Wednesday, December 11, 2013

WSJ: Obamacare sticker shock

The Lady or The Tiger, which door to open? Or in this case, higher premiums or higher deductibles are a similar choice Americans face under Obamacare.  Leslie Scism and Timothy W. Martin report in the Wall Street Journal:

As enrollment picks up on the HealthCare.gov website, many people with modest incomes are encountering a troubling element of the federal health law: deductibles so steep they may not be able to afford the portion of medical expenses that insurance doesn't cover.

The average individual deductible for what is called a bronze plan on the exchange—the lowest-priced coverage—is $5,081 a year, according to a new report on insurance offerings in 34 of the 36 states that rely on the federally run online marketplace.

That is 42% higher than the average deductible of $3,589 for an individually purchased plan in 2013 before much of the federal law took effect, according to HealthPocket Inc., a company that compares health-insurance plans for consumers. A deductible is the annual amount people must spend on health care before their insurer starts making payments.

The health law makes tax credits available to help cover insurance premiums for people with annual income up to four times the poverty level, or $45,960 for an individual. In addition, "cost-sharing" subsidies to help pay deductibles are available to people who earn up to 2.5 times the poverty level, or about $28,725 for an individual, in the exchange's silver policies.

As enrollment picks up on HealthCare.gov, many people with modest incomes are encountering a troubling element: deductibles so steep they may not be able to afford the portion of medical expenses that insurance doesn't cover.

But those limits will leave hundreds of thousands or more people with a difficult trade-off: They can pay significantly higher premiums for the exchange's silver, gold and platinum policies, which have lower deductibles, or gamble they won't need much health care and choose a cheaper bronze plan. Moreover, the cost-sharing subsidies for deductibles don't apply to the bronze policies.

That means some sick or injured people may avoid treatment so they don't rack up high bills their insurance won't cover, according to consumer activists, insurance brokers and public-policy analysts—subverting one of the health law's goals, which is to ensure more people receive needed health care. Hospitals, meantime, are bracing for a rise in unpaid bills from bronze-plan policyholders, said industry officials and public-policy analysts.

Because all health plans now are required to provide certain minimum benefits, "consumers may be tempted to shop on premium alone, not realizing that the out-of-pocket costs can have a dramatic effect upon the annual costs of health care," said Kevin Coleman, head of research and data at HealthPocket....

Of course, millions of Americans who went without insurance before the health law are in better shape today, despite the high deductibles. They are covered for much of the cost of expensive health care such as cancer treatment or major operations that could be a financial catastrophe for people lacking insurance.

And deductibles had been growing for years. It is unclear how much deductibles would have risen for individually purchased policies if the health law didn't exist. But deductibles for employer-sponsored plans, which generally are much lower than for individually purchased policies, nearly doubled over the past seven years to $1,135 in 2013, according to a Deloitte study published this year.

Meantime, hospitals likely will be treating more people who have insurance than before the law, which means they will be paid by insurers for some services that formerly ended up as bad patient debt.

Federal health officials emphasize that the exchange's pricing tiers accommodate people's different situations, and give consumers better coverage of essential services including doctor visits for preventive care that are exempt from deductibles.

Federal health officials emphasize that the exchange's pricing tiers accommodate people's different situations, and give consumers better coverage of essential services including doctor visits for preventive care that are exempt from deductibles.

"In the current individual marketplace, consumers can face unlimited out-of-pocket expenses for plans with limited benefits and high deductibles, if they can even get coverage without being denied for a pre-existing condition," said Health and Human Services Department spokeswoman Joanne Peters. "In the new marketplace, out-of-pocket expenses are capped, there are no denials based on your health and you can compare plans to find one that meets your needs."

Total out-of-pocket expenses under bronze plans are capped at an annual $6,350 for individuals and $12,700 for families of four; some older policies left consumers liable for significantly more. These totals include all deductibles, copayments and coinsurance charges for covered medical services from in-network health-care providers.....

"They're seeing sticker shock" in transitioning to the more-comprehensive coverage, and "once they start to use the policy, they will see a second sticker shock" of high deductibles, said Jamie Court, president of public-interest group Consumer Watchdog in California.

For example, the patient's typical share of the cost of having a baby through normal delivery—$6,150, according to one insurer's estimate—would be almost entirely an out-of-pocket expense for a person holding a bronze policy with the average $5,081 deductible.

"The anger is going to grow, because people are really stretched to buy these policies, then they're going to have to reach into their pocket for another five grand before it does anything for them," Mr. Court said.

Gary Claxton, who co-directs a program for the study of health reform and private insurance at the nonpartisan Kaiser Family Foundation, said the bronze plans' high deductibles represent "a difficult part of the law." The amount "is certainly a lot for some," though for some early retirees with modest income but ample savings "it's probably a better choice.".....

For a 40-year-old adult, the average monthly premium for a bronze plan is $295.51 a month, or $3,546 a year, according to HealthPocket. A typical silver plan costs $319.42 a month, or $3,833 a year, with a $2,907 deductible.

The average insured American spent $1,241 on out-of-pocket health-care expenses in 2012, according to Truven Health Analytics Inc., which analyzed medical claims from employers.

Moody's Investors Service in October cited several exchange-related risks that it said would pressure nonprofit hospitals' revenue in 2014, including growth in unpaid bills associated with the higher deductibles.

The American Hospital Association, which represents for-profit and nonprofit hospitals and other health-care providers, concurred that the higher deductibles "will likely lead to an increase in hospital bad debt," said Ashley Thompson, its deputy director for policy.

 Rest of article

17 comments:

Anonymous said...

Medical care has become a luxury good in the USA.

Anonymous said...

Remind me again ... what's the GOP counter-plan for healthcare?

