In 10 Years only 10-20% of employers will offer health insurance...

MommyLiberty5013 · June 2014

http://www.foxnews.com/politics/2014/05/31/analysts-predict-most-employer-provided-insurance-will-disappear-as-obamacare/

Analysts from S&P IQ make this prediction. Sounds good as it will enable employers to hopefully (they are not required to pay more, though) pay their employees more in salary; however, this will create even more of a burden on the federal deficit and will cost taxpayers even more than they spend now.

I think it's interesting in light of the huge problems with the VA and discussions about making that privatized.

This isn't necessarily MM but there have been a lot of HI topics lately so I figured I'd toss this out here.

hoffse · June 2014

That's interesting, but honestly not surprising. I've never thought that Obamacare really considered how insurance companies make money in the process of providing health insurance or how employer plans really work. I mean... health insurance companies are in business to make money. The more regulated they get, the more they have to charge to stay in business. There's nothing that actually requires them to exist in our healthcare system. They became a thing based on aggregate cost-benefit analysis and economics.

I really wish the ACA had spent more time tackling the root of the problem - which is really the cost of healthcare - as opposed to over-regulating health insurance companies. It would have provided more affordable/accessible health care, and health insurance companies would have been able to afford to stay in business while offering low-cost policies to more people and companies.

But obviously nobody consulted me.

Xstatic3333 · June 2014

Interesting. We're already seeing this-in my three person office, where only one employee uses the health plan. It would cost her far less if it wasn't offered and she could take advantage of exchange subsidies and the retirement benefit that we get if we don't do the health plan.

Personally, I don't have a philosophical problem with my tax dollars subsidizing others' healthcare, so I'm not too put off by this. I think universal coverage is important enough to be worth my money. I also think more choice and free market competition is good for everybody. My concern is that employers will drop healthcare without a corresponding increase in wages.

MommyLiberty5013 · June 2014

Xstatic3333 said:

Interesting. We're already seeing this-in my three person office, where only one employee uses the health plan. It would cost her far less if it wasn't offered and she could take advantage of exchange subsidies and the retirement benefit that we get if we don't do the health plan. Personally, I don't have a philosophical problem with my tax dollars subsidizing others' healthcare, so I'm not too put off by this. I think universal coverage is important enough to be worth my money. I also think more choice and free market competition is good for everybody. My concern is that employers will drop healthcare without a corresponding increase in wages.

Yes, I agree on the dropping of healthcare without the increase in wages. Probably won't happen that way.

My major concern is the cost of this to the economy. We have a lot of bubbles right now (student loans, private debt, the dollar, etc.) and I am not sure our economy can support the added burden of this program given our ever-increasing deficit. I too would like to help as many people as possible; however, if this destabilizes the economy, it's going to hurt more than help.

Xstatic3333 · June 2014

I see your point, and do agree about the bubbles. I am especially concerned about the effects of the student loan bubble. I am optimistic that overhauling healthcare will be a stabilizing force in the long run (less private medical debt, more people able to stay in the workforce, etc.) but do realize the transition could be tough. And hoffse is right as well that the high costs at the root of the problem still haven't been addressed.

Sigh. Sometimes I feel like the economy is so hopelessly broken.

sillygoosegirl · June 2014

I think that's a good thing actually. I'm sick of needing to change plans and doctors every time I take a new job or my employer decides to change health insurance options. I'm on the same plan for the second year in a row this year, and it's a total novelty to me. I've got my fingers crossed that it doesn't change before the baby arrives.

cbee817 · June 2014

hoffse said:

That's interesting, but honestly not surprising. I've never thought that Obamacare really considered how insurance companies make money in the process of providing health insurance or how employer plans really work. I mean... health insurance companies are in business to make money. The more regulated they get, the more they have to charge to stay in business. There's nothing that actually requires them to exist in our healthcare system. They became a thing based on aggregate cost-benefit analysis and economics.

I really wish the ACA had spent more time tackling the root of the problem - which is really the cost of healthcare - as opposed to over-regulating health insurance companies. It would have provided more affordable/accessible health care, and health insurance companies would have been able to afford to stay in business while offering low-cost policies to more people and companies.

But obviously nobody consulted me.

