Anyone sign up with Obamacare yet?

[Danger]

Jeez, but you guys have it hard! My entire life is paid for by the government (ie: taxpayers :s). I'm on AISH—Assured Income for the Severely Handicapped. It pays me a monthly income to cover the cost of housing, food, utilities, and whatever else I choose to spend it on in the form of an automatic bank deposit. I'm allowed to maintain ownership of my house which I still live in, and vehicle, even though I no longer drive. (Aside from my beer, internet, cat-related expenses, Phillips Lifeline service, delivered meals, and basic cable TV, I don't indulge.) All of my medical bills including ambulance rides (about $250 each), hospital stays, prescription meds and the like are covered. (My oxygen equipment is paid for by Alberta Health Services, a different entity, even though it's legally a prescription drug.) I've had a lot of ambulance trips to the ER for overnight stays (including last Wednesday), at some unknown cost. My two separate 3-week hospitalizations in ICU ran about $2,500 per day. If that were my responsibility, I would have stayed dead the first time.
On the whole, though, I'd rather be able to work for a living.

 

[mheslep]

Private physicians and hospitals must make enough revenue to pay the utility bills, pay the staff, buy supplies and medical equipment, etc. If it costs, for example, $100 to treat a

What hospitals charge, in particular, have little connection unfortunately to what care must actually cost. The primary reason for this is a lack of transparency in pricing. One generally can not shop around costs for some routine medical procedure. Also, hospitals have a monopoly arrangement with many local governments, with regulations in place preventing new hospitals from going into business in an area; i.e. the regulation basis is something like, "is likely to create disruption"

 

[mheslep]

I'm sitting here a little depressed. I need to sign up my wife and I and the cheapest plan is $450/m with a $9000 deductible. We are both super healthy, rarely visit the doctor and were happy with our old catastrophe plans which were about $100/m each.

Apparently the law now requires that catastrophic-only plans are only available for those under 30. Plugin under 30 and the lowest price I see on e-health is Aetna - $255/mo, $6600 deductible per individual, $13,200 deductible family. But, even the ACA version of "catastrophic" plans include "Well Baby Care" and other things you don't need - also mandated by the law and forcing the cancellation of plans people already had in pocket which did not include what the ACA says it should include.

Above 30 yrs old, and I get about the same price you see for over 30 (my zip code).

The US has traditionally made goods and services available to the middle class by making these things highly affordable, from transportation to housing and even to medical care before the WWII laws. Hopefully another round of reforms can place the focus where it should be.

 

[Evo]

The large insurance companies negotiate standard fees with physicians and hospitals ahead of time. A doctor who has made such an arrangement with your insurance company is "in network"; when you visit that doctor they treat you and then bill the insurance company for the agreed-upon fee, less any possible copay.

If the doctor is out of network, they have two choices. Either:
1) They bill the insurance company for their usual fee, the insurer pays whatever amount is called for by your contract with insurer, and the doctor bills you for the difference. They are more likely to do this for regular patients and people with good credit ratings. They are also more likely to do this if the practice is large enough to have people on staff who shepherd claims through the insurance company process.
2) They bill you (often requiring payment during your visit). You file a claim with your insurer, and they pay you whatever amount is called for by your contract with them.
When someone says that their coverage was "rejected" by the doctor/hospital, they mean that the provider is going with option #2 above.

None of this is new with Obamacare.

Some policies offer no coverage for 'out of network" providers, unless it is an emergency outside of your coverage area, and then maybe not. But these plans are usually the cheapest, plans that let you see any doctor anywhere usually cost more.

 

[SteamKing]

Also, hospitals have a monopoly arrangement with many local governments, with regulations in place preventing new hospitals from going into business in an area; i.e. the regulation basis is something like, "is likely to create disruption"

It's a pretty small town or city in the US which has access to only one hospital, clinic, doctor's office, vet practice, witch doctor, holistic healer, kids playing doctor, etc. Usually, such circumstances occur because the particular town is too remote or too sparsely populated to require the services of more than one hospital or clinic, however small it might be.

