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  1. #1
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    ObamaCare: Is it really affordable for the poor?

    Sources:
    Kaiser Family Foundation (no suprise, it's been used many many times for many many discussions)
    healthcare.gov (when it works)

    On its skin.... subsidizing premiums sounds great.

    So, take out the premiums from the equation.

    Bronze and Silver plans, when it comes to deductibles, which is defined as the amount of money a person/family must pay before coverage kicks in (there are exceptions) it ranges from $1000 to $2500

    The max out-of-pocket ranges from $4500 to $6400....

    so, is the $1000 to $6400 on out-of-pocket expenses really affordable to those that are supposed to benefit it the most?

    To me: The Affordable Care Act is Unaffordable for the people & families that need it the most.
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  2. #2
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    Quote Originally Posted by tednugent View Post
    Sources:
    Kaiser Family Foundation (no suprise, it's been used many many times for many many discussions)
    healthcare.gov (when it works)

    On its skin.... subsidizing premiums sounds great.

    So, take out the premiums from the equation.

    Bronze and Silver plans, when it comes to deductibles, which is defined as the amount of money a person/family must pay before coverage kicks in (there are exceptions) it ranges from $1000 to $2500

    The max out-of-pocket ranges from $4500 to $6400....

    so, is the $1000 to $6400 on out-of-pocket expenses really affordable to those that are supposed to benefit it the most?

    To me: The Affordable Care Act is Unaffordable for the people & families that need it the most.
    Lets stop and think about it for a minute.

    1,000$ to 6,400$ will not usually bankrupt families, particularly considering Hospitals will usually work out payment plans. They'd rather get their money slowly, rather than not at all.

    Whereas medical bills from a major illness can (and do) bankrupt a lot of families. The bills are just to overwhelming.

    Capping expenses at 1,000$ to 6,400$ is better than having no cap at all.

    The rest of the conversation is a matter of opinion. Deductibles allow some to save money, but do they deter others from getting preventitive health? Paying off 1,000$ to 6,400$ would be difficult for some families. But is the purpose of insurance to make things 'easy', or is it to ward off financial catastrophe?
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  3. #3
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    For a family that is making sufficient income that does not require subsidies, yes, it does not affect them much.

    For the families that do, it may very well affect them.

    Deductibles in no way allow a family to save money, based on the ObamaCare definition of a deductible.

    YOu're thinking co-pays. However, because the way the system is defined, unless you go into certain platinum plans (which means the highest premiums), insurance doesn't cover you until you meet the deductible obligation first.
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  4. #4
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    Quote Originally Posted by tednugent View Post
    For a family that is making sufficient income that does not require subsidies, yes, it does not affect them much.

    For the families that do, it may very well affect them.

    Deductibles in no way allow a family to save money, based on the ObamaCare definition of a deductible.

    YOu're thinking co-pays. However, because the way the system is defined, unless you go into certain platinum plans (which means the highest premiums), insurance doesn't cover you until you meet the deductible obligation first.
    are you sure it's not a % of cost for each bill up to the annual out of pocket max, like most other plans?
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  5. #5
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    Quote Originally Posted by bahueh View Post
    are you sure it's not a % of cost for each bill up to the annual out of pocket max, like most other plans?
    Mine you pay 100% of your bills until you reach your annual deductible, after that you pay a co-pay for each bill. If you have huge medical bills you hit the annual catastrophic cap (sum of deductible plus all co-pays for the year) and the insurance pays 100% of the bills above that.

  6. #6
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    Its subsidized up to something like 400 percent of povery line. There is also a stop-loss as measured against overall family income. That is, there is a maximum percentage of your income that you pay.

    They've gotten some pretty good quotes in urban areas. The figure that comes to mind is like $340 or so for a forty-year-old man in LA for a silver plan. Not half bad.

    Rural areas: Not so cheap.

  7. #7
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    If anything I see this a huge benefit for the hospitals. They are the ones that are now pretty much guaranteed to receive the bulk of the payment. The plans that low earners might be able to afford carry high deductables. For people living in poverty a $6,000 certainly can bankrupt them. If the illness spans over the new year then that deductable gets doubled

    Good news for hospitals is that instead of being out, say, $100k, now they will only be out $6k. We will cover the rest.

