Now that the details of the insurance markets are coming out, we’ll be re-litigating Obamacare ’til hell won’t have it anymore, so I want to get my licks in early before things get bloody. I think DougJ is right that most people, who get their insurance through their employers, won’t notice it, and those on premium support will consider it a welcome benefit. But Digby catches another group, the marginally insured, who pay for not-so-great policies that still keep them out of bankruptcy. This group will pay more under Obamacare, because half- or three-quarters- or five-eighths-assed policies won’t be available on the markets.
Notably missing from her argument are numbers, but these certainly aren’t an imaginary group, and, as Atrios points out, a lot of them are younger. Explanations of how they’re getting a better policy won’t carry much weight since they’d already chosen not to buy that policy. So, even though this cohort will be arguably better off, they will be disgruntled about their bigger premium payments.
That all said, every time I hear about one of these groups, I think about the alternative (which I would have preferred) of Medicare for All. Instead of hearing stories about small groups that are better or worse off, we’d be hearing about everyone on employer group plans who were having to move to “government healthcare.” Part of the grand Obamacare bargain was to keep the employer insurance status quo, and avoid that major transition. I can only imagine the horror stories we’d be hearing now if Obamacare had been more ambitious.
Anya
This is exactly why Obamacare has bad reputation. Liberals are always gripping about what they consider deficits and the actual shirt coming, and wingnuts are yelling about FREEDOM and death panels. Fuck this shit. Can we please celebrate a landmark piece of legislation in style and focus on getting the word out.
MomSense
I would have loved Medicare for All too but I do want to ask people what they think would happen to all the people who work for the insurance companies, the people who work for providers who deal with insurance companies, and all of the people who are invested in health insurance companies–not the assholes but the teachers, union workers, state employees, people like my Dad who never earned over 50K his entire career but whose pension fund is invested in health insurance companies. Do you honestly believe the transition to single payer would be easy?
ObamaCare is going to keep expanding and we will transition increasingly to single payer. I would love for the people who think we should have done Medicare for All in 2009 -10 to tell me what exactly that transition would be like. How long do you think it would take? Who would be affected by it? What would the implementation be like? Once you start thinking it through you realize it wasn’t realistic even if you magically did have 60 votes in the Senate for it.
Shakezula
What I fail to get is the widespread and tacit acceptance that the ACA of June 4, 2013 will be the ACA of June 4, 2020.
So you, like many people say you would have wanted Medicare for everyone. Fair enough. I think you really mean “Medicare Parts A & B as they are today (with a few expansions to cover the younger peoples and hopefully you mean also without the ban on coverage of abortions).” What you don’t mean is Medicare as it was in 1965.
What changed it and continues to change it? Mainly, at the end of the day, people bitching at Medicare. Is some of the bitching greed driven? Only about a lot of it. But it does result in better patient care. Usually.
Suffern ACE
http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html
I wish we could move off insurance to the next part of the issue, which is that the existing cost of medical care might be unnessearily high. Insurance this and insurance that won’t solve the problem that as a society and economy, we are increasingly organized around a healthcare system.
What I worry about is that too much focus on the payers will allow the providers to gut any provisions that attempt to contain costs.
Xantar
@MomSense:
Obviously, we should have done Medicare For All instantly and all at once just like the Canadians did.
Shakezula
Insurance companies would still be needed to handle claims. Admin staff will still be needed to process those claims (and all of the folks in between). Insurance companies will always be with us.
Currently Medicare contracts with … 7(?) health insurance companies to process its claims and those companies fight like dogs for those contracts. This is a fun fact to drop on people who claim that Obamacare will destroy private insurance companies.
Betty Cracker
@Suffern ACE: I’m not an expert, but I have done some research on some of the provisions of healthcare reform, and ObamaCare and related legislation DOES address this aspect of the equation more ambitiously than anything that came before it.
There’s a larger focus on outcomes-based reimbursement rather than fee-for-service (with the government driving the move to newer models and the private insurers following suit), and there are incentives / penalties in place to move providers toward digital record keeping more aggressively, which will have a HUGE impact on the ability to compare how care is delivered in different places and make reforms based on that.
MomSense
@Xantar:
If by “all at once” you mean starting in 1946 in one province and 38 years later public healthcare for all that pays 70%–wooo hooo!
Kay
I don’t agree that there’s a large group of people who make more than 400% of poverty who are uninsured. I’m not even clear on why there’s this perception that buying a policy on an exchange will cost them more than they were paying. The California exchange price is about 250 a month a less than I was paying 10 years ago for a privately purchased plan. I’d pay 250 less and get preventive care covered. What group are we talking about? 25 year olds who make $48,000 a year and don’t have employer-provided health insurance and don’t buy insurance?
40 year olds with a family of four who make 100,000 a year and don’t have employer-provided health insurance and don’t buy health insurance? Are these self-employed people?
Kay
If you make 400% of poverty, you usually have employer-provided health insurance:
MomSense
@Kay:
Kay, we are not supposed to actually look at the facts and numbers–we are just supposed to complain that the reality is totally worse than a fantasy that is completely unexamined.
askew
I think you are dead wrong about most people not noticing a difference because of Obamacare. Here are some big positives that people will definitely notice:
Keeping kids on your policy until 26 even if not in college
Free contraceptives
Free physicals, some preventative tests, and other preventative care (applies to Medicare as well)
Getting rid of the donuthole for Medicare
All of this will be noticed by more people than the issues from the concern trolls.
I love that the liberal pundits spend just as much time taking a crap on Obamacare as the Republicans do.
Gin & Tonic
@Kay: Actually, in places like NY, there are lots of single 25 year olds making $45-50k/yr who don’t have employer-provided health insurance. They work through staffing agencies that place long-term temps with major companies that want employees but don’t want to actually take them on as employees themselves, because of the benefit costs. At that salary level in that location, these people are living paycheck to paycheck, especially if they have student loans to pay off. Many take the gamble and don’t buy insurance.
askew
@MomSense:
People who were pushing for this clearly have no idea how much work it would take to open Medicare for All. It isn’t something that could be done overnight or even in 2-3 years. It would be a massive undertaking.
Anya
@Kay: it looks like, people like digby start out with the negative outlook about any Barack ( worse than Bush/not Hillary) Obama policy then they work backwards to prove it.
rikyrah
IN WHAT WORLD were we gonna get Medicare for All?
Seriously?
Did you actually live through the process of Obamacare?
Did I imagine that asshole Baucus wasting months on fucking nonsense?
Did I imagine the wretched Joe Lieberman turn against his own idea of lowering the age for Medicare to 55?
Seriously, in what universe would Medicare for All have happened?
Kay
@MomSense:
I don’t think they made a huge effort to address the “25 year old who makes 48k a year” health insurance problem. They went for the nine out of ten problem.
I think it could be a better law. I would have gone at it totally differently. I would have provided basic health care inexpensively and insured the rest, but I’m also aware that most voters have employer-provided health insurance, and they don’t want my community health centers. They want to go to a private physician. They would riot under my jack booted thug plan :)
Valdivia
I wanted to add my five cents here after missing the debate during the weekend–I am one of those self insured people who are healthy enough to even be able to get insurance on the open market. Last year I got a letter telling me how my insurance benefits would change because of ACA: free contraception, free well visits, etc. When I called to make an appt this week with my ob-gyn for a check up and they asked what my co-pay was I proudly said ‘because of Obamacare I pay nothing!’ :)
What I pay every month did go up by around 10% but I am sure it would have gone up anyway and I now get all these benefits which the insurance company had to tell me came from ACA. That made me happy. I guess that is one benefit of being self insured: they have to tell you. So those people in the open market may pay more but they will be told all the things they are getting, unlike people who get their insurance from work and they rates go up and they don’t understand anything because it is not transparent if it comes from the employer or the change in the law.
lojasmo
Catastrophic insurance is akin to no insurance. It should have been addressed in the legislation. It was a big miss.
smintheus
@Kay: Isn’t there a cap on how much anybody will have to spend, as a percentage of income? I can’t believe there are many people who’ll be hit hard by higher premiums. And if they were, they’d simply get the cheaper insurance off-exchange and if necessary accept that they get no tax break for having insurance (which may not affect their taxes at all).
ruemara
When either or all of those mentioned help me with copays, I’ll give more credence to the punditin’.
Keith G
After a long look at this it seems near certainty that my health care costs will be going up. I am he’s not aware of the dimensions of the increase, Yet, my cash flow has very narrow margins . I supported Obama care knowing that this would probably happen but I felt it was important step for the society.
NonyNony
@Kay:
Thank you for bringing actual numbers into this. I don’t expect Digby to do that (that isn’t her thing) but I’ve been disappointed that Duncan is so worried that his prediction of failure for the ACA isn’t going to come true that he’s stopped thinking critically about it or providing any real information about it and is just now reporting “from his gut”. There was a time that he was much better than that on actual economic policy issues but now, not so much. (digby has always reported “from her gut” – it’s been her “brand” since I started reading her.)
Gin & Tonic
@NonyNony: He’s been phoning it in for a couple of years now.
Davis X. Machina
@smintheus: Premium cap at 9% of AGI at the top, rolling down with income, IIRC.
Davis X. Machina
@lojasmo: It was addressed insofar as the worst qualifying plans (bronze) are better than present catastrophic-coverage insurance products.
The bronze standard is lame, by comparison with the other big-ish mandate-purchase-support plan (Switzerland).
Xantar
@rikyrah:
Obama should have used armtwistingleadershipbullypulpitstripLiebermanofcommitteechair.