I would like some examples of this practice, please.

AFAIK, hospitals are not regulated the same as public utilities, cable companies, police and fire departments, or other municipal services. Hospitals are usually regulated and accredited by state departments of health, rather than local governments, and there are a raft of federal regulations which apply as well. Such local monopoly regulations on hospitals are unlikely to withstand legal scrutiny, IMO.

The shortage of physicians willing to practice in remote or under served rural areas is so acute that programs have been set up which provide that if new physicians commit to practice in these areas for a certain period of time, all or part of that physician's student loan debt would be forgiven/repaid.

This is a list of state/federal Loan Repayment/Forgiveness and Scholarship programs:

https://services.aamc.org/fed_loan_...1&CFTOKEN=29841B58-E60F-A638-686BBE40975118D8

 

[mheslep]

I would like some examples of this practice, please.

The rules for new hospitals or medical facilities live under the euphemism of "Health Care Certificate-of-Need (CON) Laws".
From a NIHCR study

...member hospitals initially had mixed views about the benefits of CON but banded together to support the process after realizing it was a valuable tool to block new physician-owned facilities.

http://www.nihcr.org/CON_Laws.html#section8

These laws are administered by government effectiveness boards that are specifically charged with preserving the profits of existing hospitals.
http://www.ij.org/vacon
CON at it again

Competition is the impediment to monopoly practice, but with CON in place upstart competition is ruled out, and we get the like of the "golden handshake" between two large MASS providers.
Hospital Monopolies: The Biggest Driver of Health Costs That Nobody Talks About
More on Hospital Monopolies

 

[SteamKing]

The rules for new hospitals or medical facilities live under the euphemism of "Health Care Certificate-of-Need (CON) Laws".
From a NIHCR study

http://www.nihcr.org/CON_Laws.html#section8

The key phrase in the quoted excerpt is 'physician-owned hospitals'. Such physician-owned hospitals have been outlawed from expanding under the ACA now anyway, unless of course, they can show they serve a need and request a waiver from the Secretary of HHS.

http://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Physician_Owned_Hospitals.html

Not all hospitals are physician-owned. Some hospitals are set up by various religious denominations, some are set up by state and local governments to serve indigent or low-income patients, and some are set up by charitable foundations.

In any event, the certificates of need are granted by the state regulatory authorities, not local municipal governments.

 

[Nugatory]

Some policies offer no coverage for 'out of network" providers, unless it is an emergency outside of your coverage area, and then maybe not.

Yep - "whatever amount is called for by your contract with them" can be zero.

 

[nsaspook]

I'm curious: is this perceived as a good or a bad thing? Sure, the charges are excessive, but making sure everyone has access to healthcare must be a good thing?

I'm lucky to have good health care coverage but I did lose the option for an HMO last year that I've been at for 20+ years (Kaiser). I think Sen. Chuck Schumer has it about right (and I don't think he's right about much else).

http://fusion.net/story/30263/chuck-schumer-obamacare-comments-aca/

“The plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed,” he added. “But it wasn’t the change we were hired to make. Americans were crying out for an end to the recession, for better wages and more jobs — not for changes in their health care.”

 

[Nugatory]

But, even the ACA version of "catastrophic" plans include "Well Baby Care" and other things you don't need - also mandated by the law and forcing the cancellation of plans people already had in pocket which did not include what the ACA says it should include...
The US has traditionally made goods and services available to the middle class by making these things highly affordable, from transportation to housing and even to medical care before the WWII laws. Hopefully another round of reforms can place the focus where it should be.

The higher price and lower affordability of the ACA-approved policies is not primarily because they include things you don't need. Accurately estimating what a given population will need is the lifeblood of the insurance industry and they're amazingly good at it; if they weren't they'd go out of business rather quickly. It's a much longer and sadder story... here we go...

