because it was already asked by someone else: the non-exchange plan does not exclude people for pre-existing illnesses.

If you take the premium of the non-exchange plan and compare it with the nearest exchange rival (the Gold 500 plan) the increase in premium is what most people will see to keep the same level of coverage. I do understand that while similar, the plans have differences (the non-exchange plan has a $1 mil cap and requires copays for preventative care, while the exchange plan requires higher annual out of pocket expenses), they probably wash out in the end.

Also I included income caps for subsidies for the number of people in the household. As you notice, it's not much. Now imagine being the 60 year old guy making $50,000 a year...he's gonna pay out his a$$!

[Vertigo]

I posted this on another thread, but here are the premiums for the Blue Cross plans in Arkansas in black and white. There are two other insurance companies operating on the exchange in AR and while their prices will likely differ, they'll be in the same ballpark. I put down the benefits of each plan, and included a non-Obamacare plan still being offered by Blue Cross as well (it's not eligible for subsidies and you will still have to pay the fine since its not an approved plan). That can give you an idea of the differences both in benefits and costs of the exchange plans versus a non-exchange plan. And I'll state this too because it was already asked by someone else: the non-exchange plan does not exclude people for pre-existing illnesses. If you take the premium of the non-exchange plan and compare it with the nearest exchange rival (the Gold 500 plan) the increase in premium is what most people will see to keep the same level of coverage. I do understand that while similar, the plans have differences (the non-exchange plan has a $1 mil cap and requires copays for preventative care, while the exchange plan requires higher annual out of pocket expenses), they probably wash out in the end. Also I included income caps for subsidies for the number of people in the household. As you notice, it's not much. Now imagine being the 60 year old guy making $50,000 a year...he's gonna pay out his a$$!

I ran the details for a single 60 year old guy through the actual exchange website. Ran it for Arkansas, Pulaski county and found Gold plans, unsubsidized starting at $470 a month. That cheapest one? Arkansas Blue Cross Blue Shield Gold 1000 plan.

Edited October 18, 2013 by Vertigo

[HeloDude]

So they make more than 400% of the poverty level for their family size? Assuming a family size of 4 that would be about $94K/yr.

Yes, they are both college educated and have been working in their professions for close to 15 years, so fortunately they make more money than what you described. Keep in mind, people like my sister and brother-in-law, they're not asking for a government subsidy, however their rates will indeed go up anyways because of the new federal government regulations put on their insurance companies and employers. You cannot force insurance companies to cover parents' children longer, cover pre-exisiting conditions (and not charge them what the market says to charge them), force more coverage at no charge (ie birth control), etc without raising the rates for almost everybody else--there are not enough 'healthy/young' people (with money) to bring into the system to cover all these new outrageous expenses. So either the insurance company intentionally loses profit, employers pay more, and/or premiums and deductibles go up for people. It's another form of wealth redistribution and the people who will feel the tightest squeeze are the ones who work hard and don't qualify for subsidies (or enough subsidies to really make a big difference) and who aren't wealthy enough that paying an extra $3-5K/yr is no big deal.

At this point, the government should have just passed another FICA type tax that put the poorest of the poor on Medicare and left everybody else's insurance alone. Then everybody would see the tax on their pay stubs and you'd have less government regulation on the insurance companies. That being said, even a program like this would bust eventually...just like Medicare.

