Dems Want to Know What's in Republican Health Overhaul

[DittoHead]

the COBRA payments were outrageous and often unaffordable for someone trying to maintain coverage. Often much more than the company and the employee were paying together every month.

Never had to use it so I could be wrong, but wasn't that the whole point of COBRA? To keep that premium the same?

The premium cannot exceed 102 percent of the cost to the plan for similarly situated individuals who have not incurred a qualifying event, including both the portion paid by employees and any portion paid by the employer before the qualifying event, plus 2 percent for administrative costs.

[MikeB]

More to the point, most people that lost a job couldn't walk into anything else with comparable benefits within a few months.  Finding a job is one thing; finding one that pays enough and/or provides good enough coverage to stay at a comparable level is entirely another.  Plus you have a lot of people losing a good salaried job and the only thing they can get that's not hourly retail or food service ends up being 1099 work.

Which brings up one of the issues that really needed fixing. I was a 1099 consultant for over 10 years, I couldn't write off any of my health insurance on taxes, but a larger corporation can write off payments for health insurance for employees. Those are the kind of things that need to be addressed by congress. I've seen that in multiple Republican health care proposals.

[MikeB]

Never had to use it so I could be wrong, but wasn't that the whole point of COBRA? To keep that premium the same?

The one time I did COBRA it was definitely more than the employers share and mine. Maybe that company was overcharging; but the point remains. For someone who loses a job and can only find a lower paying job without a healthcare option COBRA isn't affordable to maintain insurance to deal with a pre-existing condition. Also COBRA is only good for 18 months. Something does need to be figured out to deal with the issue. Something as simple as mild hypertension can qualify as a pre-existing condition even if controlled.

[Ben]

Which brings up one of the issues that really needed fixing. I was a 1099 consultant for over 10 years, I couldn't write off any of my health insurance on taxes, but a larger corporation can write off payments for health insurance for employees. Those are the kind of things that need to be addressed by congress. I've seen that in multiple Republican health care proposals.

That has always bothered the hell out of me. If the politicians, both R & D really cared about "the little guy" they would make ALL health costs tax write-offs. Right now it's >10% of AGI with all kinds of exclusions as to what you can deduct. They would also at least double what you can put into an HSA (and I believe Trump wants to significantly raise that from the current amount).

As to pre-exisiting conditions, I don't have any answers, but it definitely needs to be addressed. It's pretty awful that someone can lose everything to medical expenses as they slowly die of cancer or whatever. Kind of adding insult to injury. I hear ads on Fox Business a lot about some kind of Christian "insurance pool" where like-minded people contribute funds that then pay for everyone's medical expenses. I'm curious about the viability of something voluntary like that, especially if you end up with a significant population of people with expensive diagnoses.

[BobR]

I hear ads on Fox Business a lot about some kind of Christian "insurance pool" where like-minded people contribute funds that then pay for everyone's medical expenses. I'm curious about the viability of something voluntary like that, especially if you end up with a significant population of people with expensive diagnoses.

I hear the same ads on Sirius on the commute and often wondered the same thing, so here it is.

bob

[Ben]

I hear the same ads on Sirius on the commute and often wondered the same thing, so here it is.

bob

Yeah, technically Sirius is where I heard it too. :)

Interesting, it appears if I wanted to chip in $5000/yr for my own expenses, then they would charge me $245/mo (I assumed I would qualify for the "healthy" rate). I currently pay $420 for a HDHP with HSA with Anthem (to jump to $480 starting in 2017 - thanks Obama) with the $6500 max out of pocket and $4800 deductible.

I didn't do an in-depth check for comparisons of what's covered and stuff, but that seems pretty darn reasonable.

[MikeB]

Yeah, technically Sirius is where I heard it too. :)

Interesting, it appears if I wanted to chip in $5000/yr for my own expenses, then they would charge me $245/mo (I assumed I would qualify for the "healthy" rate). I currently pay $420 for a HDHP with HSA with Anthem (to jump to $480 starting in 2017 - thanks Obama) with the $6500 max out of pocket and $4800 deductible.

I didn't do an in-depth check for comparisons of what's covered and stuff, but that seems pretty darn reasonable.

So you are basically at approximately $12000 a year before insurance actually starts.

