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Posted by on Jul 11, 2014 in Health | 54 comments

Commonwealth Fund Study Demonstrates Success Of Affordable Care Act

Commonwealth ACA Survey

Republicans have made multiple predictions of ways in which the Affordable Care Act would fail, and have been wrong on every one of them. They have claimed that no more people are insured now than before, that prices would skyrocket, that doctors would not accept people with Obamacare, and that so many people would seek medical care that there would be long waits due to shortages. (They don’t seem to realize that this totally contradicts their claim that Obama caused people to lose insurance and no new people are insured). A survey from the Commonwealth Fund adds to the other data debunking these claims.

The survey found that 9.5 million Americans obtained health insurance during the open enrollment period, with the uninsured falling 20 percent to 15 percent. This is similar to a new Gallup poll finding the uninsured at a new low at 13.4 percent.

The Commonwealth Survey also found that sixty percent of newly insured adults had used their new coverage to either see a doctor or fill a prescription. Among these, 62 percent said they could not have done so if not for the new coverage. While many insurance plans use restricted networks of physicians to control costs, which was also the case before the Affordable Care Act, 54 percent said that their plan included some of the doctors they wanted to see. Only 21 percent said they tried to find a primary care doctor. Of these 75 percent stated this was somewhat easy or very easy and 60 percent were able to get an appointment within two weeks.

Surveys such as these are not able to measure one important change. There are no longer any people being dropped from their medical plans due to developing medical problems, or people being denied coverage due to pre-existing conditions.

Originally posted at Liberal Values

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  • slamfu

    I’d like to see stats on the rates of ER visits and other medical care whose costs were previously being written off. One of the main points was that a lot of people were getting free, expensive ER care by default, and that this would alleviate some of that. But, good to know this stuff too.

  • slamflu,

    You might be interested in this post regarding how hospitals are benefiting by getting reimbursed for care they previously provided for free.

  • ShannonLeee

    Some of the long-term benefits of Obamacare are going to be hard to track. The preventative care/early diagnosis effect of having access to health care is going to remove a massive health care burden in 20+ years. Access to health care is going to make us a happier and healthier society.

  • slamfu

    Thanks Ron, that is exactly what I was looking for.

  • RLewis

    I thought this was supposed to be a moderate site? This looks like an ad for ACA, which I can assure you is not all good. How much overlap is there in the above figures (e.g., number of adults insured, Medicaid expansion)? Some of the numbers I’ve seen indicate much of the drop in uninsured is from Medicaid expansion, and from people getting Obamacare because their previous insurance was cancelled. I’m not sure it makes much sense to call Medicaid expansion a win for Obamacare (for example, just call it Medicaid expansion, which probably cannot be sustained economically). Regarding premium costs, my premium has gone up $200 per month each of the past two years (that’s UP $400 per month since the beginning of 2013 to almost $1300 per month). My premium was about half what it is now since ACA passed. This is with a family with nothing more than ordinary health problems, colds, flu, seasonal allergies). Closest I could get on the ACA website had a premium of about $900 with a $13,000 deductible. My main reason for getting interested in this site was because I was hoping to get away from such one-sided political arguments. I cannot say that about this article.

  • We’ve seen lots of these stories before claiming such increases in premiums, and once the differences in the policies are reviewed they inevitably turn out to be false–as are the right wing claims that Obamacare resulted in cancellation of claims as opposed to an increase in the number of people insured.

    This has nothing to do with political views. The success of the Affordable Care Act is a fact.

  • Fact checkers have looked at multiple claims of such premium increases. In every case they found that the person making such claims were incorrect. This is based upon review of cold hard facts, not the type of “left is great, right sucks” or vice-versa commentary which you (and not anyone else) is bringing into this discussion.

  • You are also ignoring the subsidies, which lower the price considerably for many people. The prices for plans in the exchanges before subsidies were in line with policies on the individual market before the ACA. People without subsidies typically pay a little more for far more comprehensive coverage. Those who cannot afford the premiums received subsidies which made this much more affordable.

    The statement of “no major health problems” has nothing to do with these premiums. Under the ACA insurance premiums can no longer be based upon health problems. Therefore people with health problems can now get insurance at a much lower rate, assuming they could get it at all before.

    You seem to be confusing rates from an employer plan and coverage on the individual market. These are two separate things and cannot be compared as you appear to be doing. Premiums on the individual market have always been higher than for employer plans. You also appear to be attacking the ACA without understanding how it works. Again, I’m dealing in facts about how the program works here, now left versus right ideology.

  • RLewis

    Did you see the news today about Chicago’s $67 million budget shortfall because of Medicaid expansion?

  • RLewis,

    I did not delete any of your comments, and I already refuted your incorrect claims. If any of your other comments were deleted it would have been by the site’s moderators for failing to abide by the blog’s commenting policy. I have nothing to do with moderation of comments

    As I already pointed out, premiums on the exchanges are comparable to premiums on the individual market prior to the Affordable Care Act passing, but are far more comprehensive. Premiums on the individual market have always been expensive compared to employer plans and this is not changed by the ACA. However, subsidies are available to help those who cannot afford the premiums, which were not previously available. The size of the deductible is dependent upon the level of the policy, with other policies available with lower deductibles. While deductibles are high, the new policies also have caps on total out of pocket expenses which policies prior to the ACA did not have. The effects of the high deductibles can be reduced or eliminated by the use of a Medical Savings Account.