What's going on is that for many years the American individual health insurance business worked by selling to people like Greg, the people who can say "We are both super healthy, rarely visit the doctor and were happy with our old catastrophe plans which were about $100/mo each". Cover 1000 people in that category and you'll take in 1.2M$/yr, and pay out maybe a dozen or so five-digit claims. However, if you didn't fall in that category, they wouldn't sell you insurance at all . That's a recipe for very affordable coverage for the low-risk population but no coverage at all for the high-risk population, with the unspoken assumption that one way or another the doctors and hospitals would eat the cost of treating the uninsured. (Medical expenses are the leading cause of bankruptcy in America, ad of course it's the providers who end up holding the bag when the unpaid bills are discharged in a bankruptcy proceeding).

Meanwhile, a completely different dynamic was at work in the group health market where (for example) employers purchased the coverage that they made available to their employees as a benefit. There the insurers were required to accept all comers (it wouldn't be much of an employment benefit otherwise), and the actuarial risks were distributed across the entire employee pool. This meant that the premiums for the super-healty were higher than would be in the individual market, but because the cost was paid by the employer not the individual staying in the pool was still a good deal; and the less healthy could also find coverage This approach has worked well for many years, l - there's nothing in the ACA that changes this part, a substantial fraction of Americans are covered this way, and a fair case can be made that it's the part of the American health system that works best, at least for the people whose jobs give them access to such coverage.

What the ACA has done is bring the economics of group coverage to the individual market. The insurance companies are required to cover everyone, and the stick of the individual mandate replaces the carrot of the employer contribution to keep the healthy as well as the unhealthy in the pool. Costs do go up for the super-healthy (at least during their youth - hit your fifties and the pre-ACA individual market isn't such an attractive place)... and as I said at the beginning of this long story, that's likely what you and Greg are seeing.

I expect several things to happen over time (if the supreme court and/or a republican legislature doesn't gut the whole thing first):
- Employers will less often buy health coverage as a benefit for their employees, as most employees will find if they look at the costs that they'd rather take the dollars and buy their own insurance. This will be a good thing, as it removes a number of serious economic distortions and makes it easier for people to switch jobs without worrying about losing their coverage.
- The group insurers have proven themselves to be very effective at controlling costs while maintaining a decent level of coverage. That's to be expected; competition limits what they can charge to cover a given group so their profitably depends on the cost of servicing that group. The experience of other countries that have chosen to provide mandated coverage through private insurers suggests that the total costs will come down and efficiency will climb.

 

[mheslep]

The key phrase in the quoted excerpt is 'physician-owned hospitals'.

Physician-owned is particular only to the source of competition in that example; the CON laws can block new hospitals owned by physicians, Donald Trump, or my granny. In other words, any would innovator, like a SouthWest Airlines of Hospitals, that comes along and finds away to cut prices in half can forget about it in the era of CON laws.

Such physician-owned hospitals have been outlawed from expanding under the ACA now anyway, unless of course, they can show they serve a need and request a waiver from the Secretary of HHS.

Do you believe such is a good thing? Who would have an interest in including such a restriction in the ACA?

 

[SteamKing]

Physician-owned is particular only to the source of competition in that example; the CON laws can block new hospitals owned by physicians, Donald Trump, or my granny. In other words, any would innovator, like a SouthWest Airlines of Hospitals, that comes along and finds away to cut prices in half can forget about it in the era of CON laws.

In order to open any hospital, you definitely need the CON from the state. But like a lot of regulatory action, I think that this process is more complicated than just a group of local politicos deciding which applications to blackball. After all, a hospital can bring a lot of good jobs to a community, the kind of thing which looks good on a politician's resume at election time.

Do you believe such is a good thing? Who would have an interest in including such a restriction in the ACA?

I honestly don't know. This and many other provisions in the law defy explanation. It's almost like Congress went out of its way to draft a shoddy piece of legislation, which no one read or understood before voting on it. ;)

 

[Evo]

We seem to be going off track here, opening hospitals has nothing to do with insurance prices for individuals. Please get back to the Op.

