As I mentioned in an earlier post, I’m going to be traveling and my wife is taking a break from her job, which means we’ll be on Obamacare, which is called Healthy New York in our home state. I mentioned earlier that it is shit insurance. Here’s how bad it is: We need insurance for December. Since my wife and I don’t have any really serious health problems, the bronze plan we’ll be using will cost almost $771/month and it is limited to $14K total outlay for the month of December.
In other words, this program, which Democrats killed themselves to pass, will allow me to feel secure that the most I can possibly pay for medical care next month is around $25K. And, by the way, it was a complete pain in the ass to enroll, and it was only because I was lucky enough to get an excellent call center rep to help me that I was able to enroll. Or, at least, I think I’m enrolled — I have to wait a couple of days for the insurance company to get my file from New York State, and then I need to pay my premium.
Folks going door-to-door in Virginia said that the number one issue on voter’s minds was healthcare. This is the Democrats’ current answer to that concern. It sucks, badly. And if I qualified for premium support, so what? Even if my entire premium were paid via premium support, the spectre of $14K of uncovered medical expense on a ~$40K paycheck-to-paycheck salary is absolutely the opposite of a feeling of security. Sinema and Manchin’s foot dragging and watering down of the BBB plan is just another nail in our coffin given the horrific state of our medical insurance system.
My other update is a little less ugly: I had asked in the comments a while back if anyone knew of an English-language Mexican newspaper. I don’t think anyone mentioned Mexico News Daily. From what I can tell, it’s basically someone (or a few people) re-writing stories in English using the big Spanish-language Mexican newspapers as a source. For $29/year, I’ll take it.
CaseyL
Month to month is usually pretty bad, if I recall correctly. It’s more like a catastrophic care policy, though I’m confused by the outlay cap. What if something happens to you in December (all the gods forbid) that requires ongoing care past the end of December?
Aide from that, will you need to continue ACA coverage in 2022? Have you priced any of that out?
Old School
Sorry you live in New York. Health insurance is cheaper on the exchange elsewhere.
Jharp
“the bronze plan we’ll be using will cost almost $771/month and it is limited to $14K total outlay for the month of December.”
Pre ObamaCare I paid more than twice that for insurance that would not cover my daughters condition at any cost.
And the deductibles were about the same.
brendancalling
Every single plan offered by my school district is inferior to Medicaid, through which I am getting a hearing aid (finally). Hearing aids aren’t covered by any ACA plan.
The ACA has a long ways to go.
Fair Economist
That is strange, because in California, with an income for two people of $50,000, I could get a Bronze PPO for $100 per month.
jonas
Kind of like the middle class paying for college trap — if you’re poor, you qualify for a lot of financial aid. If you’re super rich, you can afford to cut a check for $75k a year. If you’re in the middle and are told your kid’s college is still going to cost you $25-30k a year, and you’re not willing to burden either yourself or your kid with six figures in student loan debt, well, you’re SOL.
eclare
Is the out of pocket max $14k? Or the most the plan will pay is $14k? I couldn’t tell.
Icarus
A lot of the replies here encapsulate the problem: you can’t offer people shit and then tell them “well, it was worse before.” That may be true, but it also isn’t compelling.
The Obamacare system is difficult to navigate, expensive, and even if you get the “best” plan, you’re still stuck with high deductibles and dealing with terrible insurance companies. It’s shit, and accurately pointing out that it was worse before isn’t really helpful.
The Democrats are the party of healthcare, and they have moved heaven and earth to create that shitty system. It’s a huge problem.
germy
What would a Canadian think of your situation?
Other than “I’m glad I live in Canada” ?
Humdog
You may be blaming Obamacare for the entire mess of our health insurance industry. My husband’s employer pays over $25K for the two of us and that gets us each a $6500 co pay plus some undefinable “co insurance”. We both need colonoscopy next year so we are budgeting $18k for our portions. We make under $60k. When we complained about the high copays, the employer offered to let us pay the up charge. To get a $2500 deductible each, we would have to pay $1000 month. The math does not work, but we also know our doctors and hospitals are struggling having enough money to stay open. There is no market in healthcare.
