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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

#331

Post by heylook »

clarkmoody wrote: post #256
LarryDarrell wrote: post #60

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.

Employer-provided healthcare is an aberration created by government interference in the market. > Employer-provided health insurance has its origin in a tax policy passed in 1943, which made insurance provided by employers tax free. At the time the United States was engaged in World War II and had enacted wage and price controls, preventing employers from competing for scarce labor using the normal mechanism of offer…

Who cares? GP didn't say anything about "market" or "not-market". It's dumb that we're here. Full stop.

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

#332

Post by lordlimecat »

If you're taking a high deductible plan-- which you should be-- you should be contributing the (often substantial) savings on your premium to an HSA. In fact theres very little reason not to max out the HSA for the year. Once your HSA is at the IRS annual maximum, you have an enormous buffer between the often 20% rate post deductible and the Out of Pocket Maximum-- which the HSA will usually cover most of. You should also participate in an FSA, which being frontloaded can absorb early-year shocks.

An HSA is among one of the most tax-advantaged programs you can participate in; I would argue that it is better to contribute just enough to your 401k to get the full employer match and stick all the rest into an HSA.

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

#333

Post by lordlimecat »

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 in the states is asinine, no doubt. But when I see articles like this I have to ask, "why aren't these people making 75-100k using HSAs and FSAs"? They would eliminate many of these scenarios that people are seeing.

There's the elephant in the room that many people are absolutely terrible with money, buying entertainment goods and completely skipping on savings, HSAs, etc that could prevent these media sob stories.

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

#334

Post by lordlimecat »

heylook wrote: post #331
clarkmoody wrote: post #256

Earlier quoted context omitted.

Employer-provided healthcare is an aberration created by government interference in the market. > Employer-provided health insurance has its origin in a tax policy passed in 1943, which made insurance provided by employers tax free. At the time the United States was engaged in World War II and had enacted wage and price controls, preventing employers from competing for scarce labor using the normal mechanism of offer…

Who cares? GP didn't say anything about "market" or "not-market". It's dumb that we're here. Full stop.

It's dumb that we're here, but knowing the history suggests a possible solution.

What if the government was able to pass legislation banning employer healthcare? I imagine the issue of healthcare coverage would resolve very shortly thereafter.

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

#335

Post by danans »

mikeash wrote: post #284
danans wrote: post #283

Earlier quoted context omitted.

To clarify, I think you mean lifetime limit for the insurance company, not you.

What do you mean? The limit was on your coverage. Once you exceeded that limit, you had no more coverage.

Right, a limit on how much the insurance company will pay to cover your healthcare expenses

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

#336

Post by mikeash »

danans wrote: post #335
mikeash wrote: post #284

Earlier quoted context omitted.

What do you mean? The limit was on your coverage. Once you exceeded that limit, you had no more coverage.

Right, a limit on how much the insurance company will pay to cover your healthcare expenses

I don’t understand the distinction you’re making.

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

#337

Post by brewdad »

danans wrote: post #283
mikeash wrote: post #265

Earlier quoted context omitted.

Before Obamacare, insurance plans had lifetime limits. So even if you got a really expensive treatment approved, it would potentially push you over your lifetime limit and leave you with no coverage at all.

To clarify, I think you mean lifetime limit for the insurance company, not you.

Yes. BUT the insurance companies knew that you had hit a lifetime limit with another company and would refuse to insure you. You couldn't jump from AETNA to BCBS to CIGNA and get a fresh million dollar limit.

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

#338

Post by brewdad »

munificent wrote: post #277
newsoul2019 wrote: post #158

Earlier quoted context omitted.

I don't like the entire concept of "pre-existing conditions". It goes against the entire concept of caring for sick people. We are all people. We all get sick sometimes. Sicknesses can last a long time, or a short time. Sick people need help. Help the sick people. Pay what you can (a reasonable amount) into a common pool and take what you need (only as much as you need)

> I don't like the entire concept of "pre-existing conditions". If you have an elective health insurance system where people choose whether or not and when to participate, it implies this restriction. Say you have private health insurance companies but don't allow them to prohibit members based on pre-existing conditions. Everyone will simply not get health insurance to avoid paying the premiums until the day they ne…

Would a wait limit, like with hurricane insurance, help to mitigate this problem? You can't wait until the NWS declares a Category 4 storm is barreling towards you to buy coverage. I mean you can, but the coverage doesn't kick in until 30 days later.

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

#339

Post by pg_bot »

tptacek wrote: post #322
pg_bot wrote: post #99

Earlier quoted context omitted.

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).

I wouldn't expect it to be clear unless you've studied the area for awhile but all of those are external shocks to the marketplace.

Healthcare expenses increase during wartime since you have to treat newly injured veterans. That statement basically can be interpreted as "people get injured on battlefields and it costs money to treat them".

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

#340

Post by brewdad »

mrosett wrote: post #83
rockinghigh wrote: post #56

Earlier quoted context omitted.

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.

That's interesting data. Thanks for sharing it. In the 2017 snapshot, I'm surprised to see that HDHP plans are slightly more common for high-income families. I didn't expect that. There's a missing variable here: What are the premiums? HDHPs are attractive to insurers (and by extension employers) because they increase employee sensitivity to healthcare costs and may lead to less wasteful spending. Advocates emphasize…

My wife's employer covers our family under an HDHP. Our out of pocket cost is 0. Our plan requires us to have an HSA, though I don't thinkone is required to contribute to it. We contribute the max $ to our HSA each year.

A more traditional plan would run us about $4-5 thousand annually in payroll deductions. Most years we spend far less than our HSA contributions and can roll that money over year to year and even invest it. The one year she needed major surgery, we hit out OOP max and probably spent about $10,000 total from our HSA.

Probably our biggest risk exposure would be if one of us needed to take an expensive prescription since I don't think there is any annual limit on those costs.

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