[hardcandy]

As a self-employed developer I have an ACA plan and I can tell you first-hand it feels like a total fraud. I pay $300/month but also have a $6k deductible, which means the plan doesn't really pay for anything until I've already spent $6k out of pocket. I have no problem with a $6k or even $20k deductible because I work hard to remain healthy but then my premiums for what is essentially a catastrophic policy should be much lower (around $75/month). Fortunately I can afford the extra amount, but I can see how it would be extremely painful for a family at the median income. My MD friends tell me the economics are based on people who work diligently to improve their health subsidizing people who could care less and actively sabotage themselves (e.g. non-compliant diabetics who eat like crap and don't medicate...not even diabetics as a whole). Unless and until the conversation about personal responsibility starts it seems hopeless. Whatever Obamacare started out trying to be, it has been twisted into something else and badly needs reform.

[karmajunkie]

Just out of curiosity, when did you make the move to self-employment and the individual exchange?

I was self-employed for years prior to the advent of the ACA, and my experience was that my premiums were about the same, deductibles were the same or higher, PPOs were out of the question, and I was rolling the dice on whether I could even get coverage for myself or my family because of preexisting conditions. If that market were in place today, getting coverage would be an impossibility for myself and my wife, who is a cancer survivor, leaving us to the high-risk pools where the premiums would be in the 5 figure range annually.

Yes, the ACA has some problems, but if the right wing in Congress hadn't been so hell-bent on making it fail to the detriment of all constituents, chances are we'd have something that works a bit better (if still imperfectly.)

[hardcandy]

I've been self-employed for about a decade. Prior to ACA I had catastrophic insurance with IIRC about a $10k deductible for 25% of the ACA cost. But I was a healthy, non smoking male in my mid 20s (back then) with no pre-existing conditions. If you had pre-existing conditions then it doesn't surprise me that your ACA rates were the same or lower, which illustrates what ACA really is: a subsidy (tax) helping out the (mostly) old and (mostly) chronically ill paid for by the (mostly) young and (mostly) healthy. I prefer not to think of it as red-versus-blue partisanship and instead in objective economic terms. Personally I have no problem subsidizing people who are born with chronic illnesses, or fall on hard times; I have a few cancer survivors in my immediate family and I've seen the impact it can have. But I don't think that we should be subsidizing people who have diseases borne of negligence (adult onset diabetes and other obesity related diseases) who refuse to do anything to help themselves and as a result consume extreme amounts of health care resources. It's becoming clear that for the time being at least demand far exceeds supply in the health care services market, and that means having to decide how and when to ration care. I can afford to pay inflated ACA rates and I can afford to pay for private concierge-style care in the face of a supply-demand imbalance in the market. But what about the middle class family making $50k/year who is now spending 20% of their net take home income on health care? Unfortunately there aren't many easy answers in this debate and it's especially difficult to even start the discussion given how polarized it has become.

[rogerbinns]

Why should people who live further north have to subsidise those in more southern sunnier climate and are more likely to get skin cancer? Why should I as a non-rock climber subsidise those that do? Why should those without children subsidise those who do? Why should those in walkable cities subsidise those who drive more in less walkable ones? Why should those who have taken a vow of abstinence subsidise those who haven't? For virtually everyone there are always some discretionary choices they make that increase their health risks.

There is a fix, but it involves government taking a big picture view. Stop subsidising bad food, and ensure people have as good access to "good" food as they do to bad. Provide youth centres and similar community access to places where people can get into the habit of exercise. Examine transit and see how to get people to spend less time sitting in cars. See what can be done about improving the quality and happiness of all citizen's lives. All of this isn't instant or a magic wand, but is something that can collectively help a lot over time.

[jdlshore]

Same here. My family is healthy and yet my (self-employed) health costs were increasing by double-digit percentages every year pre-Obamacare. Go back and look at the news articles for that time. Lots of articles about small businesses unable to afford health care insurance for their employees, statements about salaries remaining stagnant because health costs were a larger and larger part of total compensation. Not to mention the rampant coverage refusal from insurance companies. (I even ran into that practice after mentioning to my doctor one time that my back was sore from picking up my infant son. It went in my medical file as "acute back pain" and bam, back conditions excluded on my policy. Even after jumping through hoops and getting a letter from my doctor.)

Once Obamacare kicked in, my health costs dropped nearly in half. It may not be perfect, and I blame the right-wingers for preventing it from being improved, but it solved a very real problem. Things are undeniably better now.

[wutbrodo]

I had roughly the same plan as you (I'm on a sabbatical). I thought autopay was set up but my second month's payment failed to go through. I was traveling for a few months at the time, and since insurance companies are universally incompetent, they sent me a few letters (and zero emails to the address they had on file) before cancelling my coverage.

The nice part is that, since I'm not not eligible to re enroll on the exchanges, the short term insurance plan I have to buy is MUCH cheaper. For the months of July - December, I'm paying around $350 for a catastrophic plan. If I was working the penalty would probably hit me hard but since I'm on vacation, getting dropped out of the exchange has actually saved me quite a bit of money.

[pgroves]

My story is very similar except my insurance company went out of business yesterday:

http://www.chicagotribune.com/business/ct-land-of-lincoln-sh...

[gohrt]

Where's the fraud? It seems that your complaint is that health insurance is surprisingly expensive when it includes too many people who might need it. Catastrophic health care protection costs $4K/yr, about as much as transportation or food, less than rent, more than telecommunications. So? Where's the fraud in that?

[hardcandy]

I just priced out a (non ACA) catastrophic insurance policy with roughly the same deductible as my ACA plan. It came in at $75/mo versus the low $300/mo for what I pay for my ACA plan. I assume this reflects the fact that I am being risk pooled with other non smoking healthy mid 30s males without any pre-existing conditions. By ''fraud'' I meant that I feel like I am being charged too much for too little, and those price points would support that. Of course it's happening in the context of a subsidy that society has determined it wants to create as discussed elsewhere.

[ZeroGravitas]

You don't seem to realise that you're subsidising your future (potentially hypothetical) self.

You have to run the numbers and put in the chance of you marrying and having kids and someone having cancer or being in a bad car crash or similar, or just getting older, and potentially getting refused coverage or going bankrupt due to medical bills.

Only then, if the NPV is less than under the current scenario is there something worth complaining about. (Since no one ever makes this argument and instead says silly things about the costs for healthy young single men with no history of health problems, I'd guess you are actually saving money under ACA)

Otherwise you're just gambling, but not even admitting you're gambling, which is pretty dumb behaviour.

[cylinder]

These plans were expensive and shit long before ACA. My parents were self employed so I had these plans all the way up to 26.

Obamacare was a patch designed to eventually fail with a complete overhaul of the system needed with single payer and private system on top. Unfortunately I don't see that happening in this country.