# An unintended consequence of affordable healthcare.



## Passepartout (Nov 20, 2013)

I think there will be a huge 'churning' of employment after healthcare becomes affordable and portable.

Employer paid healthcare has been both a benefit to the employee, AND a way for employers to assure a steady workforce. In my former work life, one way potential employers attracted employees was through differences in health insurance- as well as other perks. Vacation time, paid holidays, sick leave, etc. included. I was not alone in feeling that insurance- derived through decades of loyal employment- kept me working at the same job. Going to work at another employer in the same field would make me start the insurance 'ladder' all over again with probation period, then the employee gets coverage, and finally after months or even years, his family gets coverage. Many people feel that if they could get competitive insurance at another job- or even on their own, they'd be outta there.

If employers take the easy way out and cancel their coverage for employees, there is no 'golden lasso' holding employees to the job. Even COBRA won't keep them from bailing out. In my own case, COBRA was still $800/mo for coverage nowhere close to ACA insurance Bronze level. Many will take the opportunity to change careers, change employers to those who maintain coverage, or for the entrepreneurial, to strike out on their own. 

It will be interesting to see as the law takes effect and people realize what options exist that don't currently.

Jim


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## channimal (Nov 20, 2013)

except where those "job-hoppers" will find that most companies have figured out how to be profitable with the minimum amount of employees necessary.  Then they will join the growing number of unemployed or under-employed.  Sadly, the real number of this populace remains censored and undisclosed.


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## Ken555 (Nov 20, 2013)

Passepartout said:


> If employers take the easy way out and cancel their coverage for employees, there is no 'golden lasso' holding employees to the job.



I posted in another thread that I'm canceling my business group policy. This is not "the easy way out". It simply costs way too much and doesn't provide the value you state, at least for my small business. I know other businesses have benefited by this advantage, and in that regard it did justify some premium in order to attract the best employees regardless of age or health. Now that everyone will be permitted coverage that is no longer true - the only restriction could be how each individual pays for their health coverage. Will the company pay for it on their behalf? Will the employee pay with pre or post-tax income, or a potion paid by the employer? There will always be ways for a business to provide additional benefits to employees. There is also the advantage to the individual, in that with their own policy they can, as you suggest, hop from job to job without worry about their policy. Why should their health insurance tie them to a particular job, if they have the opportunity to change for a better job? I don't see the negative in this, even for the business - since the business needs to compete with others on a level playing field, and this imminent change will help in that regard, as well.


Sent from my iPad


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## b2bailey (Nov 20, 2013)

Jim, I think this is an interesting perspective. I know of MANY who stay holding on to their work JUST for the insurance -- when really they want to retire. If those people are able to afford retirement and new insurance coverage -- that could open up the job market for those who are looking for work.

Back when my husband was out of work -- I used to say I wasn't sure who I felt the most compassion for -- a man who had worked nearly 50 years and can't find a job -- or the newest College Graduates who can't find a job.


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## Passepartout (Nov 20, 2013)

b2bailey said:


> Jim, I think this is an interesting perspective. I know of MANY who stay holding on to their work JUST for the insurance -- when really they want to retire. If those people are able to afford retirement and new insurance coverage -- that could open up the job market for those who are looking for work.



This certainly described me. I was hardly a 'job-hopper' after over 30 years in an industry- 23 with the last employer. I simply couldn't afford to change employment because of cost or unavailability of healthcare- and lots of my co-workers felt the same.

I will watch with interest.


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## SMHarman (Nov 20, 2013)

This is something I have not read up on (does not apply to me yet).

So if I decide that  at 55 I can now afford to retire as I can get ACA medical insurance, what income is the subsidy based on?

My full time salary from 2013 or my estimated (and significantly reduced) income in 2014?


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## channimal (Nov 20, 2013)

I believe the year prior income would be the qualifying data.


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## artringwald (Nov 20, 2013)

When I retired 5 years ago after working 35 years at a large company, much of the loyalty had already disappeared. The reduction of benefits, and several rounds of layoffs, especially of the "expensive" older workers really hurt the loyalty. I was fortunate to retire with a pension and retiree medical coverage, but new employees won't have that when they get to retirement age. I understand the economic necessity of reducing costs, but that company realized they were losing to much of the knowledge and experience they needed and had to offer some incentives for people to delay retirement.