    The Commonwealth Fund’s study found that the majority of people (including Republicans) were happy with the policies they received. Incidentally, as you keep trying to make this a partisan issue, it has been Republicans who have long pushed for the idea of high deductible policies paired with a Medical Savings Account. Now that Republicans got what they have been calling for, they are suddenly opposed. The same is true of other features of the ACA as the ACA is essentially the 1992 Republican counter-proposal to HillaryCare (except that it has more restrictions on how much insurance companies can charge, which is probably why Republicans now oppose it).

    Personally my premiums are slightly higher than I was paying in the past, but the coverage is much better, overall making it a much better deal. Most importantly, as compared to insurance in the past, the policies sold on the exchanges can never be cancelled based upon developing medical problems.

    The first statement of my post is a simple statement of fact which has been proved in multiple posts on this topic. The same is true of the benefits of the Affordable Care Act.

  • You got the facts wrong re Chicago (reciting the false claims being made about this on right wing blogs). The federal government is paying the full cost of Medicaid expansion initially. The plan is also saving state and local governments money as they no longer have to cover the costs of the uninsured. In general hospital systems are also doing better because of Medicaid expansion, as is noted in the post I linked to in response to an earlier comment. Many factors influence the finances of hospitals, and it just another right wing distortion to blame any financial problems on the ACA. The reports also indicate that the deficit is likely to be much smaller than this amount. Most likely over time Cook County will profit from Medicaid expansion as many other hospitals are.

  • DORIAN DE WIND, Military Affairs Columnist

    This is the “stand your ground” I like.

    You are doing a great job of refuting the right-wing misinformation about the Affordable Care Act, Ron.

    Kudos.

  • archangel, moderator

    Hi there RL Lewis. I see three of your comments in spam. I strongly urge you to read the Commenters Rules at the top of the masthead before you comment again. There is no attacking of writers, other commenters or the site, here. Civil discussion is the rule of the day. Discuss the topic of the post, not others or what you think of them.

    Thanks

  • Additional thoughts on RL Lewis’ complaint regarding the premium costs: The rates he quoted are higher than those I was offered (and probably most people had quoted) but could be the cost in some areas. Insurance companies can base premiums on age, location, and tobacco use status (but not other health factors). Premium rates do vary from location to location. Being that this is a market system, not a government-run health care system, insurance companies set their rates considering factors such as established rates for an area and amount of competition in an area. One of the major problems with the old system was that many areas had only one or two insurance companies dominating in an area, leaving them more free to start out in the exchanges with high rates. There are also new rules regarding how much of the premiums have to go towards actual health expenses, and it is possible that those who have higher premiums will receive a refund.

    The good news is that many more insurance companies have expressed interest in entering the exchanges next year, which should help tremendously with rates in areas where insurance is more expensive than the norm (such as the rates RL Lewis quoted). Regardless, the policies under the ACA are better deals than was available in the individual market in the past.

    Regarding Chicago, the problem is that Cook County Health and Hospital System is losing money this year, and ultimately the County will be responsible. Cook County has generally run a deficit, so claims of a deficit this year cannot be blamed entirely on the ACA.The final deficit is expected to be smaller than the amount currently quoted.

    In general hospitals nation wide are doing better due to the Medicaid expansion. There is a good chance that it is management issues at Cook County which have led to them not doing as well. In a market system, there are always going to be those who are more efficient who make more money, and those who are less efficient who make less. Caring for the poor and newly insured around Chicago was undoubtedly a challenge–but ultimately it is a good thing that so many more people now have insurance coverage. There were likely higher expenses at first to care for people who have had untreated problems going on for years and the initial deficit is not expected to continue long term. Of course right wing blogs are twisting the information to serve their own purposes.

  • RLewis

    Interesting that you (author of the article above) are not deleting these other comments but somehow managed to comment on those that were deleted, even within 10 or 15 minutes of my posting. I am fairly sure that I did not violate rules that were described (any more so than in my initial post), although I was fairly angry that the author essentially wrote that I was lying in my post. That is allowed I guess? The author continues to refer to me making this a partisan issue. Please refer to the first sentence in his article, his comment to my first post, and his subsequent posts (e.g., “right-wing,” etc.). Notice how he also drew Dorian into that. I challenge anyone here to find a comment that I made about anything other than the ACA. I made comments about the author’s partisanship in posts that were deleted, because this is what most people find despicable in today’s political discourse. This is the reason I was looking for a moderate news source. The author’s last post is what I suppose I would have hoped for in his response to my first post.

  • RLewis

    I’m not sure if editing and reposting my deleted posts would make it easier for people to follow the author’s responses to them. Just a thought.

  • DORIAN DE WIND, Military Affairs Columnist

    Notice how he also drew Dorian into that. I challenge anyone here to find a comment that I made about anything other than the ACA.

    No one draws me into anything, Mr. or Mrs. Lewis.

    I have always been a staunch supporter of the Affordable Care Act and disappointed by the unwarranted attacks on it and shameful misrepresentations made by those opposed to it for political or ideological reasons.

    I have found Dr. Chusid’s defense of the ACA and rebuttals of attacks against it to be factual, well substantiated and above board.

  • RLewis,

    I saw and responded to your posts before they were removed. I still have the ability to see them. While the conversation is broken up by the deletion of comments, I think that people will be able to follow the significant issues regarding premiums cost for policies sold on the exchanges.

