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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

#321

Post by tbirdz »

loeg wrote: post #111
kasey_junk wrote: post #53

Earlier quoted context omitted.

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.

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.)

Only partially. If you fund your HSA outside of your company's payroll system you can deduct your contribution amount from your MAGI for income tax purposes, but you still have to pay FICA taxes (social security and medicare) on that income.

If you have your HSA contributions made through your company's payroll department, then you don't have to pay FICA taxes on it.

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

#322

Post by tptacek »

pg_bot wrote: post #99
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.

While the growth rates for healthcare have been lower over the past decade I would be hesitant to attribute it to the ACA. Most of the higher rates over the previous 30 years were due to landmark legislation increasing demand for services. If you take a look at numbers you might be less convinced. year | growth rate 2005 | 6.7% (Bankruptcy act passed making it harder to discharge medical debt) 2006 | 6.5% 2007 | 6.5%…

The numbers here are quite helpful. The parentheticals are harder to understand and, for that matter, so is "higher healthcare costs due to war" (we have a nationalized health care system for war veterans).

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

#323

Post by skwb »

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…

Not in the least. Just to name a few of the ways the ACA changed things in the right direction for most "normal" ESI:

- ACA threw out lifetime nor annual limits [0]

- Essential benefits ensuring you have a more comprehensive plan that covers actual health insurance [1]

- Ability to stay on a parent's insurance until you're 26 [2]

- For every $1.00 your insurance company takes in from premiums, $0.80 has to be spent on patient care [3]

- There's a max of a 3:1 ratio of age rating for health insurance premiums, irrespective of your health. It used to be that insurance companies would raise your premium or even cancel your policy if you got a costly disease like cancer [4].

The problem with your secular analysis is that there is not positive control for the "what if?" without these sort of policies. Most healthcare economists suspect it would have been even worse without the (somewhat modest) regulations that were imposed by the ACA. Again, this is high level policy analysis that requires dedicated study, and there's lots of evidence that the market has highly benefited consumers across most socioeconomic strata.

[0]. https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/...

[1]. https://www.healthcare.gov/glossary/essential-health-benefit...

[2]. https://www.healthcare.gov/young-adults/children-under-26/

[3]. https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/

[4]. http://us.milliman.com/uploadedFiles/insight/2017/MillimanAC...

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

#324

Post by tptacek »

evgeniysharapov wrote: post #260
bradfa wrote: post #98

Earlier quoted context omitted.

Regarding price negotiation, my wife and I have asked multiple doctors, nurses, and billing departments to tell us how much a given service we have received will cost. Both before the service and after the service. We've even called the insurance company with the billing codes from the doctor's office to get quotes. NO HUMANS CAN TELL US HOW MUCH ANYTHING COSTS! We are continually told that we have to wait for the in…

When I was shopping around I was told by hospital rep, that they can't tell me the price, because of a) they don't know until they talk to insurance company, b) EMTALA prohibits that.

I had to negotiate an emergency CAT scan for my daughter about 8 years ago, and they ultimately had to make up a price on the spot for me ($1000).

Lack of price transparency is an enormous problem with our current system. Of course, it's a problem on the provider side of the system, not the payer side, which is where everyone spends all their attention.

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

#325

Post by thatoneuser »

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…

Why should we, the conscientious readers, trust your claim that you know what's best? Cuz it sounds like something that sounds good but which has no verifiable backing.

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

#326

Post by trashface »

mieseratte wrote: post #155
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.

> If you're saying the ACA harmed the health care system, strong disagree. The system? No. Corporate welfare is great for "the system." But the consumers? Absolutely harmed! > Again: the cost increases you're talking about were a fact of life before the ACA. I've been working for over a decade now. 100% increases, year-over-year have never been even close to a thing with employer plans I've held. Not even close. Typi…

I think many economists would say that while you had an employee-based plan your costs were actually going up significantly, you just didn't see it because those increases were coming out of (what would have been) your yearly salary raises.

I don't think ACA plans are much more expensive that what we are _really_ paying for employer insurance. I recently became unemployed and when I priced it out, an ACA plan that offered benefits similar to what I would get with a COBRA plan were pretty much the same price - both ridiculously expensive, so I went with a cheaper silver HMO ACA plan. And my old employer charged a 4% "fee" on COBRA premiums as well - I guess the benefits companies want some of the action.

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

#327

Post by lotsofpulp »

golover721 wrote: post #306
lotsofpulp wrote: post #102

Earlier quoted context omitted.

401k are tied to employers, but I don’t see what HSA has to do with employers since they’re just as easy to have without an employer. It’s just a savings account with tax advantages for people with HDHP.

Yes however it is definitely a way for employers to save a bunch of money while convincing employees that they are better off too. The whole smokescreen of we will give you a bunch of money "for free!" that goes to your HSA and somehow that is better value for you than a traditional PPO. In much the same way that 401k contributions are better than a pension.

401k are better than defined benefit pensions. I want control of my money, why would I trust a random pension board of trustees? And even though 401k isn’t really under my control, I trust an index fund more than an opaque board of trustees doing god knows what with the funding.

The only defined benefit pension that is doing okay is taxpayer funded pensions, and that is only because government has the power to tax. And even then some have been cut and some states are seeing economic decline because of them.

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

#328

Post by thatoneuser »

JMTQp8lwXL wrote: post #87
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…

Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage. How I see it: if you were in the pre-ACA pre-existing condition pool, your perspect…

True but we could have had preexisting without all the other garbage included. Some of it sure but overall I have yet to see any compelling data to say the tradeoff was efficient.

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

#329

Post by pdonis »

BurningFrog wrote: post #290
epicureanideal wrote: post #258

Earlier quoted context omitted.

Maybe we should have two separate kinds of health insurance? One for true emergencies (like car accidents), and rare life threatening diseases (like cancer before 60). Another for routine things, but as others have said, routine things shouldn't be so expensive. I like the idea of structuring it like a term life insurance policy. If you die, you get money, and in some policies you even get some percentage before you…

> Another for routine things, but as others have said, routine things shouldn't be so expensive. But this is not an insurance. Structuring it as an insurance - as we have done - only makes it a lot more expensive than paying for it out of pocket.

Exactly.

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

#330

Post by thatoneuser »

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…

You're right. Know why you're caveating this and tip toeing? Cuz ACA had a huge propaganda/rhetoric element to it. Even after it was an abysmal failure for most, politicians behind it kept pushing it like it was just a matter of time before it improved. It had a few good components but for the tradeoffs it wasn't worth it. (No Preexisting conditions should have always been a thing).

This is the world we live in. People have to apologize while expressing perfectly reasonable objections.

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