Obamacare success stories please

[lauradis]

*yawn* That argument was stale on the 'Bash Obamacare' thread.

lol here have some coffee

 

[mikek]

Non-profit doesn't mean the money is going to care, though. For example, executive compensation... 12mil in '12, 16mil in '13 for the CEO. $93mil in total executive compensation, $40mil of that in bonuses for lower claims and higher enrollment. Non-profit doesn't mean charity, it just means they're playing the same game for their own pocket books instead of for their (and others') stock values. ..

The lively discussions got me to looking about what is really going on with insurers. So I googled and found Horizon BCBS of NJ’s numbers for 2012. For those that don’t know, the majority of BCBS plans are not for profit- NJ’s attempted to go for profit circa 2005-2010 or so but ultimately decided against it- so it is still not for profit. Also it is the largest insurer in NJ (I think I saw 3 million covered which would be more than a third of the state).

The annual premiums for 2012 were something like 9 billion.

Here’s the numbers as a percent of premiums for 2012 from their annual report
-Medical costs 86.7%
-Taxes 0.6 percent
-Increase in capital reserves 3.2%
-selling, general, and admin expenses (SG&A) 16.5%
-Charity 0.1 percent (numbers found in a press release- probably part of SG&A)

the numbers add up to greater than 100% because they have other income from “administrative services” which I guess is they get paid by big companies to manage things even though the big company is self-insured (anyone know?), and also they had investment income (insurance companies, like banks, hold a nest egg of investments for rainy days).

Bottom line is BCBS seems to “waste” 13.3 to 16.5% of premiums on SG&A depending on how you calculate it.

So then I figured let me look at Medicare and what that overhead is. Seems there’s some debate there about what the number really is for medicare overhead with the 2 camps arguing that it’s only 1-2% or 5-6% (apparently some argue Medicare freeloads off other parts of the government for certain services- too late to look that up). Either way it’s a boat load less than BCBS of NJ’s 13.3-16.5% . BAMN I instantly became a lover of the single payer system.

Then I kept reading and seems that’s a lively debate in and of itself what the “right amount” should be. Apparently the SG&A costs include things like fraud detection, wellness programs, outcome management, and quality improvement. (So things like the nurse at BCBS who’s always calling my house to check on my asthma and make sure I’m keeping it under control are in that pile- she’s trying to keep people with asthma out of the ER) So there’s an argument that spending more on “overhead” is actually a better way to spend the money and gets people better care. Seems that both liberal and conservative think tanks even sometimes agree that medicare should spend MORE on fraud detection as an example.

I guess either way might work as evidenced by that Kaiser link that shows both private insurance and medicare per capita went up the same exact percentage over the previous 10 measured years.

So I guess like everything else in healthcare there’s not a silver bullet here.

and the magical 80/20 rule means nothing (I actually beleive- but could be wrong that NJ has had a similar rule for years already so our higher prices have nothing to do with this anyway.) Oh and by the way- if you own a small business and only insure yourself becasue your business is that small it's open season becasue the 80/20 rule doesn't apply to you- they're free to rip us off at will. thankfully BCBS is no where near 80% so it doesn't matter. And if their premiums go up too much there's a second non-profit that just started in NJ)

AND I TOTALLY AGREE The head of horizon is a crook (and i thnk several others behind him too!) - I think i posted already (or meant to post)- that how 'bout we fire that pud and have the 10 people below him divide up his job- everything instantly would get like a $5 a month discount. Instead of the clerks doing more for less, how about the executive team does it for once?

If i was more anal then i already am by reading and writing this post- lol- I guess i could compare the numbers from 2012 to 2011 and see if medical costs per patient went up and things like that. But I'm pretty sure it wouldn't find any smoking gun that BCBS's waste is the sole reason why healthcare costs so much.

 

[mikek]

....
For example, in my state/county, a family of 5 making:

$111,000 (403% of poverty level) --- eligible for $0 government tax credit subsidy

$110,000 (399% of poverty level) --- eligible for $2,734 government tax credit subsidy
....

that's just plain wrong- aside from MAYBE the AMT i don't know of any example where you literally go backwards for getting a raise. Sounds like there could be more cut points where a raise sends you backwards?

 

[johde]

thanks for looking out for the wealthy, but at $110k a year, you really shouldn't need government subsidies to help pay for your insurance. If we want to go that direction, we need to just socialize the whole darn system - give everyone healthcare out of our tax dollars - that is the way we started with this - but the wealthy (by and large) fought it tooth an nail. Apparently, we don't want it.