    To clarify the discussion re partisanship, I called it nonpartisan in the sense that the arguments regarding the Affordable Care Act are based upon the facts, not based upon support or opposition based upon party affiliation.

    There is an unavoidable partisan aspect of any discussion of the ACA as the Republicans as partisan strategy have uniformly opposed the law, made multiple predictions of doom which have all failed to come true, and have launched a partisan political campaign based upon spreading false information, which has been confirmed by multiple fact checkers, and discussed in multiple previous posts. These are all verifiable and proven statements of fact about the Republicans, made from the perspective of providing the facts on the issue.

  • RLewis

    @ Dorian, surely you understand how the author cannot possibly refute what I pay for health insurance, and that it went up $200 per month in March of last year and another $200 per month in December of last year. He does not appear (I would have to re-read) to be refuting the numbers that I saw at healthcare.gov, which were not really any more affordable than what I pay (looking at premiums and deductibles). Even though I have insurance through work, I can switch to the exchange if I choose. I could but am not inclined to provide check stubs to prove the numbers in my original posts and above. Re: republicans wrong about every criticism (e.g., higher premiums), I find that especially irritating because I am living that. I suspect I make more money than most people (not wealthy by any stretch of the imagination), but I see that there is so much more that I cannot afford because of the increase in health premium. That is the scariest thing to me about ACA because I anticipate that people who can afford these premiums even less than I can will be less and less able to afford to do business with me. I have read articles about right-wingers screaming “the sky is falling” about such things, but I am posting what I am living and MY anticipation about how things will get worse.

  • Regarding problems from partisanship, I suggest you see the writings of Norm Ornstein and Tom Mann. They are two centrists who have shown that the Republican are the cause of the problems from today’s hyper-partisanship. I have a recent post on their works here. I suggest seeing the op-ed from them which I linked to, and their entire book, It’s Even Worse Than It Looks, is also well worth reading.

  • RLewis

    So when somebody like me points out that you are ignoring relevant facts because of obvious liberal/democrat ideology, that’s the republicans’ stirring the partisan pot? I am fairly sure that there is plenty of blame on both sides.

  • Except that I’m not ignoring any relevant facts. As I said before, my argument is based upon the facts, and not at all based on ideology. I already explained above your misconceptions regarding the facts.

    As Ornstein and Mann demonstrated, when Democrats and the current extremist Republicans give different “facts” it is quite often the case that Democrats are being far more honest while Republicans are putting out misinformation. This is especially true with regards to health care reform. The two parties are not mirror images of each other. The Republicans have become so radical, and so divorced from reality, that as Ornstein and Mann have demonstrated, today the Republicans are the problem.

  • Your own numbers debunk the Republican claims. Premiums were always high in the individual market, and frequently increased by double digits annually. You said, “that it went up $200 per month in March of last year and another $200 per month in December of last year.”

    Any increases before January 2014 were before the new exchange policies under the ACA came into effect. Both of the increases you mentioned were from before then. Even if the $200 increase you stated in December actually came in January under a new ACA compliant policy, by your own numbers the increase is no higher than experienced the previous year.

    The policies offered now are considerably more comprehensive than the policies offered before. Among the benefits, preventative services are provided with no copay or deductibles. Children can be covered until age 26. There is an annual cap on out of pocket expenses. Many of the limitations in coverage which were present on plans offered on the individual market can no longer be continued. Policies cannot be canceled due to developing medical problems. The benefits of plans offered on the exchanges are well worth an extra $200, even for those of us who do not qualify for subsidies. Many people receive subsidies further reducing the premiums. A small number of us high income individuals are paying more, but also getting better coverage in return. I have written about this in the past–it is certainly not a fact I am ignoring. I have also posted on multiple Republican claims used in commercials and articles making claims about premium increases far beyond what is true, and which have been repeatedly debunked by fact checkers.

    But wait, you also said, “Even though I have insurance through work, I can switch to the exchange if I choose.” Yes, you can change but this does not mean you can compare premiums from employer policies versus policies on the individual market. Prices for plans in the exchange reflect the fact that policies on the individual market have always been more expensive. Your comparison is so bogus that you aren’t comparing apples and oranges–you are comparing apples and baseball bats.

    Of course if cost of coverage is your main concern, then a single payer plan would be more cost effective. This, not the old Republican plan repackaged as Obamacare, is what the left wanted. However Republicans certainly are not going to go for that. Other cost cutting ideas such as the public option and a Medicare buy-in were killed by the two most conservative Senators voting with the Democrats (Nelson and Lieberman) but Republicans also opposed those.

  • DORIAN DE WIND, Military Affairs Columnist

    @RLewis,

    I am sure you are not misrepresenting that your health insurance costs may have gone up.

    But I also, have been following — and understand — why such could be the case because, as Ron, has been trying to explain, better coverage, less or no pre-existing conditions exclusions, fewer limitations, “apples to oranges” comparisons, inflation, lesser copays or deductibles in many cases, additional services, such as preventative services, non-cancellations features, etc., etc.

    I honestly believe that if you put a dollar figure on at least a few of these, you would find you are getting much better coverage for the money.