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## Conan (Nov 20, 2013)

Passepartout said:


> This certainly described me. I was hardly a 'job-hopper' after over 30 years in an industry- 23 with the last employer. I simply couldn't afford to change employment because of cost or unavailability of healthcare- and lots of my co-workers felt the same.
> 
> I will watch with interest.



I hadn't appreciated this aspect of ACA but it is an intended result of Obamacare:

http://bit.ly/1bRxpTL

http://bit.ly/1cGQ2I9


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## geekette (Nov 20, 2013)

Certainly, people will no longer be 'tied' to their jobs out of fear of ins loss.  I am not one that overstayed a job for benefits, but plenty of folks I have worked with have stayed with jobs they hated for the insurance.  I remember putting in my resignation and feeling quite glad that I didn't feel 'trapped' in that manner.  

The laid off that exhaust COBRA now have options also, especially if they had pre-existing conditions that ruined any chances of non-COBRA insurance.


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## Patri (Nov 20, 2013)

For the last decade or more, employees are not loyal to companies, and companies are not loyal to employees. Those days of a one-employer career are gone. ACA won't change that either way. If nothing else, the younger generations embrace change.


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## b2bailey (Nov 20, 2013)

*Pretty sure it is based on 2014 estimated income.*



channimal said:


> I believe the year prior income would be the qualifying data.



I got that far on my application.


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## pjrose (Nov 21, 2013)

b2bailey said:


> . . .  I know of MANY who stay holding on to their work JUST for the insurance -- when really they want to retire. . . . .



Count us in that category.  When DD with her extensive medical history hits 26, then we can retire, or before then if DSIL and she get coverage as good as our current coverage from work.


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## Rose Pink (Nov 21, 2013)

A year or two ago, my DH posted on FB a letter to the editor from an adult woman in her 20s who had chronic health problems and was unable to get insurance. She stated that she was forced into accepting employment unsuitable to her skills and education just for the reason she could get health insurance at that job. The letter rang so true with us because our DD is in the same position. She has a master's degree but has been unable to find full-time work in her desired field. She is back working her high school job because she gets health benefits. She is miserable but has had to keep that job for the vital insurance benefits. Before she had fulfilled the required 90 days employment for the insurance to kick in. she found herself in the ER. Bill came to 11K for about three hours. The hospital waived their portion (much to her relief--she had called them to explain she had no insurance and wanted to set up a payment plan) but the doc wouldn't. The doctor came in to see her about three times for no more than 30 minutes total. The bill was $800. They told her if she paid half of it up front, they'd waive the rest. So, she put $400 on her credit card. It's criminal IMO that healthcare is so expensive.  No wonder it is the #1 cause of bankruptcy.

Now with the ACA, she can't be denied the ability to purchase insurance. She had to go back to her high school job because she couldn't buy insurance on the open market at any price due to her pre-existing conditions. Now, she and others like her, can buy insurance and aren't forced into accepting unsuitable jobs just for the insurance benefit. If she wants to freelance, she can do that. If she wants to work a couple of part-time jobs that don't provide benefits, she can do that. And still be able to buy insurance.


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## isisdave (Nov 21, 2013)

b2bailey said:


> I got that far on my application.



And I think at the end of 2014, it gets reconciled -- your actual credit is figured out at the end of the tax year, but you get it month by month as the subsidy ... so if you guess wrong, or your situation changes and you don't adjust the subsidy, you'll have to settle up at the end. Kind of like guessing at your quarterly withholding if you're self-employed.


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## zinger1457 (Nov 21, 2013)

SMHarman said:


> This is something I have not read up on (does not apply to me yet).
> 
> So if I decide that  at 55 I can now afford to retire as I can get ACA medical insurance, what income is the subsidy based on?
> 
> My full time salary from 2013 or my estimated (and significantly reduced) income in 2014?



When going through the ACA application you're asked to estimate your income for 2014, that's what your subsidy will be based on.  If your income changes in 2014 you are suppose to be able to go into ACA and change it.  In any case when you do your 2014 taxes you could get a subsidy refund (or have to pay some of it back) depending if your income was less or more than you estimated.


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## geekette (Nov 21, 2013)

zinger1457 said:


> When going through the ACA application you're asked to estimate your income for 2014, that's what your subsidy will be based on.  If your income changes in 2014 you are suppose to be able to go into ACA and change it.  In any case when you do your 2014 taxes you could get a subsidy refund (or have to pay some of it back) depending if your income was less or more than you estimated.