Cameron
I went straight from my employer insurance to Medicare. I thought that was a pain in the ass to sign up for, but ACA sounds like a nightmare.
dimmsdale
This raises a question in my own mind, “When is Biden going to do Medicare for All, or SS for All,” or whatever the hell our favored fix for this godawful system might be. I’m hoping all the horsepower for change isn’t getting spent (in the sense of ‘spent’) on BBB and voting rights, there’s still SO much to do!!
I’m concerned that whatever momentum Biden’s programs may have gotten initially has been vitiated by President Manchin and our media whores discovering their “mean girls” anti-Biden chops after four years of lap dances for Republicans.
I’m guessing a real fix for our “healthcare” system would have to wait till after the midterms, ASSUMING Manchin and Sinema can be neutralized owing to a greater Den majority being elected…and honestly, between the media whores we have and the eternal Dem messaging weaknesses, I wonder if that’ll happen?
germy
@dimmsdale:
We can’t get much else accomplished if we don’t get voting rights taken care of, though.
kindness
Kvetch all you want about the Democrats Health Care plan because if it were Republicans in charge all along you’d have no health care options.
I’m sorry it is so cumbersome but the alternative is nada. Be thankful nada isn’t what you can get.
Sure Lurkalot
I believe it will long be thus, having all these different silos for the provision of insurance…private, Medicare, VA, Medicaid, ACA, COBRA…is expensive and for some, insanely profitable.
My grandma’s Medicare was fully funded and managable but now every year it’s a good idea to price out the supplementals because their estimates of 1.5%-5% per year increases are a joke. My Part D from Cigna is increasing from $24 to $48 this year. Same plan.
It seems few who frequent this site have any love for single payer or Medicare for all but the incentives in our current “system” are perverse and in my lifetime all of it has gotten worse. Many other countries have figured this out for decades. I guess this is another arena where we Americans can’t have nice things.
eclare
I’ve had a good experience with my Cigna ACA plan in TN. Signup was easy, and my out of pocket max is around $1500.
I’ll be signing up for next year this month, I hope it goes as smoothly.
clay
We shouldn’t forget that whatever Obamacare is, it has had to endure four years of active sabotage under the former administration, and longer than that undermining by various Republican judges and justices. Sure, it wasn’t perfect to begin with, but it was supposed to be improved upon. That didn’t happen.
So once again, Republicans make things worse, and Democrats get the blame. It isn’t fair, but it’s something we have to deal with.
Four Seasons Total Landscaping mistermix
@CaseyL:
Yes, it’s like $800/month and we’ll get premium support because my wife won’t be employed and I’m scaling back for our travels. Depending on the wild-ass-guess I make about my income, we will be out of pocket like $150 for premiums, but still have the $14K total exposure.
@Fair Economist: Same in New York. I just don’t qualify for premium support with my 2021 income.
@eclare: Out-of-pocket max is $14K. It is basically bankruptcy insurance, for me at least.
Omnes Omnibus
@Sure Lurkalot: No, people here don’t accept that the mantra of single payer or M4A will automatically fix everything. The details matter, and the fact that there are entrenched interests that would fight it also matters. Those entrenched interests include people who have good insurance through their jobs.
Another Scott
@dimmsdale: The GQP is up-front about trying to delay everything that Biden-Harris wants to do as long as possible. Including normal things, like the FY22 budget…
GovExec (from Monday):
“The only way out is through…”
Cheers,
Scott.
lashonharangue
@dimmsdale:
Reforming our “system” will probably require FDR levels of political majorities. The fundamental problem is we spend way more than any other developed country for healthcare as a % of GDP. There are several alternative models that other countries have adopted. All would require the key players in the industry (not just insurance companies) to get less. Many oxen need to be gored – some whom the public trusts more than politicians.
Bill Arnold
Bronze sucks. What it does get you is negotiated rates (plus that rather large but still helpful cap). Retail rates are a horror. Well, a much bigger horror.