  • Among the Republican predictions which did not come true (and discussed in previous posts):

    More people would wind up uninsured than would receive coverage due to cancelled policies

    The increase in the insured would lead to excessive demand for health care services causing long delays and rationing. (Ignoring the fact that these two first to predictions are contradictory)

    Doctors would not take patients with Obamacare policies

    Only around 60% of people would pay their premiums

    Death panels

    Government take-over of health care.

    None of these predictions have come true, but that isn’t stopping Republicans from continuing to make many of these claims. Ironically the biggest real problem faced, the computer problems in the first couple of months, is a problem which the Republicans did not predict.

  • RLewis

    Not quite sure how anyone concluded that anything in my previous point was about comparing individual to employer policies other than to say that neither is affordable (“apples to bats” was cute though). Also not sure if you recall from one of the deleted posts, to which I believe you responded, that the reason our office renewed at the end of the year last year (rather than March as usual) was because many of the ACA requirements for us went into effect at the beginning of this year. Renewing at the end of last year allowed us (according to our insurance broker) to avoid what would have been even higher premiums this year. Not sure if this is correct, but that would lead me to believe that we are not yet paying for many of the ACA requirements. To be more specific about my affordability, any insurance coverage that I would get (other than routine physical exams) would be after my paying $15,386 ($1283/month) plus $6000 deductible, for a grand total of $21,386. For what percentage of the population do you think this would be affordable? You’ve mentioned subsidies, but I’ve seen some reports that those could be in jeopardy (not likely to be economically sustainable anyway). The percentages of people not paying premiums? I wonder what that looks like when you exclude Medicaid expansion (fairly substantial percentage of “new ACA coverage growth”), which as you know has no premiums. There are nut jobs on both sides making thoughtless predictions. I’m thinking about more big picture stuff, things that will affect the broader population. I can less afford to do business with various businesses in my community and other people can less afford to do business with me. I’m looking at economic impact that will affect everyone. My expectation is that my premiums will be even higher at the next renewal. I’m not sure if you noticed, (this is what I meant by Dorian being drawn in) but I’m still the one not using the words republican, democrat, liberal, conservative, left-wing, or right-wing. I’m thinking conversations could be more productive if people used those less.

  • RLewis

    I hope you can accept that not all Republicans make thoughtless predictions.

  • “For what percentage of the population do you think this would be affordable? You’ve mentioned subsidies, but I’ve seen some reports that those could be in jeopardy (not likely to be economically sustainable anyway)”

    You have some major errors here.

    Only a very tiny percentage of the population would be charged the amounts you stated. The premiums you cite are higher than premiums generally are, but as they vary by area it is possible that this is the case where you live. They also vary by age–younger people would have lower premiums.

    Only a small percent of the population even gets insurance on the individual market. Those who do were frequently already paying premiums comparable to current premiums, but had less comprehensive coverage, and coverage which could be terminated if they got sick. Others might have been paying significantly less, but had junk policies designed to collect premiums without paying out. The individual market was a real racket in the past, and the ACA has solved this problem.

    Subsidies are an integral part of the AFA. Your statement about them being in jeopardy or not sustainable is not true–sounds like another in a long line of misinformation spread by Republicans. In the end maybe 1 percent of the population is likely to have premiums such as you cite. The vast majority of people are receiving better coverage at a lower price than they paid previously.

    “I can less afford to do business with various businesses in my community and other people can less afford to do business with me”

    Most people pay less than before, so by your logic more people will be able to do business with you. We will also no longer have the high rate of bankruptcy we previously had because of medical costs and people losing insurance. Better medical care leads to less people missing work and improves productivity. The non-partisan Congressional Budget Office has projected that the ACA will help stimulate the economy, decrease the deficit, and decrease unemployment. Our old system, in contrast, was a terrible drain upon the economy.

    “My expectation is that my premiums will be even higher at the next renewal.”

    Considering that double digit increases annually were common in the individual market in the past, it is likely premiums will go up for most people, but projections from insurance companies are that they will not go up as much as in the past. More insurance companies are planning to enter more markets and the increased competition will help with premiums. Some areas may even see decreases. As the premiums you say you were offered are higher than typical premiums, you might be one of the lucky ones who sees a decrease.

    If cost is the main concern, we would have been better off if ideas which would have cut costs had passed, but they were opposed by conservatives (including conservatives voting with the Senate Democrats).

    Republicans have claimed that only sixty something percent have paid their premiums. The actual numbers as reported by insurance companies has turned out, depending upon company, to be in the 80’s or 90’s. Republicans were far off on this prediction and continue to spread this claim after the data contradicting them came in. (Most of those not paying premiums did not pay because they got other coverage–either got a job with insurance or qualified for Medicaid.)

    “but I’m still the one not using the words republican, democrat, liberal, conservative, left-wing, or right-wing. I’m thinking conversations could be more productive if people used those less.”

    Who are you trying to fool? I saw your comments which removed by the moderator which were full of such hyper-partisanship, and claims that factual information about the ACA was based upon ideology as opposed to facts.

    “I hope you can accept that not all Republicans make thoughtless predictions.”

    The point is that the Republicans have put out a misinformation campaign, and that Republican politicians and pundits have made a long list of predictions of disaster which have failed to come true. Whether all Republicans did this is rather meaningless considering I don’t see any Republican leaders who have stood up to the dishonest ones and spoken the truth about the Affordable Care Act.