I believe the subsidy goes directly to the insurer, there will be no refund to the individual, but would instead be between the govt and the ins co.  If the govt overpaid ins co because you made more than estimated, you may be required to square up with the IRS.


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## Icc5 (Nov 21, 2013)

*Benefits*

I worked for a large grocery chain for 42+ years and stayed with them mainly because of the health benefits that covered myself and my family.  Over the last several years those benefits deteriated and starting costing us to pay for part of them.  This was always considered part of our wages and the job would not have been worth it without the benefits or by having to pay even for part of them.
I retired recently and the main reason was we started losing the benefits and having to pay for part of them.  The few times we went on strike the benefits were thrown in our face as being the best there was which at one point was true.  Now though, new employees only get half the benefits for twice the price.  
We used to give up pay raises to have more money put towards the benefits which hurt us on each contract because then even getting a small increase like 2% was linked to the lower wages.  When the company started taking away benefits or charging they sure didn't bother to increase the wages.
Bart


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## Laurie (Nov 21, 2013)

Also some women (esp with pre-existing conditions) have stayed in marriages they hated, for the same reason. I've known some, near and dear to me.


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## geekette (Nov 21, 2013)

Icc5 said:


> I worked for a large grocery chain for 42+ years and stayed with them mainly because of the health benefits that covered myself and my family.  Over the last several years those benefits deteriated and starting costing us to pay for part of them.  This was always considered part of our wages and the job would not have been worth it without the benefits or by having to pay even for part of them.
> I retired recently and the main reason was we started losing the benefits and having to pay for part of them.  The few times we went on strike the benefits were thrown in our face as being the best there was which at one point was true.  Now though, new employees only get half the benefits for twice the price.
> We used to give up pay raises to have more money put towards the benefits which hurt us on each contract because then even getting a small increase like 2% was linked to the lower wages.  When the company started taking away benefits or charging they sure didn't bother to increase the wages.
> Bart



Fully paid benefits are absolutely a thing of the past, I have never had that.  Instead, as costs kept going up, it got passed along to us.  this is not unusual.  

I do know people that believe the job should fully pay the benefits but seems to me that being picky about that these days will equal unemployment.  In fact, the first person I knew with this weird mindset was long-term unemployed and eventually took a job with no benefits.  

While it is extremely kind of a small business to carry everyone, it's not reasonable nor feasible to expect it.  I would prefer that they stay in business rather than smother themselves in fully paid benefits.  One would think that their employees would also prefer it to unemployment.


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## MommaBear (Nov 21, 2013)

My daughter is switching to the government plan as it provides better care than her employer. She can stay in a job she loves!


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## geekette (Nov 21, 2013)

MommaBear said:


> My daughter is switching to the government plan as it provides better care than her employer. She can stay in a job she loves!



govt plan as in medicaid or medicare?


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## simpsontruckdriver (Nov 21, 2013)

I think she means the PPACA ("ObamaCare"). Medicaid has an income limit, and Medicare is only for those who are disabled or minimum 64 years 9 months old.

TS


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## Passepartout (Nov 21, 2013)

*guess who signs up for affordable healthcare...*

Well, it took him 4 hours, and a few false starts, but he got it done. http://home.cableone.net/news/read/...p-boehner_signs_on_to_obamacare_after_dela-ap Hard to argue with success.

Jim


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## FL Guy (Nov 22, 2013)

Passepartout said:


> Well, it took him 4 hours, and a few false starts, but he got it done. http://home.cableone.net/news/read/...p-boehner_signs_on_to_obamacare_after_dela-ap Hard to argue with success.
> 
> Jim



Why is Mr. Boehner signing up?  Doesn't all of Congress get fully paid insurance coverage (along with their exorbitant salaries and perks)?


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## Passepartout (Nov 22, 2013)

FL Guy said:


> Why is Mr. Boehner signing up?  Doesn't all of Congress get fully paid insurance coverage (along with their exorbitant salaries and perks)?



Not after 1/1/14. They get to sign up for ACA insurance. No doubt a Platinum plan. And at their salaries, no subsidy.


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## geekette (Nov 22, 2013)

simpsontruckdriver said:


> I think she means the PPACA ("ObamaCare"). Medicaid has an income limit, and Medicare is only for those who are disabled or minimum 64 years 9 months old.
> 
> TS



Yes but I have no clue as to the age nor situation of the daughter.