 

[mcknia07]

I work somewhere where we hear all about obamacare. People seem to be paying high prices, but in the end are getting an insurance equal to Medicaid.

My job also offers full time and part time insurance. :) huge plus! I've never had to look into new insurance due to living at home and just taking the cheapest plan offered to me since I hardly ever go to a doctor.

 

[mheslep]

The large insurance companies negotiate standard fees with physicians and hospitals ahead of time. A doctor who has made such an arrangement with your insurance company is "in network"; ...

None of this is new with Obamacare.

Yes the concept of in and out of network is not new. The definition of what is now "in-network" by the insurers is new, based on the advent of the ACA exchanges. Networks are shrinking significantly, a significant reason why the "keep you doctor" promise was broken for many. Losing in-network access to a given doctor, a major hospital, or perhaps the only hospital nearby in a rural area is a downside of the ACA. The upside of this effect is that the more narrow networks should increase competition on price, thereby bringing prices down. For instance, insurers might now decide to exclude the expensive big-campus teaching hospital that it previously had in-network for years. See, e.g. the UCLA Cedars-Sinai hospital, now excluded from some insurance plans in CA.

http://www.forbes.com/sites/theapot...our-choice-of-doctors-and-thats-a-good-thing/

 

[Nugatory]

Such physician-owned hospitals have been outlawed from expanding under the ACA now anyway, unless of course, they can show they serve a need and request a waiver from the Secretary of HHS.

Do you believe such is a good thing? Who would have an interest in including such a restriction in the ACA?

It would be a bad thing if it did that, but that's not what the ACA does. It couldn't even if someone wanted it to; it should be obvious that the American federal government has very little power to limit hospital construction and expansion.

[WARNING - What follows is a huge oversimplification. We're talking about a quarter-century of arcane legislation spawned by a cat-and-mouse game between the regulators and the people trying to game the system. To get the whole story, you have to google for "medicare stark act" (it's named after representative Peter Stark, who introduced the legislation 25 years ago) and read the history starting from 1989 when the law in question was passed.]

There is an obvious conflict of interest when a physician can refer patients for highly profitable treatments at a hospital that the physician owns; no private company would tolerate that sort of arrangement between its suppliers. So the Stark act, passed in 1989 and taking effect in 1992, said that Medicare and Medicaid won't automatically pick up the bills from these hospitals. However, under certain circumstances existing physician-owned hospitals were grandfathered in so could continue to bill the government for such referrals; that created a loophole, as the grandfathered businesses were free to increase their billings by building new capacity to increase their throughput. The ACA closed this loophole by saying that new capacity at these grandfathered businesses would not also be grandfathered in.

So under this part of the law no one is stopping anyone from building or expanding any hospital or other medical facility. They're just saying that you can't take it for granted that the government will pay for any treatments delivered by this new capacity and that are recommended by the hospital owner.

 

[Nugatory]

Yes the concept of in and out of network is not new. The definition of what is now "in-network" by the insurers is new, based on the advent of the ACA exchanges. Networks are shrinking significantly, a significant reason why the "keep you doctor" promise was broken for many.

Are they shrinking? That may depend on where you live. I've found that the network available to me under the various ACA policies that I'm looking at includes all of the providers that were available to me under the employer group plan that I'm currently covered (under COBRA) by, and the costs are a bit better than what I'm paying under COBRA.

 

[lisab]

All I know is that Obama made it possible for my older daughter, Spawn of Evo, who has Chrons disease and was canceled by her previous insurance and uninsurable to get cheap insurance. His law made it illegal for insurance companies to turn her down. It's not the new plan, but I thank him every day.

My daughter also has a chronic illness (an autoimmune disease). Obamacare has made a huge difference in her life path.