Oh, right: people with money get healthcare, and everyone else can drop dead.

Pointing out faults without having any ideas themselves is all the GOP is good for these days.

Anonymous said...

Ya' think they're (the gubmint)depending on Medicaid to pick up the slack. I bet they have a plan,.

Anonymous said...

The choice has always been between high premium/low deductible and lower premium/higher deductible.

We can continue to pay for the inadequately insured or uninsured who don't now have employer contribution and given the increase in part time /minimum wage jobs, see health care cost continue to sky rocket while our health care quality stats continue to decline.

If you are opposed to single payer and to requiring health insurance or face fines to help government pick up the bill, just tell me what you are FOR. Describe some alternative other than with meaningless generalities .

I'm sick of hearing a choir of critics without one single constructive, specific suggestion as to how to fix Obamacare or replace it with something certainly to be better.

It's way past time to put up or shut up!





Anonymous said...

(The preceding was the daily appearance of the JJ troll. Carry on.)

Anonymous said...

"just tell me what you are FOR"

If that's trolling, then more trolls, please. Or better yet, a meaningful answer to the troll.

Anonymous said...

12:30 You're not required to read JJ's blog, and you've added no useful commentary. You're second paragraph explains a lot, brought on by ACA/Bombercare.

Anonymous said...

12:30 You're not required to read JJ's blog, and you've added no useful commentary. You're second paragraph explains a lot, brought on by ACA/Bombercare.

Kingfish said...

Actually, those of you demanding a GOP alternative make a valid point and Kimberly Strassel agreed with you two weeks ago in the WSJ. There are conservative plans out there and maybe it is time I started posting them. I've always thought McCain's (the tax credit) was a good idea worth exploring. There are others.

Denninger has a good post on The Market Ticker where he blasts both parties for doing nothing about the monopoly pricing.

Anonymous said...

to 12:30, the president has, by his own actions in modifying, adding waivers, postponing deadlines, and other such legally questionable acts that effectively CHANGE the ACA as it was passed, unwittingly made the case that the law is a disaster.

Anonymous said...

Good advice from someone who experienced incredible and cost efficient healthcare as a US citizen living in France.
1. Pay the Penalty,
2. Buy international health insurance (mine was $550 per YEAR for $1000 deductible with 80/20 plan),
3. Travel to France for your major healthcare needs. It ranks #1 by WHO!,
4. Pay full cost for your medical care (which is more timely and efficient than anything in the USA. (Btw, I was a healthcare provider in USA). Examples of FULL costs CT scan with and without contrast = $150 compared to $2000 in US; PET scan = $1600 ($6000-$8000 in US); surgery = $1900 which included surgeon, Anesthesia, 1.5 days in hospital.
5. Submit your bills with a 1 page claim form to your insurance and receive your reimbursement in 4 weeks!

Even with airline ticket/hotel, you will come out cheaper than anything under Obamacare!!!

Anonymous said...

12:30 am here
Sounds good to me 1:33 pm
And, for those of you who respond to challenges with snarkiness, I didn't defend Obamacare. I don't like much of it but did like some parts of it like the " pre-existing conditions" and coverage of children until age 25 ( the age at which most can get their own).
But, I waited through the entire Presidential primary and race to hear a plan with some specifics which had party-wide support or hopes of getting party-wide support.
Will look forward to what KF has in specific plans .
1:33pm has a suggestion we all should have heard long ago. Why can't Americans buy into an international plan?

Anonymous said...

With medicare Part D insurance for drugs one will hit the donut hole at $2,850. total drug cost and be on their own afterward until about $4,350. total drug cost annually. I've found ordering meds from Canada via the internet is 80% less than buying locally.

Anonymous said...

"Travel to France for your major healthcare needs."

There you have it - the GOP healthcare plan!

... Looking forward to alternatives being posted here, KF.

Anonymous said...

There are conservative plans out there and maybe it is time I started posting them.

Long past time.

Anonymous said...

6:02 pm, you missed the points being made.
1.France ranks higher than we do. In the US, the hospital is now one of the most dangerous places you can go due to medical mistakes
2. Costs in France ( though their cost of living is high) are dramatically less for the same medical tests.
3. The cost of insurance is dramatically less in France yet the insurance companies in Europe apparently are doing just fine.
The words " industrialized nations" could be substituted for France.
The GOP position on health care has been " best in the world here" and warning of " socialized medicine" with the exception of Dole,then Romney and Rand. None of those three got unified support for their approaches to the problem.
While there's political mileage still to be made bashing Obamacare, it's doomed to failure in the long term because we have a REAL problem with health care that has to be addressed.
We should STILL have the best health care system in the world as we have all the bells and whistles. That we don't and are dropping like a rock SHOULD be a scandal!
And, it's not just a money problem. It's a systemic problem.
Why in the hell are we afraid to look at success elsewhere and see if we could mimic,adapt or improve that success? Why can't we face we aren't perfect all the damn time? It's not patriotic for pride to stand in the way of national success! That kind of pride is called " stupid".

Anonymous said...

Advice from France here. I failed to mention the timeline in my post on Dec 11, which is important:
My problem was identified by a routine chest x-Ray at the immigration office, the next business day I was being seen by a specialist. Next day was CT scan, which I delivered the scan to the specialist on the following day! The following week I underwent tests in hospital. One week later I had PET scan 3 weeks later surgery. Start to finish it was 6 weeks - that would have NEVER happened so quickly in the USA!

Additionally, I had just had annual checkup/physical just 5 months prior in the US. My US doctor did not do a chest x-ray because I was under age 50.



Recent Comments

Search Jackson Jambalaya

Subscribe to JJ's Youtube channel

Archives

Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).


Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.


Note: Security provided by INS.

Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

Note: Security provided by INS
.