  • RLewis

    I’d be interested to see your sources re: most people pay less than before (not counting Medicaid and subsidies, in which somebody else is paying for them, which would not really count as healthcare being more affordable). I work for a small business as most people do. From the news that I’ve read (and I do not follow conservative sources, such as Foxnews, I tend to scroll through Yahoo, etc., sources are left, right, and between) small businesses have generally seen significant increases in premiums across the country. I have not seen any headlines indicating stabilizing or less expensive premiums for small businesses. For the Affordable Care Act to really be successful, predictions by those who oppose it would appear less relevant than indicators of healthcare becoming more affordable. Just considering economics 101, the logic would be that a purchase being mandated would result in increased demand, which would result in higher prices. Can you name a few things in healthcare that are getting more affordable? I had kidney stones about six years ago, just the CT scan (and I understand the ER prices will always be higher) was around $8000. Are you able to make sense of that? It should be obvious to you by now that I would love for healthcare to be more affordable. I just don’t believe that it is other than for people with Medicaid, subsidies, etc., which again does not mean more affordable, just that somebody else pays. When you say that claims of skyrocketing premiums have been debunked, do you mean like you debunked mine in your response to my first post (debunk = it doesn’t fit with what you believe?). If other people are writing about their debunking, does that just mean that they just did what you did to claims similar to mine? With my paying over $20,000 per year before any coverage kicks in, it would appear that this comes close to the point where not having insurance would be more affordable (e.g., not likely to have over $100,000 medical expense in the next five years). If one of your responses is that it is fairly easy to have sudden medical expenses of several hundred thousand dollars, you won’t be helping any ACA argument.

  • “Just considering economics 101, the logic would be that a purchase being mandated would result in increased demand, which would result in higher prices.”

    The opposite is the case. Increased hospital and other costs because of the uninsured increases costs for the insured. Having a higher percentage covered will reduce this factor. In the past one or two insurance companies typically dominated each market allowing them to increase prices as they wished. The ACA is leading to increased competition in most areas which will help with prices. There are new regulations regarding the percentage of premiums which must go to medical costs, and now many people are receiving refunds for part of their premiums.

    “When you say that claims of skyrocketing premiums have been debunked, do you mean like you debunked mine in your response to my first post (debunk = it doesn’t fit with what you believe?). If other people are writing about their debunking, does that just mean that they just did what you did to claims similar to mine?”

    You are missing the point. The skyrocketing premiums have been occurring for years and it is fallacious to blame them on the ACA.

    Many people have made claims of much higher rates this year. Factcheckers have typically found that they weren’t considering all the factors and that when the actual policies were compared they are receiving a better deal. Often people would still deny this even when the facts were clear that they were getting a better deal. I also bet that if I compared your entire policy before the ACA and after that you have some of your facts wrong. People outside of health care frequently do not realize the limitations of their policies until they become sick and the insurance company doesn’t pay what they expected. Even if you are paying significantly more for an individual policy than in the past, you are in a very rare situation which does not affect the arguments in favor of the ACA. It doesn’t make

    The facts are quite clear–it is not a matter of fitting with what anyone believes. Facts are facts.

    “With my paying over $20,000 per year before any coverage kicks in, it would appear that this comes close to the point where not having insurance would be more affordable (e.g., not likely to have over $100,000 medical expense in the next five years). If one of your responses is that it is fairly easy to have sudden medical expenses of several hundred thousand dollars, you won’t be helping any ACA argument.”

    It is extremely rare for anyone to have over $20,000 before coverage kicks in. The numbers you cite are quite atypical. Even if this is the case for you, preventative testing is still covered without any cost to you. With your premiums significantly higher than the premiums for most people, there is an excellent chance that a portion of this will wind up being refunded, further reducing this.

    You have the argument backwards. The possibility to have sudden high medical expenses is an extremely strong argument for the ACA. Before the ACA it was quite common for people to develop a problem such as cancer, lose their insurance (assuming they had it) and then roll up such high medical bills that they wound up in bankruptcy. This can no longer happen as out of pocket expenses are capped, with most people also having far lower out of pocket expenses than you claim you have, and insurance companies no longer being able to drop people when sick.

    Health care was always expensive and it will remain so. Conservatives have limited the cost cutting aspects proposed so potential savings will be reduced, but the vast majority of people are still paying significantly less now than in the past while receiving better coverage.

    See the multiple links to sources in the previous posts on ACA for further references, along with the data in the survey in this post.

  • RLewis

    Yes, I remember that individual coverage cannot be compared to employer sponsored, but re: my premium being atypical, I’m guessing that roughly 100% of people in my age group are paying the kinds of premiums that I’ve described at healthcare.gov (not sure how their search there would be much different from mine). It also appears that employers are increasingly looking to get out of the healthcare sponsoring business (more part-timers, just not offering it as a benefit), which would put all of those people into the exchange. I don’t recall making partisan comments other than those critical of yours (I don’t have perfect recall and those posts have been deleted). I suspect that this is getting tiring for both of us. I’ll let this be my last post, but I will read your reply. I have been searching for moderate discussion to learn more about important issues, and despite what you might think, I have learned from our exchange. I do think that your partisan comments (such as those at the beginning of your article and those in response to my first post implying that I must be no more than some right-wing nut) will put roughly half of your readers (such as me) in defense mode rather than think mode.