    What of the 50%-67% of people that do not have insurance that WILL NOT sign up for Obamacare?

    We all know the current Obamacare rates are teaser rates to get people to sign up. What happens when the real rates take over? Only time will tell what those rates are. We shall see if the rate of increase in medical insurance costs go up or down as compared to say 2006-2009 (before Obamacare).
    Last edited by Blue CheeseHead; 10-18-2013 at 04:24 AM.

  8. #8
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    Quote Originally Posted by Bill2 View Post
    Mine you pay 100% of your bills until you reach your annual deductible, after that you pay a co-pay foreach bill. If you have huge medical bills you hit the annual catastrophic cap (sum of deductible plus all co-pays for the year) and the insurance pays 100% of the bills above that.
    I think most of the plans I've heard about pay 100% of wellness programs, regular checkups, timely tests like colonoscopies and such. The insured pays 100% of charges for hospital stays and illnesses till they reach their deductible/max. What this doesn't explain is that the insurance company works off of the bills, not what the insured pays. There will be payment plans and such to help get the deductible/max paid. That's how it works now too.

    I think the effort to get people with high deductables to have those regular wellness checkups is even more aggressive, giving the lie to the idea that they involve unnecessary visits to Doctors and various tests. Early detection is important.

    Overall, the theory behind the ACA sounds very good. We will have to wait and see how it actually works once it's in place. I have little doubt that it is going to be a factor in the lives of all of us with the exception of the very wealthiest among us. it is also going to be the most expensive government project since Medicare and Part D, sheer numbers seem to mean that it will dwarf those costs.

  9. #9
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    With the medicaid expansion? That's poor. As for the subsidies on the market...

    I think the better question is whether or not it makes health insurance MORE affordable. More affordable than before.
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  10. #10
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    As someone who has been living with high deductible plan for 2 years while having a wife undergoing medical treatment for the past 3.5 I can say a $3000 deductible and $8000 out of pocket max is big money. I make too much to qualify for subsidies, but spending 8k a year on top of premiums is a big expense. Frankly I have not idea how the poor will be able to do it. Right now between my contribution to health premium at work and my out of pocket is about 16k a year and over 3.5 year (4 medical plan years) I am into this for 35k not counting premiums which when up after ACA was passed. The only upside is that my wife is not dead.

    For 2014 my premiums are going up (est 5%, but I won't know till 10/22) and my deductibles are staying the same. My insurance carrier is changing however since my company is dropping United Healthcare. I am not certain how my new carrier will respond to the particulars of what is covered and what is not. I have checked and it appears all my wife's critical doctors are on the new carrier.

    Fact is if you are poor and reasonably health it makes sense to pay the penalty and go to the emergency room when you need it. They will always take you and can simply not pay and they will eat it.
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  11. #11
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    Quote Originally Posted by JoePAz View Post
    As someone who has been living with high deductible plan for 2 years while having a wife undergoing medical treatment for the past 3.5 I can say a $3000 deductible and $8000 out of pocket max is big money. I make too much to qualify for subsidies, but spending 8k a year on top of premiums is a big expense. Frankly I have not idea how the poor will be able to do it. Right now between my contribution to health premium at work and my out of pocket is about 16k a year and over 3.5 year (4 medical plan years) I am into this for 35k not counting premiums which when up after ACA was passed. The only upside is that my wife is not dead.

    For 2014 my premiums are going up (est 5%, but I won't know till 10/22) and my deductibles are staying the same. My insurance carrier is changing however since my company is dropping United Healthcare. I am not certain how my new carrier will respond to the particulars of what is covered and what is not. I have checked and it appears all my wife's critical doctors are on the new carrier.

    Fact is if you are poor and reasonably health it makes sense to pay the penalty and go to the emergency room when you need it. They will always take you and can simply not pay and they will eat it.

    Well, remember, half the people who get coverage under Obamacare are the poor, who get picked up by Medicaid expansion to something like %120 of the poverty line. The other fifteen million are people who get a sliding scale subsidy up to I think, 400% of poverty line. So we should get pretty good coverage of the population, if they ever get their computer to work.

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