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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

#311

Post by SOLAR_FIELDS »

golover721 wrote: post #304
mikestew wrote: post #176

Earlier quoted context omitted.

Or COBRA, unless you expect your pregnancy to last longer than 18 months.

COBRA these days ends up being way too expensive for most people to afford. Perhaps at one time it was a useful regulation. Now it is pretty unaffordable.

If it was useful, it was a very long time ago. I remember my parents being in between jobs in the late 90’s and early aughts and complaining that COBRA was extremely expensive. The only reason the law seems to exist anymore is for people who somehow have some expensive debilitating condition yet can still work (or are a worker covering a family member with such condition). And that’s a pretty small subset of all health insurance buyers.

Data seems to agree: in 2007 the usage of COBRA was 10%: http://www.cnn.com/2009/HEALTH/01/23/cobra.health.insurance/

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

#312

Post by manfredo »

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. 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.

No, whether or not expanding the pool raises costs depends on the cost of the added population. If 80% of the population is insured, and they consume an average of $1,000 in healthcare costs each year and the uninsured population consumes $10,000/yr then expanding the risk pool to the entire population will increase the cost of insurance. We saw this happen firsthand when we mandated that insurers take on all patients at the same cost regardless of prior conditions. The population that was added to the risk pool was more expensive than average, thus driving up the cost charged per person.

Universal healthcare isn't a magic wand that makes healthcare costs go down, these plans are affordable for the average person because they are paid for by taxes which are levied at different rates depending on income. I many of these countries if you charged the cost of healthcare per person on people's post-tax income (and adding back in the tax paid for healthcare) they would be paying a greater portion of their paycheck for healthcare than most Americans. The affordability isn't solved by dumping everyone into one risk pool, it's solved by changing the way healthcare is paid for. Furthermore, most universal healthcare implementations don't put everyone in the same risk pool they tax and give citizens funds to spend on healthcare but the risk pools themselves are managed by insurance companies.

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

#313

Post by trashface »

refurb wrote: post #125
tptacek wrote: post #113

Earlier quoted context omitted.

If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree. If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.

The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just i…

The government subsidizes ACA plans for many participants. That was partly meant to soften the impact of requiring coverage for pre-existing conditions. And then there is/was the individual mandate, to get everyone to contribute even if they were currently healthy. The ACA also imposed a tax on high earners (IIRC, >=200K, not sure if it is inflation adjusted) to fund the subsidies, and it cut spending on Medicare Advantage, which costs the government more than the other medicare plans.

That being said, I'm not disagreeing that costs went up after the ACA more than they would have, but, IMO that was just insurers/providers raising prices because they could.

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

#314

Post by tptacek »

JamesBarney wrote: post #298
ameister14 wrote: post #120

Earlier quoted context omitted.

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.

It also impacted prices all the way into 2012, by moving people out of full-time employment and onto COBRA, and by reducing the number of young people on health insurance plans.

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

#315

Post by mnm1 »

rayiner wrote: post #220
FireBeyond wrote: post #214

Earlier quoted context omitted.

Right. And therein lies the rub. The US is quite possibly one of the worst in the world for "Fuck you I got mine" (until you don't got yours). And then there's the cognitive dissonance of people who might have otherwise screamed about "socialized medicine" who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...…

By contrast, would the US be able to stomach denying cutting-edge treatment because it’s too expensive, like the UK? https://www.theguardian.com/science/2017/dec/20/drug-giants-... That’s what makes me nervous about socialized medicine in the US. I’m absolutely in favor of universal coverage—a healthcare system that maximizes the health of the average productive person. But I worry that Americans lack the cold realis…

Private insurance companies do this every single day. So you're worried that the government might do what insurance companies are guaranteed to do. At least the government wouldn't have the profit motive that drives insurance companies to these measures that literally kill people. Your argument is completely out of touch with reality.

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

#316

Post by tptacek »

trashface wrote: post #313
refurb wrote: post #125

Earlier quoted context omitted.

The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just i…

The government subsidizes ACA plans for many participants. That was partly meant to soften the impact of requiring coverage for pre-existing conditions. And then there is/was the individual mandate, to get everyone to contribute even if they were currently healthy. The ACA also imposed a tax on high earners (IIRC, >=200K, not sure if it is inflation adjusted) to fund the subsidies, and it cut spending on Medicare Adv…

There's no evidence that costs went up after the ACA more than they would have, and, in particular, costs grew significantly faster under Bush than they have at any point after the ACA. I'm not sure I understand why we're supposed to give credence to HN-style first-principles analysis of why insurance costs should have increased; in particular, most employer-provided health plans already complied with the ACA's coverage requirements. The data simply doesn't back these arguments up.

