What is that ACA anyways? Basically what our dear leader and his henchmen did was to rewrite the basic non-group major medical (MM) insurance policy.
It used to be that one could buy a basic MM policy that cost $125 or so per month and covered up to a million or so coverage for the year -- there were limits; and it had a deductible of $10k or so. Don't quote me on the numbers, this is my general knowledge and, of course, those days are gone for the nonce.
What was decided was that 1) everyone needed Health Insurance (HI) and 2) the basic policy had to have a bunch of stuff.
The bunch of stuff is the big problem. They decided that there would be a lot of "free" stuff and that even if you didn't want some of the stuff, you still had to pay for it. For example, maternity is covered. Great if you are female and 20 to 40, but worthless otherwise.
(I'm going to discuss the Bronze plans. I signed up for one of these. The others cost more up monthly, but the deductibles kick in earlier. They are worth looking at if you get sick a lot and your income is low as there are subsidies. )
So the bare-bones policy went from $125 per month to $650. Rumor is that the numbers will rise as there is a lot of red ink in the system. But the deductible went down. It's not $10k but it is $6500 and there is no limit per year.
So basically before you get anything for your bucks, you will spend 12 * $650 + $6500 per year. This is $7800 + the $6500 or about $14k. Now that might be cheap if it keeps you from bankruptcy, but as a normal monthly expense, it's over $1000 per month. Some of that can be paid for via a Health Savings account, which allows you to use pretax dollars. But there are restrictions on who can use that and it is only for the high deductible plans for people with low income.
"What about the poor people?" I hear you cry. Yep, we have something for them.
In California if you have limited income, you can get help with the plans. If you have very little income then they will plunk you into medi-cal
Note that financial worth is not part of this -- it is based solely on income. Note that if your income cannot be confirmed from a ping to the IRS, you may have to document the income you have. There are a number of ways to do this -- basically you upload various statements. They give you some time to do this.
The Kaiser plan I signed up for allows some free stuff before the deductibles kick in. Per their blurb on the web site, the plan provides for 3 office visits, 3 urgent care visits and 3 emergency visits per year. After those you pay everything until the $6500 limit, then they get the rest. As I mentioned above, if you are not very sick and don't go to the Dr. much, this is a reasonable plan.
Now, as the law stands, and I would guess it will change drastically if Washington gets their act together, you only need this until you are 65 and are enrolled into MediCare. The reasonable strategy is to keep income low and ride the subsidies until 65. (Note that while universal HI might be a good idea, the way this was done and what was covered and what was "free," the program is not self sustaining. There will be changes if the pols have any intelligence. I'd prefer going back to a cheap, high deductible plan and others for folks that want more / need more services. But note that if you need $500 worth of care every month, then that policy has to cost $500 + $125 (for the big stuff) + some overhead + some profit.)
Note that there is a period of time in the year that you can change your plan. There are life events that will open the door and let you change or enroll. Loss of job, divorce, retirement, etc.
I used the phone exchanges to some of this and it went quite well. The operators were good, knew what they were doing and could get stuff done. For example I did something reasonable when I started my account, but my record was locked. It needed the phone guys to unlock it. Also the code is crappy. For example, I wanted to enroll on 4/1 and I couldn't do that 2 weeks in advance. "Call back on 3/30 or 3/31 and we can sign you up." Who wrote that policy? It's not like there isn't a start date on everything.
That's about all I know. Is this the best way to get health care to everyone? Well, we didn't do that. We got them health insurance. And if they can't afford the deductibles, then they can't use it. Basically it feels to me like a vast rip off of the folks that buy the basic plan at anywhere close to the full pop of the policy and are not very sick. If you are expensive to treat, then this might work for you as someone else will be paying your medical bills.
"What about single payer," I hear a member of my family say. In theory I think she is right. You could design a system where all the bills get paid by some benevolent government agency.
However, I believe that in practice, that is the path to disaster. The reasons I believe this is that the insurance companies have reasons to be frugal, to be efficient. Government agencies don't work that way. In fact the more they spend the better it is for the agency. Bigger budgets are a goal if you are a government agency. And it is not their money they are spending. It's yours. More on this at some later point if I get inspired or have a couple of beers.
Comments are welcome. I believe the numbers to be fairly accurate, but don't trust my advise for anything -- well, I know a lot about yo-yos and software.
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