(I think socialized health care would be a good thing, but that isn't what we ended up with, and frankly, it wasn't what 'we the people' asked for).

It's not "looking out for the rich", it's looking at tax fairness. Instead of looking at the rich, let's look at me. I make about $25,000 a year as a part time instructor at a community college. I currently pay my own health insurance. The money I use to pay my premiums is after tax for Federal, Local, FICA, and Teachers Retirement (I do get a deduction for state). If my employer cut my pay by $2,000 a year and used the money to pay for health insurance instead of me paying the $2,000 myself, My income would drop to $23,000, I would pay less Federal, local, FICA, and Teachers Retirement. I'm better off than before. By my employer can't (won't) do that. If I could deduct those premium myself, I could at least get the federal tax portion of the benefit I could have gotten if my employer would pay.

$110,000 or $25,000 it doesn't make a difference. Under the current system, if you don't have employer sponsored health insurance you're effectively paying more taxes than a comparably paid person who has employer sponsored insurance.

My point was to be "fair" with their counterparts on employer sponsored health plans, and the self employed, the person making $110,000 should at least be able to get a tax deduction for some of their premiums.

Under the ACA, because of the way the credit is structured, low and moderate income people purchasing insurance through the exchanges, now getting a bigger "tax break" than their employer sponsored plan counterparts. High income individuals and those who purchase individual healthcare somewhere other than the public exchange are still paying more in taxes then their employer sponsored counterparts.

 

[lauradis]

that's just plain wrong- aside from MAYBE the AMT i don't know of any example where you literally go backwards for getting a raise. Sounds like there could be more cut points where a raise sends you backwards?

wow can you imagine the conversation Boss say something like you work so hard Sue you deserve a raise. Sue would normally say something like thank you, I love working for you and want to see the company do well.

Sue would tell everyone she knows and possibly go out and celebrate her raise

Now if sue gets a raise it might cost her more then the raise... think she will celebrate and take the raise or tell her boss I would love to have raise and thank you so much for valuing my work, but I cannt take it.

 

[mikek]

fingers crossed there are success stories galore for many.

I'm going to head over to my other obsession - getting MB's for our december visit.

peace, joy, and good luck to everyone!

 

[johde]

that's just plain wrong- aside from MAYBE the AMT i don't know of any example where you literally go backwards for getting a raise. Sounds like there could be more cut points where a raise sends you backwards?

There are at least a couple more credit I know of that have some vicious breakpoints. For example, the saver credit that encourages low income individuals to save for retirement. In 2012 person with AGI of $17,250 who put $1,000 into an IRA get's a $500 tax credit. If that same person has $17,251 in AGI get's a $200 tax credit. In this situation, like the healthcare credit, there is things that can be done. The saver credit individual needs to put $1001 into their IRA. That $1 extra into the IRA get's them $300 more in their refund.

Likewise, the person making $111,000 could possibly put enough into an IRA, HSA, or other front pay deduction from income on the front of the 1040 form to bring their income down to 399.9% of the poverty level. Obviously, there are limits on how much you can shift. But people on the boarder do have a few method to manage their income a little.

 

[Keli]

My health insurance premiums usually go up every other year, premiums go up by about $5.00 a month and my copays by $1-$5 a visit.
I have to think the change in my policy (lot less benefits, ie, my deductible went from $300 to $1200, my total out of pocket costs from $1400 to $2500, copay from $16 to $25 for pcp and from $25 to 45 for a specialist, prescriptions all went up substantially as well) has to do with Obamacare. I am definitely not a success story!

 

[lauradis]

There are at least a couple more credit I know of that have some vicious breakpoints. For example, the saver credit that encourages low income individuals to save for retirement. In 2012 person with AGI of $17,250 who put $1,000 into an IRA get's a $500 tax credit. If that same person has $17,251 in AGI get's a $200 tax credit. In this situation, like the healthcare credit, there is things that can be done. The saver credit individual needs to put $1001 into their IRA. That $1 extra into the IRA get's them $300 more in their refund.

Likewise, the person making $111,000 could possibly put enough into an IRA, HSA, or other front pay deduction from income on the front of the 1040 form to bring their income down to 399.9% of the poverty level. Obviously, there are limits on how much you can shift. But people on the boarder do have a few method to manage their income a little.