Breezeblock
Slightly off-topic, but in any way can someone envision this well-baby program adopted in the USA? I can’t.
http://www.bbc.co.uk/news/magazine-22751415
Davis X. Machina
@rikyrah:
In the world where all the pulpits are bully, and all the firesides chat, and the arms are self-twisting.
Betty Cracker
@Valdivia: We have employer-based healthcare coverage via my husband’s company and ALSO got a letter stating that copays were going away for certain services, contraceptives, etc., due to ACA. My husband is somewhat of a firebagger, so I cherished that letter. ;-)
patrick II
I am one of the few liberals who prefers Obamacare pretty much the way it is — as private for now, but the seeds for transition in place. The most important part of the law, as far as moviing to a “public option”, is the availability of state discretion in how Obamacare is implemented — as long as they meet certain criteria. Eventually states will try public option and, as it should work better and be more efficient, eventually more states will do it that way until eventually we have just the former slave states keeping themselves poor and their people underinsured for principle’s sake.
The problem with just going to the public option immediately is that there are a lot of ordinary people vested in the current system — not just the big stockholders and CEO’s, whom I don’t care too much about, but the hundreds of thousands of employees in the insurance business, and the smaller stockholders who would take a beating if their investment and jobs were suddenly destroyed.
I prefer evolutionary change, and Obamacare has the seed for that mechanism in place.
Kay
@Gin & Tonic:
I just think you have to do better than “lots”. There’s 40 million uninsured. 9 out of 10 of them make under 400% of poverty. Other than Medicare for all, what would the trade-offs have to have been to subsidize or cover the 25 year old who makes 48k a year free or inexpensively? What would Medicare for all cost them, anyway? Wasn’t the plan to “buy into” Medicare? It isn’t free. The plan was actually to buttress Medicare by including younger people, was it not? Isn’t that forcing young people to subsidize other people? Under this theory, they weren’t going to “use” Medicare anymore than they would use insurance from an exchange. They’d be paying for Medicare they don’t use, right?
I think this “forcing” people to subsidize other people is a bad argument for liberals. The whole Medicare program is based on “forcing” people to subsidize other people. Do we really want to advance this idea?
aimai
@Gin & Tonic: Hm. People up to age 25? Don’t these working poor youngsters now have the chance to stay on their parent’s insurance plan? But I see that Kay has answered you with some actual facts.
MomSense
@Kay:
I was doing a lot of organizing for health care and will say that reassuring people with health insurance that they could keep their health insurance was critical to keeping their support for the legislation. There is always anxiety with change and there is tremendous anxiety around medical care.
beltane
@Anya: Digby is a perpetual Eeyore who sees gloom and negativity in all places. It’s a good blog to read if you want to cultivate a sense of futility and dread. I have no doubt that even if the health care bill contained 98% of what she claims to have wanted, she’d still be sighing and groaning about it. As one of those people with the type of chronic condition that would have made me an uninsurable piece of meat pre-Obamacare ( I have MS), I can’t begin to express the relief I feel that if something happens with my husband’s job I won’t become a health care pariah.
smintheus
@Davis X. Machina: Thanks for supplying an actual number, which are usually in short supply in debates about Obamacare.
The most important thing in the end will be that people now know that they can get health care and that it can’t just be stripped from them arbitrarily or because they lose a job, which is a huge burden off the minds of millions of people.
ETA: …as beltane just above said about herself.
mistermix
@Kay: The cohort Digby identifies is 50-somethings who have chosen cheap insurance policies that don’t cover as much as the Obamacare-mandated policies. So:
* Over 400% of poverty line.
* 10-15 years from Medicare
* Underinsured (not uninsured)
It is just pure laziness on my part that I haven’t researched how many of them there are. There may only be 2 – Digby and her husband.
Gin & Tonic
@Kay: Anecdata, as I don’t have real data. You were speaking of them as if they are mythical beasts, but there are significant sectors of the NYC (at least) economy that run on paying young people decent money but no benefits nor any prospect of long-term stability. How we got to that is a discussion for another time.
As to cross-subsidization, or pooling of risks, I’ve worked in the insurance industry (not health) for my entire career, and I well know how rating and subsidies work. I pay substantial money for my auto insurance, too, even though it’s been over a decade since I’ve had cause to file any sort of claim. That’s how insurance works, and I don’t think we can or should hide it.
MomSense
@Kay:
People subsidizing other people is how insurance pools work and Medicare is also a public insurance pool. The whole idea of Medicare and ObamaCare is that people contribute into the insurance pool so that they can draw out of the insurance pool when they need it.
beltane
@Kay: All insurance is based on forcing people to subsidize other people. I have paid homeowners insurance premiums for 15 years without ever filing a claim, thus subsidizing those people who lost their homes due to storms, fires, etc. Al lot of people really do not understand how insurance works.
rikyrah
if you really want to push along Obamacare,
then work like crazy to make California and New York the best possible platforms of what’s possible with Obamacare.
Hell, I’m rooting for single payer Vermont, but I’m a realist…it after all only Vermont, with less than a million people in the entire state.
But, if California and New York can be shown as good models for what’s possible……they will lead the ‘market’, IMO
catclub
@MomSense: How about, each year, the medicare eligibility age drops one year, so that comes down, and in addition, any newborn is put on it and the family becomes eligible to be on it. That gets it closing in on both ends of the age range. By the time 80% of the US is on it, the middle wedge will be ready to jump.
aimai
@MomSense:
Yes. One thing that people did know was that you couldn’t let your care lapse. They might understand absolutely nothing else about their employer sponsored/bargained for health care but they knew about COBRA and what happens if you fell out of your group plan, or were terminated, and then couldn’t buy in again.
COBRA and health care benefits are a huge part of every divorce settlement these days with the formerly unemployed or underemployed spouse getting kicked in the gut when they are terminated from their spouse’s family policy. I know a lot of women who ended up with the short end of that stick. Creating a benefit like the exchanges for single and newly divorced people is HUGE.
sparrow
I’m not so sure they will be upset, it depends on the numbers as everyone is saying.
For 2 months between my PhD and postdoc, I worked as a ‘contractor’ for a research group, and had to buy a catastrophic plan. Now, I paid $150 per month for basically the right not to go bankrupt if something horrible happened (Cancer, car wreck, etc). There was no coverage for seeing the doctor or even an ER visit (I think I had to pay out $5k first before anything kicked in). Now I’m young and healthy, but I still need to see a doctor now and then, so this was never something I wanted to be on long-term, and it was a pretty big bill for no real usable coverage. I think my yearly equivalent salary was $40k, don’t know what Obamacare would cost in that situation but I doubt I’d count as indigent. If I was still in that situation, I would be pretty excited about Obamacare, if it meant I could afford real insurance. The catastrophic plan is not a direct comparison, and smart people know that. The question is, does it bring *premium* insurance to an affordable rate?
Valdivia
@Betty Cracker:
:D
I am happy to see that it wasn’t only the self insured who got that. I noticed it because as someone who is self insured everything I get from my insurance company makes me nervous. But once I opened it I got a huge smile on my face. I kept the letter too!
Valdivia
@rikyrah:
Add Maryland to this. They have been pretty ahead of the curve in the setting up the exchanges too. I am very curious to see what they came up with.
Kay
@MomSense:
I think it was the biggest thing. Chuck Schumer said during the debate that there wouldn’t be a huge political benefit for Democrats because most voters have health insurance. I think it was great he said it. This was ignored during the debate, because it’s a class issue, and we hate those. We have to pretend everything is evenly distributed. Even-steven.
We did the same thing with unemployment. The huge numbers on unemployment were those with (only) a high school degree. They were the 25% unemployed group. No one would break it down. I think there’s this determination to pretend “we’re all in the same boat” because if we don’t do that we have to admit we have classes.
Elizabelle
@Breezeblock:
Finland includes condoms in the maternity pack.
I think that’s brilliant.
MomSense
@catclub:
I suspect that it won’t be long before MediCare eligibility drops to 55 and up. The solvency of MediCare has been extended and some of the better cost control mechanisms are just starting to be implemented. Age 55 and up is an expensive group to insure so I do think this will happen before long.
Gin & Tonic
@aimai: And on their 26th birthday, they are between a rock and a hard place.
the Conster
@rikyrah:
I remember – every day was Different Preening Asshole President-for-a-Day Day. Lieberman, Baucus, Nelson, Nelson, Snowe, Collins, Lincoln – every one of them took their chance to concern troll the country about why we couldn’t have a national health care policy that works for everyone. It’s really amazing we got anything.
Kay
There’s a different straight political calculation, too, and I think it’s the one they made. If the uninsured don’t vote, and they don’t, not in the percentages the insured do (because it’s tied to income and education) one would seek to cover the uninsured and then turn them into regular voters. Turn the 9 out of 10 into 50% voters instead of 15%. There are more of them :)
RP
I stopped reading Atrios about 4 years ago. I see I haven’t missed anything.
Focusing on one tiny subset of the population that might be slightly worse off under Obamacare seems utterly pointless and the kind of thing the Daily Caller would do.
Cassidy
The future of medicine is “Med Home”. Med Home is built to be long term, preventative care right in line with how Medicare and the VA does business. The industry is moving to single payer on its own.
aimai
@sparrow:
As I said on a previous thread somewhere I was essentially uncovered from 22 to almost 35–I forgot that for a couple of years I actually had Kaiser through a fellowship at Berkeley. It wasn’t great and I had no real idea how to access it or what it would have been like if I’d gotten really sick. I do think there’s a difference between how young women (18-30) and young men view health care and I think there’s a reason why the modal character everyone imagines complaining is a young, white, male who “chooses” not to have insurance. He’s partly real and partly a fiction of people’s imagination. He’s real because he just went from being a passive consumer of health care (yearly checkups arranged for him by his mother, invisible medical care in the form of pediatric care as necessary, being a child on his parent’s insurance) to being responsible for his own health care–naturally he isn’t going to have a lot of forethought about something which he has always just consumed without thought.