(The NYS gold plans are better than a typical corporate employer plan; even my large multinational previous employer’s plan offering was similar or slightly inferior. Very high end employers’ plans might be better but I’ve never had one.)
LongHairedWeirdo
Quick note: I needed insurance; I knew I wasn’t subsidy eligible. I gave up on the useless state of Washington insurance call center, and just called Premara, and asked if they had policy_X available, or a near equivalent. They did; I set up bill pay through my bank and sent payment. The policy cost was precisely as on the state website.
And if you think about it, that all makes sense: why *not* sell the same policy directly to people who don’t qualify for subsidies?
So if enrolling on a state or federal website is a pain, you can try working with the insurance company directly, if you’re pretty sure you’re not getting a subsidy. No promises it will work, because insurance regs vary state to state, and it might just be a quirk in Washington’s laws that made things work for me. Still, there’s fewer moving parts to a direct purchase of a policy.
debbie
@Fair Economist:
I may be misreading, but I believe he’s purchasing insurance for just one month.
Jharp
@Icarus: “A lot of the replies here encapsulate the problem: you can’t offer people shit and then tell them “well, it was worse before.” That may be true, but it also isn’t compelling.”
It is true and might not be compelling so what do you think we should do?
Brachiator
@Icarus:
In 2014, I was in the hospital. I had employer health insurance. While waiting to be moved into surgery, I heard a guy a few feet away from me tell the medical personnel that if it weren’t for Obamacare, he would be dead.
The ACA is not shit for everyone.
Icarus
@kindness: ”Kvetch all you want about the Democrats Health Care plan because if it were Republicans in charge all along you’d have no health care options. I’m sorry it is so cumbersome but the alternative is nada. Be thankful nada isn’t what you can get.”
Hard to find a better encapsulation of “better things aren’t possible” than this comment…
Icarus
@Jharp:
Well, the Democratic party platform in 2020 was pretty clear. They explicitly promised to “reduce prescription drug prices, premiums, and out-of-pocket costs.” They control the presidency and Congress, so maybe they should do those things!
Sure Lurkalot
@Omnes Omnibus: Can’t disagree with anything you’ve said.
Still, employer based insurance isn’t exactly the bee’s knees. It restricts mobility and advancement. And at least in my experience, it got ever more and more expensive…from employers fully funding premiums to shifting that burden to employees more and more.
Jim, Foolish Literalist
@Icarus: better things are possible if we win more elections
myself I don’t think running against democrats and democratic policies is the way to do that
I know there is an attention seeking, and getting, faction of the left who disagree
Bill Arnold
Yeah. For a lot of Americans (particularly the young) health care consists of scrounging leftover antibiotics from people with insurance, and veterinary medicines, and the like. (And yes, I have seen this happen, personally. Badgered them to get an ACA plan so I wouldn’t be emotionally on the hook to drain my life’s savings to pay for medical costs for a vehicular accident, or whatever.)
Cameron
@Icarus: Those would all be great things, but I’m not sure you could get an exemption from the filibuster in the Senate for them and even then you might not get all the Democrats to vote for them. For sure you’re not going to get any Republicans.
Four Seasons Total Landscaping mistermix
@Jim, Foolish Literalist: We won an election and it sure as shit isn’t “the left” that is sabotaging our party right now.
Bill Arnold
@Icarus:
Mitch McConnell and fellow Senate members of the Party of Death smile at you.
Wvng
@Brachiator: Truth. The ACA has saved a lot of lives, and saved a lot of families from financial ruin. That is for the exchanges and also expanded Medicaid, which is also part if the ACA. When we needed insurance after my wife retired from state work, the ACA was by far the best option.
Jim, Foolish Literalist
@Four Seasons Total Landscaping mistermix: they sure as shit have in the very recent and relevant past
Brachiator
@Sure Lurkalot:
I keep hearing people plead for single payer “like they have in Europe.” But other countries have universal health care, set up and paid for by various mechanisms. Single payer is not the only option. I think a lot of legislative time has been wasted by a narrow band of supposed progressives who insist that there can only be one solution.