It's hard to believe people think it's OK that insurance companies should make policies that wreck the lives of people who are ill through no fault of their own. I'm not talking about making decisions on million-dollar treatments that extend life a few months. I mean simple, affordable treatment that can transform someone from medically disabled into a tax-paying, employed person. This is considered "normal" in all developed countries.

The system was screwed up for so long, and both both parties had ample time to fix it. Obamacare may need some fine-tuning but I'm happy it's the law of the land now.

 

[SteamKing]

It's great that Evo and Lisab are well served by the ACA, but there were others suffering from chronic illnesses before the ACA who had in place insurance policies and physician networks which satisfactorily provided treatment at a price which these patients could afford. After the ACA was signed into law, the health care arrangements of these patients were thrown into turmoil, as their physicians and specialists were not part of the available ACA compliant health networks, or their premiums rose to unaffordable levels. If the Administration had been serious about keeping its promise that you could keep your doctor/insurance plan if you liked it after the ACA became law, there would be a lot more acceptance of the law than there is currently.

The problem with the ACA is that it is considered a "signature" piece of legislation by the Democrats, a part of Obama's presidential legacy, and that any "fine-tuning", "revisions", "amendments", etc., imply that the law as written was flawed. Given the length of the original bill and the massive amount of regulation stemming from its implementation, it is not surprising that there are problems. There was no compromise entertained during the legislative process, which was why this bill did not receive the bipartisan support it should have garnered to be accepted by a majority of the population at large.

Failing to realize that changes were required to the law (or stubbornly refusing to do so, take your pick) as it has been partially implemented to date was a big reason why the recent election results were so dismal for the president and his allies in congress.

 

[dlgoff]

I need to sign up my wife and I ...

How does it work for married couples? Can you apply individually? Like IRS tax; married but filing separate tax returns?

 

[SteamKing]

How does it work for married couples? Can you apply individually? Like IRS tax; married but filing separate tax returns?

It depends. If you are looking to get a subsidy to pay for your coverage, the combined household income will normally be used to determine if you qualify and what amount of subsidy you can get. Different marital situations will have (like if you are separated) will have different rules to follow.

Different marital situations are covered here:

http://www.healthreformbeyondthebasics.org/question-of-the-day/

 

[Evo]

Steamking, I don't know anyone that had to change doctors. I heard that it affected some people because their insurance company changed their list of "in-network" providers, but this has always happened in the past, policies change, prices change (always increase) and the doctors and hospitals willing to accept the insurance negotiated fees back out of the plans. Do you have any documentation on how many doctors and hospitals were *removed* by the ACA and not because of normal changes, that the doctors opted out because of the money? My health insurance is going up next year, same policy, but an increase of $39 a month. But that's not unusual, my employer was always shopping for the best deal and it was not unusual for our health insurance provider to change. And it always meant it wasn't as great, in the last ten years, we had started to see annual deductibles that we'd never had before and this was before Obama was even elected. Insurance changed every year. My company had a fight with the largest, best hospital near me, so that hospital was no longer an option for me, they denied insurance coverage for it. That was 12 years ago, now that I am on medicare, I can go to that hospital, not going to name it, but it's a name you'd recognize.

Also, it has to be an official site, not some complaint site. I am in my open enrollment period for health insurance right now and was looking at some *sites* where people make complaints and some of the complaints were utterly ridiculous. The things people believe are just mind boggling.

 

[Evo]

Different marital situations are covered here:

http://www.healthreformbeyondthebasics.org/question-of-the-day/

Steamking, this is for Medicaid and SSI. This is for people below the poverty line and extremely low income individuals. It's not for people with normal incomes. Where exactly in that link does it address the question dlgoff posed for people with normal incomes, not the impoverished that qualify for medicaid and SSI? I am on Social Security and I don't qualify for either Medicaid or SSI (Social Security supplemental income) because my Social Security payment is too high. I don't work anymore. I am on Medicare due to disability, not old age.