Just as a FYI, that's not the case for all insurance companies. I work at a health insurance company that is defined as nonprofit by our state. We are required to provide Loss Ratio testing on all of our products and file our rate increases to the state. If one product line does better than expected, we have to cut a check to the members every year.. if one does worse, we're SOL. We are not public and are only allowed 11% of revenue to be for admin (salaries, employee benefits, everything). I believe that's how health insurance companies should run their business- you shouldn't be allowed to make tons of money on people's health.

jtmh2012 · June 2014

Xstatic3333 said:

My concern is that employers will drop healthcare without a corresponding increase in wages.

This is exactly what will happen. Companies will drop health insurance as a cost saving measure and take all that money to the bank or pay it out to the executives. The average worker will not see one cent of this.

Xstatic3333 · June 2014

cbee817 said:

hoffse said:

That's interesting, but honestly not surprising. I've never thought that Obamacare really considered how insurance companies make money in the process of providing health insurance or how employer plans really work. I mean... health insurance companies are in business to make money. The more regulated they get, the more they have to charge to stay in business. There's nothing that actually requires them to exist in our healthcare system. They became a thing based on aggregate cost-benefit analysis and economics.

I really wish the ACA had spent more time tackling the root of the problem - which is really the cost of healthcare - as opposed to over-regulating health insurance companies. It would have provided more affordable/accessible health care, and health insurance companies would have been able to afford to stay in business while offering low-cost policies to more people and companies.

But obviously nobody consulted me.

Just as a FYI, that's not the case for all insurance companies. I work at a health insurance company that is defined as nonprofit by our state. We are required to provide Loss Ratio testing on all of our products and file our rate increases to the state. If one product line does better than expected, we have to cut a check to the members every year.. if one does worse, we're SOL. We are not public and are only allowed 11% of revenue to be for admin (salaries, employee benefits, everything). I believe that's how health insurance companies should run their business- you shouldn't be allowed to make tons of money on people's health.

That's very cool! I didn't know insurance companies like that existed. That's how it should be.

Mom987 · June 2014

I work at a group benefits broker's office and hope this doesn't happen or else I'll be out of a job.

vlagrl29 · June 2014

This won't affect us at all since we always have bought our own insurance. Actually the insurance we are on now is the best we have ever had. I decided that we might as well try out the ACA and I've been pleasantly surprised.

hoffse · June 2014

cbee817 said:

hoffse said:

That's interesting, but honestly not surprising. I've never thought that Obamacare really considered how insurance companies make money in the process of providing health insurance or how employer plans really work. I mean... health insurance companies are in business to make money. The more regulated they get, the more they have to charge to stay in business. There's nothing that actually requires them to exist in our healthcare system. They became a thing based on aggregate cost-benefit analysis and economics.

I really wish the ACA had spent more time tackling the root of the problem - which is really the cost of healthcare - as opposed to over-regulating health insurance companies. It would have provided more affordable/accessible health care, and health insurance companies would have been able to afford to stay in business while offering low-cost policies to more people and companies.

But obviously nobody consulted me.

Just as a FYI, that's not the case for all insurance companies. I work at a health insurance company that is defined as nonprofit by our state. We are required to provide Loss Ratio testing on all of our products and file our rate increases to the state. If one product line does better than expected, we have to cut a check to the members every year.. if one does worse, we're SOL. We are not public and are only allowed 11% of revenue to be for admin (salaries, employee benefits, everything). I believe that's how health insurance companies should run their business- you shouldn't be allowed to make tons of money on people's health

***********************

It's great that some work this way, but many (most) don't. And frankly, I don't think it's a problem. Insurance is a risky business. And I think that it's fine for risk to be rewarded by profit. That is the sort of thing that drives market forces in a positive way and inspires competition. My frustration is the fact that Congress seemed to ignore the fact that most really ARE in the business to make money. Whether they like it or not, that's the framework that they had to work with, and they just ignored that reality while legislating.

If we really want true universal health care, then let's cut out the need for health insurance altogether. Or let's at least start addressing the root of the problem so that low-cost health insurance really can be a viable business model, while offering products to people who are willing to gamble with the likely cost of their health care (raises hand).

There are a lot of people with medical needs. They should have access. There are a lot of other people who haven't had more than a sniffle in over a decade (I'm one of these), and they shouldn't have to pay out the nose for insurance simply because the costs of providing access to those who need it is stupid high. Should they pay some? Sure - that's the nature of insurance. But there comes a point where it's entirely unreasonable. Insurance for other things is not all that unreasonable for most people - home, life, car, etc. But medical has become ridiculous.