For example someone making $30k a year that doesn't leave much for rent/mortgage/food/etc. While the libertarian in me doesn't believe healthcare is a right and the government shouldn't pay for it something needs to be done. Obviously the ACA isn't it. Even as a pretty rabid libertarian I'd rather the government just pay for basic insurance in tax credits for those on the lower end than pay a billion dollars to a company that can't make a website work and then bail out the insurance companies when they can't make a profit.

[Ben]

So you are basically at approximately $12000 a year before insurance actually starts. For someone making $30k a year that doesn't leave much for rent/mortgage/food/etc. While the libertarian in me doesn't believe healthcare is a right and the government shouldn't pay for it something needs to be done. Obviously the ACA isn't it. Even as a pretty rabid libertarian I'd rather the government just pay for basic insurance in tax credits for those on the lower end than pay a billion dollars to a company that can't make a website work and then bail out the insurance companies when they can't make a profit.

Agree with all you said except the $12k is worst case (still outrageous though). For my annual physical and blood etc tests (pretty much the only time the doctor sees me) I end up paying like $20 to cover lab work that the insurance doesn't. There are other visits and procedures where the insurance will kick in at least partially as well, though it is a ridiculous maze to figure out what is what. If I ever ended up having an emergency operation though, I guess $12K is still better than $75K.

I do basically pay nearly $6000 for an annual physical though, if you just look at the part of the insurance that I use.  

[MikeB]

Agree with all you said except the $12k is worst case (still outrageous though). For my annual physical and blood etc tests (pretty much the only time the doctor sees me) I end up paying like $20 to cover lab work that the insurance doesn't. There are other visits and procedures where the insurance will kick in at least partially as well, though it is a ridiculous maze to figure out what is what. If I ever ended up having an emergency operation though, I guess $12K is still better than $75K.

I do basically pay nearly $6000 for an annual physical though, if you just look at the part of the insurance that I use.  

Yeah. I did edit my post slightly to make sure it was clear the dollars were an example not necessarily what your situation is. I probably with my employers "contribution" pay the same for the same limited care. That is I would think where the catastrophic policies that the ACA basically outlawed would have come into play.

There still needed/needs to be a pre-existing condition fix. I've never understood why the insurance companies didn't just put all individuals in a pool to deal with it. I suspect a government regulation was the reason, but I may be wrong.

[Hawkmoon]

Never had to use it so I could be wrong, but wasn't that the whole point of COBRA? To keep that premium the same?

If that was the point -- the insurance companies didn't get the memo.

Been there, done that. COBRA was VERY expensive.

Which brings up one of the issues that really needed fixing. I was a 1099 consultant for over 10 years, I couldn't write off any of my health insurance on taxes, but a larger corporation can write off payments for health insurance for employees.

Been there and done that, too, and I agree completely. If the .gov is going to pretend that corporations are just like people, then why can a corporation deduct health care premiums but sole proprietors (and partners, I guess) can't? Manifestly unfair.

[Hawkmoon]

Agree with all you said except the $12k is worst case (still outrageous though).

But it only takes one open heart surgery event to generate that worst case scenario.

Ask me how I know ...

In my case, the heart surgery was in the same year as and followed just a few months after my wife's death, so I had the double whammy of funeral expenses (for which we were not insured) followed by the mega-deductable on the health insurance policy. That was definitely not a good year.

[sumpnz]

Pre-0bamacare I had a health insurance policy from the open market.  I was a W2 employee, but they didn't subsidize the insurance at all.  Compared to the cost of what they offered (and comparable open market policies), I saved a ton by getting a high deductible plan with an HSA.  I ran the numbers.  Even if I used the whole deductible in any given year I'd still be better off than getting the more traditional plan even if I never went to the doctor.

These days I'm not sure where things stand without employer sponsored/subsidized insurance.  And I hope I don't have to find out.

[Firethorn]

the university I went to had ridiculously cheap (often free) health care available. I'm sure that has only expanded since my time. I'm still in favor of cheap catastrophic care options. That plus what they can get in school for preventative care would cover them.

Since Obamacare passed, my University has stopped offering healthcare.  You'd have to go to the exchange, get on medicare/medicaid, or similar.

Even as a pretty rabid libertarian I'd rather the government just pay for basic insurance in tax credits for those on the lower end than pay a billion dollars to a company that can't make a website work and then bail out the insurance companies when they can't make a profit.

As a non-rabid libertarian, I can't help but note that if we could get medical care costs down to reasonable levels as seen by much of the rest of the world, the federal government already spends enough on medical care to cover 90% of the healthcare needs of the country, and states more than make up the remaining 10%.  IE you wouldn't have to spend $6-12k/year on your healthcare.