I just want to be clear that the only govt plans are Medicaid and Medicare. All else goes thru actual insurance companies and is not Govt Insurance.


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## x3 skier (Nov 22, 2013)

Anything that happens with Obamacare is not an unintended consequence.  The fact that things like the topic of this thread may be a surprise to some is because nobody except the people who wrote it knew what was in the law. As Ms Pelosi once observed, we have to pass this to see what's in it. 

In the case of portability or guaranteed access, it was specifically included to allow job switching while maintaining coverage. My opinion on this is that it is a good thing. Health insurance should not be the sole derterminant of where you choose to work. It certainly is a factor in that some companies may offer better health insurance and some not at all.

OTOH, the fact that a couple of 60+ must have maternity coverage (among other required coverage) seems dumb but it is required to make the whole thing work which personally, I don't believe it will. If waivers and adjustments are made on the fly like exempting big business or unions or left handed red haired people within 10 miles of the Washington Monument, the thing will collapse since the insurance companies will go broke. Either follow the law and stop this "Wait a minute, I didn't really mean what I said" or start over. And no, I don't have an answer to what would be better. 

Cheers


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## Passepartout (Nov 22, 2013)

geekette said:


> I just want to be clear that the *only* govt plans are Medicaid and Medicare.



 Not. And Veteran's Healthcare System.


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## x3 skier (Nov 22, 2013)

Passepartout said:


> Not. And Veteran's Healthcare System.



And the Federal Employees Health Benefits Program. That's the one the Congress belonged to until they decided to improve their re-election potential and left it for Obamacare.  

It is managed by the Government but the actual policies are offered by various insurance companies. The difference would be Obamacare requires certain benefits (one size fits all) and the Government doesn't manage the actual program while in the FEHBP, OPM sets minimums and the insurance companies offer various policies Feds can pick from. 

Cheers


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## geekette (Nov 22, 2013)

Passepartout said:


> Not. And Veteran's Healthcare System.



ooop, not at all sure how I forgot them, having been married to a vet.  Some years ago they dumped him from dental (he is diabetic and of course has many dental issues).  I am not sure how it is going with throwing people out, but he was disabled vet, possibly not 'disabled enough.'  

Since I always had insurance thru work, I never did the Champus thing and quickly dumped having a second carrier as back then the paperwork was on the patient and secondary made a big pile of doo, and I was not going to change doctors.   A few years later, I simply would have felt guilty using them since vets were getting thrown out.  I did nothing for our country but marry a vet.  

VA is not for the masses, leaving just Medicaid and Medicare for The Masses as govt plans.  govt WORKER plans are covered in another post here, and I would not call that A Govt Plan but an employee plan.


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## Passepartout (Nov 22, 2013)

x3 skier said:


> OTOH, the fact that a couple of 60+ must have maternity coverage (among other required coverage) seems dumb but it is required to make the whole thing work



I've heard this argument before, and it's true about making the thing work.

Case in point... I am childless and a senior. 

For more than 40 years, I have been billed for and continue to pay property taxes. The VAST majority of which is used to pay for schools in which I have never set foot nor produced a child who benefited. My taxes also provide for fire protection which I have never used (thank goodness). All this so that, to paraphrase you, "to make the whole thing work."

It's part of making society work as whole. The price we pay for not living as animals, under a 'survival of the fittest' mentality- though it seems some would like it to be such.


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## Icc5 (Nov 22, 2013)

*Point is we paid for it by lower wages*



geekette said:


> Fully paid benefits are absolutely a thing of the past, I have never had that.  Instead, as costs kept going up, it got passed along to us.  this is not unusual.
> 
> I do know people that believe the job should fully pay the benefits but seems to me that being picky about that these days will equal unemployment.  In fact, the first person I knew with this weird mindset was long-term unemployed and eventually took a job with no benefits.
> 
> While it is extremely kind of a small business to carry everyone, it's not reasonable nor feasible to expect it.  I would prefer that they stay in business rather than smother themselves in fully paid benefits.  One would think that their employees would also prefer it to unemployment.



We paid for it by taking lower wages and now we still get the lower wages and have to pay more for it with less benefits.  Next contract will again start where pay is now (low).


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## geekette (Nov 22, 2013)

x3 skier said:


> OTOH, the fact that a couple of 60+ must have maternity coverage (among other required coverage) seems dumb but it is required to make the whole thing work


The one-size-fits-all nature of it is for simplicity and cost reduction.  And maybe you haven't heard, but there are women that can have kids at that age.  Not sure who the oldest woman was, but well past 50.