Lower the cost of care itself, and you have lowered the cost of insurance. Or possibly eliminated the need for it.

cbee817 · June 2014

One of the biggest issues we run into is provider fee schedules- if we don't come to an agreement with them on what we'll pay out for services, they can term their arrangement with us. If we lose a larger provider group, urgent care, or hospital(s), it can be really devastating for our members, so our negotiating power is sometimes pretty limited. If there was a national fee schedule that everyone had to follow, it would help a lot!

formerlyGDaisy09 · June 2014

hoffse said:

cbee817 said:

hoffse said:

That's interesting, but honestly not surprising. I've never thought that Obamacare really considered how insurance companies make money in the process of providing health insurance or how employer plans really work. I mean... health insurance companies are in business to make money. The more regulated they get, the more they have to charge to stay in business. There's nothing that actually requires them to exist in our healthcare system. They became a thing based on aggregate cost-benefit analysis and economics.

I really wish the ACA had spent more time tackling the root of the problem - which is really the cost of healthcare - as opposed to over-regulating health insurance companies. It would have provided more affordable/accessible health care, and health insurance companies would have been able to afford to stay in business while offering low-cost policies to more people and companies.

But obviously nobody consulted me.

Just as a FYI, that's not the case for all insurance companies. I work at a health insurance company that is defined as nonprofit by our state. We are required to provide Loss Ratio testing on all of our products and file our rate increases to the state. If one product line does better than expected, we have to cut a check to the members every year.. if one does worse, we're SOL. We are not public and are only allowed 11% of revenue to be for admin (salaries, employee benefits, everything). I believe that's how health insurance companies should run their business- you shouldn't be allowed to make tons of money on people's health

***********************

It's great that some work this way, but many (most) don't. And frankly, I don't think it's a problem. Insurance is a risky business. And I think that it's fine for risk to be rewarded by profit. That is the sort of thing that drives market forces in a positive way and inspires competition. My frustration is the fact that Congress seemed to ignore the fact that most really ARE in the business to make money. Whether they like it or not, that's the framework that they had to work with, and they just ignored that reality while legislating.

If we really want true universal health care, then let's cut out the need for health insurance altogether. Or let's at least start addressing the root of the problem so that low-cost health insurance really can be a viable business model, while offering products to people who are willing to gamble with the likely cost of their health care (raises hand).

There are a lot of people with medical needs. They should have access. There are a lot of other people who haven't had more than a sniffle in over a decade (I'm one of these), and they shouldn't have to pay out the nose for insurance simply because the costs of providing access to those who need it is stupid high. Should they pay some? Sure - that's the nature of insurance. But there comes a point where it's entirely unreasonable. Insurance for other things is not all that unreasonable for most people - home, life, car, etc. But medical has become ridiculous.

Lower the cost of care itself, and you have lowered the cost of insurance. Or possibly eliminated the need for it.

As a newly minted holder of a MS in health policy, I think these are really interesting points. Part of the reason insurance for homes and cars are affordable is because they are insurance to cover catastrophic events, i.e. the unexpected, which dont occur for a high percentage of customers holding policies, so insurance companies can spread the costs of covering those events over a large pool of people. Those companies can also charge people more based on their history. Those insurance companies don't cover preventative maintanence: oil changes, fixing the kitchen sink, cleaning the rain gutters or routine care...new break pads, new appliances...

However, the ACA is now requiring that insurance companies cover preventative care...which theoretically all their clients are using, and doctors are not going to provide for free. so the ACA has gone and flipped the insureance model on its head, it's got a high percentage of users filing lots of claims. personally I think it's wonderful that I can see my PCP once a year for free, have an eye exam once a year, and get my birth control for free. Professionally...I'm not sure how the boat is going to stay afloat. the focus on screening and prevention is creating a lot of overuse of care, driving the cost of care up. ( if you want a really interesting read I reccommend "Overdiagnosis" by Gil Welch, he writes frequent opinion pieces for the NYTimes and does a great job highlighting the down sides to screening we often forget)

Access is important. However we're a society of over-uesers (in most cases) whose insurance is insulating us from the true cost of the care that we use, so we're insentitve to the differences in price from one hospital to another, which ends up driving prices up more. I've also talked about the need for a capitated payment system (the ACA is pushing things this way), the current fee-for-service structure rewards doctors for seeing patients more often, and patients who have insurance don't have a cost barrier to being seen more often.

