[Frondo]

When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services.

And, to be totally frank, having had a pre-existing condition that kept me from buying any insurance (literally no one would sell to me pre-ACA), the law's been a net positive for me.

I feel bad for people in other states, in Oregon it was been a pretty sweet deal for me.

[mgkimsal]

Yeah, it's pretty crappy in NC. First year of ACA we only had one company even offering any insurance in my county. And yeah, it's county-based for some reason - if I lived 2 miles in another direction I'd have had multiple options about 10-15% cheaper than what I had available.

Second year we had another option in our county which was about 15% higher than BCBS (which had gone up about 25% from the year before).

Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing?

We are > 100% from where we were wrt premiums from 2012. I expect some increase every year. I don't expect > 100%.

Colleague of mine is now facing > $1800/month health insurance pricing. He's... early 50s, married, 3 kids. This is with a $10k deductible. Another colleague with just one spouse and a child was facing going from $1300->$1650 this year, again with a fairly hefty deductible.

Given that this is effectively only something you'll get any benefit from if you're in a horrific accident of have a massive illness, this is now just really expensive catastrophic insurance.

I might feel slightly better about some of this if I actually knew anyone personally (beyond Frondo now!) who's benefitted. In my social circles, this has not even been close to a win for anyone. Either insurance has gone way up for people who can afford it, or it's still too expensive for some of my friends who are still unable to afford it (because they don't make enough money to qualify for the 'subsidized' pricing).

Bring on single payer...

[zrail]

We started on a $1500 indv / $3000 fam deductible PPO in 2014 for about $800/mo for two people. In 2015 the premiums went down maybe 0.5%. In 2016 the premiums have gone up 6% and the out of pocket max went up $500 per person to $4k.

ACA has absolutely been a net positive in my life. I had cancer in 2012 and so it would have been literally impossible for me to get health insurance outside of a group plan. With ACA I've been able to go independent, start my own business, choose my own clients, and fully control my destiny.

[ghaff]

The ability to get insurance for an affordable price (the parameters of which I realize people differ on) with pre-existing conditions outside of group plans has been one of the big wins of ACA. It's at least reasonable to argue that particular problem could have been addressed outside of the massive and controversial implementation that was ACA as a whole.

[briandear]

I agree. The Federal subsidies should actually be limited to subsidizing pre existing condition coverage. I am willing to allow tax dollars to cover the difference of pre-existing condition coverage since it would be a net gain for everyone. The problem is that the subsidies are available for everyone, regardless of prior insurability, thus, just like student loans have accelerated college cost inflation, subsidies for almost everyone in the middle classes have resulted in price increases.

Essentially, pre-existing condition insurability is where the government could have make a huge impact with minimal disruption to the overall system. Much like there are government mortgage guarantees available for higher risk borrowers, the same kind of system could have helped the pre-existing conditions people get coverage while not throwing the baby out with the bath water.

The alleged goals of the ACA were to get everyone insured. However it shouldn't have taken thousands of pages to accomplish that. A good portion of ACA has nothing to do with insurance at all.

I wish there was some scope restriction on bills. For example the latest highway bill contained passport revocation provisions for those with delinquent taxes. This forces politicians to reluctantly vote for something they don't like because the overall bill is important. Poison pill amendments are often not poisonous enough so we get stuck with a bunch of really bad laws.

[mgkimsal]

> The alleged goals of the ACA were to get everyone insured. However it shouldn't have taken thousands of pages to accomplish that. A good portion of ACA has nothing to do with insurance at all.

My own view is "getting insured" shouldn't really have been the goal, at least not with the current 'insurance' system in place. The goal should be making sure people have access to care/service, not access to purchase insurance. I have insurance, I'd be hard pressed to use it outside of a catastrophic event, because I have such a high deductible. Headaches with blurred vision... I may eventually go, but... I don't really want to be on the hook for $10k+ in bills just to find out "oh, it's nothing, get some rest".

Expanding medicaid would have ensured that more people would have had more direct access to care with minimal disruption to everything else.

[lisper]

> Yeah, it's pretty crappy in NC.

That's because your state is run by people who want desperately for the ACA to fail, and so they are intentionally making it as crappy as they can.

[yareally]

For comparison, my state's ACA plan is the same as Medicaid (several choices of insurance providers and I believe no cost for prescriptions).

The more surprising part was our Republican Governor was the one that advocated for it and pushed it through the party line (with a lot of grumbling). His argument was it would save the state quite a bit of money and so far I believe it has.

[dzeanah]

> Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing?

Let's be fair here. The ACA said that the feds would match the expanded medicaid enrollment for a few years, but after that the states would need to continue to sustain the larger enrollment on their own. Medicaid is a significant chunk of state budgets, and doing that meant raising taxes, or lowering expenses in other areas, or taking on debt.

It's not as simple as "screw obama, and screw poor people we ain't doing it." In the post-crash years, while money was scarce, there was some real concern over where the money would come from, how much it would need to cost, and how states would cope.

