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Employees Start to Feel the Squeeze of High-Deductible Health Plans

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Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#51

Post by mrosett »

WalterSear wrote: post #37
mdorazio wrote: post #16

Earlier quoted context omitted.

The parent comment is exaggerated, but I think the point is that prior to ACA, employer-provided plans tended to be cheaper and have lower deductibles largely because insurance companies were able to drop or deny coverage whenever they felt like it for individual plans to keep their margins up. While logically true, this is roughly equivalent to hearing from an old coworker that South Africa was a great place to be w…

It's more extreme than your example. The parent is ignoring the fact his great healthcare experience is predicated on them being able to drop him the moment they could, when his illness became too expensive. Ending pre-existing conditions was the game changer in the AMA. Treating people is obviously more expensive than not treating them.

That's just not how it worked with employer insurance. Perhaps they could drop your whole company, but the insurer couldn't unilaterally cancel a single employee's plan.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#52

Post by IronWolve »

apohn wrote: post #32
tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

I think the value of this really depends on the employer. At a previous role they started switching to an HDHP with an HSA and did a great job (initially) making that fairly attractive versus the low deductible plan with higher premiums. At my current employer, the deductible per person is close to $4000 and the family limit is ~$10K. The employer provides some money if you have an HRA, but very little if you take th…

Same, Work switched to HSA medical. Pre-ACA single employee had basically medical paid by work, Post-ACA, they moved to an HSA (almost mandatory I guess) that work kicks in money per paycheck. BUT, now I have to match the minimum and have a high 8k deductible. So everyone just took a pay cut post-ACA, and if we use the medical, we even pay more. No more co-pays, I have to pay full price doctors visits.

Its easier for me to go to urgent care, say I dont have medical insurance, so I get a cheaper uninsured rate, then submit my medical care expense to my HSA for reimbursements, then if I hit the yearly deductible, claim I have insurance.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#53

Post by kasey_junk »

johnnyletrois wrote: post #12
tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

Not all employers offer HSAs to go along with their HDHPs. Mine doesn’t and it’s very frustrating. I want to save pretax money in an HSA but I can’t.

There is no requirement for your employer to provide the HSA. Frequently the employer can get better deals on the HSA than you can individually (like no waived maintenance fees and the like) but you can for sure open your own.

In fact once you have enough money in there that you are moving out of liquid investments then you definitely want to shop around for HSA much like you would for an investment account.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#54

Post by jandrewrogers »

duxup wrote: post #3
mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

How so? The choice of covering crappy plans is the employer's choice... and crappy plans are what have been pushed AFTER the ACA was passed. Largely by the GoP... Is that what the ACA was, or what someone(s) who want it to fail want? There's a weird narrative where any event is tied to the ACA while they ignore what the healthcare system is in the US overall.

The cost to employers of very good plans massively increased after ACA went into effect. When this changeover happened, I was running a company where we paid 100% for one of the best healthcare plans available in the state for both the employees and their families -- people really appreciated this benefit. This was the polar opposite of a "crappy plan", and it wasn't inexpensive to begin with.

After the ACA, this plan became so expensive so quickly that continuing this plan became nearly untenable financially and now these types of plans have become increasingly unavailable in any case due to that cost escalation. If you were formerly on one of these plans, of course the post-ACA environment seems like a big step backward. This happened in one of the deepest of blue states; the Republicans can't be blamed for the destruction of health insurance benefits here because they were never involved. The cost of healthcare here has not risen nearly as fast as the cost of providing top-tier healthcare benefits did.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#55

Post by jdoliner »

I've been trying for a while to figure out what would be a good metric to judge the ACA by. Most of the time it's success is talked about in terms of number of people insured, but that doesn't really capture how well insured they are. Life expectancy seems to be the only well known (at least to me) stat that begins to capture the health of the nation. We've now had 3 straight years of declining life expectancy in the US [0], a single year is virtually unheard of in developed nations. Now there are lots of confounding variables, and it's certainly not possible to say the ACA is the cause. And 3 years of downward trend, isn't historically unprecedented. However, it certainly makes it hard to paint the ACA as a success, I'd want to see some compelling evidence that the ACA had made America healthier, which doesn't exist right now. The question to me is how long we can accept a downward life expectancy trend before we start looking at the ACA as a potential cause.

[0] https://www.smithsonianmag.com/smart-news/us-life-expectancy...

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#56

Post by rockinghigh »

mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

The increase in high-deductible health plans (HDHP) enrollment predates the ACA by many years. You can look at the trend here: https://www.cdc.gov/nchs/products/databriefs/db317.htm

Their role is to protect against very high bill of $5,000 and up due to major surgeries, illness, pregnancy, and so on. They should definitely be completed by a health savings account (HSA) for day-to-day coverage.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#57

Post by sithlord »

tptacek wrote: post #38
mrosett wrote: post #2

You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance. I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best onc…

I'm not seeing the connection to the ACA in your argument. If your argument is that the ACA raised the price of health insurance, that's incorrect: health insurance premiums had been skyrocketing prior to the ACA (that crisis was what generated the political capital to pass the bill), and the ACA in fact reduced the rate of growth in health care costs.

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance.

With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did that put it in place.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#58

Post by overcast »

jak92 wrote: post #21
johnnyletrois wrote: post #12

Earlier quoted context omitted.

Not all employers offer HSAs to go along with their HDHPs. Mine doesn’t and it’s very frustrating. I want to save pretax money in an HSA but I can’t.

I don't understand that. Literally the only "benefit" of a HDHP is the HSA. Why do employers not offer one?

Because you can get your own HSA, it does not have to be employer supplied. I have an HSA with Fidelity, and an HDHP from my employer.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#59

Post by overcast »

johnnyletrois wrote: post #12
tptacek wrote: post #4

Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

Not all employers offer HSAs to go along with their HDHPs. Mine doesn’t and it’s very frustrating. I want to save pretax money in an HSA but I can’t.

Yes you can, go to Fidelity and sign up for one. Takes like 10 minutes. Transfer money, buy a fund, away you go. Just like an IRA, except never taxed at any point. Besides employer matching it's the best freaking retirement deal there is.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#60

Post by LarryDarrell »

If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room.

I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

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