As for young women we need gynecological services, especially if we are sexually active, and may be quite aware of that fact so we are already connected to health care. As for young men I agree that they may see themselves as “not needing” medical care on a regular basis but aren’t they also more likely to be injured on the job and need ER care? Guys who work construction are always getting hurt and they don’t get paid sick days. And the truth is that people have chronic issues of pain, skin lesions, etc…that they just don’t treat until it gets so painful and dangerous that they end up in the ER.
Bringing people into the health care system is an important first step in having a healthier, wiser, better informed populace. We should want people to consume more preventive care, more self care, rather than less. Getting people into contact with primary care doctors, dentists, and psychiatrists should be our goal. Any system which leaves out 18-25 year olds on the grounds that they “don’t need” health insurance would be crazy. Everyone needs health care on a regular basis, just like they need daily showers and sanitation.
Belafon (formerly anonevent)
One of the things that will always make Obamacare suck for the unthinking is what I hear a lot: “My insurance rates have gone up under Obamacare.” Well, yeah, they were going to go up without Obamacare as well, probably faster, and you still wouldn’t have gotten the other benefits.
Kind of like “My brakes were useless. When that deer ran out in front of me, I pushed on them as hard I could, but I still ended up hitting it.”
jshooper
Clearly it would have been better to KILL THE BILL.
I’d rather starve to death, than get half a loaf from lazy sellout Obama and the totally progressive congress he had to work with.
I remember those MASSIVE THROBBING Democratic majorities he had. They were so eager to pass Single Payer lollipop healthcare but dark, evil Barack & his henchman Rahm refused to allow it.
Every day I weep thinking about how much better the country would be if Obama had never been elected. Thank goodness I have true progressive legends to inform me of what should have been.
beltane
@RP: There is a vibe I get from certain liberal commentators that their concerns lie with the “haves” who want to have more than with the have-nots who can use any crumb of help that is thrown their way. It is a class issue more than anything else.
aimai
@Gin & Tonic: No worse off than before. And probably better off under the exchanges since they can still buy a policy whereas before they couldn’t.
liberal
@Kay:
Depends on the context. I sure as hell don’t want to be forced to subsidize flood insurance in coastal areas so people can put homes and condos right on the damn beach.
liberal
@aimai:
While I’m a big fan of preventive care in principle, studies on actual benefits of preventive care are pretty mixed in many situations.
MoeizW
Everyone here is aware of the Libby, Montana ObamaCare provision, right? The one that says everyone in Libby, Montana gets access to…Medicare?
I wish Max Baucus was my senator!
http://ssa.gov/libby
liberal
@catclub:
Yeah, that’s what I’m thinking.
Kay
The question I get the most from insured people is one of equity among people “like them” not across the whole country. They want to know if similarly situated people (people who make the same as they do) will get “free” health insurance when they pay for health insurance through their employer. They think that would be unfair. It would be unfair, too, but it isn’t going to happen, because people “like them” (middle income) will pay about what they pay.
PhoenixRising
@beltane: @mistermix:
No.
There are more than 2 of the uninsured/underinsured middle class in the spot Digby and her husband, and my wife and I, are in.
As you know, jobs with benefits went away for a group of Americans some of whom are now uninsured. The rest of us have the kind of lousy coverage individuals can buy at inflated prices that covers nothing. Some of us can’t get insurance at all, at any price we can pay, even with a state high risk pools which are a suck for another post, due to pre-existing conditions like cancer, autoimmune disease, etc.
For us, a system in which the healthy 25 year olds are forced to pay in out of their above poverty level income, and both premiums AND benefits are fixed and transparent at certain minimums, is a great advance, regardless of what Digby thinks. I suspect that she hasn’t had her cancer yet.
It’s going to cost more every month than not being insured (my wife) or having crappy policies that pay for nothing (me and our child). It’s going to be painful to pay those premiums, I’m not going to lie.
And my wife is going to get a complete physical for the first time since she was discharged by the oncology clinic at UCSF in 1994. Although we could well afford one-off medical care, and have been buying an annual membership at a concierge clinic for her for a decade, we just have to hope that their docs never find anything that can only be treated with expensive tools, more quickly than we can liquidate an asset.
When I was a 25 year old making “good money” in an urban area, the $100 a month for the premium would have been painful to me, because the COL is so high. But that’s the price we’re going to pay to make this society ever so slightly more civilized.
There are many families like ours that run a business successful enough to support 25 people (staff plus dependents) but nowhere near successful enough to provide health insurance. That’s how you get uninsured working people. That’s why we needed reform.
Violet
@aimai:
Just like there are health care handcuffs keeping people in jobs they don’t want to be in because they or their family members need the health insurance, there are probably people who stay in marriages they don’t want to be in because they can stay on their spouse’s health insurance plan. I wonder if there will be a small increase in the divorce rate once its possible to get a plan on the open market at a reasonable price?
I also wonder how it’s going to affect corporations. Once they don’t have you handcuffed by health insurance, people are going to feel much freer about leaving their job and maybe striking out on their own (entrepreneurship increase!) or taking a job at a small business or start up because they don’t have to depend on their employer for the health insurance.
JohnK
@37 Mistermix: I find it frustrating that so many people do not take the time to review what ACA actually does before commenting.
Here is a nice report entitled: A Profile of Health Insurance Exchange Enrollees (http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8147.pdf)
In addition, most of the discussions regarding who may pay more under ACA are not clear that the the law provides: “premium credits to eligible individuals and families with incomes between 100-400% FPL to purchase insurance through the Exchanges.(http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf)
Here is information about how much the tax would be in you don’t have employer-base insurance and choose not to buy your own: http://www.businessinsider.com/how-much-is-the-obamacare-penalty-tax-2012-7
Digby can’t be bothered to figure out if she is even eligible for subsidy. Well, here is a subsidy calculator to find out (http://kff.org/interactive/subsidy-calculator/). As an aside, Kaiser Family Foundation has tons of information about health care reform and is an easily accessible resource.
Digby says: ” I’d be thrilled if our coverage is better and our out-of-pocket maximums are lower.” This will very likely be the case. For example, most preventive care will be available without co-pays: http://www.healthcare.gov/law/features/rights/preventive-care/index.html.
Honestly, I’m not that worried about people who have incomes higher than 400% of the FPL may have to pay more.
The biggest problem is states not expanding Medicaid, leaving many low income people without any coverage. And, who are too poor to be eligible to participate in the exchange: http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all.
Kay
@liberal:
I don’t know though. I once got subsidized flood insurance in Swanton, Ohio, which is pretty far from a coast.There was this creek across a football field from the house. It was in a “50 year flood plain” or something. I don’t really know how it works.
Villago Delenda Est
Change is, I’m afraid, oftentimes a painful process.
Yes, there will be issues. The question is, will the overall picture be improved?
The ideal situation would be the extinction of the health “insurance” industry, the purging of any notion of a profit (in the modern sense of the word…lucre for MBAs) driven health care system, and the ending, for all time, of the notion that health care is a “business”.
We’re not going to get there, I’m afraid, in anyone’s lifetime here. The meteor is taking its bloody time getting here.
The overall picture will be improved by Obamacare.
someguy
My mother is retired and on Medicare. It stinks. It’s as bad as the worst HMO I ever had to deal with. I guess if we all had it, then we’d all be equal. But I’d miss the really good insurance I have through my employer.
On the other hand it’s good that we’re making the under-35 set pay their fair share. For a long time many of them, particularly single men, went without insurance or with cut rate insurance in order to save a few bucks of beer money. It’s about damn time they carry their weight.
liberal
@beltane:
That’s not a valid point. While of course insurance is a matter of spreading risk, in a purely abstract system the insurer adjusts premiums based on expected risk on a case-by-case basis.
In the case of health insurance, there are public policy reasons why we want to limit this—we don’t want to let people born with the wrong genes (for example) to be left hanging in the wind. But that’s a form of subsidy that’s distinct from risk pooling across a cohort with roughly even risk characteristics.
flukebucket
Can somebody explain to me why small businesses that currently provide health care for their employees are against the ACA?
Gin & Tonic
@aimai: I agree that they are better off under the ACA. However, those who turn 26 during 2013 still have a problem, as they’re off their parents’ plan (assuming there was one) but have no exchange to sign up with. They’re in limbo until January.
liberal
@Kay:
I don’t see why we should be subsidizing that, either.
Health care is a different animal—people (at least of our ilk) don’t want to see folks dying in the streets because they inherited the wrong genes or were, through no fault of their own, exposed to environmental hazards.
But there’s no good reason to subsidize flood insurance for real estate lying in flood zones.
Shakezula
@liberal: Studies on particular types of preventative services when compared to other preventative services show that sometimes some preventative services are better than others or the frequency with which they are administered needs to be adjusted …
Honestly, you can say the same thing about diagnostic services.
Villago Delenda Est
@liberal:
Yes, this is true…my bolding.
However, as we saw during the Rethug Primaries last year, there are plenty of vile infestations of teabagger scum who CHEER when their candidates advocated letting those moochers die in the streets. They are outraged that they are cast in the role of brother’s keeper. Never mind that this Jesus guy they claim to revere and worship would definitely be in favor of Obamacare.