[popmystack]

If your state can't sustain something with the federal government funding 90% of your expanded costs, then maybe you need to rethink the state you're in. It's no doubt, most likely in the "south" in some form, so I'm not surprised the government can't operate correctly.

[maxlybbert]

> Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing?

Well, the increased Medicaid funding is temporary, but comes with permanently higher Medicaid spending. So a state might reasonably not want to accept that offer.

[jljljl]

Doesn't the federal government continue to cover 90% of the costs beyond 2020? That's still a pretty huge increase in funding.

[benjamcal]

To clarify, yes. After 2020, the federal government continues to cover 90% of the cost (compared with 60% normally) of the expansion indefinitely. So, for a state government, it is likely the cheapest way to ensure a large number of low income people are insured.

[dragonwriter]

60% is not the normal federal share; the normal federal share varies by State, depends on state economic performance relative to other states, and is a minimum of 50% for certain populations, 65% for other populations.

[benjamcal]

What you said doesn't contradict the 60%. 60% is the normal federal share. I had a job that specifically involved forecasting state budgets (which obviously involved looking at historical trends) and forecasting the ACA's impact.

To clarify, these variations have historically averaged around 60%, and likely will continue to (sans ACA expansion): http://kff.org/medicaid/state-indicator/federalstate-share-o...

[dragonwriter]

The increased Medicaid funding is permanent, though the 100% federal funding share for the expansion population drops in stages down to its permanent level, which is "only" 90%.

[bane]

My premiums have gotten lower (in one case they were completely covered by my employer). My father is going through some very expensive medical care right now for cheap and my mother has insurance for the first time in more than a decade. What has gone up is my providers increasing their charges with the final negotiated price being something like 50% higher than before.

[tracker1]

I'm paying less out of pocket now than my share at my last job, with netter coverage... though this year I'm paying as much for a plan with $1k more for deductible... it's pretty sad... I keep it because I'm on a few medications that would be far more out of pocket.

Something needs to happen with USPTO, especially medicine at this point.

[briandear]

Something needs to happen with tort reform and the cost of FDA approvals. The FDA process is hugely expensive and inefficient. Contrast the FDA with Switzerland.

The patent system is essential for medicines. I know many people don't like that reality but who will invest in pharma companies if their investment could quickly be nullified due to the loss of intellectual property? Would you invest in a company when the competitive advantage that company is immediately rendered moot?

However, there are definitely places for reform, so I am not fully defending the USPTO system, I am simply suggesting that a strong patent system is a fundamental motivator of pharmaceutical innovation.

[tracker1]

Pharmaceutical companies still make generic medications that are no longer covered by patents as well as over the counter medications. As for approval costs, the biggest cost for these companies is marketing, plain and simple. The actual people doing the research, I'm guessing are not solely guided by their pay or patents for that matter. I would presume that many people just want to make society better.

I am not suggesting that patents go away entirely, but their scope should definitely be reduced... extension patents in particular should not receive the same 20 years that original patents receive. The patent system has resulted in generations of gaming the system to the point where it no longer works.

I'm unconvinced that patents serve the public good in this day and age. I am convinced, however, that the vast majority of patents granted should not have been.

[ghufran_syed]

"Bring on single payer" - like the veteran's administration? Because that works so well?

[limeyx]

Those #s are insane

[rbritton]

Unfortunately, your situation must be specific to Oregon. I'm in Washington, and the closest plan we could get to what we had pre-Obamacare went from a $2500 deductible to $6300 with a premium increase of around 40-50%.

In my opinion, the problem was never the unavailability of insurance. The problem was (and still is) the out-of-control pricing of medical care -- $5000+ for non-sterile gloves [1] is a bit extreme.

[1]: http://www.rd.com/health/wellness/wildly-overinflated-hospit...

[cookiecaper]

I agree with you. I wish more people would realize their quibbling over a treatment for a symptom when they're hashing out a regulated private insurance marketplace v. single-payer. Our existing insurance system allows a lot of perversions of the marketplace and contributes to the root cause, but having the government sign a blank check isn't the answer either. We need to return ordinary market dynamics to health care if we want something that's sustainable over the long term.

[novalis78]

I think we need to talk way more about cost/pricing/fraud/transparency than the "insurance" red herring, which just became a problem because of cost in the healthcare sector.

[briandear]

The expensive gloves problem is due to cross subsidization and cost recovery. A good portion of the problem is due to under-market Medicare reimbursement rates; another part of the problem is that certain demographics that aren't eligible for Medicaid due to their lack of legal status incur expensive care (via the emergency rooms) that goes unreimbursed. This problem is especially accute in places like Texas.

I would suspect that more free primary care clinics could take some of the burden off of emergency rooms in terms of cost and those free clinics could even be funded by insurance companies from the money their saving from not having to pay for $5000 gloves anymore.

A cash-payment medical system would also solve some of these problems. With opaque pricing, hospitals get away with solving budget issues by overcharging. If you actually saw the menu of what things would cost and you were paying out of your pocket, nobody would ever tolerate $5000 gloves. Market forces would fix the cost overages very quickly. As it is now, very few people actually directly pay for their own care and thus are less motivated to care about price. "Insurance covers it," is all many people care about.

