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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

#291

Post by jowiar »

dominotw wrote: post #195
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…

COBRA is cheaper for me than ACA.

If your previous employer had a cheaper risk pool than the general public, it makes sense that this could be the case.

Fair warning: if you’re doing this while self-employed, there are tax issues that may make getting a plan on the exchange cheaper.

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

#292

Post by AnthonyMouse »

inetknght wrote: post #100
AnthonyMouse wrote: post #49

Earlier quoted context omitted.

> The only "advantage" is that companies have to pay smaller premiums and employees are greatly discouraged from getting care due to high costs. In principle the advantage is that employees are greatly discouraged from paying too much for care. If the insurance pays for everything then what do you care if your doctor is charging $1000 for a physical instead of $50? If you're paying out of pocket, now you care. The pr…

> we also have a lack of price transparency Transparency is only half the battle. Setting prices to something reasonable is the other half.

That is one of the major ways prices get to something reasonable. Once you have people taking cost into consideration when choosing a provider, it becomes a competitive advantage to have a lower price in a way that it hasn't previously.

Obviously you have to execute this well and without the rules getting corrupted by inefficient businesses that want to keep their margins, but "rules are not corrupt" is the sine qua non of reducing prices regardless of which specific mechanism you use.

One way to fix that central problem is to decentralize it. Eliminate the federal rules to be replaced with state and local rules. Then you may get one city or state screwing things up, but it at least puts the upper limit on how expensive things can get there at the cost of traveling to a different place with different rules and lower costs, and the travel cost is naturally lower between cities or states than between countries. (And having the option to do that generally prevents you from having to actually do it, because the local providers still want your business more than they want the higher margins.)

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

#293

Post by greendestiny_re »

I was recently introduced to the idea of gluing and/or stitching one's own body parts or open wounds in case of a severe injury due to the costs associated with US healthcare. I found the nonchalant discussion of such horrible suffering absolutely incredible and would advise everyone to try some medical tourism. Here in Bosnia&Herzegovina, abdominal ultrasound is 20€, colonoscopy is 100€, one tooth filling 15€ and a tooth implant 600€. Nearly all my friends have settled outside B&H but I stayed simply because healthcare is so cheap compared to other, wealthier countries.

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

#294

Post by lamarpye »

klipt wrote: post #274
lamarpye wrote: post #154

Earlier quoted context omitted.

Was the ACA the best to address the problem of pre-existing conditions? https://www.theatlantic.com/business/archive/2011/06/why-has... "There were supposed to be millions of people who were uninsurable because of pre-existing conditions. We heard lengthy testimony about their terrible plight. I don't think it's too strong to say that this fear--that you could get sick and no one would insure you, that's right, you,…

> Wouldn't be better to create a special program for people who fall into this category? Why? The only difference between "people who have already been diagnosed with cancer" and "people who are going to be diagnosed with cancer" is that you know who the first group is. The second group is hidden among the "healthy" people. But both groups will need the same treatment.

You didn't understand what I wrote. I am talking about the group of people that were uninsurable because of preexisting conditions. This group of people was used as a reason for the ACA. However when a pilot program was run before the ACA went into effect, the size of said group appeared to vastly over-estimated.

So the reason for a special program would be to help the people that need it and not mess with the entire country insurance.

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

#295

Post by [deleted] »

nostrademons wrote: post #192
WrtCdEvrydy wrote: post #108

Earlier quoted context omitted.

My favorite one was pregnancy being a pre-existing condition so if your husband got fired (noone would ever fire a pregnant woman for no reason), you couldn't get insurance when you needed it the most.

"noone would ever fire a pregnant woman for no reason" Companies do this all the time. My sister worked at a major oil company that laid off all the pregnant women and new moms out on maternity leave within her department. (To be fair, they also laid off about 1/3 of the rest of the company as well.) It's totally illegal, but if you've just been laid off and have a new baby on the way are you really going to have the…

[deleted]

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

#296

Post by victor106 »

pdonis wrote: post #230
CptFribble wrote: post #196

Every discussion on healthcare payment structures in this country is completely asinine. Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool. How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed. But as long as we keep ourselves fractur…

> Healthcare is best managed as a risk pool. No, health insurance is best managed as a risk pool, which, as you say, should obviously be everyone. But much of health care is not health insurance because it doesn't deal with insurable risks. Your need to get an annual physical isn't an insurable risk. Neither is a one-time appointment with a doctor to see if your headache and runny nose is just a cold or an infection…

This is a very interesting perspective that I never thought of before.

>the second isn't because it's a routine service that shouldn't be so expensive that you can't pay it out of pocket.

This is a little dicey. What if my doctor thinks it’s just not a normal cold and he needs to order blood work and ct scan? And that leads to a insurable risk.

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

#297

Post by trashface »

brazzledazzle wrote: post #198
ComputerGuru wrote: post #153

Earlier quoted context omitted.

AFAIK, preexisting conditions weren't a disqualifier for any employer-provided health insurance (which is why group policies are so expensive).

Is there any legal basis for that or is that something negotiated by employers with the plan provider?

I don't know the details but my understanding is that it is partly covered by tax law - if the employer kicks employees who get sick off the insurance, they (and all the other employees) lose some or all tax deductions for health care premiums. The employer can, however, still fire people to get around that.

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

#298

Post by JamesBarney »

ameister14 wrote: post #120
tptacek wrote: post #40

Earlier quoted context omitted.

Yes: if you go back in time, health care costs go down, because they've been rising rapidly over the past 20 years. But the only thing that happens at the point in time when the ACA passed is that the rate of growth in cost falls .

That's not really true, though. Costs as a % of GDP went down from '05-06 and went up slightly from '06-07. In real numbers, in 2008-2009, the increase in overall cost per year was actually lower than in 2014-2015, when the exchanges opened. You're right that the rate of growth in Medicare cost fell after the ACA passed, but that's much more specific than overall cost delta.

Something very relevant happened in 2008-2009.

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

#299

Post by kasey_junk »

snowwrestler wrote: post #222
loeg wrote: post #111

Earlier quoted context omitted.

Can you actually fund a non-employer HSA with tax-deductible funds, or is that a benefit that only applies to payroll HSA contributions? If not, a lot of the benefit of an employer HSA disappears. (FWIW, I have an HDHP, employer HSA, and an individual HSA that I roll my employer funds to annually for lower-fee investing.)

Where do you have your individual HSA? I have an employer-provided one and I'm looking for a place to move it.

Fidelity has a pretty compelling offering: https://www.fidelity.com/go/hsa/why-hsa

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

#300

Post by cr0sh »

mikeash wrote: post #261
pdonis wrote: post #248

Earlier quoted context omitted.

> No insurance company will want to underwrite a plan that doesn't bundle routine services, since those clearly reduce risk of complications down the road But current plans don't require you to get routine services like an annual physical; they just cover them if you get them. That doesn't make sense if the insurer's incentives that you describe are driving the plan. Also, these incentives don't seem to be operating…

I’m sure they would require you to get routine services if they could. Car insurance doesn’t cover routine maintenance because they also don’t cover problems that arise from not getting routine maintenance. I’d you neglect oil changes and blow up your engine, they don’t care, they don’t have to pay for it.

What if you neglect getting your brakes repaired and...?

/I'm not sure this means anything, just a thought...

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