The problem is that there are millions of Americans who want something for nothing, and that something has to come from somewhere. You can keep raising taxes (assuming you don't cut anything else) to pay for these programs, but I think the myth of taxing your way into prosperity has been debunked. I also keep hearing 'well, other European countries make this work'...having spent a little time in Europe and having friends who are local there, I've learned that a more-so socialist type system only even at least somewhat works when you either have A) Nearly everyone on board with the system, from the top down and who work hard to good of community (something closer to Germany), or B) At the pointy end of a gun (former Soviet Union). Maybe we'll be closer to option A in the future, but we're definitely not there now. If not everyone is on board with the more 'communal' type system, then you run the risk of the thought experiment where everyone in class gets the same grade--eventually the really smart kids are less incentivized to do their best, the kids who rarely study are happy, and the kids in the middle realize that it's easier to be the kids who rarely study, and overall, everybody does worse. I'm not saying that this would happen over night, or ever get 100% to the point of full destruction, but I think it's safe to say that there is a growing culture in the US who are realizing that you don't have to work very hard to have a minimum standard of life which is decent (ie a roof over your head, food in your belly, a basic phone to communicate, some sort of healthcare, on and on)--and I don't think this helps you grow economically and as a society. And what makes it worse is that these people breed, and they breed quite a bit. And why? One reason is because there are even more government incentives to have children (I know it doesn't make sense to us, but a lot of people do see it this way).

Anyways, I think people are going to see a big change in the healthcare world in the next few years. There will be more demand with not as much of an increase in supply, premiums will go up for many and will affect the people I mentioned above the hardest, and businesses will have a reduced incentive to grow their business to increase their profit. I'm sure the liberals will have somebody else to blame and then will argue for a single-payer type system which will then put us all on Medicare essentially...again, this single-payer type system struggles to work in cultures where this is more accepted (everybody goes along to get along)--not so much here, which I'm sure will mean it will be worse.

If we really wanted to see a decrease we'd open up the exchanges nationwide for better competition.

Agree 100% on this one.

[Hueypilot]

I pulled those off the Blue Cross Arkansas website the other day. It asks if you want to apply for a subsidy which walks you through the exchange process, but I pulled up the non-subsidized plan prices and that's what they gave me.

[Vertigo]

I pulled those off the Blue Cross Arkansas website the other day. It asks if you want to apply for a subsidy which walks you through the exchange process, but I pulled up the non-subsidized plan prices and that's what they gave me.

Even your graphic doesn't match their website as of today.

https://secure.arkansasbluecross.com/LookingForInsurance/individualandfamilies/2014/results.aspx?zip=72002&productType=M&county=Pulaski&city=Alexander&variantId=00#/results.aspx?zip=72002&productType=M&county=Pulaski&city=Alexander&variantId=00

The bronze 6200 shows a $6200 deductible (hence the name - Bronze 6200)with a max out of pocket of $6350 not a $12000 deductible per person.

Edited October 18, 2013 by Vertigo

[Hueypilot]

I checked again and the prices are the same. The deductibles vary based on the number of people on the plan so I apologize if my graphic doesn't show that, but if you have 2 or more on the Bronze 6200, the deductible listed is $12,400 with a max out of pocket of $12,700. Here's the page right off the web:

Note: I ran this for a couple, both aged 60. Max income for subsidies is a little over $60,000.

[Vertigo]

I checked again and the prices are the same. The deductibles vary based on the number of people on the plan so I apologize if my graphic doesn't show that, but if you have 2 or more on the Bronze 6200, the deductible listed is $12,400 with a max out of pocket of $12,700. Here's the page right off the web: Note: I ran this for a couple, both aged 60. Max income for subsidies is a little over $60,000.

Gotcha- I ran mine as a single male aged 60 (since that's what you ended your piece with).

Your first graphic is misleading because it says deductible per person at $12,400. Not total for two people.

Edited October 18, 2013 by Vertigo

[Hueypilot]

Like I said I apologize that it's off, I was trying to compile a lot of data and I mistyped and only included numbers from plans for 2 or more persons. That being said, this insurance is quite expensive. Additionally, the non-Obamacare plan has a $200 copay for emergency room visits. The Bronze 6200 would require you to pay up to your deductible, then cover only 70% of charges after that. All while charging you quite a bit more on premiums. That's the point of my graphic. You can nit pick over the small details but the big picture shows these plans are substantially more expensive and cover less.