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

#317

Post by nobleach »

mieseratte wrote: post #72
tptacek wrote: post #38

Earlier quoted context omitted.

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.

I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit by a bus" plan that was so expensive, one year I said fuck it and paid the penalty instead. I understand well what could have been had something truly happened, but I ended up saving money paying the penalty while still having a few minor doc-in-a-box visits o…

When I look at what my insurance company actually covers for all of my doctor bills, I'd probably be better off just paying the penalty. At least I'd have a few hundred more every pay check to cover that 11 extra dollars that my insurance company could dare to part with for a $300 X-Ray.

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

#318

Post by tptacek »

refurb wrote: post #125
tptacek wrote: post #113

Earlier quoted context omitted.

If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree. If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.

The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just i…

You are "most certain" about something that empirical data refutes. Health care costs grew more slowly after the ACA than before it and, in particular, at no point subsequent to the passage of the ACA have health costs grown more than they did during the Bush era.

There are all sorts of things that should have (and perhaps even did) impact prices after the ACA. Not just coverage requirements (which, again: most employer-provided health plans --- which is what we're talking about here --- already complied with), but, more importantly: unprecedented instability in the insurance markets during the almost decade-long concerted effort by the GOP to hamstring and ultimately repeal the bill. And yet, the numbers are right there: health care costs are growing, but they are not growing more than they were prior to the ACA.

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

#319

Post by tptacek »

nobleach wrote: post #317
mieseratte wrote: post #72

Earlier quoted context omitted.

I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit by a bus" plan that was so expensive, one year I said fuck it and paid the penalty instead. I understand well what could have been had something truly happened, but I ended up saving money paying the penalty while still having a few minor doc-in-a-box visits o…

When I look at what my insurance company actually covers for all of my doctor bills, I'd probably be better off just paying the penalty. At least I'd have a few hundred more every pay check to cover that 11 extra dollars that my insurance company could dare to part with for a $300 X-Ray.

The penalty has been more or less hamstrung by the GOP, so if that's your only consideration, then, yes, you're better off not paying for health insurance.

Additionally: you can (you shouldn't have to, but you can) shop around for cheaper medical imaging. Imaging in particular has wildly varying prices, and if you stay on the "happy path" your PCP and hospital puts you on, you're going to pay the higher end of the range of prices.

You are not, as a general matter of life advice, better off going without health insurance. Rather, find the least expensive HSA-qualified HDHP, fund the HSA with the savings, and pay for routine care (effectively) out-of-pocket. The point of insurance isn't to make your annual checkup cheaper, but rather to avoid going bankrupt if you get hit by a car or your appendix bursts.

From the way you write, your appendix presumably hasn't burst yet. That's great! Neither has mine! My house has also not caught fire† and I have not managed to crash my car into a fully occupied city bus. But I am insured against both of those things, too.

† since we bought it, i mean

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

#320

Post by tptacek »

mieseratte wrote: post #168
irq11 wrote: post #162

Earlier quoted context omitted.

Again, consumers have absolutely been harmed by the skyrocketing cost of health care. But every bit of evidence shows that the ACA slowed that growth. The only connection you’re making here is that your own costs went up after the ACA. It’s a post hoc fallacy.

> The only connection you’re making here is that your own costs went up after the ACA. The connection is that the ACA rates, and rate-increases are out-of-touch with the employer-offered system, even when those firms are tiny and not nearing some kind of "scale" cost-savings. I have been hollering about this issue for years, and I've yet to have someone say "Ya know, I actually experienced something radically differe…

I'm having trouble parsing what your argument here is. Are you saying that rates on the individual market are more expensive than the large group market is? Yes, that's true, and always has been (the small group market is effectively a facsimile of the individual market, for the obvious reason that there's not much actuarial benefit to pooling 10-20 random people).

There also isn't one "employer offered" system. In addition to the aformentioned small-group marketplace, there are also large group plans that cover big companies, and very big companies often self-insure, using health insurance companies solely to administer benefits but financing the care themselves. Can you be specific about which of these kinds of health care financing have been impacted by the ACA, and how?

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