You can call it ridiculous, but I call it a safety net.  If a lady in her 60s becomes pregnant and wants to raise a child, good for her.

While I will never use the prostate exam coverage, it wouldn't bother me for it to be there.  I'd prefer that over everyone having to have all of their peculiarities noted in order to customize policies.  

Plans targeted For The Masses need standardization.  This also keeps women from being charged more for the pre-existing condition of being female.  Plus, men do have something to do with the medical condition of pregnancy.


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## geekette (Nov 22, 2013)

Icc5 said:


> We paid for it by taking lower wages and now we still get the lower wages and have to pay more for it with less benefits.  Next contract will again start where pay is now (low).



I would assume that folks staying the course are ok with the arrangement or would have left by now (of course, high unemp may have made new jobs difficult to impossible to land).

Presumably the company is increasing the amt it shells out each year per employee?  If that is not the case, and they are growing profits, then it seems focus shifted away from the employees.

On two of my jobs, HR would prepare a Comprehensive Benefit Statement for us every year so that we would know exactly what was spent On Us Individually.  That was a really good idea as most people do not think past salary.  But they pay life ins and ST/LT disability on me, a huge amt of health benefits, administer and contribute to 401k on my behalf, allow me to take paid time off at a rate higher than when I earned it, provide flu shots, appreciation parties, etc.


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## x3 skier (Nov 22, 2013)

geekette said:


> The one-size-fits-all nature of it is for simplicity and cost reduction.  And maybe you haven't heard, but there are women that can have kids at that age.  Not sure who the oldest woman was, but well past 50.
> 
> *You can call it ridiculous*, but I call it a safety net.  If a lady in her 60s becomes pregnant and wants to raise a child, good for her.
> 
> ...



*I* didn't say it was ridiculous, I said it * may seem dumb*. I also said it was necessary to make it work. I have no problem with a standard set of benefits and in fact, I am happy with my current plan, even if it does cover maternity benefits for my wife of over 70 and I, who is incapable of fathering a child for my medical reasons. 

What does bother me is that one is forced to accept these types of things when prior to the ACA, one could choose a policy that fits ones needs and that option is now gone regardless of a statement "If you like your current insurance, you can keep it, period." 

The ACA is the law and another thing that bothers me is a propensity to ignore parts of the law when it becomes inconvenient. BTW, such an approach is not limited this law nor to this administration. 

Cheers


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## geekette (Nov 22, 2013)

x3 skier said:


> *I* didn't say it was ridiculous, I said it * may seem dumb*. I also said it was necessary to make it work. I have no problem with a standard set of benefits and in fact, I am happy with my current plan, even if it does cover maternity benefits for my wife of over 70 and I, who is incapable of fathering a child for my medical reasons.
> 
> What does bother me is that one is forced to accept these types of things when prior to the ACA, one could choose a policy that fits ones needs and that option is now gone regardless of a statement "If you like your current insurance, you can keep it, period."
> 
> ...



Apologize for mischaracterization, there is another older fellow QUITE pissed about this point, you absolutely understand that it makes the wheel go round.

It was never going to be a level playing field with pick n choose.   Even not-wanting-kids females got hosed on rates (I am childless by choice, but, being female, of course insurers "know" that I want babies more than anything else so jack my rates).

Forced to accept?  Look at it from the other angle - insurers Forced To Offer because they wouldn't if they could get away with it.  that's how people ended up with skimpy policies.  Sounds great to buy only what you need, accept ins sales is like timeshare sales and people don't know they are screwed until they go to try to use the product.  I consider it consumer protection.

People can buy all the additional riders they want, there are just Minimum Required Elements for each policy.


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## Ken555 (Nov 23, 2013)

Passepartout said:


> I've heard this argument before, and it's true about making the thing work.
> 
> Case in point... I am childless and a senior.
> 
> ...