  • Repeating why your numbers are way above what most people are paying:

    1) You are dealing with the individual market which only covers a relatively small percent of those obtaining coverage to begin with. About 8 million people obtained coverage on the exchanges. Your numbers do not apply at all to the rest of the population.

    2) 83 percent of those purchasing on the exchanges qualified for subsidies, greatly reducing the cost for most people. Many people pay $100 per month or less. We are already down to 17 percent of 8 million who pay full rates on the exchanges. These include people who already had individual plans which were already quite expensive, along with people who previously could not purchase insurance due to pre-existing conditions.

    3) Premiums are based upon age. Younger people have substantially lower premiums than those you were quoted

    4) Premiums are based upon location. The numbers you cite are substantially higher than most other premiums I have seen, but as I don’t know where you live it is possible that your area is more expensive at present. Someone in the next county very well could have much lower premiums.

    Also, when you say that it won’t kick in until you pay $20,000 you ignore the fact that high deductible plans are typically paired with MSA’s which will cover the deductibles and copays. Republicans have long been calling for this model of coverage–high deductible plans paired with MSA’s.

  • RLewis

    Sorry, not really responding as much as still looking for a response to a previous question. Still wondering about sources you have regarding rates. I did find a Kaiser Family Foundation (kff.org) ACA subsidy calculation tool which also gave premiums (national average, by states using federal exchange, and by zip code in states using their own exchange). I’d be curious to know if you think it is accurate. Seems that the calculations would be pretty simple with no health issues being considered. With my rates being about the same as the exchange (using same deductible) in my area, I’m guessing that this would be true in many areas. This site says that my area (Georgia) is actually lower than the national average for the federal exchange anyway. Actually I do have one more response (I hope). You indicated that rising rates have nothing to do with ACA. In my case, prior to ACA my rates increased at about 8 to 10% per year, the first year after ACA about 12%, the next year about 15%, and the two increases of close to 20% each last year.

  • I don’t have rates handy at the moment but the ones you quote are well above what I was charged and other rates I viewed last fall during the open enrollment period.

    This is the first year of policies offered on the exchanges from the ACA. Your reports re rate increases are prior to the polices offered under the ACA. Rates under the ACA are offered per year and there cannot be two increases in a year anymore. Rates varied from year to year in the past, with double digit increases such as you report being common. It looks like you are blaming rate increases on the pre-ACA system on the ACA.

    The ACA will have some effect on rates as there is going to be an increase considering how much more comprehensive plans under the ACA are compared to previous policies on the individual market. I paid more in 2014 (first year under ACA) compared to 2013 but the increase wasn’t much more than a typical annual increase, and coverage is far better making it a better overall deal. Fortunately (for me) my rates are also well below what you report.

  • Other people with junk policies in the past had bigger increases. Many of the old policies on the individual market didn’t really cover much if people got sick, so naturally real insurance will cost more.

    Most people (83 percent) received subsidies to help with the cost.

  • dduck

    I know I’m late, but isn’t “success” a little premature?
    If things are going well, even if some are getting screwed, after all some say this is a redistribution of wealth, it still remains that if some poorer folks are getting much needed medical help, I’m OK with that. But this is a big program, so instead of the Bush “Mission Accomplished”, how about “Good Progress Made”. You see, people don’t like exaggeration.

  • You have to measure from where you are. So far it has been a success in terms of the increased number of people getting coverage, without people getting screwed. It is a success in terms of eliminating the problem of people being denied coverage for pre-existing conditions. It is a success in terms of no longer having anybody being dropped from their coverage because of getting sick.

    The plan has been a success. That doesn’t mean “Mission Accomplished.” There is more to do but that doesn’t mean we haven’t already seen a tremendous success.

  • Plus after how things started out last October, just enabling people to purchase coverage through the exchanges feels like a success. 🙂

  • dduck

    Thank you Mr. Bush.

  • No, thank you Mr. Obama for pushing such a successful law through Congress, when so many previous presidents have failed to accomplish health care reform.

  • dduck

    There you go again. Have a jelly bean.
    It is not a successful law YET. As you point out, it got through congress, so did prohibition. Be patient, and when all the components come on line, and we see how it works out, I will join all those that at that time call it “successful”.

  • It did more than get through Congress. It has been implemented. And it has been a success.

    Your Republican friends made all sorts of predictions regarding failure. The predictions of doom have not occurred and the law has greatly surpassed what Republicans predicted in many measurable areas. You can’t have it both ways–arguing against it with a number of predictions and then deny that it was a success when proven wrong.

  • RLewis

    One more clarification about rates. You indicated that it would be rare for people to pay over $20,000 before coverage kicks in. It would appear that almost all of the rates in my age group (early 50’s), and for those somewhat younger (mid/late 40’s) would require people to have expenses over $20,000 (at the exchange rates described at kff.org) before insurance would cover expenses other than routine physical exams etc., considering premiums and deductibles. The above site gives numbers for silver and bronze plans (silver deductible $9,000 or $10,000, bronze $12,000 or $13,000 – that’s my recollection from my search at healthcare.gov last December). My plan at work would be more similar to the gold plan, $6,000 deductible. I kept that because my employer contributes what is now a little less than 10% ($125, was about 50% of the premium when I started there), and it is a pre-tax item. This is like paying silver prices for a gold plan compared to the exchange (there was an opportunity to switch late last year). The numbers that I saw at kff.org seemed more like the minimums that I saw given by insurance companies that I had never heard of. Our two increases last year were because that was recommended by our insurance broker (rather than renewing in March this year after more ACA requirements went into effect, and would have likely made the second of those increases $250?, $300?). Even though the increases last year were pre-ACA, it would appear that this represents shrewdness of insurance companies (two or three increases of $200 vs. one increase of $500 or $600), a sort of ratcheting up of rates that they knew that would need to charge, rather than unrelated to ACA.