Ultimately we're moving towards a capitated payment system, and I think Accountable Care Organizations (ACOs) are the insurance model of the future. this would mean that healthcare providers form networks (hospitals, primary care practices, specialty care practices, and even pharmacies) the ACO gets paid a lump sum for each person who is a patient in that system, if patients are well the ACO keeps the money and comes out ahead, if the patient is ill the system looses money. Providers are incented to provide care to keep it's patients well, and when they are not well it is incented to provide the right care at the right time to return the patient to a well state and eliminate waste in the system

formerlyGDaisy09 · June 2014

AprilH81 said:

I think Congress and a lot of citizens/residents have forgotten that Health Insurance =/= Health Care. There are issues with a shortage of trained health care workers and nearly all levels but especially for general practictioners. Doctors don't want to become a family doctor, the money is in a specialty of some sort.

Even if EVERYONE had health insurance it doesn't mean that people can actually get in to see a doctor in a reasonable amount of time.
This is a huge problem in Europe and Canada where universal coverage is the insurance model...it is normal for it to take 6++ months to be seen for anything.

We need to incentivize the medial field, and I think a good start would be with tort reform. Doctors spend a fortune in malpractice insurance. Yes, they still need to be held liable for honest to goodness life altering medical errors (cutting off the wrong leg, gross negligence, etc.) but there are too many people out there who want a multi-million dollar settlement because their scar didn't heal the way they thought it would.
There is work being done here, since the publication of "crossing the quality chasm" in the late 1990's there has been a huge effort to shift medical culture from a shame and blame culture to a Just Culture, where true medical errors are addressed on a system-level (rather than by pointing fingers) and centinal events (wrong site surgery ect) get full ethics board reviews to determine if it was system failure or a case of neglignece/maliciousness.

Reward doctors (student loan forgiveness, bonuses, etc.) who go into general practice and/or serve in areas with shortages.
Programs exist for this! there are also loan forgiveness programs for doctors serving in critical access hospitals.
There are so many other options (including allowing plans to sell across state lines) that would lower the cost of health insurance and possibly the cost of care itself without requiring everyone to have insurance.

hoffse · June 2014

Yes overuse is a huge problem. And coverage for things that are unnecessary is another big problem.

I personally have a problem with covering things like birth control... simply because there's a perfectly free way to not get pregnant (don't have sex). If I'm a consenting adult choosing to have sex, then I think I should have to pay for my own pregnancy prevention or else pay for the cost of not preventing. I feel similarly about other perfectly preventable medical things.

Honestly, this is why I like catastrophic insurance. I feel like it's a model that treats health insurance as a true insurance. If I want to see a doctor for a screening, then that's on me. But if I am in a car accident and need immediate care, then my insurance kicks in and covers me after my very high deductible.

And really... people should look at the billings to their insurance and find out what these things cost. I go to a dermatologist once a year to monitor moles because I'm very pale. She bills my insurance $110. So for $110/year I can pay for that out of pocket. Instead, I might spend $1,000/month on insurance that covers that $110/year payment. Same thing for my primary care physician. He bills my insurance $125 for a check up. The lab work is another $30 or so. I go once a year.

I would come out way ahead if I paid for those things out of pocket and simply maintained a catastrophic policy - in other words, if I used insurance the way it's designed to be used.

formerlyGDaisy09 · June 2014

@Hoffse, you're also seeing the insurance company rates...I could go on for pages about payment systems for health care...but I'll try to be breif

Hospitals mark-up their charges in anticipation of giving discounts to insurance...and by mark-up I mean like 800-several 1000%. think about it they're charge you $4 for a couple ibuprofen...you can pick up a bottle of 100 ibuprofen for $6...that's a 3,333% mark-up on advil. when it goes to your insurance they get a discount and pay $1-2 for that ibuprofen. Medicare/aid has a set fee structure and will reimburse a set amount for specific codes...like they may pay $0.25 for an ibuprofen.

now, the hospital has over head, they're probably coming out behind with government insurance, and making up the diference with the private insurance companies...that said if you pay cash, likely you'll pay less than what you're insurance company paid, if you call and ask about a discount. I know my hospital gives cash payers a standard 42% discount on services they pay for in cash, if they ask.