Oh, I forgot. It’s not Jesus they revere and worship…it’s Jeebus, son of Mammon.
Cassidy
@flukebucket: Because freedom.
Seriously, they’ve been told it’s bad for them and they eat up the talking points.
RP
@beltane: Sadly, he and Digby are just catering to their audience, which is largely middle and upper-middle class, college-educated, white people between the ages of 20 and 50.
liberal
@PhoenixRising:
An advance, maybe. A great advance? It’s effectively a regressive tax. A great system would socialize both insurance and medical care itself, since the empirical evidence and theory both show that health care is fraught with so many market failures that it’s impossible to have a reasonably efficient private system of medical care.
Others might think that flushing 10% of GDP down the toilette for no better outcome in the aggregate is OK, but I don’t.
Kay
@mistermix:
There are more than that. I’m just saying I paid 950 a month for essentially catastrophic insurance for 2 adults and 2 children, and that was ten years ago. In California I would get a much better policy for around 700. That’s at 100k, which is just over 400% of poverty for a family of four. Will it cost more than “no insurance”? Sure. But I think you have to remember that my neighbor who makes 100k and has employer-provided insurance is paying for insurance. It isn’t free. It isn’t a gift from her employer. It’s part of compensation. Could they put me on a better footing than her because I’m self-employed? Wouldn’t the person who is insured thru work object to that? We should pay about the same amount, right? If you are your own employer you’re paying for your own health insurance out of pocket, but people who work for others aren’t getting it “free”.
Cassidy
@Shakezula: You could also argue why are we subsidizing recovery efforts in places like Texas with lax regulations or Oklahoma (sorry Sooner). I figure, if we’re going to subsidize the lives and recovery efforts for people who make conscious choices to live somewhere dangerous, the least we can do is subsidize preventative care for people.
liberal
@Shakezula:
I’m pretty sure there’s little or no evidence that annual physicals are useful.
Davis X. Machina
@liberal:
No sane person does, which is a problem with any majoritarian form of government.
Gin & Tonic
@liberal: From FEMA:
Q: How are flood insurance premiums changing under the new law and who will it impact?
A: Starting Jan. 1, 2013, premium rates for subsidized non-primary residences will begin increasing. Rates will increase 25 percent per year until they reflect the full risk-rate. Later in 2013, there will be premium rate increases for additional categories of subsidized properties, including business properties, substantially damaged or improved properties, severe repetitive loss properties, and any property that has incurred flood-related damages where claim payments exceed the fair market value of the property. Rates for these additional categories of properties will phase in at a rate of 25 percent per year until they reflect full risk rates. Additionally, in late 2013, FEMA will begin to apply full risk rates to policies written for newly purchased property. Beginning in 2014, premium rates for other properties, including non-subsidized properties, will increase as new or revised flood insurance rate maps become effective and full risk rates are phased in for these properties. These premium rate increases will include properties in areas that have received new or revised flood insurance rate maps since July 6, 2012 (the date of enactment of the new law). Additionally, even if you build to minimum standards today, you will be subject to significant rate increases upon remapping if your flood risk changes in the future.
liberal
@Villago Delenda Est:
Yeah, well, the problem with our ilk is that the critique that really, completely crushes the libertarian/teatard “you can’t force me to be my brother’s keeper” is the Henry George critique, but most people of our ilk don’t understand that.
Violet
@someguy:
A problem my older relatives and their friends are having is that their doctors are no longer accepting Medicare. Anyone know anything about that?
Another question I have is, I know that kids can stay on their parents policies up to age 26. However, what if the parents had the kids when they were older? Let’s say the parents were 42 when they had the kid. When the parent turns 65 the kid is only going to be 23. If the parent then is on Medicare, can the kid go on Medicare until they are 26? That is their parents’ insurance.
Joel (Macho Man Randy Savage)
@Kay: Wait, what, someone actually read the provisions of the law before commenting on it?
aimai
@Gin & Tonic: I just don’t understand what it gets you to keep pointing to a (really small) segment of the population:
people who are turning 26 right now
people who are not married and 26
people who are making too much for subsidies but in jobs with employer subsidized health care.
Up until Obamacare they would have been worse off, now they are not as well off as someone else for a few months?
The whole ACA was a massive balancing act, a machine with many moving parts trying to bring as many people into the system as posible and subsidze the poor while doing so. Of course there are going to be a few people who, for a few years, fall between the cracks. Are they worse off than before? Absolutely not. We are assured that those 26 year olds were always healthy and refusing to buy health insurance anyway, or stuck buying overpriced and underserving catastrophic care. The cost of their emergency care was transferred to us when they hit the ER uninsured. How on earth is the fact that some small proportion of this cohort is now either uninsured or expensively insured “until January” even a problem?
liberal
@Davis X. Machina:
Hmm…I could swear that there were commenters on Balloon Juice who weren’t noticeably insane who thought no male would ever choose watchful waiting if diagnosed with prostate cancer.
liberal
@Gin & Tonic:
That’s great.
Kay
@mistermix:
I don’t think you can start the analysis with “people who have employer provided health insurance get it free”, which seems to be the starting point of all these discussions.
Then it’s like this: “the uninsured 25 year who makes 48k will pay 300 a month while the insured (thru an employer) 25 year old pays nothing.” That isn’t true. The insured 25 year old is paying for employer-provided health insurance. They aren’t paying out of pocket on an exchange, like the uninsured 25 year old who makes 48k will, but they’re paying. The employer isn’t just giving them a gift.
Joel (Macho Man Randy Savage)
@Anya: To be fair to digby, she would have been bitching just as hard if it were Hilary as President. Sometimes it’s good to have a loyal opposition from the left, sometimes it’s just trolling.
aimai
@liberal: Its not a “regressive tax.” There is no guarantee that a 25 year old isn’t going to wind up in the ER for a whole shitload of things. Its a complete myth that 25 year olds don’t get sick or us ER services for which we end up paying if they are uninsured. In addition 25 year olds are usually related to older people who do use health care and if their parents and grandparents aren’t getting health care the 25 year old may very well be the only person financially supporting their elders. OF cousre it would have made sense to isntitute a single, national health care tax to cover everyone but we couldn’t do that for a whole lot of political reasons. That doesn’t mean that forcing 26 year olds into the system and requiring that they pay, pre-emptively, for their potential cost to the system when they do have to access it, is some kind of “regressive tax” or loss to the system.
Villago Delenda Est
@liberal:
George is of course ignored by the glibertarians, who are not nearly as intellectual as they imagine they are.
Then again, they’re all neofeudalist thugs, so there’s that.
liberal
@flukebucket:
AFAICT “small business” has historically been one of the most reactionary segments of any society. Not exactly sure why this is…my guess is that they might have a higher ratio of labor to capital costs, and progress in good governance typically aids labor.
(A good example is the NFIB going on about the “death tax,” when the fact is that only a tiny fraction of small business owner’s ever pay it.)
Villago Delenda Est
@Kay:
DING DING DING DING DING
Employer health care has ALWAYS been another form of compensation, and was one of the few ways that employers could give their employees more compensation than WWII wage and price limitations allowed.
Employers have never offered health care out of the goodness of their hearts. It’s always been a cooly calculated business decision to do so. Of course, back during WWII, most employers were not Randian assholes, they had a broader concept of the value of an employee than modern beancounting Ferengi greedheads.
liberal
@Villago Delenda Est:
When I try to convince people that taxing land heavily is a good thing, I get pushback from almost everyone, including so-called liberals and leftists.
On the right, there’s usually intense pushback too, since right-wing crypto-feudalist thugs luv themselves some rent. OTOH, I’ve occasionally trotted the argument out and had a good reception (by a right-wing libertarian type). Not very often.
Like I say, though, I understand right-wingers not liking it.
Gin & Tonic
@aimai: It isn’t a major problem, and I even said they’re beter off. I’m beating a dead horse, but this started when Kay made what seemed to me to be the assertion that 25 year olds making 400% of poverty have employer-provided plans. I know plenty who don’t.
I know there are tradeoffs. I know people will fall into weird situations, where for a time they are worse off, and later they are better off. But every tradeoff involves some winners (maybe most) and some losers (ideally not many.) I know some of the latter personally, that’s all. If one of these folks gets in a car crash, or tears an ACL playing hoops later this year, they are facing bankruptcy.
I’m out.
liberal
@aimai:
Of course it’s a regressive tax. What fraction of his income (better yet, wealth) is Bill Gates going to pay?
liberal
@Gin & Tonic:
Wait…someone who is actually thinking clearly about the issue?
Davis X. Machina
@liberal:
No chance it’s ignorance, and not malice? Georgists aren’t that thick on the ground.
liberal
@Villago Delenda Est:
Actually, I thought the story was that due to government controls in WWII, employer-provided health insurance was a way to increase total comp and get around the controls.
liberal
@Davis X. Machina:
Yes, it might be ignorance, but arguing with people about it is tiring.
There was a thread a week or two ago where people (even otherwise very intelligent commenters) didn’t understand that Ricardo’s theory of rent applies to urban land as well. I made the obvious point—why are two similar apartments in NYC and Peoria so differently priced?—and no one got it.
Not to mention the most common fallback—we can’t have granny thrown out off her land in a tax sale!
Kay
@Villago Delenda Est:
There’s only two categories of 25 years who make 48k a year a right? There’s those who get health insurance as part of compensation and those who will have to pay on an exchange. The insured and the (currently) uninsured. That’s the comparison. There is no third “free” category of 25 year olds who make 48k a year and are insured. It’s not “zero” versus “300 a month”. The insured thru work are also paying for insurance they don’t use, I would think, if indeed they aren’t using it.