Medicare currently has a lot of problems. The current administration tried to improve Medicare with provisions related to hearing, dental and prescription drugs. And the current system will only get more expensive as a larger proportion of the population live past age 65.
And here in California, where health insurance is mandatory and programs like Covered California has increased availability, I still see that many people do not have a primary care physician or regular access to medical care even if they are insured.
There is a lot of work to be done, and we do have some good people working on it, but it is not as easy as just voting for some single payer plan.
Jim, Foolish Literalist
@Sure Lurkalot:
I love it all to pieces. Doesn’t make it a winning political issue, because the vast majority of people don’t want their own boat rocked on this very delicate, even frightening, issue.
germy
that’s why the rallying cry was “Improved Medicare for all”
Jharp
We had the local power company do an energy audit of our home.
Young twenty something recent Indiana University grad showed up for the job.
Highly functioning, polite, good communicator….
He did not work for the power company, they farmed it out to a sub.
Anyways, he was on a salary plus health insurance.
Didn’t bother to read the policy or do any digging to gauge his coverage.
Turns out it was not ObamaCare compliant and didn’t cover hospital stays.
He only found this out after a $58,000 dollar several night stay in the hospital after an emergency appendectomy.
Only in America.
Jim, Foolish Literalist
@Four Seasons Total Landscaping mistermix:
“an” election….
Icarus
I mean, even in their current BBB bill draft, the Democrats want to spend $285 billion on tax cuts for rich people (SALT cap repeal — people making <175k/yr get essentially no benefit, people making >850k/yr get a massive tax cut) and only $125 billion on reducing health care premiums.
Their actions make it clear clear that actually reducing health care costs for people is not a real priority for the Democratic party.
Omnes Omnibus
@Icarus: Cool story, bruh.
Cameron
There does seem to be some magical thinking about how tough it will be changing the system going forward. If you want an idea of the time frame, take a look at the evolution of health care in Korea.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447690/
Jim, Foolish Literalist
Folks going door-to-door in Virginia said that the number one issue on voter’s minds was healthcare.
and then they voted on racial panic, gas prices, and “oh, he doesn’t seem like he was one of those Republicans…” twas ever thus
Sure Lurkalot
@Brachiator: I pointed out in my post that Medicare too has gotten more problematic over time. I’m sure many countries are struggling with the costs and burdens of their systems. But most of them do not have the different strokes for different folks clusterfk that we have contrived.
I am cognizant of the power structures that keep it thus but it is cumbersome, inefficient and very costly.
Fake Irishman
@Icarus: you can quibble with SALT, but extending the American Rescue Plan subsidies (which are saving our friend Mistermix several thousand dollars next year) is a big deal to making health insurance affordable for upper middle income and lower earning families, not to mention filling in the Medicaid gap. So let’s ease off the maximalist trolling about Democrats’ priorities being screwwd up, OK?
(not to mention all the money this sinks into universial preschool and child care and making the child care credit refundable, and climate change)
Brachiator
@Sure Lurkalot:
This may be true, but many have other challenges. There is no magical health care nirvana where a system is installed and then runs perfectly. I know that Japan is having problems adequately maintaining a system with an increasingly aging population and not enough younger workers, and the British NHS is facing a number of challenges, including attempts by the Conservatives to undermine and privatize the system.
Omnes Omnibus
@Brachiator: The Swiss and Dutch have universal coverage but not single payer.
Icarus
@Fake Irishman:
Look I sincerely hope BBB gets passed (though I’m skeptical Manchin/Sinema will come on board now that the infrastructure bill is passed). But spending far more on SALT tax cuts for rich people than on making health care affordable (all while failing to do anything about skyrocketing drug prices) would represent a failure.
As I noted above, the 2020 party platform promised to “reduce prescription drug prices, premiums, and out-of-pocket costs.” So far, they haven’t done that, and BBB as currently written does nothing about prescription drug prices and little about out-of-pocket costs.You can’t break your campaign promises and then be surprised that voters aren’t rewarding you. “We didn’t keep our promises, but elect more Democrats and we might next time” isn’t a compelling pitch…
Ohio Mom
Too late for this advice now but I would have run my options by that Mayhew fella.