vlagrl29 · June 2014

The cost of healthcare is crazy expensive! When I got the bill in for my out patient hernia repair it was $13,000 for the hospital and anesthesia combined. The doctor was $1,000 for her work. We have had our fair share of shitty insurance so I highly recommend if something is not covered don't forget to ask for a discount because they charge the insurance company crazy amounts but if you pay for it out of pocket they take it down anywhere from 20-50%. We recently got a 50% discount for a service on our last plan that wasn't discounted. I think the costs have gotten so crazy that insurance is pretty much a necessity when you go in for anything these days.

formerlyGDaisy09 · June 2014

Time Magazine focused on exactly this a little over a year ago in their Bitter Pill issue

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/

strickland8052 · June 2014

hoffse said:

Yes overuse is a huge problem. And coverage for things that are unnecessary is another big problem.

I personally have a problem with covering things like birth control... simply because there's a perfectly free way to not get pregnant (don't have sex). If I'm a consenting adult choosing to have sex, then I think I should have to pay for my own pregnancy prevention or else pay for the cost of not preventing. I feel similarly about other perfectly preventable medical things.

Honestly, this is why I like catastrophic insurance. I feel like it's a model that treats health insurance as a true insurance. If I want to see a doctor for a screening, then that's on me. But if I am in a car accident and need immediate care, then my insurance kicks in and covers me after my very high deductible.

And really... people should look at the billings to their insurance and find out what these things cost. I go to a dermatologist once a year to monitor moles because I'm very pale. She bills my insurance $110. So for $110/year I can pay for that out of pocket. Instead, I might spend $1,000/month on insurance that covers that $110/year payment. Same thing for my primary care physician. He bills my insurance $125 for a check up. The lab work is another $30 or so. I go once a year.

I would come out way ahead if I paid for those things out of pocket and simply maintained a catastrophic policy - in other words, if I used insurance the way it's designed to be used.

I think you hit the nail on the head about catastrophic policies vs. policies that cover optional services. However, I strongly believe that everyone in this country should be required to get (at minimum) a catastrophic policy. If you have a heart attack in the middle of a crowded park, you are going to be sent to a hospital and the doctors are going to stabilize you, whether you have insurance or not. If you don't have either insurance or a ton of money, someone is going to have to pay that (and chances are... it won't be the uninsured heart attack victim). The hospitals have to take a loss and then make up for it by overcharging other patients.

In a country where emergency rooms are required to take in dying patients regardless of their ability to pay, I think that it is a drain on society for someone to not have some form of catastrophic insurance. As a result, I think that if the government requires doctors to treat a specific medical issue, then they should also require patients to pay for those medical issues.

To put it bluntly, if you are going to live a country that is kind enough to treat you when you are on the border of death, then you need to pay at least something every month for that privilege. However, if you want to not go to your annual check ups, then that is your own choice and risk to take, and you should therefore not be required to pay for a plan that covers it.

brij2006 · June 2014

I'm not really sure what to think about Healthcare Reform and ACA at this point.

On one hand I agree with hoffse that it is treated like a maintenance plan now. It shouldn't be. That is how homeowners and auto insurance companies stay afloat, because their plans are not maintenance plans. They charge higher rates for higher risks, which makes absolute sense.

However, between the costs of going to the Dr with insurance versus without is outrageous. We did not have fertility coverage last year and had testing along with a treatment done. They billed my insurance $5,500. Of course insurance put a big bold stamp on it that said INFERTILITY - NOT COVERED, and sent it back. So we became cash paying patients. Our bill was $4k because it wasn't going through insurance, and we negotiated to pay $3k for paying in full with cash. Why the big jump in amount?

I understand there is a negotiated rate for Dr's and insurance companies, which is why there are preferred providers and things like that. But why can't they be charged a little less to begin with, then the rate would go down on insurance for the consumer too.

formerlyGDaisy09 · June 2014

Catastrophic coverage is fantastic for people who are generally healthy, but want coverage in case of an unexpected event. However, healthcare costs have gotten so out of hand that it's impossible to come up with a one-size-fits all health care plan. healthcare costs are driven by medicare/medicaid and insurance reimbursements, hospital's ethical obligation to treat every patient who walks through their doors leads to bad-debt and charity care, which hospitals must make up revenue somewhere because if a hospital doesn't meet it's bottom line, it risks having to close it's doors. Like you said, someone has to pay for it...an in reality that someone is anyone with private/non-government insurance.