+1

Good example. The entire principle behind this initiative is that society has determined that everyone should have health insurance, just like everyone is entitled to an education and everyone is required to have auto insurance. There are certainly ways to improve upon this first version, as I doubt anyone thinks it's ideal in its current form, and I'm really hoping we can look back at this time as the catalyst which brought us back to having a very good health system which everyone could afford to use when needed. The details matter, but I don't let them worry me since from my perspective the overall goal is to provide a mechanism for health insurance for all, and though we aren't there yet I think we are on the way. And since I don't base decisions based on fear, and instead look to substantiated facts, I know this initial solution is a step in the right direction if only that I can personally now change health insurance without worry of existing conditions, and that my policy will save me money and provide greater coverage than my current policy. I know that's not the case for everyone, but hopefully other insurance companies will get into the market and offer these plans in more regions so more can benefit. I'm staying positive.


Sent from my iPad


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## isisdave (Nov 23, 2013)

I really like the education reference.

Before the 1840's, there were almost no public schools in this country, and the prevailing attitude about education was "if you want your children educated, pay for their schooling yourself. Why should the public pay for your family's needs?" Does that sound familiar?

Starting with people like Horace Mann about 1840, the sentiment came around to "hey, maybe if we educated more people, we would have some better workers, and at least wouldn't have so many idle kids getting into trouble," or in other words, universal education benefits society generally.

[There are lots of other things that used to be considered privileges that have become things we have a right to, although not all are free: for example, citizenship, if you're not white; voting, which used to be a privilege of those who were wealthy (and male); clean water; public roads; access to government records.]

Now we're in the midst of implementing "if we can keep more people healthy with relatively cheap preventive care, maybe we won't have to spend so darn much on them when they show up in the Emergency Department"

A hundred years hence, this will all be an amusing footnote, just like the education story is today. I wonder what other element of life in 2200 will be starting to be thought of in a similar way? Implanted network connections? Access to teleportation centers? Free lunch?


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## ScoopKona (Nov 24, 2013)

isisdave said:


> I wonder what other element of life in 2200 will be starting to be thought of in a similar way? Implanted network connections? Access to teleportation centers? Free lunch?



I seriously doubt human beings will be anywhere other than "subsistence level" in 2200 -- not unless we can pull a deus ex machina to stop rising sea levels. I have a feeling that the people in 2,200 AD when they stop to think about the past, will mostly wonder, "What in God's name were those people THINKING???"


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## littlestar (Nov 24, 2013)

I know quite a few people who will go ahead and retire because of the Affordable Care Act.  I think affordable coverage not linked to employment is a good thing.  Because any of us are just a pink slip away from losing employer based health coverage. For sure there's a lot of work to be done to get things right, but at least it's a start. 

My husband and I saw the handwriting on the wall at my husband's former employer when the company newsletters were bemoaning the cost of healthcare for their "older" workers.  When they went through and downsized they really hit the "50 plus" workers very hard. Ultimately, the former employer's business has suffered by losing all that knowledge and talent. My husband (and a lot of his former co-workers) are now working for a competitor and they are taking business away from the former employer at a fast clip.  

It's definitely interesting to watch.


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## Kal (Nov 24, 2013)

ScoopLV said:


> ...-- not unless we can pull a deus ex machina to stop rising sea levels. I have a feeling that the people in 2,200 AD when they stop to think about the past, will mostly wonder, "What in God's name were those people THINKING???"


 
 Yes, global warming is a serious issue.  Only 3 "worst ever" records set around the globe in the last 3 weeks.


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## bogey21 (Nov 24, 2013)

Icc5 said:


> We paid for it by taking lower wages and now we still get the lower wages and have to pay more for it with less benefits.  Next contract will again start where pay is now (low).



Same for those who took lower paying jobs with lower pay and nice Defined Benefit Pension Plans only to see the terms of their Plans changed to their detriment.

George


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## tashamen (Nov 25, 2013)

littlestar said:


> Because any of us are just a pink slip away from losing employer based health coverage.
> 
> My husband and I saw the handwriting on the wall at my husband's former employer when the company newsletters were bemoaning the cost of healthcare for their "older" workers.  When they went through and downsized they really hit the "50 plus" workers very hard.



This is what I'm worried about - since both DH's and my employer can downsize us without cause that I may be out of a job soon because the health insurance that we get through my employer is costing that employer much more for next year.  Normally they would have announced the cost by now for enrollment for 2014, but they have not - only saying that it's going up a "significant" percentage for both employee and employer portions.  (Note - I am NOT suggesting this is necessarily just because of ACA.)  So I wouldn't be surprised if several employees get pink slips in the next month.