Actually, Ohio Family was in a pickle once a few years ago, and *did* run our options past David Anderson. He suggested Cobra for the uncovered month and to wait until the month was over, because you have a month to sign up and the coverage is retroactive. At least that’s how I remember it.
None of us had any medical emergencies, we skipped paying for Cobra and slid into the coverage provided by Ohio Dad’s new job. Of course that wouldn’t work if our gap had been longer.
All that said, the only hassle-free insurance my family has ever experienced is Ohio Son’s Traditional Medicaid. He’s eligible via his disability (that’s the short version, there were hoops to jump through to qualify), it pays for everything without deductibles or copays, and there has never been an argument about something being covered.
It looks like he’ll soon be forced into a managed care plan, the better for our elected officials to get a kickback or two. But until then, this is what I wish for everyone.
WhatsMyNym
That $14,000 max you keep talking about is the Family Out-of -Pocket Max. You have a individual max and you would only be paying part (third?) of any bills above the your individual deductible.
In Seattle, two 40 year old spouses can get a Bronze plan for Zero dollars/month. A Gold plan as cheap as $160/month (which lowers the deductibles and out-of-pocket).
ETA: income of $40,000 for the two.
Ruckus
@Icarus:
You are absolutely correct, it was far worse.
If rethuglicans come back in power it will be worse again. Part of that IS telling people that it was worse before, because it was and can be true again. If you don’t understand history, even recent history you are extremely likely to repeat it.
Our medical care industry is broken and it is broken by the same people that have broken the educational system, those people who think the only important thing in the world is money and how to get and keep as much of it as possible, no matter the damage. It is broken on many levels and one of them is how we pay for it.
I have a friend, he is 3 yrs older than me and we are both vets. He worked for a large corporation and was retired at 30 yrs employment when the company decided that they didn’t need to continue to pay anyone who’d been there longer than 30 yrs. (Yes losing all that experience has paid off well for them. Not.) They paid him a nice retirement bonus, his pension and paid him well enough as an employee that he get a nice deposit every month from SS. He uses the regular public healthcare system and has to make appointments and go to several different locations to get the same care I get in one place, the VA. He pays more for his meds than I do. When his insurance company decides that his doctor or healthcare professional is charging too much on his insurance, he has to find new caregivers. I don’t. Because of my income before I retired I had copays at the VA. It was still cheaper than what he pays. I’ve used the normal healthcare system for most of my decades and it isn’t better or worse actual healthcare than the VA. But the hassle and the cost is more in the civilian healthcare system. It was worse before the ACA. It’s not wrong to tell people about that, it’s not wrong to remind them, because the only way to get any of it better is to change it, and the only way to do that is to know what it was, what it should be and how to get there. It’s not magic but not knowing the history makes it far, far more difficult to change it, or even know the direction to change it.
What’s the old saying – “Those who forget history are doomed to repeat it.”
The Thin Black Duke
Don’t feed the troll, folks. Also: elect more Democrats, medical care gets better. Bitching about what the Democrats didn’t do isn’t helping because the problem is we don’t have the numbers yet. Pushing the narrative that voting is useless is tossing a toolbox into the gears.
Lyrebird
I has a confusion.
HealthyNY was here for at least a couple years before ACA was passed.
Hoping you can get a better plan somehow!
Chris T.
I’m paying over $1800/mo for ours. (But it is a Silver plan, and once I show no income, we should get subsidized, which will return roughly $20k for the year so that we end up paying about $240/mo or something.) This is in Washington state.
Mart
@WhatsMyNym: that was the key for wife and me on ACA coverage, keep 1040 income under $45k and was cheap. Stupid policy since gives repubs ammo “all your money is going to those people”.
marcopolo
My ACA plan (which includes dental & vision benefits) costs me ~$100/month and I get a ~$750/month subsidy (total out of pocket is capped around ~$2500/annually), but I make about the bare minimum one required to not be sent into my state’s Medicaid program. As I live in a red state where the lege tried to not fund the successful Medicaid ballot initiative that enshrined the program in the state constitution, I’d prefer to get my insurance thru the ACA than worry about the state dicking me over somehow thru Medicaid.
