[smsm42]

I though medical insurance is available to self-employed. Is it not the case?

I've also heard many self-employed people now face a significant increase in their healthcare costs due to the fact that many high-deductible catastrophic insurance plans are illegal under ACA and plans that cover everything from contraceptives to mental health problems cost a lot more. At least I've seen many reports from self-employed people that they got notes from their insurance companies that their plan is cancelled under ACA and is no longer available.

[timr]

No, high-deductible plans are not "illegal" under the ACA. The ACA marketplaces offer high-deductible plans. If all you want to do is pay for catastrophic coverage, you can do that.

What's happening is that some existing catastrophic plans don't meet the requirements of the ACA with regards to coverage, cost-sharing, annual spending caps, and other metrics. Some of these plans are closing rather than conform to the law. But there is no blanket provision against high-deductible plans.

There are some suspiciously similar stories floating around the conserv-o-sphere involving vaguely specified elderly couples who are just spitting mad about having to give up their cheap, crappy, high-deductible plan because of the ACA. These stories smell very much like astro-turf propaganda, and should be treated with high levels of skepticism.

[dragonwriter]

Another thing that is happening is that some insurers are realizing that the individual plans they offered prior to the ACA (which they have to do all the work of acquisition/marketing, and whose potential client pools are limited compared to exchange-listed plans because no one is eligible for a subsidy to purchase them) are no longer competitive in the marketplace given ACA exchanges where: 1) A substantial part of the cost of marketing is subsidized by the public who provides a discovery portal, and 2) Lots of potential clients will be eligible for premium subsidies.

The net effect is that exchange-listed plans -- because of the two forms of subsidy -- have lower per member acquisition costs than traditional individual plans, meaning that for any given premium level, they can provide more profit and/or more coverage. These plans can expect to lose lots of their existing customers to exchange plans in the short-term, and its not really worth the effort to replace them -- so, for the insurer, it makes sense (especially since if they are also offering exchange listed plans) to just cancel the no-longer-viable non-exchange individual plans rather than continue to bear the fixed overhead of operating them when their sales prospects aren't good.

[smsm42]

>>> No, high-deductible plans are not "illegal" under the ACA.

Of course, the mere fact that plan is high-deductible does not make it illegal. However, as far as I know, under ACA it is illegal to offer plans that restrict coverage of certain options. Which makes specific plans that were restricting them (and thus making the plans cheaper) illegal, and they are getting cancelled because of this.

>>> There are some suspiciously similar stories floating around the conserv-o-sphere involving vaguely specified elderly couples

I've personally seen multiple scans of officially looking letters saying things in the vein of "our insurance company discontinues this plan because of ACA". Are you saying all of these scans are fake and produced by astro-turf propaganda? To choose most "propagandy" one, just to get it out of the way, here's an example: http://michellemalkinblog.files.wordpress.com/2013/09/screen... This is from Michelle Malkin, google who it is if you don't know, it is a very real (though not that elderly) person. Is it true or fake?

[timr]

As I said: some existing plans don't meet the requirements of the new law, and are being discontinued. It doesn't matter if I think your one cherry-picked example is fake, because, again, some plans are being discontinued.

Regardless, high-deductible plans are legal under the ACA.

[GabrielF00]

Contraception and mental health services are basic medical needs. In a given year more than 25% of college students seek treatment for a mental health problem[1] - and given the stigma surrounding mental illness, that may be a gross underestimate. At Harvard about 40% of seniors reported seeking mental health treatment. I don't know the percentage of women who use contraception, but I'd imagine its very high. If you're going to provide health insurance, it should cover common medical problems. You should also cover things that are preventative so that people don't end up needing catastrophic coverage. Paying for someone to see a therapist and take an anti-depressant is cheaper than paying for inpatient treatment if things spiral out of control. Paying for contraception is a hell of a lot cheaper than paying for an unplanned pregnancy.

[1] - http://www.nami.org/Content/NavigationMenu/Find_Support/NAMI...

[smsm42]

That's like saying gas is a basic need for a car to move, so car insurance should cover gas. You are emphasizing exactly the problem that is at the base of all current healthcare debacle - medical "insurance" is no longer an insurance - probably wasn't for quite some time - it is a byzantinely complex system of payments for various services with wildly varied degrees of necessity, and significantly based on political considerations.

>>> You should also cover things that are preventative so that people don't end up needing catastrophic coverage.

Some people will end up needing catastrophic coverage, that's what it is for. But what you are saying people should not have a choice between buying only catastrophic coverage and managing other issues according to their current financial needs and abilities - possibly, yes, taking some limited risk on themselves - and buying comprehensive, but more expensive full-care all-included package. That would make it more expensive for those who were willing to take the risk, since this risk would be taken now by insurance company, and they will want to get paid for it, risk-shifting is never free.

>>> Paying for someone to see a therapist and take an anti-depressant is cheaper than paying for inpatient treatment if things spiral out of control.

Paying for car maintenance is cheaper than buying a new one. Yet nobody says car insurance should pay for routine car maintenance - those are different things, and people manage to take care of their cars just fine without car insurance paying for it. You're again confusing healthcare and health insurance and seem to be under impression that the only way to administer healthcare is under the umbrella of all-encompassing "insurance" policy. My point is exactly that it is not true, and that ACA moving in this direction makes it more expensive, especially for people that otherwise would like to take a bit more risk than average person in order to allow them to profit later. Those exactly people are entrepreneurs, so the claim that ACA makes them better off sounds a bit doubtful for me.

[dragonwriter]

> That's like saying gas is a basic need for a car to move, so car insurance should cover gas.

Not spending money on gas doesn't make things that existing mandatory car insurance does cover (liability) more likely or more expensive. In fact, it makes them less likely. Not spending money on mental health and contraception, OTOH, does make things that catastrophic medical insurance would cover more likely.

Financial incentives to defer costs is one of the reasons why the US healthcare system is by far the most expensive, not just in total but on a per capita or per GDP basis, in the world, despite it nor producing better results that other developed-world systems and, unlike every other OECD country except Mexico, not providing universal coverage.

[true_religion]

Well its not really "insurance" if it covers a condition that is not just predicable, but probable. For example, nearly all women on health 'insurance' will eventually use either contraception or pre/post-natal care. Since its a given, the health insurance system is just negotiating rates for you rather than betting that you'll never need contraception.

It'd be better I think to separate the systems into basic health care, and catastrophic insurance.

[ryandrake]

Not to everyone. I seriously thought about contracting full-time, and when I went to buy personal health insurance, I was denied based on a pre-existing condition (they wouldn't even tell me what the condition they thought I had was). So, my only choices were 1. contract and risk health bankruptcy or 2. go back to W2 work.

[smsm42]

That sounds weird - I thought there's COBRA and HIPAA explicitly provides plans for people with uninterrupted (for more than 63 days) coverage, regardless of medical history, e.g.: http://www.dmhc.ca.gov/dmhc_consumer/hp/hp_hipaacp.aspx

But of course, not knowing your specific situation (and not being a lawyer) I don't know what happened, but it seems like whoever denied your coverage may have violated the law.

[ryandrake]

To clarify, I was long past the COBRA period, out of work for quite a long time by the time I applied for individual coverage.