[Turing_Machine]

" Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better."

You are in the minority.

Every insurance company that provides Obamacare in Oregon is increasing rates for the average customer this year.

http://www.oregonlive.com/health/index.ssf/2015/07/more_than...

In fact, the State of Oregon has actually ordered some of the companies to increase their rates more than they'd originally planned.

http://www.cnbc.com/2015/06/22/oregon-dumps-cold-water-on-lo...

[mgkimsal]

That seems really crazy, but then... Frondo just said the company he was with before went out of business. Why? Were they, in fact, not charging enough to cover their costs (supposedly the motivation behind Oregon raising prices)?

[SwellJoe]

It isn't ACA that has caused me problems, or at least the law itself.

The description given matched my experience with insurers before ACA. My problem with ACA is Healthcare.gov (still). It is possible to go through the entire application process, make one mistake or fail to provide the right detail, and end up disqualified from buying insurance through Healthcare.gov (in my case, I used a mail forwarding service address, because I travel full-time). There is no do-over, no online process for correcting the problem with the application. You have to go through a protest process that involves mailing physical letters somewhere. Fuck that. I'd go back to the nightmare that is pre-ACA private insurance, before I beg some bureaucrat, by mail, for the privilege of paying too much for insurance.

Healthcare.gov got a lot of flack in the beginning for costing too much, delivering too little, and being too flakey. All of those things are still true. It's also dehumanizing.

[dragonwriter]

The federal exchanges (for which healthcare.gov is the portal) were never intended to be a good choice (or even to have to exist at all), they were in the law as a minimal fallback to be applied for states that failed to implement their own exchangees.

[SwellJoe]

Yes, my "home" state is Texas, which has been extraordinarily regressive on ACA. It might be time for me to consider making another state "home".

[briandear]

The traveling full time "problem" affects me as wel. When some company or another asks, "Where do you live?" My response is preceeded by an audible shrug.. I seems that many companies actually plan to come visit me and are put out when I explain that my physical location is really of no concern to them. For example, banking. If I give a Texas address and agree to Texas terms and conditions, why would it matter that I spend 11 months a year in Europe. My mail arrives, I do my transactions online.. So what's the problem? Twentieth century thinking, that's what.

[zo1]

Those are most likely regulations enforced on to the banks. By the time it gets to the low-level employee that checks/asks/confirms your address, it's probably morphed a bit, and each employee has their own interpretation of what is "okay" when it comes to addresses.

[snatoeusntaoeu]

I feel bad for people in other states, in Oregon it was been a pretty sweet deal for me.

I moved back to Oregon from California several years ago. I was astonished at how much more expensive insurance was in OR than in CA.

I've been told that Oregon has had a lot of protectionism for local health insurers, so they didn't have to compete much. So perhaps you're just seeing Oregon coming into line with other states...

(By the way, I had a pinched nerve in my neck when I moved. No insurer would take me, and one told me that they wouldn't insure me until nine years had passed without any symptoms)

[akulbe]

Who's your carrier currently? I'm in Oregon as well, and I'm not impressed with the offerings here, at all.

[MCRed]

The reason nobody could sell you insurance with your pre-existing condition before is that regulations prevented making plans for conditions. EG: You couldn't make a national diabetes insurance plan for people with diabetes (and the economies of scale that go along with a pool of all people with diabetes) because it was effectively illegal.

If the ACA had merely fixed that, then your premiums would be going down more and you'd be getting better insurance.

[Frondo]

You know what? My pre-existing condition was that I'd had my gallbladder removed in the early 2000s. That's it. Uninsurable for 10 years because of an operation which I recovered from fully in less than a week.

Telling me it's "regulations" that had every insurer reject me? Pull the other one, it's got bells on.

[facetube]

My preexisting condition was "history of headache". I was denied by every insurer that did business in our state in 2010 and 2011. I wish I was kidding. Had I failed to mention the headache thing and sought treatment, I would have been vulnerable to rescission.

[mgkimsal]

My "pre-existing" condition was that I'd been to the doctor for heartburn in 2008 and been prescribed a 2 week course of medication.

Sorry - it wasn't quite the same as not being able to get insurance at all. Didn't mean I couldn't get insurance at all, but was 'rated' fairly higher than what was originally quoted.

[HarryHirsch]

Citizen Frondo, you don't understand. If the market says you must not be insured it is right because the market is always right. Why, on this board you had people tell with a straight face that one should not bother to eradicate schistosomiasis and malaria in the African continent because if the continent was meant to be productive people would be spending money in the project right now.

[zo1]

If the OP is correct, then it is not the market that is enforcing the insurance scheme to reject cover for him based on pre-existing conditions, but rather the state that is making it illegal for schemes to be tailor-made for specific (pre-existing) conditions.

[zo1]

>"The reason nobody could sell you insurance with your pre-existing condition before is that regulations prevented making plans for conditions"

I didn't know about this, but it changes quite a bit regarding pre-existing conditions. Could you please point me to a citation or something about this?