Yes, I know preventative visits are free, but I'd rather pay the $30 copay than double or in some cases triple premiums just to get a few free visits for a checkup. Also, I realize the $1 mil cap is there for the non-Obamacare plan, but 99% of America will probably never get close to using a million bucks in direct benefits in their lifetime. To me, it's a steep price to pay for a very slim chance if need over $1 mil in benefits.

[Spur38]

I don't plan on getting sick but just trying to follow all this is making me ill.......summation: It may be very dated but remembering walking in for sick call or a flight physical at a base hospitial I remember all the moms with their kids that had colds, the old vets and uniformed service members sitting in the waiting area.....a great example of what socialized medicine is all about and where we are headed with ACA...tax payers paid for our medical needs in service; appropriate. But I don't feel good about paying for the health care of 46% of Americans that don't pay taxes anyway....wait..... how do those folks sign up for health care or will they under ACA?. How does Sam even know that they are out there? What's to stop anyone who dosen't want to play the ACA game from just going into the local ER for free care anyway?

[Vertigo]

But I don't feel good about paying for the health care of 46% of Americans that don't pay taxes anyway....wait..... how do those folks sign up for health care or will they under ACA?. How does Sam even know that they are out there? What's to stop anyone who dosen't want to play the ACA game from just going into the local ER for free care anyway?

Uhh... it was 46% that had no tax liability. It doesn't mean 46% didn't file taxes.

[Spur38]

I stand corrected...but I'm still becoming ill about all of this....

[matmacwc]

If we really wanted to see a decrease we'd open up the exchanges nationwide for better competition.

Yes! So open insurance across state lines.....oh wait, we have mentioned that before, but they wouldn't do it. How bout the government gets out of insurance?? You're the libertarian right? And I agree with you more and more every day.

And why sell something that needs a subsidy.? We are broke, make it cheaper or don't do it at all.

Edited October 19, 2013 by matmacwc

[M2]

I've seen enough illegals in the E-room in Del Rio to know crap is out of control.

It's OK, because according to Page 50, Section 152 of the AHCA, the bill will provide insurance to all non-U.S. residents, even if they are here illegally!

Obama is going to tackle immigration next, let's see how well this one goes!

[nsplayr]

Swing and a miss.

[HeloDude]

Swing and a miss.

Well, I thought the Executive Branch of the US Federal Government was charged with enforcing all US laws...but this administration (and ones before it) seems to have a bit of a trouble doing that. Or are you going to tell me that the President and his departments are fully enforcing all of our immigration laws?

Sorry, but when it comes to the federal government, I don't trust what they say just because it was written in some 'law'.

By the way...when is my sister and her family going to see a $2500 decrease in their health insurance premiums? The liberals can't seem to answer that question.

[matmacwc]

This isn't about Health Care

[Alpharatz]

Something HAS to happen to change the U.S. healthcare system (imagine that). As the billionaire level of management actively strips all of the spare cash out of the middle and lower levels of the economy they are ensuring (actively guaranteeing) that there will be nothing left for pensions, healthcare, vacation, full time jobs etc. Take Wally World as an example. We have a "Supercenter being built near here and the estimate is that one supercenter is worth about one million yearly in food stamp and health care pay out locally. They are busy hiring retirees who have Tri-Care so they can avoid the health care cost. What the big employers are really worried about is that if they do offer health insurance, they have you by the cojones. No matter how bad it gets you almost can't quit. Now why would anyone put up with the misery of such a job if they have health care through the national system. I could rant on about the HMO's and insurance co's salivating over the new biz. Sick people using the emergency Dept as urgent care at 10x the cost. I know that being a G.I. sucks now and I have stopped recommending it to young people unless they are desperate..Why get killed defending some billionaire's business interests. But believe me if you or your kids get out or need insurance or have a pre-existing, it will give you mondo peace of mind.

Anybody know if "George the Crook's" in Pria is still open?

[HeloDude]

From NBC News...

Obama admin. knew millions could not keep their health insurance

Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.”