This was actually discussed honestly when I was in a union. The complaint was older members were “trading” wages for health insurance. True, too. 25 year old don’t need elaborate vision coverage. They would laugh outright at 2 “free” pairs of glasses a year. “Thanks! How much am I paying for that?”
Kay
@Gin & Tonic:
But don’t you have to address the equity issue of 25 year olds who make 48k a year and have employer plans and are paying for them? Because they are paying for them. One way or another. Is 48k a year (clear) for self-employed the same as 48k a year with a full benefits package? I don’t think it is. I think they’re paying for their “benefits”.
Forum Transmitted Disease
This talk of “25-year olds who make 50k a year and have no insurance”. That was me at age 20, 25, 30, and 33, at which point I finally managed to get a job with a stable company that had decent health care benefits.
@lojasmo: THIS is all I had all those years. If I got run over by a bus, it would save my life, sort of. Oh, I’d still be bankrupt, but it would only be to the tune of about a hundred thousand dollars or so rather than millions.
ACA is going to end up being a world-class fuckup unless the powers-that-be put some teeth in the penalties and MAKE everyone buy in. As it is, a $95 tax penalty for not doing so gives a 25 year old low income earner – who think they’re fucking immortal anyway – zero incentive to take $200 out of the $1500 or so a month that they earn and send that off to pay for insurance.
Personally, I think it’s going to end up being a world-class fuckup anyway, but am willing to see how it plays out.
CADoc
I worked hard in my little sphere of influence to get ACA passed. I’m the health insurance holder in my family. I’m currently on disability for cancer treatment, theoretically my employer could kick me onto COBRA in 3 more months and then I’d have 18 months before the shit hit the fan and I’d be uninsurable (my husband was already uninsurable on the individual market). As Joe said, the ACA is a big f*cking deal and a huge improvement from the status quo. The thing we should be griping about is how many states are screwing over big segments of their vulnerable population by refusing to expand Medicaid for political spite.
rda909
@MomSense: “ObamaCare is going to keep expanding and we will transition increasingly to single payer.”
This is so obvious to anyone paying attention to California, Vermont, Maryland and other states with Democrats more in control. They are building upon on the momentum of Obamacare and expanding it before it even gets fully implemented. This is exactly what happened in Canada. So many of us could clearly see this even when these same bloggers were robotically typing “KILL THE BILL” 200 times per day. And here we are 3-4 years later and they’re basically saying the same things. They’ve done this on so many other issue too.
I’ve concluded the Online Progressive Party is a complete lost cause, and hopefully they’ll all just stop blogging and go on to have nice happy lives offline.
El Caganer
@liberal: When I used to try to talk about LVT to people (I don’t bother any more), I found that while I was saying “land,” they were hearing “property.” Which, of course, is exactly wrong.
negative 1
OK, so breaking out the calculator — the hypothetical single 27 year old who makes 48K a year but somehow gets no premium support at all from their employer has to pay $360 a month, or $90 a month less than I paid for catastrophic coverage for my family of 3 when I was laid off.
It’s possible that some of the white collar temps (I have been one twice in my life, both times for many months, and once entirely without insurance) that you speak of know how much the policy used to cost, and will be happy that they can afford a real plan for 9% of their pay. I had the streetsurance plan I did because COBRA was $1,200 a month, and that’s while I was collecting.
MomSense
@aimai:
Also that 25 year old might get strep throat and go to the ER where it is incredibly more expensive to be treated than if they went to a primary care physician.
Also that 25 year old may be wicked healthy until they turn 29 and then get diagnosed with skin cancer or a chronic illness. The way the insurance pool works is that 25 year old pays into the pool so that they can draw from it when they need it.
Joel (Macho Man Randy Savage)
@liberal: I’m cool with land and property taxes. I hate sales taxes, though. Don’t know why economists love themselves a VAT, either. Fuck that noise.
MomSense
@liberal:
I think the problem with that previous thread was that it started with me mentioning property taxes with respect to the way lowering Federal and State income taxes has shifted the tax burden to sales taxes, fees and property taxes. I am not at all opposed to increasing taxes on urban land–but that is not what we were discussing. You were saying that rents do not go up based on land taxes and we were saying rents do go up when property taxes go up.
ericblair
@liberal:
There’s a vertical supply curve for land in there that seems to have stuck in everyone’s craw and that’s going to take a lot of explanation. For example, why is there one curve for supply when land is zoned for different incompatible uses which would seem to have different demand curves, it seems that we’re really talking about land that is subject to the Land Value Tax, and a specific rate of it, which would seem to be variable over the mid- to long-run, and so on. If there’s a good walkthrough of this that would help.
Villago Delenda Est
@liberal:
Yes, it was a means of attracting employees in a non-traditional way since the traditional way (paying them more in direct wages) was not available, even though they had the means to do so.
The system just sort of took off from there.
Health care SHOULD be a universal right. It should be financed by the entire society. The beauty of progressive taxation is that it takes from those who are getting the most out of the system the greatest…and they can afford it beyond the basic needs of human survival. I note that a new BMW every year is NOT necessary for human survival.
Kay
@liberal:
I’d just like to see more, um, far-sighted arguments. If 25 year olds “won’t use” health insurance they buy on an exchange, then they “won’t use” health insurance through their employer or Medicare for All either, and they would pay for all three options. None of the three options are free.
We can’t just pluck out insurance on an exchange and say “oh, 25 year olds won’t use that“. They don’t use any of it, then, and they pay for all of it.
The whole liberal argument for 30 years has been “people are dying without health care!” Now they won’t use it anyway? I thought they were dying? I just don’t think we can drop the argument when we’re unhappy with the mechanism. Seems like a trap to me.
Alex
Speaking as a young healthy person, my health care insurance cost is obviously going up.
Because young healthy people don’t get health insurance.
Xenos
@flukebucket:
A successful small business has put together a smart, productive, and efficient team of employees and can afford to provide a nice benefit package. So long as it is difficult for those employees to find similar health security elsewhere that team is retained for the employer. And if the employees can’t go out on their own and compete against the employer without walking a tightrope without a net for themselves and their families, all the better.
It is all about power.
catclub
@CADoc: “The thing we should be griping about is how many states are screwing over big segments of their vulnerable population by refusing to expand Medicaid for political spite.”
yep. I do gripe about it. And I keep hoping that the hospitals will have enough clout to get them to change their small minds on it.
IN the bad news department, I read that some proposed fix will keep sending the unreimbursed care compensation to hospitals, which will keep them alive, but will not motivate anyone to get the medicaid expansion. I hope I misread.
mistermix
@Villago Delenda Est:
@Kay:
I think you’re both right that employer-sponsored healthcare is considered a freebie rather than compensation. As is the employer share of FICA.
As someone who is self-employed, I see this all the time in comparison of cost of hourly contractors versus paid employees. Part of the negotiation is explaining how much an employee really costs to the person who wants to contract with you. It’s not just a negotiating tactic for them – they really think that paying someone the yearly equivalent of, say $100K as a contractor, just to pick a number, is the same as paying an employee $100K/yr.
Changing this discussion is hard.
Xenos
@Xenos: Or, to put it more succinctly, coffee is for closers.
Kay
@mistermix:
I think it’s easier to see if you’ve done both, been employed and then been self-employed. Then there’s the whole category of self-employed who are covered under a spouse who refuse to acknowledge that someone, somewhere is paying for their health insurance. They have it thru force of will and bootstrapping individualism or something. My husband calls this “find the health insurance”. They’re usually married to a teacher or a nurse or an auto worker or a gubmint employee here. It’s always self-employed conservatives who are outraged that people need health insurance.
Forum Transmitted Disease
@flukebucket: Sure. Small businesses that pay for healthcare pay the highest premiums of all of an insurer’s customers.
Let’s take two businesses. Jack’s Coffee Shop and Costco. Costco can go with any health care provider they want. Hell, an insurance broker would kill their firstborn live on TV to nail down the Costco account. So you can’t raise Costco’s premiums too much, if at all, because if you did they’ll just go to another insurer that’s willing to take a cut for the business.
Jack’s has no such luxury. Nobody wants to do business with them, they’re small, there’s no commission on that sale. So Jack’s is already starting out at a huge disadvantage. Maybe two or three insurers are even willing to take on the account. When it comes time to re-up for next year, you can hand Jack’s a 20% premium hike and there’s not a fucking thing they can do about it. It’s not like they can play one company against another.
So when ACA hits, the small business guy knows the money to pay for that has to come from somewhere, and it isn’t going to come out of Costco’s ass. It’s going to come out of his. And it’s not like he can just not offer insurance anymore and tell his people to go on the exchanges – there are huge fines for doing that, and…don’t know how else to say it, but there is going to be quite the social stigma for a while of being on “government insurance”. That’s an issue nobody’s even talking about, and everyone should be.
(From personal experience, as I’m the one who pays our bills, I can tell you that the small company I work for has been getting slammed with premium increases between 20-30% per year since the ACA passed – I assume the insurance companies are using that money to offset the hit to their obscene profit margins that will occur once ACA kicks in.)
Belafon (formerly anonevent)
@Forum Transmitted Disease:
1. Yet everyone has bitched about it.
2. From what I understand about Australia, the penalty for not voting is like $10-$20. And yet, it makes everyone vote.
Belafon (formerly anonevent)
@Forum Transmitted Disease:
Yet, the small business isn’t going to be going at it alone. It will get subsidies. As for the stigma…really? “I would have my family insured, but I’m worried about what my neighbors think?” I think this is an argument for social services to move in and take away your children.