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## bogey21 (Nov 25, 2013)

I have been retired for about 13 years now and have kept my ex-employer's insurance as secondary to Medicare.  It basically covers everything that Medicare doesn't plus dental, vision and prescriptions.  When I first retired it cost me about $350 monthly.  Now it costs over $600.   Main reason I keep it is that it is hassle free.  Ex-employer is self insured.  If their paying agent tries to drag out paying a legitimate claim, all it takes is a phone call to ex-employer and it is paid.

George


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## Passepartout (Nov 25, 2013)

bogey21 said:


> It basically covers everything that Medicare doesn't plus dental, vision and prescriptions.  When I first retired it cost me about $350 monthly.  Now it costs over $600.
> 
> George



I suspect you could get a Medicare supplement that would give as much coverage for a LOT less. It seems you can afford what you have, so why change? Me, I would at least look at the possibilities on www.medicare.gov/ You just have until Dec. 7 to change.

Jim


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## simpsontruckdriver (Nov 25, 2013)

For the most part, Medicare Advantage (either PPO - you choose your doc/specialist - or HMO) are MUCH cheaper than MediSupp plans. I also suggest going to Medicare's website to compare plans with all your drugs in hand. 

After December 7th, you can change your Medicare plan ONLY if you end your employer plan, as well as moving, leaving jail, in/out-of a nursing home, gain/loss of government assistance, etc (Special Election Periods).

TS


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## Kal (Nov 25, 2013)

simpsontruckdriver said:


> For the most part, Medicare Advantage (either PPO - you choose your doc/specialist - or HMO) are MUCH cheaper than MediSupp plans. I also suggest going to Medicare's website to compare plans with all your drugs in hand...


 
 In every situation, do some very careful analysis and projection to the next year.  Look at bottom line costs and not just the premium.  Advantage plans can have cheap premiums, but there are significant short comings. Those include high Co-pays, limited selection of doc/specialists and geographical limitations.  Medicare is driving all Advantage plans to HMO so it's one year at a time.  HMOs also have major limitations.

 In some states (e.g. Washington) the insured can change MediSupp plans many times during the year.  Start out with one plan and move up or down as potential health situations change.


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## x3 skier (Nov 25, 2013)

I thought about Medicare Advantage but just today, the local paper had a story about one of the biggest Advantage players in the area is dropping a large number of Doctors. This is supposedly because Medicare is cutting back on Advantage reimbursement year by year.

Cheers


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## momeason (Nov 26, 2013)

Ken555 said:


> +1
> 
> Good example. The entire principle behind this initiative is that society has determined that everyone should have health insurance, just like everyone is entitled to an education and everyone is required to have auto insurance. There are certainly ways to improve upon this first version, as I doubt anyone thinks it's ideal in its current form, and I'm really hoping we can look back at this time as the catalyst which brought us back to having a very good health system which everyone could afford to use when needed. The details matter, but I don't let them worry me since from my perspective the overall goal is to provide a mechanism for health insurance for all, and though we aren't there yet I think we are on the way. And since I don't base decisions based on fear, and instead look to substantiated facts, I know this initial solution is a step in the right direction if only that I can personally now change health insurance without worry of existing conditions, and that my policy will save me money and provide greater coverage than my current policy. I know that's not the case for everyone, but hopefully other insurance companies will get into the market and offer these plans in more regions so more can benefit. I'm staying positive.
> 
> ...



Me too. Thank you Ken


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## Kal (Nov 26, 2013)

x3 skier said:


> I thought about Medicare Advantage but just today, the local paper had a story about one of the biggest Advantage players in the area is dropping a large number of Doctors. This is supposedly because Medicare is cutting back on Advantage reimbursement year by year.
> 
> Cheers



It's actually getting worse than that. I was told that in 2014 one MAJOR Advantage insurance provider will specify each person's Primary Care doctor. That doctor will be a member of the ever decreasing pool of doctors who will still participate in that provider's preferred network.  I was also told this will become policy across the board for Advantage Plans and maybe extending into Medicare Supplemental Plans too.

Medicare's reimbursement for Advantage Plan doctors continues to be decreased. This started a few years ago. Originally the compensation was extremely excessive and highly profitable to the insurance companies. Once that profit margin started to drop, so too did the number of companies who continued to offer Advantage Plans. That federal money was one of the major "cuts in Medicare funding". Just cutting the fat payments to insurance companies.