Dont save more then 10k per joint return into those accts a year if you make to much because the over amt is taxed twice once you put it in and once when you take it out

Yet another reason why flat tax is better for the "lucky"

 

[runwad]

While on the other hand, those numbers look horrible to me. I pay $177 a month ($2,100 a year) for me. I have a $2,500 deductible then it pay's 100% after that. I pay about an extra $10 a month over what's currently listed online because of my weight. I currently live in a state that has a low level of mandates on the insurance industry. A nearly identical plan in California would cost $288 a month.



You forgot the first round on "Free" preventative health measures. The money for all those wellness checks, vaccines, etc have to come from somewhere. If the government required car insurance companies to provide free oil change and wiper blades every year and new tires every 3 years as preventative measures against accidents, car insurance would go up until it was proved that accident costs go down.

So in your mind, I can't put any of the price increases I've had over the past several years on the ACA. Not even the 28% increase in premium in June 2011 when the "average" has been 9-10%. Can I put any of the 160% increase in premiums for 2014 on the ACA.

Yesterday, I called to see what my premium was going to be next year. They couldn't tell me that, I would need to wait for my early renewal letter. They could quote me for their most comparable plan in the change. A plan with a $2,000 deductible (instead of $2,500 now) has a premium of $463 (instead of $177). In full disclosure, I do qualify for a subsidy and based on this years income, my share of the premium would be $250 and the American tax payer (which I'm included in) pays the other $213.

On the other hand, I don't know if this qualifies as a "success story" but if my projected Modified Adjusted Gross Income comes in $2,000 lower I will qualify for a "silver 87" plan. Plans that most people here would love to have. $500-$750 deductibles 90/10 after that, the one with the higher deductible has $30 office visits and $10 generic prescriptions before deductible, and $2,250 out of pocket maximum per year, for $120-140 a month depending on exact plan and coverage. $110 less a month in premiums is $1320, taxes could go down by $500 - $750 depending on how I lower my income between federal, state, local, and STRS. All I need to do is make sure front page income on 1040 in 2013 dollars under $22,980.

Just a question, can you bring your income down by putting a higher % in your 401k?

 

[Robbi]

Maybe Disney could use the same excuse for their sad IT failures?
Depending upon how his company handles the insurance, I told my husband we should just take the penalty which would be $2767.00

This is how the plan would work for our family:

Results

Because your income is more than 4 times the poverty level, you would not qualify for subsidized exchange coverage. The information below is about unsubsidized exchange coverage.

Household income in 2014:
1274% of poverty level
Unsubsidized annual health insurance premium in 2014:
$14,527
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
None
Amount you pay for the premium:
$14,527 per year
(which equals 4.84% of your household income and covers 100% of the overall premium)
You could receive a government tax credit subsidy of up to:
$0
(which covers 0% of the overall premium)

Bronze Plan

The premium amounts above are based on a Silver plan. You could purchase other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

For example, you could enroll in a Bronze plan for about $12,040 per year (which is 4.01% of your household income). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Out of Pocket Costs

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

A Silver plan has an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Other Coverage Options

Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($12,700 in 2014). However, preventive services are covered with no cost sharing required.

 

[lauradis]

Just a question, can you bring your income down by putting a higher % in your 401k?

joint return can only have 5000 per worker, In other words your husband gets up to 5000 you get up to 5000 into an approved retirement account.

I'm not sure if the amount for approved income level comes from your adjusted taxable income or from tax line before adjustments.

 

[johde]

Just a question, can you bring your income down by putting a higher % in your 401k?

For most people MAGI used for subsidy purposes is line 38 of the 1040, line 22 of 1040a, or line 4 of 1040ez. For more precise information see this web site.
http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

 

[disneyfreakk]

joint return can only have 5000 per worker, In other words your husband gets up to 5000 you get up to 5000 into an approved retirement account.

I'm not sure if the amount for approved income level comes from your adjusted taxable income or from tax line before adjustments.

You are thinking of an IRA.

Just a question, can you bring your income down by putting a higher % in your 401k?

Yes! You can put up to $17,500 per working adult into your 401K for 2013. Unless you are closer to retirement, then you can put more in there.

 

[lauradis]

You are thinking of an IRA.



Yes! You can put up to $17,500 per working adult into your 401K for 2013. Unless you are closer to retirement, then you can put more in there.

This is why we pay a pro to many loop holes and junk.

 

[Marionnette]

Maybe Disney could use the same excuse for their sad IT failures?
Depending upon how his company handles the insurance, I told my husband we should just take the penalty which would be $2767.00

This is how the plan would work for our family:

Results

Because your income is more than 4 times the poverty level, you would not qualify for subsidized exchange coverage. The information below is about unsubsidized exchange coverage.