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”

I'm sure Jay Carney will spin this into something else...probably blame the Republicans. No question--we have the best politicians money can buy!

[matmacwc]

The "Cadillac" healthcare plans and Obama Care thread isn't about healthcare? My bad...

If you watch the video one of Stewart's points is that because the website has been so terrible no one has been able to benefit from "affordable health care" which is supposed to be the whole purpose of the bill.

Or we could just go back to listening to nsplayer and joe1234 argue with insert conservative baseops member X across every page ong the forum.

Lighten up . It's funny.

Allow me to retort......

This is about spreading money around, not about your or my health care.

[Flaco]

My good friend who is a small business owner and is on an individual insurance plan just got his cancellation notice. His choices under Obamacare: pay double premiums for lesser coverage he does not want or need or pay a tax under threat of government force.

Despite claims to the contrary from the law's proponents, he recognizes this for what it is: an over-reaching, government-mandated redistribution of wealth from the middle class, hard-working, job creating people in this country to the ill and poor.

The American people may swallow socialism in small, edible bites, but not in double premiums.

[HeloDude]

Your friend is not the type of voter the Dems are counting on during an election year. He is expendable.

[Hueypilot]

Loyal Obama Supporters, Canceled by Obamacare

Lee Hammack and his wife JoEllen Brothers thought they had a great insurance plan. Now, their cost is more than doubling to $1,300 a month, with higher out-of-pocket costs.

San Francisco architect Lee Hammack says he and his wife, JoEllen Brothers, are cradle Democrats. They have donated to the liberal group Organizing for America and worked the phone banks a year ago for President Obamas re-election.

Since 1995, Hammack and Brothers have received their health coverage from Kaiser Permanente, where Brothers worked until 2009 as a dietician and diabetes educator. Weve both been in very good health all of our lives exercise, dont smoke, drink lightly, healthy weight, no health issues, and so on, Hammack told me.

The couple Lee, 60, and JoEllen, 59 have been paying $550 a month for their health coverage a plan that offers solid coverage, not one of the skimpy plans Obama has criticized. But recently, Kaiser informed them the plan would be canceled at the end of the year because it did not meet the requirements of the Affordable Care Act. The couple would need to find another one. The cost would be around double what they pay now, but the benefits would be worse.

From all of the sob stories Ive heard and read, ours is the most extreme, Lee told me in an email last week.

Ive been skeptical about media stories featuring those who claimed they would be worse off because their insurance policies were being canceled on account of the ACA. In many cases, it turns out, the consumers could have found cheaper coverage through the new health insurance marketplaces, or their plans werent very good to begin with. Some didnt know they could qualify for subsidies that would lower their insurance premiums.

So I tried to find flaws in what Hammack told me. I couldnt find any.

Hammack recalled his reaction when he and his wife received a letters from Kaiser in September informing him their coverage was being canceled. I work downstairs and my wife had a clear look of shock on her face, he said. Our first reaction was clearly theres got to be some mistake. This was before the exchanges opened up. We quickly calmed down. We were confident that this would all be straightened out. But it wasnt.

I asked Hammack to send me details of his current plan. It carried a $4,000 deductible per person, a $40 copay for doctor visits, a $150 emergency room visit fee and 30 percent coinsurance for hospital stays after the deductible. The out-of-pocket maximum was $5,600.

This plan was ending, Kaisers letters told them, because it did not meet the requirements of the Affordable Care Act. Everything is taken care of, the letters said. Theres nothing you need to do.

The letters said the couple would be enrolled in new Kaiser plans that would cost nearly $1,300 for the two of them (more than $15,000 a year).

And for that higher amount, what would they get? A higher deductible ($4,500), a higher out-of-pocket maximum ($6,350), higher hospital costs (40 percent of the cost) and possibly higher costs for doctor visits and drugs.

When they shopped around and looked for a different plan on California's new health insurance marketplace, Covered California, the cheapest one was $975, with hefty deductibles and copays.