There is also emerging research that in some areas patients who regularly see thier doctors actually have lower healthcare costs that patients who don't, this is perhaps where the ACA model of providing free preventative care came from. in this case offering cheap preventative care actually results in lower costs for insurance companies because they are less likely to require a trip to the ER or hospitalization. However, this is may only be the case for patients with chronic illnesses, but given the high rate of diabetes, CHF, and hypertension in this country, is the majority of patients.

I work with patients with chronic illness every day, many of whom require expensive medications that might cost them $15,000 a month...for these patients insurance is essential, some of them prefer the high deductible plans, and they know that their first dose of the year will cost them their deductible and they reach their out of pocket maximum, others prefer plans that have a higher premium, but cover the drug, and still others use patient assistance programs to afford the drug.

Like the rest of health care our insurance model needs to be reworked into a patient-centered model that begins to keep the best interests of the patient in mind rather than the bottom line of the insurance company. I see patients who can not get their insurance companies to cover their medications that they need (that their doctor has determined they need), this results in more stays in the hospital, a low quality of life for the patient, and more costs for the insurance company, that is low value healthcare (low quality, high cost).

formerlyGDaisy09 · June 2014

brij2006 said:

I'm not really sure what to think about Healthcare Reform and ACA at this point.

On one hand I agree with hoffse that it is treated like a maintenance plan now. It shouldn't be. That is how homeowners and auto insurance companies stay afloat, because their plans are not maintenance plans. They charge higher rates for higher risks, which makes absolute sense.

However, between the costs of going to the Dr with insurance versus without is outrageous. We did not have fertility coverage last year and had testing along with a treatment done. They billed my insurance $5,500. Of course insurance put a big bold stamp on it that said INFERTILITY - NOT COVERED, and sent it back. So we became cash paying patients. Our bill was $4k because it wasn't going through insurance, and we negotiated to pay $3k for paying in full with cash. Why the big jump in amount?
I understand there is a negotiated rate for Dr's and insurance companies, which is why there are preferred providers and things like that. But why can't they be charged a little less to begin with, then the rate would go down on insurance for the consumer too.

Just because they charged your insurance company $5,500 doesn't mean your insurance company was going to pay that much, it wouldn't surprise me if they paid less than half that amount. one of the specialists I see charges my insurance company $136/visit, the insurance company pays $60. That is the problem with hospital chargemasters, they know that insurance companies are only going to pay a percentage of what they charge, so they mark-up their rates to off-set that. they also know the medicare and medicaid have set fee-schedules that are about 80% of a hospital's cost so their charge master is set-up to make sure that what insurance companies and cash payers (sorry) pay off-sets the about 20% they loose treating medicare and medicaid patients. and with the aging population that problem is only going to get worse.

vlagrl29 · June 2014

I'm not sure why hospitals/doctors charge the insurance company so much when the insurance company has an "allowed amount". I guess insurance companies have contracted rates with the hospitals. I read my "EOB" all the time and notice that the insurance never pays close to what the doc/hospital charges. It's a total scam. LOL.

formerlyGDaisy09 · June 2014

vlagrl29 said:

I'm not sure why hospitals/doctors charge the insurance company so much when the insurance company has an "allowed amount". I guess insurance companies have contracted rates with the hospitals. I read my "EOB" all the time and notice that the insurance never pays close to what the doc/hospital charges. It's a total scam. LOL.

again, this is a result of government plans (Medicare and especially Medicaid) reimbursing hospitals at rates that are below their costs, hospitals must inflate their rates in an effort to make-up that loss from commercial insurance, and cash payers (the hospital I work for has a payer mix that's 65% medicare/medicaid, and then another 5-6% that's charity care and bad debt(people who will never pay)). They inflate their rates so much because they know they are going to have to negotiate with the other payers, and to keep their doors open they need to make sure they keep their margin in mind.

Most NFP hospitals have a target margin of 4%, few achieve that margin, many are thankful if they achieve a positive margin.

BlueBirdMB · June 2014

I don't normally post stuff on this board, but this subject gets me really riled up and I've seen how insane it is first hand.

I used to buy my own insurance. I bought minimal insurance that didn't cover pre existing conditions, and i liked it that way. It was far cheaper to pay more of my medical bills in cash than it was to buy more comprehensive insurance. Luckily, I am now on H's insurance, because I couldn't have afforded buying the insurance that is now required.