Household income in 2014:
1274% of poverty level
Unsubsidized annual health insurance premium in 2014:
$14,527
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
None
Amount you pay for the premium:
$14,527 per year
(which equals 4.84% of your household income and covers 100% of the overall premium)
You could receive a government tax credit subsidy of up to:
$0
(which covers 0% of the overall premium)

Bronze Plan

The premium amounts above are based on a Silver plan. You could purchase other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

For example, you could enroll in a Bronze plan for about $12,040 per year (which is 4.01% of your household income). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Out of Pocket Costs

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

A Silver plan has an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Other Coverage Options

Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($12,700 in 2014). However, preventive services are covered with no cost sharing required.

We are small business owners and pay for our health insurance ourselves. After looking into the exchanges, it appears that we would pay MORE for LESS COVERAGE if we were to join the exchange.

Our health insurance agency sent a letter last month that we could renew our policy with them for a 2-year period and incur a 12% increase this year, which will still be less than what the "silver policy" would cost us. The decision needs to be made by 10/15. With the way that the exchange websites have been acting and the lack of information that is available, we've decided to take Aetna's offer. I'd rather pay Aetna than give the money to the government so that they can give it to someone else. When the increase from Aetna takes effect, we will be paying $15K annually for our high co-pay, high deductible health insurance policy for 4 non-smoking adults. Obamacare did absolutely NOTHING TO BEND THE COST CURVE and is anything but an "affordable" healthcare act.

 

[Free4Life11]

Not Obamacare, but for 2013, my employer (major bank) did not raise premiums for employees who make less than $50,000. They also started putting $250 into a FSA for us to use towards co-pays and the annual deductible ($500.) For employees making less than $50,000, premiums will not be increasing in 2014 and they will still be putting $250 into the FSA!

I could not be more pleased & I appreciate that they are trying to make things easier for us lower paid employees.

 

[SinceDay1]

Not sure how it will play out, but to those who feel they are getting great deals, that is great, but for me, I just don't see it.

 

[Karlzmom]

That isn't true though. The 80/20 rule did more than shuffle the deck chairs between subscribers; insurance companies are now required to spend most of what they take in on providing the service they sell. And there's also an economy of scale you're failing to take into account; the ACA means risk is spread over a larger pool of insured, rather than limited by excluding those who are more likely to make claims. Net costs should also come down as providers no longer have to build in the "deadbeat" cushion they need now to account for those who cannot afford care but who seek it anyway (though I'll admit to skepticism on this point; I think when operating costs fall prices generally stay the same while profits increase).

To go back to the lifeboat analogy, those of us who have been treading water are supposed to be sympathetic that others will have to give up some leg room and squeeze together a bit to make room for the rest of us in the boat. Yes, their situation is going to be less comfortable and that isn't lost on anyone, but they're doing it to keep other people from being one medical issue away from sinking.

Whether the pool got larger or not, the risk was increased enough that people who were previously rated at one dollar amount now have to pony up extra cash to cover a risk that was not previously present. A rate increase is still a rate increase.

I bit up on somebody else's boat analogy. My point was that sympathy goes both ways, and the "yeah" someone got got a life-vest should be considered in light of the one that was taken from someone else. The vests do not drop out of the sky. I highly doubt most of us in the boat were born into deck chairs and drinking lemonade, which the underlying envy of your comment suggests. We work and struggle too. There is a long stretch from offering compassion to your fellow man and having money confiscated to be handed out as though it grows on trees. Are my labors worth less than yours? No doubt there are people worse off then you...how much of what you make should you forced to surrender to help them out?

We will never be able to create true equality of outcome and I fear if we continue to try eventually wherever the line is drawn between the "winners" and "losers" we will find people unwilling to continue to risk/fight/struggle when they can simply cross the line and then where will we be? I, personally, am back at the drawing board to figure out how to rearrange my budget to accommodate the increased costs. I dream of a day when someone will let me know how much of my wages to which society "deserves" so I can plan [which is what most responsible people try to do] and just live my life.

 

[ldoogie]

My friend's daughter was born with half a heart and had to get a heart transplant when she was 2 which was 4 years ago. Last year she had reached her lifetime maximum and would have been cancelled had it not been for Obamacare doing away with that. Also she is Canadian and moved here when she married the Dad. They got divorced a couple of years ago and she was going to move back to Canada so her child could still have insurance but now she doesn't have to. I call that a success.