Jacqueline Squid Onassis
My ACA plan – which covered my wife and myself from 1/1 through the end of this month cost $73/month up until the subsidy increased mid-year at which point it cost us $8/month. All of my wife’s doctors were covered as were mine except my PCP. It has a $250 deductible/$1,000 max out of pocket. I had my nose rebuilt in March, hit my max out of pocket and haven’t paid a cent for anything since. I didn’t pay for Doctor’s visits (including multiple specialists), I didn’t pay for surgery, I didn’t pay for prescriptions. I didn’t pay for labs. It was the best health insurance I’ve ever had.
I started a 6 (or maybe 4) month contract job last month. Beginning in December I’ll have the pleasure of paying $800/month for a plan through my employer that pays zero for anything (doctors visits, prescriptions, hospitalization, labs) until I hit my deductible of a mere $6,000.
I guess state government is important for the marketplace.
I’m in Oregon and I couldn’t have asked for a better plan than my ACA plan. Thankfully this job will be over in April (or February) and I can get my great plan back again at that point.
David Anderson
@MisterMix — e-mail me.
Kim Walker
Please don’t start envying Canadian health care. When 1 out of 4 people do not have the family doctor to gain entry into the system, it is not good. Five day minimum wait to see your family doctor (if you have one) for urgent needs. At least 6 hours in an ER, if God forbid you need it. Over a year to get a friggin’ MRI, or a colonoscopy. And so on. It is just remarkably shitty. The bright spot is that you can get euthanized relatively easily and the powers that be are trying very hard to make it easier and more accessible.
Another Scott
@Kim Walker: We were visiting Banff a few years ago and stayed in a B&B. Another couple there was from Texas. The second morning, a Saturday, the Texas man came down for breakfast and was looking very bad and said he wasn’t feeling right. The hostess immediately called up some GP that she knew and he was seen that morning – maybe within the hour.
The next morning he was much better and sang the praises of the hostess and the doc he saw. It cost him nothing, or almost nothing.
It seemed like a pretty good system compared to what we have here in the “best healthcare in the world!!1” system in the USA. I’m sure it varies though.
FWIW.
Cheers,
Scott.
Mai Naem mobile
Unless you’re very wealthy, on Medicare or working for some governmental organization you’re basically screwed in this country if you get seriously ill. The ACA isn’t perfect by any means but at least a lot of people can dig themselves out of a $8-25K hole instead of a >$150K hole.
Raven Onthill
If you don’t have income for that month, I would think you’d qualify for a better deal, but listen to David Anderson, he’s the expert. Also, talk to a good insurance agent, who can help you navigate the system.
In general, the way to think about the low-end ACA plans is that they are club memberships. The club has a lot more fees, but they’re lower if you’re a member, and the membership gets you in the door.
sab
@Brachiator: Obamacare has problems, but at least it is actual insurance. Before Obamacare, you could by “insurance” but if you ever actually needed it you found out that they would find you had a preexisting condition that wasn’t covered so all your years of premiums were wasted money.
I am another one of those people whose life was saved by Obamacare. And yes it is really expensive insirance and that needs fixing, but at least it gets you real insurance.
J R in WV
@Icarus:
You display wilful ignorance, or are a troll, perhaps both. You know as well as I do that current legislative rule making requires a 60 vote margin in the Senate to pass anything that you mention.
We do not have 60 votes for anything in the Senate. Unicorns squirting out gold coins won’t get 60 votes in today’s Senate, let alone health care improvements.
Welcome to the pie safe… Goodby forever!
l3000
I would have sympathy if I didn’t live in KS and, as a single adult who makes below the level to get ACA at all, am currently uninsured due to red state Medicaid requirements. Be thankful you can get it at all. ACA is still too expensive for a lot of people; it also allowed a lot of us to get insurance when previously we were priced out of the market by actual illnesses. So yes, it is too bad two healthy adults pay a ridiculous amount. Now imagine pre-ACA and being someone with chronic illnesses priced out of the market altogether.