Villago Delenda Est
@mistermix:
This is similar to the actual cost of owning and operating an automobile. Most people see the monthly payment, the insurance premium, and the price at the pump as it. But there’s maintenance, there’s tires, there’s car washes…I could go on and on and on. When you add it all up, then balance that against the convenience of the private auto (nearly) always available to you, versus the relative inconvenience of public transportation in most American cities, well, then you’re straining the old noodle.
A lot of people don’t want to strain the noodle.
Villago Delenda Est
@Belafon (formerly anonevent):
You underestimate the idiocy of the wingtard mind at your own peril.
aimai
@Gin & Tonic: But they always were facing bankruptcy. Anyway given the fact that we don’t have a way of forcing people to buy the insurance and they can, instead, pay a minor fine via taxes I’m not sure why this is the fault of the ACA. First everyone is arguing that these uninsured, unmarried, youths (of whom I was one) don’t want/can’t afford health insurance pre-exchanges and then they are arguing that we should be upset because they can afford health insurance under the ACA and yet might not buy it and then suffer a catastrophic injury? I just don’t know what to think. I would have loved to be able to buy health care when I couldn’t–but the cost of individual plans was prohibitive. At least the ACA is creating a system whereby you can buy in for less than you would have previously on the individual market and eliminating the real thing that has prevented a whole loto f people from buying in: pre-existing conditions.
Why is this not being factored in? My Sister in law works with disabled kids and their families. These are people who were born with pre-existing conditions. And under modern insurance conditions a whole lot of people were found to have “pre-existing conditions” that either prevented them from accessing health insurance or kicked them off it once they tried to use it. It is a component part of the ACA that stricter controls are being placed on insurance companies w/r/t both denial of getting a policy and denial of service. These are benefits that apply to everyone, regardless of age–even in this weird sour spot you are claiming to have located.
Kay
@CADoc:
The Medicaid thing is interesting, because I think most governors want it. Kasich in Ohio started out below the radar, talking to liberal interest groups, asking them for help in getting it past the cowards in the statehouse (I know this because one of them comments here) and he’s gotten more and more public and vocal. He just wrote an op ed in US Today that is mildly pathetic and pleading; it’s about how Reagan expanded Medicaid.
I don’t know if it’s national, but the entire Tea Party movement in Ohio is grounded in opposition to Obamacare. They’ve turned on Kasich because of it. It’s really their single issue. After the initial media slobbering over the Tea Party, the only thing that kept them going was working on and passing a state amendment that “bans” Obamacare, but it’s bullshit, because federal law trumps state law. If they lose on Medicaid expansion, it’s a huge loss. They’ll fracture. The politics are more complicated than presented by national media. There’s real cracks in the conservative coalition.
MomSense
@Forum Transmitted Disease:
As someone who is self insured I can tell you that we have been getting hammered with 20-30% increases for more than 10 years now. And if you live in a state that does not regulate insurance companies you have no recourse.
mistermix
@Kay: I’ve been all three – was employed, then self-employed and paid for insurance (what an expensive PITA that is) and now am self-employed but covered by my wife’s insurance.
Part of the issue for middle-age and older people is that medical insurance used to be affordable back when they were purchasing it. I remember buying a “major medical” high deductible catastrophic insurance plan in the 80’s for a hundred bucks a month. Then I got a job and for many years my employer paid. If I hadn’t decided to become a contractor, I would have absolutely no idea how much insurance costs.
I’ve seen the “find the insurance” case many times – one recent example is a union-hating wingtard friend-of-a-friend “financial advisor” married to a teacher.
aimai
@CADoc: I’m sorry to hear about your situation. As someone who was handed the disability papers a couple of years ago for my husband (thankfully it worked out and he got better) I know the horror of looking at that sheet and realizing that life is about to change forever, just when you need the backing of your employer and your health insurance more than ever. Its ridiculous of people to talk about private/employer based insurance and the exchanges as seperable things, or to imagine that employer based insurance is somehow “real” or “effective” or enduring. Its not. You are at the mercy of your employer’s choices and their firing you every second. Especially once you turn out to need the health care in more than a pro-forma way.
Mnemosyne
@Forum Transmitted Disease:
How will those increases be offset by the tax breaks you will be getting starting in 2014? IIRC, there will also be more federal limits on how much they can increase starting in 2014, so you may be right that they’re trying to get their licks in now before the crackdown.
Also, yeah, it sounds like you’re in a state where health insurance is not regulated, which sucks. I think California has been monitoring increases pretty closely to make sure the for-profits don’t get out of control in the run-up to Obamacare.
Kay
@mistermix:
It’s always that scenario. There’s another horrible flip side to that, though. I see it a lot. It’s women who were stay at home mothers or worked part time “to help out” and then are past 50 and get divorced and lose their health insurance. There is absolutely no good option for those people. Nothing. I alway think Pelosi should gather a group of them around like she did with kids and SCHIP expansion. It’s right up her alley and it would drive conservatives wild with anger, so it would be fun, too. They are this large group of women that conservatives ignore, although they supposedly want everyone staying home with kids. It’s brutal.
Forum Transmitted Disease
@Mnemosyne: We’re in California. I cannot imagine what a non-California business is dealing with.
As far as tax breaks, that’s not my department so I don’t know if we get them or not. I just pay the bills.
ericblair
@Kay:
I’m guessing that the fucked up Medicaid decision in the Supreme Court case didn’t really do the goopers any favors, even though I’d bet it was supposed to.
Left Coast Tom
@MoeizW:
I followed your link, and it’s only for people with asbestos-caused disease.
Are you claiming everybody in Libby, Montana is suffering from an asbestos-caused major disease?
aimai
Here is an on point comment from a diary at Kos. The boy in question, Browne, was born with Cystic Fibrosis. His mother was on Medicaid so she can’t “keep him on her insurance” until age 26 because she doesn’t have employer sponsored insurance.
Kay
@ericblair:
In a way, Roberts was true to conservatism, though. Throw it back to the political branches. Elected conservatives rely on courts a lot to protect them from political consequences. I would resent it it if I were a judge. They’re doing it with the Voting Rights Act right now. It’s bullshit. If Scalia were a real conservative, instead of a fraud, he’d throw the VRA back to the elected branches. He as much as announced he’s protecting conservatives in Congress from political fall-out. That’s bullshit. The “discrete minority” courts are supposed to protect doesn’t include GOP Senators from Virginia. They’re not powerless. At all. If gutting the VRA in Congress harms conservatives politically, well, that’s how it’s supposed to work.
CADoc
@Kay: Reaping what you sow, right? The GOP created these dingdongs and now they are running their asylum. It would be funny if it didn’t have real life implications for ordinary people.
Shakezula
@liberal: Which is it, studies have shown or you are pretty sure that the nebulous annual physical isn’t useful?
Well, you could. But you’d be a dick. Which I think is the point we’re both making. You could get really dumb and say none of my money should go to worker’s comp claims for [fill in the blank hazardous occupation] because people who work dangerous jobs should be willing to accept the risks, but at that point you’d be Matt Y and the self-loathing might kill ya.
CADoc
@aimai: This is what I could never understand about the opposition to the ACA. We are all at risk for this scenario, and yet all these people couldn’t imagine themselves needing these protections?
taylormattd
Oh god, so the PUMAsphere is cracking out their greatest hits album, huh? Digby should just re-run some of her old “kill the bill” shit and call it a day.
IowaOldLady
Do the letters saying you now get preventive care with no co-pays actually cite the ACA as the reason? I ask because I’ve heard people who don’t know that 25-year-olds on parents’ policies is there because of ACA.
IowaOldLady
People on Medicare are actually more satisfied with their insurance than others are, though traditional Medicare outranks the Advantage plans.
http://news.yahoo.com/medicare-beats-private-plans-patient-satisfaction-survey-210509930.html
Monala
@Kay: My family, perhaps? We’re at 300% of poverty level. My employer covers health insurance for employees only. You can pay out of pocket for dependents, which I do for my daughter, at about $275 per month.
My husband works as a contractor – hence, no insurance. He’s a diabetic, so hello, pre-existing conditions. To cover him through my job would cost about $580 a month, but he’d have to wait 9 months to get any coverage for his pre-existing conditions. So if we paid that, we would have no disposable income left after paying bills – nothing for emergencies or unexpected costs – and nothing left to pay for his sliding scale doctors appointments at a community health clinic where his diabetes is currently being monitored, or his generic medications that we purchase at Walmart now.
We looked into the high-risk pool in my state, which is also about $580 a month. He’d get coverage right away, but the deductible is $4000. How would our situation improve under Obamacare?
Matt McIrvin
@Shakezula:
Because the Republicans have all united behind repealing it, and are therefore not interested in making little tweaks to make it better. There will be no improvements if we spend the time from now until 2020 fighting a DDoS avalanche of repeal attempts. That requires legislation, and with a paralyzed Congress in the grip of apocalyptic fanatics there can be no more legislation.
MomSense
@Monala:
Here is a subsidy calculator for ObamaCare done by Kaiser.
http://kff.org/interactive/subsidy-calculator/
coldie
BJ readers and writers would do well to tiptoe around Hullabaloo citations and criticisms. She has that nasty habit of being perpetually correct, usually on the early side of things. I don’t blame diehard dems for being butthurt about her astute writing and analysis, but tread lightly. Obama gets harder to stand up for by the minute, and his Neoliberal policies deserve her criticism. Obamacare may very well have been the best he could do. We will never know because he did not try. He continues to not try. WDS wasnt coined for nothing. She is smarter than you. Love ya Digby, never stop.