 

[SteamKing]

Steamking, this is for Medicaid and SSI. This is for people below the poverty line and extremely low income individuals. It's not for people with normal incomes. Where exactly in that link does it address the question dlgoff posed for people with normal incomes, not the impoverished that qualify for medicaid and SSI? I am on Social Security and I don't qualify for either Medicaid or SSI (Social Security supplemental income) because my Social Security payment is too high. I don't work anymore. I am on Medicare due to disability, not old age.

I think you got confused because at the link cited, the Question of the Day dealt with Medicaid and SSI.

If you scroll down the page, you will see a variety of different FAQs for ACA enrollment. These FAQs are grouped into different topic sections, the first of which deals with questions about Modified Adjusted Gross Income (MAGI).

For dlgoff and his question on the effect tax filing status and marital status have on ACA enrollment, the section entitled

"Tax Filing Status and Eligibility for Premium Tax Credits"

might answer his specific questions.

 

[Evo]

I think you got confused because at the link cited, the Question of the Day dealt with Medicaid and SSI.

If you scroll down the page, you will see a variety of different FAQs for ACA enrollment. These FAQs are grouped into different topic sections, the first of which deals with questions about Modified Adjusted Gross Income (MAGI).

For dlgoff and his question on the effect tax filing status and marital status have on ACA enrollment, the section entitled

"Tax Filing Status and Eligibility for Premium Tax Credits"

might answer his specific questions.

What are "Premium Tax Credits"? I want to thank you for all of your helpful information, just not sure who this applies to.

I believe this site is better.

Basic Information
Starting in 2014, if you get your health insurance coverage through the http://www.irs.gov/uac/Newsroom/The-Health-Insurance-Marketplace, you may be eligible for the premium tax credit. This tax credit can help make purchasing health insurance coverage more affordable for people with moderate incomes.

http://www.irs.gov/uac/The-Premium-Tax-Credit

The Health Insurance Marketplace is the place to go to learn about financial assistance options.
When you get health insurance coverage through the Marketplace, you may be able to lower your monthly premium through advance payment of the premium tax credit. The credit is generally for people who have household income between one and four times the federal poverty level.

http://www.irs.gov/pub/irs-pdf/p5121.pdf
.

 

[SteamKing]

Steamking, I don't know anyone that had to change doctors. I heard that it affected some people because their insurance company changed their list of "in-network" providers, but this has always happened in the past, policies change, prices change (usually increase) and the doctors and hospitals willing to accept the insurance negotiated fees back out of the plans. Do you have any documentation on how many doctors and hospitals were *removed* by the ACA and not because of normal changes? My health insurance is going up next year, same policy, but an increase of $39 a month. But that's not unusual, my employer was always shopping for the best deal and it was not unusual for our health insurance provider to change. And it usually meant it wasn't as great, in the last ten years, we had started to see annual deductibles that we'd never had before and this was before Obama was even elected. Insurance changed every year.

Also, it has to be an official site, not some complaint site. I am in my open enrollment period for health insurance right now and was looking at some *sites* where people make complaints and some of the complaints were utterly ridiculous. The things people believe are just mind boggling.

Like I said, Evo, I'm pleased you and you daughter are being treated right under ACA.

However, just because you personally do not know anyone who has been adversely affected doesn't necessarily mean that such people and situations do not exist. I don't think any insurance policy, whether for health care, automobiles, home owner's, etc., can reasonably be expected not to change at all over time, either in terms of coverage or amount of premium charged.

For example, I used to have a perfectly affordable home owner's policy which cost less than $1000 a year for the premiums. It had been this amount for ages, and I never had filed any claims. Because I live in the SE US and there was an uptick in claims filed on HO policies by folks living in Florida and other coastal regions who sustained losses in hurricanes a number of years ago, my company dropped my coverage because they claimed I lived too close to the water (I'm at least a half hour away from a protected bay, and about an hour away from any sea). Wind coverage is all but unobtainable now, at any price, and the last time I renewed my HO insurance (about 4 years ago), the premiums had increased from less than $1000 a year to just under $3000 annually. I couldn't afford this, so I dropped it.