  • dduck

    If you say so Mr, Bush.

  • RLewis

    I’ve focused mostly on predictions about rates, but I will comment on one other prediction (and thank you dduck for reminding us that it really is too early to rate the predictions). Re: doctors accepting “Obamacare,” I saw a post from a doctor in FL, who indicated that he favored ACA, but that he and many other doctors were no longer accepting Medicaid, I think because of excessive burden of paperwork/documentation/dictation of care provided (may be a state-specific issue). Not sure if that is ACA related or not. I think I have heard similar Medicaid issues where I live. I also have seen that some doctors in my area have gone self-pay only, and give “superbills” for patients to file the insurance themselves (they have resigned from insurance panels, so they don’t have to go by the rules/contracts of the insurance companies). Other doctors in my area are accepting coverage from fewer insurance companies than they had before (I assume because of low reimbursement, unreasonable contracts, etc.). Again, not sure if that would be ACA-related or not.

  • My coverage, also for in 50’s, has premiums below what you cite, but this varies from county to county. Current costs under the ACA are in line with what such costs were before, with far more comprehensive coverage. These numbers only affect a small part of the country. They do not affect people with insurance from large employers or government programs. Of those they do affect, 83 percent of those obtaining coverage on the individual market receive subsidies. Plus, as I mentioned earlier, these high deductible plans are intended to be paired with a MSA to cover the out of pocket costs.

    Your deductible amounts are well above the actual deductibles. A $1000 to $2000 deductible is more common for a silver plan, with deductibles even lower for gold plans. (The actual amount varies as plans can have higher deductibles and lower copays, or vice versa.) Here is one description of the silver plans:

    In addition to your monthly premiums, each time you use your health insurance, you’ll have to pay cost-sharing like deductibles, coinsurance and copays. How each silver plan makes you pay your 30 percent share will vary. For example, one silver plan might have a high $2000 deductible paired with a low 20 percent coinsurance. A competing silver plan might have a lower $1000 deductible paired with a higher coinsurance and a $40 copay for prescriptions.

    There is also a cap of around $6000 for individuals and $12,000 for families for out of pocket expenses.

    Increases prior to this year could not be do directly to the ACA. If your premiums were increased by citing the ACA there are two possibilities. One is that it is a scam. Because of all the misinformation spread about the ACA, lots of businesses have cited it as a reason to increase charges even if not really related as man people will fall for it.

    Another possibility is that the insurance could have been crap insurance which is now meeting the requirements for insurance under the ACA (although this is not yet required as old policies are still being grandfathered in). I see lots of patients with insurance on either the individual market or from small businesses who have no idea as to how little their insurance actually pays once they get sick.

    I have often seen people with plans which only cover out-patient or in-patient services, or vice versa. Often they have severe limitations, such as only covering a limited amount of office calls or lab for the year. I have seen people with chronic medical problems who think they are covered but then find that they have reached their annual limits by around March. There are no longer such limitations. As you have been healthy, there might have been serious problems with your coverage which you never ran into which is now being fixed. In that case, the increases could be based upon improvements in coverage.

  • The things you mentioned in your next comment have nothing to do with the ACA. Medicaid has always had its problems with limited funding. There have always been doctors who don’t accept Medicaid and most will limit the amount of Medicaid patients seen. The biggest problem with Medicaid is that payment is well below what Medicare and private insurance pays. One aspect of Obamacare might help with this. In order to help with the need for more primary care physicians, the ACA includes provisions to increase payment for primary care services for both Medicare and Medicaid.

    (As I often see these two confused, Medicaid is the plan for the poor and is run by the states with the federal government contributing towards the costs. As a state-run plan, the paperwork burden can can vary from state to state. Medicare covers those over 65 and the disabled. It is technically run by the federal government with more uniform rules nation wide but they use regional intermediaries, such as insurance companies, to administer the day to day operations.)

    The government also pays facilities different from individual physicians in private practice and there has been a trend for facilities such as hospital-run clinics to handle more Medicaid as private doctors limit this.

    The other issue is also unrelated to the ACA. This has been going on for several years, only involving a small percentage of doctors. One trivial error–superbills refer to the paper used in medical offices to mark what charges there are. (Thinking about it, including “super” in the name doesn’t make much sense, but that is how it has always been). Superbills are generally used to generate claims to go to the insurance companies from the physician offices, but in some cases can also be used to have the patient file their own claim. In my office, I currently put the charges on a superbill and an employee enters them into the computer for billing. (In the future as the electronic medical records improve I might go to direct entry into the computer). Other offices which don’t handle their own billing typically send the superbills out to a billing service to submit them as claims. Then there are the rare offices which don’t participate in insurance and leave it to the patient.

    This all pre-dates the ACA. I suspect that the ACA will have two contradictory effects on this:

    1) With a mandate to obtain insurance coverage, and subsidies to make this more affordable, most people will go with an insurance plan and doctors in the plan, making it harder for most doctors to work outside of the insurance companies.