Monala
@MomSense: Just tried it. I’m not sure how this works for us. The first question – is employer health care available? Do I answer yes or no? Yes, it is, for me and my daughter; it could be for my husband, but he wouldn’t be able to use it for 9 months. So can I truthfully answer no for him?
So I answered no just to see what comes up. At our income and the subsidy level, we’d still pay $576. But is that for all 3 of us? (Since the option “some family members are covered, some not” isn’t available). Is it less if we’re just trying to cover one family member? And what are the copays and deductibles? That wasn’t mentioned on the site. And at $576 a month, that’s still pushing our budget to the breaking point. (Not to mention, we have other medical bills we are still paying off – some for my husband’s care, some because my insurance for my daughter and me doesn’t cover 100% except for preventive care).
Mnemosyne
@Forum Transmitted Disease:
If I were you, I would hang onto those bills and check with the Department of Insurance to make sure those increases are valid. It wouldn’t be the first time an insurance company tried to pull a fast one hoping that their customers didn’t know that what they were doing was not actually permitted.
Matt McIrvin
@Belafon (formerly anonevent):
If the rates go down under Obamacare, they’ll still say it. People who paid reduced income tax bills under Obama firmly believe that Obama massively increased their taxes. The actual numbers do not matter.
This is why I still have a hard time believing the ACA will last long. It won’t become popular, because even when people like the policies of Obamacare they will never believe that those policies and Obamacare are the same thing. If Republicans ever luck into the Presidency again or gain a sufficient supermajority in Congress, they’ll repeal it in a minute.
NobodySpecial
This thread? TL;DR, for the most part.
What everyone seems to be forgetting is that your premiums aren’t fully covered between that 133 and 400 percent of the poverty level. Furthermore, that mythical family of four level doesn’t apply to, say, single people or couples, or single moms.
I am a case in point as a person whose expenses will go quite a bit higher. I’m a 42 year old single male who has been uninsured since his company went Chapter Whatever in 2004. I work. I make more than 200 percent of the single person’s poverty level of 11k.
Now, on the one hand, Obamacare is excellent in that I cannot be turned down for insurance now, as I was by multiple companies in the last 18 months before it became law. (with no reason given, of course, because they don’t have to give a reason.)
On the other hand, now I have to come up with the money for premiums, since Baucus’s little dump job made sure that credits won’t come close to covering premiums and I have to come up with ~10% of my yearly income for said premiums. There’s a couple of thousand dollars, figure a couple of hundred dollars each month that I have to carve out of my living right now.
I guess I could quit paying my car loan. I could certainly find a cheaper place to live, although that might well be offset by the utilities I don’t pay for. Maybe stop the CareCredit thing I’m using to fund my pet’s perscriptions and vet visits. Thing is, no matter what I do, things are going to get a lot tighter in the NobodySpecial household, and there will be less chance of being able to recover from the ordinary disasters that hit, like car problems or if they cut my hours at work. Or I could pay the tax penalty and pray the (officially undiagnosed due to money issues) health problems I do have don’t kill me or make me unable to work. And even a lot of those who HAVE insurance have funny stuff like Starbridge, Wal-Mart’s fave. That one when I had it capped expenses at $1000 for the YEAR. One ER visit and done. This article at the NYT gives some percentages, not great numbers – 25 percent of the ‘near poor’ uninsured, 42 percent with ‘private insurance’, which includes the aforementioned Starbridge and other funny policies. Even raising the cap on Medicare to 133 percent is still going to leave a few million people with a hard choice to make in October.
I really wish Balloon Juicers and a lot of other people would have got their heads around how many people are going to be negatively affected by the premiums and left their smartass rhetoric about ponies and unicorns at home.
Mnemosyne
@Monala:
Assuming you entered 2 adults, 1 child into the calculator, the $576 number is for all three of you. If you’re trying to find out what the cost would be to get private insurance for only your husband, enter your household income but only one adult.
Mnemosyne
@NobodySpecial:
My premiums aren’t fully covered, either, and I have employer-sponsored insurance. That’s kind of the point — the playing field is being leveled so people at similar income levels are paying similar amounts whether they have employer-sponsored insurance or private insurance.
Did you try the Kaiser calculator at #148 to confirm that the numbers are what you’re assuming they will be?
Monala
@Mnemosyne: the answer is the same, because now he looks like a family of 1 making well over 400% of poverty level, and no longer eligible for any subsidy.
Mnemosyne
@Monala:
That seems … weird. Did you try the calculator at Healthcare.gov? That should give you some state-specific information.
I’m not the expert kay is, but maybe she’ll wander back. The question seems to be what someone is supposed to do when they are NOT covered by their spouse’s health insurance. You won’t have to worry about the pre-existing conditions part of it (unless he smokes) because the insurance companies will no longer be allowed to use that to calculate his rate.
The other part of the question is, can someone leave their employer’s plan and go onto the exchanges for the whole family if the employer’s plan doesn’t cover spouses?
Trollhattan
Last time I was laid off (during the Dubya Reign) I didn’t pay enough attention to COBRA rules and didn’t bother immediately opting in, presuming I’d find another job quickly.
[SFX: extended laughter]
Three months later I decided hey, I’d best check out this COBRA thing, only to discover I’d have to pay for those lost months to sign up, a four-figure check I couldn’t justify or easily afford. Instead I became a walk-in customer of the same HMO for substantially less than my old plan’s premium, but with less-spiffy coverage (bigger deductables, fewer services). I’m betting California’s exchange would have been perfectly suited to my situation back in the day. I never, ever presume I or my family won’t be directly affected/a customer of the ACA. The landscape is far better than it was ten years ago.
Paul W.
@Kay:
This, there are ginormous subsidies for those who cannot afford care as well as caps on what % of your income you have to pay for health care. Not to mention a clearer market for individual private plans, the fact that you can no longer be thrown out for pre-existing conditions, and that 80% of the money you send to the insurance company must be spent on healthcare outcomes and not bureaucracy.
I just don’t think that group exists, except in the veil of ignorance and deception caused by the media’s atrocious reporting and the GOP being so crazy wrong about everything.
MomSense
@Monala:
Did you subtract the tax credit?
JMS
Don’t be so sure that people with “good” employer sponsored plans won’t notice negative changes. Cadillac plan taxes don’t just hit rich people. If employers like mine do away with copays except for govt mandated preventative care because of this tax, people will notice and complain as people at my company have. They blame the company but you could easily see the blame go back to Obamacare. On balance Obamacare is an improvement, but there are certainly people who will see negative changes.
LAC
@Anya: Oh honey, no. Let’s spend time enhaling Digby rose scented purity farts and wallow in stories of “OMG, I am 42, have no insurance and whaaaaa, I have to pay premiuims that I know are going to a be a gazillion dollars a month” (not true, but proceed, whiny). Much better this way. :-)
Monala
@Mnemosyne: @MomSense: Yes, I did. @Mnemosyne: Why is the result weird? Our incomes (low ’70s) doesn’t change. So if I enter a family of 3, we get a subsidy, with a remainder of about $6k+ that we have to pay out of pocket, which is about $576 a month. If I only enter my husband, he looks like a single man making low ’70s, and he no longer qualifies for the subsidy. He can get individual insurance for about $6k+ a year with no subsidy, which is about $576 a month. There is no option on the calculator to say, “Family of 3, with XX income, but only one member needs health insurance.”
ETA: your questions are good ones. Is there the type of flexibility to address atypical situations like mine (covered by insurance, but spouse is not).
Mnemosyne
@Monala:
It’s a weird result because I’m pretty sure that the PPACA answer to your situation is not, “Well, you’re fucked and you have to pay through the nose.” IOW, I don’t think the calculator is giving you the correct answer, because it’s not written to cover your situation, which is more complicated than most people’s.
ETA: That’s why I’m hoping kay will be able to come back and chime in — she’s been dealing with a lot of PPACA stuff in her law practice in Ohio, so she may have seen a situation like this come up.
Betsy
@Davis X. Machina: and all the beneficiaries white.
NobodySpecial
@Mnemosyne: Yes. I did it back when they were first released and talked about them here. What I got for it was shit like LAC above, who’s more than happy to kick people off the lifeboat if they get to feel superior.
What Monala and I have got here is not what people consider the ‘normal’ situation, but this is what it is. There was an implicit assumption that a few million people WOULD get screwed here in order that the majority would benefit. Now it looks like more and more of that majority are NOT going to benefit and we’re still screwed.
Betsy
@liberal: OK so, “great advance” as in, a great advance for this country, in the political moment we were in when Obamacare was passed, but OK, not a great advance compared to say, other western democracies.
In other words, “this is why we can have nicer — but not much, much nicer — things”
aimai
@NobodySpecial: Again: Monala and her family are no worse off than they were before the ACA, and neither are you. You wanted health care coverage and you can now get it–its more expensive than you want so you don’t want to pay it. So pay the fine and don’t get it and keep hoping that you don’t get sick, which is what you wer edoing before. Obama and the Dems have practically broken the party trying to balance the competing needs and interests of people who have been uninsured and uninsurable for a really long time, they have tried to ensure that states can expand medicaid coverage. If the Dems had had their way and not been placating blue dogs or republicans to try to get their votes no doubt we could have subsidized people more fully or up to 500 percent of poverty or whatever would have been great. It is what it is. You are no worse off than you were before the ACA and you may yet end up in a better situation. The fact that healthcare is expensive and that insuring everyone is complicated is not the fault of obamacare its the fault of our fucked up political system. It remains the fact that although not everyone will make out like a bandit some people, a huge number of people, will finally get coverage and treatment or will, because of their coverage, not fall into complete financial ruin.
liberal
@NobodySpecial:
Stop bothering people with actual facts, will you? If it has something to do with Obama, it has to be good!!elventy!
liberal
@Shakezula:
Not my own experience or whatever; studies.
liberal
@MomSense:
Except that they don’t—not the part falling on land, anyway.
liberal
@Joel (Macho Man Randy Savage):
You know why economists like it—it’s not very progressive, and might even be regressive depending on the incidence.
liberal
@Betsy:
It’s plausible it’s a great advance, and I agree that advances can occur in a gradual, evolutionary way. But the jury is still out.
liberal
@aimai:
Uh…it’s pretty clear that he’s saying he’s worse off than before.
