Obamacare - practical discussion

Obamacare - practical discussion


[quote=“xerty, post:19, topic:31, full:true”]
So here is a nice matrix…
http://acasignups.net [/quote]

Thank you for linking to that site - it has some good information – I think I’d visited the site before, but I made the assumption that maybe it was a bit spammy or iffy due to the way the graphics looked a little amateur – but now that I have read around on there a bit, I see that their data appears reputable and they are spending a huge amount of time in researching how each state is going to be affected.

Of course there are about 4 different ways the states have decided to manage how their marketplace insurance companies cope with the last-minute major changes announced last week, making the whole thing very complex.


Another article on the Silver plans and how they should be avoided in many states if you aren’t getting the relevant subsidies.

As a side note, observe that the individual market here is 11M people, nearly all subsidized, on the exchanges and another 7M off exchange who aren’t. The 30-50% annual price hikes we keep seeing are in part a consequence of the death spiral in rates when you try to load all the costs of the very sick and poor onto some fraction of this 18M person group, which is less than 10% of the country’s population.


Yeah the real solution, which no one has the political will to do, is to eliminate the advantages that employer-provided insurance has so we can have large pools of insured in every state. Right now there’s lots of little pools so the risk is not spread as well as it could be, and folks are stuck in jobs they may not want because of insurance.

I’m very concerned that there’s not going to be a whole lot of insurers left in the ACA exchanges for 2019. With these insane rate increases folks without subsidies are not going to be buying insurance.


2018 rates are available on the federal marketplace so you can preview the pain:

Looks like the average price hike is 38% for the benchmark Silver plan (which was also up 25% for 2017 from 2016). Good news for AK, AZ, and ND customers and bad news for pretty much everyone else without a big subsidy. IO, WY, UT, and NH are up 50-70%.


38% increases… :frowning:

I have read that in some situations the gold plans can be cheaper than the silver due to the subsidizies that were killed. I found a gold that is a better deal than silver from Kaiser. Its only a ~300 more a year but thee deductible is $3000 less.


With regard to the avoiding Silver strategies discussed above, there are some updates to the states and some of their changing cost allocation approach to the CSRs expenses. You might double check this one in case your state changed at the last minute:

Also, if you’re looking for group options despite being single (“self employed”), check out this thread for some of companies that aggregate small businesses and offer benefits including PPOs at least in some cases.

My understanding is that the insurance is marked up a fair bit going through these intermediaries, but given how overpriced the ACA plans are for normal people, you can probably got about the same level of coverage but with a decent national network.


Ugggh Previewing plans in New Orleans / Orleans Parish. Exactly zero of any doctors I’ve ever seen are included. Even on the most expensive plans. Probably going to take the absolute cheapest plan and just see who I want on a cash basis. And this is with a partial subsidy.

I do wonder if the provider networks will evolve or this is it.


WSJ: Insurers Leave ACA Markets; Some Premiums Will Jump

The num­ber of in­sur­ers par­tic­i-pat­ing on the fed­eral ex­change, known as Health­Care.­gov, will drop to 132 in 2018 from 167 this year, ac­cord­ing to the De­part­ment of Health and Hu­man Ser­vices analy­sis. As a re­sult, about 30% of con­sumers will have only one in­surer to pick from, up from 20% this year.
The av­er­age monthly pre­mium for one of the most pop­u­lar, mid­dle-priced plans on the ex­change—a key met­ric for pre­mi­ums around the coun­try—will in­crease by 37% for a 27-year-old con­sumer across states that rely on Wash­ing­ton to run their ex­changes, ac­cord­ing to the HHS


Well yeah, this is what happens when you actively try to sabotage the marketplace. Instead of fixing what’s broken let’s just screw everyone over and see what happens.

Got our new 2018 policy enrolled with no issues on healthcare.gov this morning, our previous insurer (Blue Cross) left the ATL so now we’re on Ambetter. They were the only one left that had our local doctors and hospitals in-network. Other choice (which we’re lucky to have) is Kaiser and you have to switch everything to them. We may end up with them after next year if/when Ambetter pulls out too.


Trump’s action (or if you prefer the poor drafting of the law, or the Congress who declined to authorize the necessary appropriation to pay the CSRs legally) accounts for about 15-20% of the 35-40% premium hikes we’re seeing for 2018 (so 1/3 to 1/2). The trend towards fewer insurers and rapidly rising premiums has been going on for the whole time Obamacare has existed, and it’s just accelerating now that the artificial taxpayer subsidies like the risk corridors have expired and we can see the true cost of things.


Chatter about removing the “individual mandate”, ie the part of Obamacare that taxes you if you don’t buy insurance, in the tax reform bill discussion going on in Washington. The Republicans are trying to pass something without any Democratic support, in which case they need it to appear, for political accounting purposes, to be budget revenue neutral. This is where the mandate comes in favorably:

Part of the repeal’s allure is that it could reduce the federal deficit by about $400 billion, according to a calculation from the nonpartisan Congressional Budget Office. That is because many individuals who get insurance because of the mandate also get government subsidies, and if the mandate were repealed and those people didn’t obtain coverage, the government would no longer be paying for their subsidies. It would also reduce the number of people on Medicaid.


Which is yet another attempt to gut the ACA without meaningful reform. Removing the mandate means all the healthy people bail which inevitably leads to death spiral. And then you say ‘Look, we told you it was bad! We win!’.

Guess that estimate doesn’t include the massive premium increases (and even more subsidies paid out) when the insurers factor in that only sick people will get ACA insurance going forward if this passes.


You’re not looking forward to the day when your subsidized insurance premiums are $250/month at an income of $X, but at an income of $(X+1) your unsubsidized premiums for the same policy are $2000/month?


In some states we’re there now. Not kidding, I’ve seen quotes from folks in their early 60’s of over $2k a month for two.


There is a big change happening in healthcare, specifically in the drug sector. Many people are unaware of it, but it’s having a profound impact on the industry.

Drug prices are falling across the board. Generic prices are practically collapsing. It’s due mainly to recent FDA reforms. Competing drugs are being approved faster.

Hopefully, more competition can be brought to other areas of healthcare soon. Medical device makers, hospitals, insurers, and doctors need to be exposed to real competition.


As I understand it, the subsidies for people on ACA are based on the cost of the Silver plan. With the elimination of the CSR, the cost of the Silver plan has increased and thus the subsidies have increased. Those on ACA who are not on a Silver plan might pay less this year than last. I believe all others will pay more.


Correct, if you are getting Silvers you won’t see much diff in premiums because subsidies rise to cover the second lowest-cost plan. The folks that get shafted by CSR subsidies going away are the ones not getting subsidies because they’re just over the income cliff (same folks that hated the ACA in the first place for that reason).

Ours went from $36/mo. for BCBS last year to $68/mo. for Ambetter next year, with lower max OOP cost. This is a 94% CSR’d plan.


Question. For a provider that’s out of network for ACA (blue cross) but would otherwise accept normal blue cross (BCBS), do you still get the benefit of usual and customary pricing? Or are you at the whims of the providers cash pricing? Will I need to negotiate in advance every single time?


I don’t know, proabably best to check in advance but I could see it going the wrong way depending on the situation. Possibly relevant:



False alarm. The provider networks aren’t fixed yet. I’m seeing some of my preferred providers listed as in-network who weren’t there a few days ago.