    2) There probably will be a number of people who believe what the hear on Fox and refuse to get a plan through the ACA. Some will pay more to rebel against the system and maybe there will be enough of them in certain areas to support practices which cater to such people.

  • RLewis

    Re: my increases, I think we renewed at the end of last year for the purpose of being grandfathered in. Re: the increase being a scam, it is Humana, they’ve been around a while so I wouldn’t think so. Also, the premium is in line with the exchange rates. I’m not sure why employer sponsored policies would differ from the exchange much at this point. I know our state teachers’ union was screaming quite loudly about their rate increases at the beginning of this year.

    @dduck, you pointed out (at least) one other issue related to ACA, transfer of wealth. I’ve not considered that issue much, but I assume it would be defined as people getting things paid for by other people. Medicaid expansion and exchange subsidies would surely count (@Ron Chusid, you and I are probably not as far apart as you might guess on the humanity aspect of that).

    Another issue that has not been mentioned yet (I don’t think) is the new system to play/defraud. I read somewhere, not sure if true, that incomes that determine subsidies in the exchange are not verified. As I mentioned in a previous post, I am interested in learning about the ACA, good or bad. I think I’ve learned a way (playing the system) that I could semi-retire in about five years. House will be paid for, kids’ college should be paid for, I’ll downsize houses and bank some money, and could reduce my income such that I could receive some of that wealth transfer (i.e., somebody else via the USA paying for most of my health premiums). My wife and I could continue to put $2000 to $2500 per month into our retirement accounts, which would reduce the amounts considered for subsidies. I probably won’t, but I could.

    On a lighter note: dduck? Simply Daffy Duck, or something more interesting?

  • RLewis

    And good grief, it would appear that we’ve all left out the biggest issue of all. Actually lowering costs of healthcare. I suspect this actually comes down to people taking MUCH better care of themselves, just considering obesity in this country. If we focused more on motivating people to take care of themselves, that would be a great start. I take good but not excellent care of myself. Humana will give me a little more than 1% premium discount (may be as much as 2%, but I don’t think it was that high) to be in excellent health and complete lots of forms about my excellent health. Doesn’t seem worth it so far. Now if that discount were 25% or more, that would be another story.

  • “incomes that determine subsidies in the exchange are not verified”

    That’s another distortion commonly seen in the conservative media. People could have lied about their income when first signing up, but ultimately they have to settle with the IRS to get the subsidies.

    Don’t be so certain that Humana, or more likely whoever is selling a Humana policy, might not be ripping you off. Insurance companies pull lots of stuff to increase their income.

    Helping people with subsidies or expanded Medicaid is definitely a transfer of wealth. This is largely an ideological issue of whether people who cannot afford it should receive assistance for health care, as is done in every other modern industrialized country. Note that this doesn’t necessarily mean that everyone’s taxes are increased to cover the poor under the ACA. Financing this comes from measures such as a tax on medical equipment–an industry where rip offs are common and I don’t mind seeing them pay higher taxes. Plus we we already pay to cover the uninsured with higher rates to cover the expenses faced by health care facilities.

    The ACA does promote preventative health which might reduce costs over time, but not necessarily. It would be less expensive if people don’t smoke, followed better diets, etc. On the other hand, preventative care could also lead to people living longer, meaning that there are more years in which they will receive health care benefits, potentially increasing health care costs. Hopefully preventative care will still save money by reducing high cost treatments such as dialysis and caring for people after strokes, but nobody really knows if preventative care will save money long term. Regardless, promoting preventative care is a good thing to do regardless of its impact on costs.

    I receive links to a huge number of health care articles a day and don’t get to all of them. The last day or so I had a link to a headline which pertains to your last comment–consumers don’t like wellness requirements in their health insurance policies. I didn’t read the article but I think we can easily guess what it says.

    Humana’s Medicare Advantage plans send patients a list of preventative studies and tell them they get certain rewards if a certain number of them are done. Every now and then I’ll have a patient bring in their list to make sure they have had enough preventative studies done this year to get their rewards. People seem to like that sort of thing, but don’t like insurance programs which try to change their actual behavior.

  • There are other aspects of the ACA which were designed to try to reduce costs. This includes promoting research regarding which treatments are most effective, and promoting plans to improve coordination between physicians. While I disagree with dduck in arguing we already have enough data to show that the ACA has been successful in many areas such as reducing the number of uninsured and prohibiting some insurance company practices, it is too early to say whether these other measures will really be successful at saving money.

    From a political perspective the aspects of the ACA to provide basic protections to the insured and increase the number of people covered made it through Congress while cost cutting proposals often didn’t in the face of opposition such as Republicans screaming about imaginary death panels.

  • “Humana will give me a little more than 1% premium discount”

    At least there is a bigger difference between premiums between smokers and non-smokers, and it would certainly cut costs if we could greatly reduce tobacco use.

  • dduck

    Good news for people like me that would like to see the ACA improve (yes we are here): http://www.nytimes.com/2014/07/20/us/insurers-face-new-health-law-rules-to-widen-networks-and-prevent-surprise-bills.html?_r=0
    Bigger networks, yea.
    New York, the best insurance department in the country, yea.

  • I’ve also heard that insurance companies in New York have been the most aggressive in pushing narrow networks to cut costs, so this might really make a difference.

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