Raven Onthehill
People without health insurance by income level, 2009. Numbers in thousands:
————————————————-
Less than $25,000 15,483
$25,000 to $49,999 15,278
$50,000 to $74,999 9,352
$75,000 or more 10,561
————————————————–
From Income, Poverty, and Health Insurance Coverage in the United States: 2009 (PDF), p. 26 table 9, US Census Bureau.
Tell me again how most people with household incomes over $50,000 have employer-provided health insurance.
Mnemosyne
@NobodySpecial:
Then please repeat the numbers, because I don’t remember. Also, which level of coverage are we discussing? There are three different levels at three different costs.
I know that here in California, the rates came out lower than expected when the insurers participating in the exchange turned in their final ones. I’ll admit that California is pretty well-run when it comes to insurance (we already have a lot of consumer protections in place), but it’s going to be pretty hard for insurers in other states to claim that it’s more expensive for them to do business in, say, Ohio, than it is in California.
Mnemosyne
@Raven Onthehill:
Wow, you posted a meaningless number ripped from its original context! So original.
Raven Onthehill
@Monala: My total sympathies.
Your situation is a common one. It’s a straightforward question: if spousal coverage is available does the PPACA require the purchase of that employer insurance? I can’t seem to find an answer, however. The best one I’ve seen so far is directed at employers, at Employee Benefit News, and it doesn’t look good for your household but I can’t really tell.
My suggestion is that you contact your congresscritters and see what they say about your specific situation under their “help for constituents” line. There may also be advice sources becoming available as the exchanges near implementation. If you have a family accountant, I suggest you consult them–the law is complex.
To the broader issue: this law is a mess. Let’s admit it, already, and start dealing.
Paula
@Mnemosyne:
That piece of news may have already affected current rates in the state (I don’t know how though). I’m preparing to quit my job and therefore my employer-based benefits for my own individual health plan via Anthem. The rates are now about $20 cheaper than they were 2 months ago (I don’t know whether they’re including the subsidies).
Healthy 30 YO woman here.
Admittedly, I’m not scared off by the rates because my share of of the rate for my employee plan is not insignificant. Of course, my employer pays a whole hell of a lot more of that rate (over $400 a month).
PhoenixRising
@liberal: Yep, a lot of people who have been going without coverage and aren’t yet incurring costs for health care are “worse off”, except that unless they live to be old and die in bed without ever incurring costs–they’re going to END UP better off, in the long run of the coming decade. Because when something happens, they won’t be bankrupted by it.
A lot of these complaints including the Digby who launched it sound pretty nice to have. From my shoes as a cancer patient married to a cancer survivor raising a teen who needs new hearing aids every year, you all’s problems about how to pay a premium that was going up regardless of ACA sound very serious, but not compared to what I’ve been living with.
Monala, the key is that once your husband is on your family policy, or the three of you are on a family policy instead of an employer-based one, all of your out of pockets are coming from the same pocket. You will get to your OOP and deductible more quickly, thus saving you money in the event that you USE any health care. If this were a premium paid for an insurable but avoidable event, like auto accident insurance, your objection would make a lot of sense. But you already know that all 3 of you are going to need some medical care…right?
Raven Onthehill
Bottom line is that
no-onemost of the public is not going to know anything until October, when prices have been set, the initial version of the regulations have been written, and the exchanges open.Tell me again, who thought up this crack-brained scheme?
Paula
TBH, I would not even remotely consider quitting my employer-based health insurance if I incurred a chronic condition after I got on it. My decision to get an advanced degree full-time at my first-choice program would probably not occur in a universe without the ACA.
Not exactly a “saved me from cancer-related bankruptcy and/or death” kind of story, but I’m grateful all the same.
Paula
And my mother has Type 2 Diabetes, is over 60, and trying to get back on the job market. She has insurance through my father, but it’s nice to know that she can have her own insurance without worrying about a preexisting condition.
Raven Onthehill
I’m struck by the paucity of specific consumer information on the PPACA, three years after its passage, and four months before its implementation. There’s tons of advice for employers. But, without even trying hard, I am able to come up with simple questions that I can’t find answers to. I just looked to see if coverage delays for pre-existing conditions are still allowed under the PPACA. I think that’s been outlawed (if it is, that is favorable to @Monala) but I am not sure. I also can’t find out what the law and regulations say about families in Monala’s situation—not a particularly uncommon one.
And of course the biggest question is, “What is this going to cost?” And no-one seems to have an answer to that one.
Paula
@Mnemosyne:
Also, one would think that the Medicaid expansion in California would be getting more headlines. It’s a big deal. State legislators have been trying to institute some form of public health insurance for years.
Mnemosyne
@Raven Onthehill:
Part of the problem is that we live in the United States, and each state is allowed to set it up their own way. We’re not going to have one Obamacare, we’re going to have 50 of them. It sucks, but it’s the way our system of government is set up. That’s why (for example) people in California know what kind of pricing they’re looking at starting in 2014 and can plan for it, but people in states that don’t have state exchanges and/or did not accept the Medicaid expansion are kinda screwed until their states get their acts together.
IMO, at least some of the red states are going to try and claim that they didn’t have enough time to get set up and say that they shouldn’t have to implement their plans, but I don’t think they’re going to get very far. HHS Secretary Sebilius seems to be taking this extremely seriously and I don’t think she’s going to let them wiggle out of their responsibilities since they’ve had 5 years to plan for it.
Mnemosyne
@Paula:
I think California is one of the states that’s planning to eventually have a “public option” on the exchanges so people can choose that over a private insurance company.
Paula
@Mnemosyne:
Guess I can’t relate to any of this. CA’s rollout of the health care exchange has been methodical and informative. People can get sample rates and percentages for each of the participating plans right now at the Covered CA site.
The only reason I don’t know how I’m going to be affected is that I will be going out of state for graduate school and therefore may not be able to take advantage of a CA-based plan.
Kay
@Raven Onthehill:
You’re looking at household income, Raven, not people. The question was, “are there a lot of people with a household of one and income over 50k who are uninsured?” Or, “are there a lot of people with a household of 4 who make over 100k who are uninsured?”
You need to know how many people are in the household. If I make 50k and have a household of 2 I’m not over 400% of poverty. If I make 50k and have a household of 1 I am over 400% of poverty.
Ruckus
@mistermix:
Twenty five years ago when I had employees and paid health insurance I used to add 40% to the hourly wage to come up with a number that included taxes, health insurance and workers comp insurance. That was my cash cost of an employee.
Ruckus
@aimai:
Seven and a half years ago I quit my job and opened a small retail business. I needed insurance but I could not afford it because all of the pre-existing conditions were not covered and what was left was prohibitively expensive. I had to take the risk, not because I wanted to, I just could not afford it even if I had quit eating. I was better off risking bankruptcy due to an accident or major illness than actually going bankrupt by paying insurance.
David Koch
Even the liberal Digby and Atrios…
The Raven on the Hill
@Kay: Yes. I just didn’t quickly find those numbers. I wonder if HHS has them. But most likely some in those numbers are under FPL. And even if it’s a small percentage, a small percentage of roughly 50 million people is a lot of people.
The Raven on the Hill
@Mnemosyne: Yes, it will vary state-to-state. (I wrote about this a while back here.) I think the states that did not expand Medicaid are probably also going to be the states with poor insurance regulation and therefore problems with the insurance available on the exchanges. :-(
Kay
@The Raven on the Hill:
No, it isn’t a lot of people. Between 10 and 15 million of the 5o million uninsured are undocumented. They don’t get any subsidies.
9 out of 10 of the uninsured make less than 400% of poverty level. 90%.
Why is this unbelievable to you?
You’re also making another mistake. You’re comparing “zero” to what people on the exchanges will pay.
You can’t do that. People who have employer-provided health insurance aren’t paying “zero”. They pay for it.
You have to compare “people who have employer-provided” to “people who purchase on an exchange”
There is no group of “free, but insured” people at that income level. That’s an imaginary group. It doesn’t exist.
Kay
@The Raven on the Hill:
To compare costs between an uninnsured 25 year and a 25 year old who has employer-provided insurance you can’t just plug in “zero” for the insured 25 year old.
Obviously, it isn’t free.
What is the insured 25 year old paying?
The objective wasn’t to provide free health insurance for self employed people who make 50k.
The objective was to put them in the same position as the insured.
The Raven on the Hill
All possibly true, though the 90% figure seems high. (I can’t quickly source it. Can you?) Even granting it, 10% of 20 million is…2 million.
Is the coverage offered by individual insurance going to be comparable to employer-provided insurance of similar price? I would be very surprised if that turns out to be so, especially in states with weak insurance regulation.
Economists and businesspeople look at the cost of health insurance as part of a compensation package, but many people don’t think that way.