My parents are both self employed. The used to pay about $5,000 per year for insurance that had a $3,000 deductible (that's both people combined). Now that they have to buy such high quality insurance, they will be paying $15,000 per year for a $12,000 deductible (again both people combined). The cost now goes by age brackets- the older you are the more you pay. They are at the highest bracket- the one just before medicare.

If they had bought insurance through the market place, it would have been a few thousand cheaper. However, what nobody seems to know is that if you buy that insurance, then no doctors outside of your state will be covered. My dad works in a different state and likes to have doctors near to their work and they'd like to have insurance when they travel in case of emergencies, so they opted to buy insurance outside of the market place. But when you are talking those astronomical prices, a few thousand more doesn't seem like a lot!

Another thing to realize is that this new law mandates that your insurance must cover things like, maternity, pediatrics, rehab, etc. My parents have no children on their insurance and aren't capable of having more children- why the hell should they be required to buy insurance that covers those things.

People will understand all these things once the law starts applying to corporations. They keep delaying that. My theory is because they don't want people to truly understand the ramifications of this law until after the election.

BlueBirdMB · June 2014

Gdaisy09 said:

vlagrl29 said:

I'm not sure why hospitals/doctors charge the insurance company so much when the insurance company has an "allowed amount". I guess insurance companies have contracted rates with the hospitals. I read my "EOB" all the time and notice that the insurance never pays close to what the doc/hospital charges. It's a total scam. LOL.

again, this is a result of government plans (Medicare and especially Medicaid) reimbursing hospitals at rates that are below their costs, hospitals must inflate their rates in an effort to make-up that loss from commercial insurance, and cash payers (the hospital I work for has a payer mix that's 65% medicare/medicaid, and then another 5-6% that's charity care and bad debt(people who will never pay)). They inflate their rates so much because they know they are going to have to negotiate with the other payers, and to keep their doors open they need to make sure they keep their margin in mind.

Most NFP hospitals have a target margin of 4%, few achieve that margin, many are thankful if they achieve a positive margin.

Ding ding ding. Simple economics. And folks, when you pay cash for those medical services, you also will only pay what the insurance companies pay. That was always the case for me when I was self-insured, so that's why I opted for cheap insurance (that is no longer available). Doctors would much rather you pay in cash also- it's a nightmare for them to deal with insurance companies and they are thrilled when you just offer up cash… which can't happen anymore apparently.

vlagrl29 · June 2014

BlueBirdMB said:

I don't normally post stuff on this board, but this subject gets me really riled up and I've seen how insane it is first hand.

I used to buy my own insurance. I bought minimal insurance that didn't cover pre existing conditions, and i liked it that way. It was far cheaper to pay more of my medical bills in cash than it was to buy more comprehensive insurance. Luckily, I am now on H's insurance, because I couldn't have afforded buying the insurance that is now required.

My parents are both self employed. The used to pay about $5,000 per year for insurance that had a $3,000 deductible (that's both people combined). Now that they have to buy such high quality insurance, they will be paying $15,000 per year for a $12,000 deductible (again both people combined). The cost now goes by age brackets- the older you are the more you pay. They are at the highest bracket- the one just before medicare.

If they had bought insurance through the market place, it would have been a few thousand cheaper. However, what nobody seems to know is that if you buy that insurance, then no doctors outside of your state will be covered. My dad works in a different state and likes to have doctors near to their work and they'd like to have insurance when they travel in case of emergencies, so they opted to buy insurance outside of the market place. But when you are talking those astronomical prices, a few thousand more doesn't seem like a lot!

Another thing to realize is that this new law mandates that your insurance must cover things like, maternity, pediatrics, rehab, etc. My parents have no children on their insurance and aren't capable of having more children- why the hell should they be required to buy insurance that covers those things.

People will understand all these things once the law starts applying to corporations. They keep delaying that. My theory is because they don't want people to truly understand the ramifications of this law until after the election.

wow! That's such an insane amount to pay for such a high ded. They are basically paying a mortgage payment for their insurance. I couldn't even imagine that. My parents are almost 60 and got on the ACA. A bronze plan doesn't cost them anything in premium right now.

In 10 Years only 10-20% of employers will offer health insurance...

Re: In 10 Years only 10-20% of employers will offer health insurance...

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