In a speech in Boston last week, President Obama said those receiving cancellation letters didnt have good insurance. There are a number of Americans fewer than 5 percent of Americans who've got cut-rate plans that dont offer real financial protection in the event of a serious illness or an accident, he said.

Remember, before the Affordable Care Act, these bad-apple insurers had free rein every single year to limit the care that you received, or use minor preexisting conditions to jack up your premiums or bill you into bankruptcy. So a lot of people thought they were buying coverage, and it turned out not to be so good.

What is going on here? Kaiser isnt a bad apple insurer and this plan wasnt cut rate. It seems like this is a lose-lose for the Hammacks (and a friend featured in a report last month by the public radio station KQED.)

I called Kaiser Permanente and spoke to spokesman Chris Stenrud, who used to work for the U.S. Department of Health and Human Services. He told me that this was indeed a good plan. Patients in the plan, known as 40/4000, were remarkably healthy, had low medical costs and had not seen their premiums increase in years. Our actuaries still arent entirely sure why that was, he said.

While many other insurance companies offered skimpier benefits, Stenrud said, our plans historically have been comprehensive.

Kaiser has canceled about 160,000 policies in California, and about one third of people were in plans like Hammacks, Stenrud said. About 30,000 to 35,000 were in his specific plan.

In a few cases, we are able to find coverage for them that is less expensive, but in most cases, were not because, in sort of pure economic terms, they are people who benefited from the current system ... Now that the market rules are changing, there will be different people who benefit and different people who dont.

Theres an aspect of market disruption here that I think was not clear to people, Stenrud acknowledged. In many respects it has been theory rather than practice for the first three years of the law; folks are seeing the breadth of change that were talking about here.

Thats little comfort to Hammack. Hes written to Californias senators and his representative, House Minority Leader Nancy Pelosi, D-Calif., asking for help.

We believe that the Act is good for health care, the economy, & the future of our nation. However, ACA options for middle income individuals ages 59 & 60 are unaffordable. Were learning that many others are similarly affected. In that spirit we ask that you fix this, for all of our sakes, he and Brothers wrote.

Consumer advocate Anthony Wright said its important to remember the way the insurance market worked before the act was passed, when insurers could deny coverage based on pre-existing conditions. Its impossible to know what the world would have looked like for these folks in the absence of the law, said Wright, executive director of the group Health Access.

We certainly had an individual market, especially in California which was the Wild Wild West, where there was huge price increases, cancellations, a range of other practices.

That doesn't mean that there were certain people who lucked out in the old system, who wound up in a group with a relatively healthy risk mix and thus lower premiums, he added. The question is: Is health insurance something where people get a rate based on the luck of the draw or do we have something where we have some standards where people who live in the same community, of the same age, with the same benefit package are treated equally?

Wright said discussions should focus on how to provide consumers like Hammack with assistance if they barely miss qualifying for subsidies.

So what is Hammack going to do? If his income were to fall below four times the federal poverty level, or about $62,000 for a family of two, he would qualify for subsidies that could lower his premium cost to as low as zero. If he makes even one dollar more, he gets nothing.

Thats what he's leaning toward - lowering his salary or shifting more money toward a retirement account and applying for a subsidy.

Were not changing our views because of this situation, but it hurt to hear Obama saying, just the other day, that if our plan has been dropped its because it wasnt any good, and our costs would go up only slightly, he said. Were gratified that the press is on the case, but frustrated that the stewards of the ACA dont seem to have heard.

Edited November 6, 2013 by Hueypilot

[Spur38]

"We believe that the Act is good for health care, the economy, & the future of our nation" that will be the context of the Hammicks letter that Pelosi sees and reads on the congressional dais....Only that....guaranteed!

[TreeA10]

Just had to pass it to see what was in it. The audacity of those that voted for the law that are now acting upset with the law, should be thrown out of office for general stupidity.