[wmenorr67]

Let it become a damn free market.....

As for forcing doctors to bill cash paying people the same as they do those with insurance, there is a lot less paperwork and headaches to deal with when you accept cash.

[Jocassee]

Time for some Deem and Pass baby!

[roo_ster]

Let it become a damn free market.....

As for forcing doctors to bill cash paying people the same as they do those with insurance, there is a lot less paperwork and headaches to deal with when you accept cash.

True, but many try to use cash-payers to make up for the no-payers they have to treat.  Insurance company carried more water than an individual patient with cash.

[KD5NRH]

As for forcing doctors to bill cash paying people the same as they do those with insurance, there is a lot less paperwork and headaches to deal with when you accept cash.

Give them some extra teeth when dealing with insurance companies that drag out payment or challenge every little charge, but at the same time tighten the screws on the truly unnecessary extra charges.  The $40 Tylenol at sign in comes to mind.  If you tell them you're paying cash, you suddenly don't need that "critical treatment."

[Ben]

Since Obamacare passed, my University has stopped offering healthcare.  You'd have to go to the exchange, get on medicare/medicaid, or similar.

Interesting. I hadn't considered that. If they stop offering health services, probably 90% of the student body qualify for a pretty fully subsidized silver plan on the exchange at taxpayer expense.

[Firethorn]

Interesting. I hadn't considered that. If they stop offering health services, probably 90% of the student body qualify for a pretty fully subsidized silver plan on the exchange at taxpayer expense.

I'd say that the 90% is probably closer to how many are getting insurance through their parents.  Remember that the age to be covered was increased to 26.  That said, if the parents aren't providing coverage, they would indeed qualify for the fully subsidized silver plan.  I'm not sure how objectionable that would be.  College students are normally pretty cheap, healthcare wise, and I don't want healthcare to be a barrier for higher education.  Moan about useless degrees if you like, the fact is that a college graduate is more likely to be a net tax contributor than a drain.

A complicating factor might be that Alaska is one of the states where you don't ever have to pay the penalty because even the most basic plan busts the affordability guidelines.

And yes, UAA/UAF stopped offering healthcare to any student other than 2 categories.  Graduate and foreign exchange.

http://obamacarefacts.com/health-plan-options-for-college-students/

Yep, generous assistance if you're not covered otherwise and not making enough as a student to be well over the poverty line.  Huh.  Yeah, if the student claims themselves for the tax return, they probably qualify for free healthcare from the government in some fashion.

Oh, and I forgot a way for students to have healthcare - part of Obamacare is the expansion of coverage of children to 26, remember?  So 90% of them are riding their parent's coattails.  The rest is probably a mix of uninsured, people who have returned to college but have healthcare otherwise(I have tricare)

[Ben]

I'd say that the 90% is probably closer to how many are getting insurance through their parents.  Remember that the age to be covered was increased to 26. 

Yeah, sorry - I should have specified that I meant if they were getting insurance on their own. I'm sure you're correct on how many are on the parents plan.

[wmenorr67]

I'd say that the 90% is probably closer to how many are getting insurance through their parents.  Remember that the age to be covered was increased to 26.  That said, if the parents aren't providing coverage, they would indeed qualify for the fully subsidized silver plan.  I'm not sure how objectionable that would be.  College students are normally pretty cheap, healthcare wise, and I don't want healthcare to be a barrier for higher education.  Moan about useless degrees if you like, the fact is that a college graduate is more likely to be a net tax contributor than a drain.

A complicating factor might be that Alaska is one of the states where you don't ever have to pay the penalty because even the most basic plan busts the affordability guidelines.

And yes, UAA/UAF stopped offering healthcare to any student other than 2 categories.  Graduate and foreign exchange.

http://obamacarefacts.com/health-plan-options-for-college-students/

Yep, generous assistance if you're not covered otherwise and not making enough as a student to be well over the poverty line.  Huh.  Yeah, if the student claims themselves for the tax return, they probably qualify for free healthcare from the government in some fashion.

Oh, and I forgot a way for students to have healthcare - part of Obamacare is the expansion of coverage of children to 26, remember?  So 90% of them are riding their parent's coattails.  The rest is probably a mix of uninsured, people who have returned to college but have healthcare otherwise(I have tricare)

As do I and Tricare will not cover up to 26.  Because it is government subsidized.