People are having to make the same decision with regard to health insurance, even though coverage is mandated. Sure, subsidies are available for some who qualify, but even with these, it comes down to whether the cost of the coverage is affordable.

 

[SteamKing]

What are "Premium Tax Credits"?

It's how the premium subsidies are administered:

http://www.cbpp.org/files/QA-on-Premium-Credits.pdf

 

[mheslep]

It would be a bad thing if it did that, but that's not what the ACA does. It couldn't even if someone wanted it to; it should be obvious that the American federal government has very little power to limit hospital construction and expansion.
...
So under this part of the law no one is stopping anyone from building or expanding any hospital or other medical facility. They're just saying that you can't take it for granted that the government will pay for any treatments delivered by this new capacity and that are recommended by the hospital owner.

Per the CMS reference that SteamKing provided earlier, the ACA states that physician-owned hospitals are "prohibited from expanding facility capacity", i.e. no new and no expansion of existing. Apparently the prohibition applies to any doctor-owned hospitals that would accept Medicare or Medicaid beneficiaries. The Stark Law as I understand it blocked referrals from physician-owners, but not any and all payments to Medicare/Medicaid beneficiaries at such physician-owned as does the ACA. By blocking the customer base (~49 million people for Medicare), it is obvious that the government has a great deal of power to limit hospital construction. One can argue the rationale, the avoidance of conflict of interest, etc, but not that the federal government has acted to block physician-owned hospitals. This source suggests the restriction was intentionally placed in the law to win acceptance for the ACA from other hospitals.

...the restrictions [on physician-owned hospitals] were a deal-breaker for hospitals when the White House sought their support for the law in 2009, industry lobbyists say.

 

[jz92wjaz]

We're on the exchange. Our prior policy covered more providers, including out of network. We lost one major provider and a minor one, but it wasn't a big deal. In spite of being in the highest risk group on our old policy, the premium without a subsidy went up. For the extra 80 or so a month (which is about what our subsidy was this last year), we now have pregnancy coverage, which we couldn't get before. Our pre-exchange policy had a much lower deductible but an ever so slightly higher maximum out of pocket. The cheapest exchange policy was beyond horrific when it came to the network.

Pre-exchange and post-exchange, we're forking out roughly $15,000 for medical on a yearly basis, because we have a family member with a lot of medical needs. If we hadn't been able to get onto an insurance policy when my work coverage ended, we'd have been thrown into a high risk pool, which could have cost us over $25,000 every year for the next few years, and that would have tipped us over the edge. We would have been better off making less money so we'd qualify for government medical assistance.

There are still substantial problems with the new law, but the ACA starts to fill in that gap where people who make just a little too much were funding all sorts of medical assistance for most everyone else though their taxes (medicare, medicaid, and tax breaks for employer sponsored insurance), and yet were going broke themselves.

 

[Astronuc]

It seems implementation of ACA is inconsistent?

And now - Exclusive: U.S. CEOs threaten to pull tacit ACA support over 'wellness' spat
http://news.yahoo.com/exclusive-u-ceos-threaten-pull-tacit-obamacare-support-120556143--sector.html

It is necessary to have health insurance, but it doesn't help so much if it isn't affordable, since one must chose whether or not to seek treatment based on affordability. As it was, and probably still is, some are still forced to go without.

The problem with affordable health insurance is that so many people need significant care. If only 1% or 0.1% needed costly health care, it might be affordable. However, if something like 30% +/- need costly healthcare, then that would impose a burden. On the other hand, a free market system would mean a lot of folks going without healthcare, that is beyond an annual or periodic visit to the doctor.

There needs to be a nationwide wellness program in order to reduce the incidence of heart or pulmonary disease, diabetes, cancer, . . . . I remember when the President's Physical Fitness program was an annual event in school. I don't hear much about it anymore.