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## Icc5 (Nov 26, 2013)

*Exactly-happened to us*



bogey21 said:


> Same for those who took lower paying jobs with lower pay and nice Defined Benefit Pension Plans only to see the terms of their Plans changed to their detriment.
> 
> George



This is exactly what happened to us.  The only good part for me is I built up lots of years under the original plan.


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## simpsontruckdriver (Nov 27, 2013)

There's a difference: rumor vs TRUTH with Medicare Advantage plans. Here is the ACTUAL truth. Budget negotiations in Washington led to cuts to Medicare. As a result, less money is being sent to Medicare Advantage plans from CMS (Centers for Medicare and Medicaid Services). With less money being sent to them from the Government, MAPD plans have to cut here and there to stay profitable.

Right now, there are two "big" types of MAPD plans: PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization). Which one costs more? The PPO. With the HMO, the insurer has worked out what they are paying the doctors. With a PPO, if a member goes "out of network", the insurer is forced to pay - except for the Copay - higher rates. So, that makes an HMO cheaper. Doctors who require more money in an HMO are booted out - or leave - the network, they only become "out of network" in a PPO.

In other words, the Government *IS NOT FORCING* any insurer to become an HMO, the simple fact is insurers are going HMO to save money. The plan I sell in Florida gives Medicare recipients $100 per month, lots of $0 copays, but we are an HMO. People want to stick with their physicians, but logistically, it may be better to switch. It saves you money, it saves the insurer money, and is most likely better for YOUR health

TS.


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## bobpark56 (Nov 27, 2013)

Kal said:


> It's actually getting worse than that. I was told that in 2014 one MAJOR Advantage insurance provider will specify each person's Primary Care doctor. That doctor will be a member of the ever decreasing pool of doctors who will still participate in that provider's preferred network.  I was also told this will become policy across the board for Advantage Plans and maybe extending into Medicare Supplemental Plans too.



So....What will be the chances now that the doctor one gets will be from the 50% that graduated in the bottom half of their class?


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## Kal (Nov 28, 2013)

bobpark56 said:


> So....What will be the chances now that the doctor one gets will be from the 50% that graduated in the bottom half of their class?


 
 The contracts negotiated between the insurance company and the doctor often are not a good deal.  So doctors refuse to accept Advantage Plan coverage offered by that company.  The reasons for doctors refusing to accept the terms could be the level of payment, the time it takes to get paid or the volume of paperwork required to submit a claim.  Given those types of issues, one might question the reasons a doctor does accept unreasonable contract terms.  Doctors from the bottom half of their class might readily accept those terms.


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## talkamotta (Nov 28, 2013)

artringwald said:


> When I retired 5 years ago after working 35 years at a large company, much of the loyalty had already disappeared. The reduction of benefits, and several rounds of layoffs, especially of the "expensive" older workers really hurt the loyalty. I was fortunate to retire with a pension and retiree medical coverage, but new employees won't have that when they get to retirement age. I understand the economic necessity of reducing costs, but that company realized they were losing to much of the knowledge and experience they needed and had to offer some incentives for people to delay retirement.



That sounds like the company I worked for.  I retired with 32 years and I was close to the bottom on seniority.  The company couldnt lay off the older workers because it was a union shop. Every contract we would give up an  increase in pay just so they didnt hit our benefits too bad.  The difference in health care coverage alone between management and craft was awful. Management paid more.  The contract 5 years ago stopped new hirees from getting a pension. The company doesnt have the loyalty of the younger workers  and the managers that lost thier's. 

Ive been retired for almost 2 years and have been asked to come back 3 times, each time it was from a manager higher on the totem pole. This company has lost alot of its expertise.  The learning curve is years for my job. I was loyal to this company, I worked hard and gave it my all because they had my back.  For many years we were like a family.  Without good health care and benefits the employees wont do that and EVERYONE LOOSES.


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## simpsontruckdriver (Nov 28, 2013)

In terms of retirement/pensions, a lot of states, and companies, are cutting back current pensioners' health care benefits. What Presidential candidates called "Cadillac Plans" are raising (or adding) copays. The current anti-union laws are turning phenomenal union retirement into average. Ironically, the best pensions are still for those in either the House or Senate, as well as the White House.

As a side note, if your pension health care drops to almost basic, it would help to sign up for a Medicare Advantage plan. They will work hand-in-hand to give almost $0 health care.

TS


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## simpsontruckdriver (Nov 28, 2013)

As more proof of changing pensions: Illinois lawmakers are reforming their state pensions.

TS


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## vacationhopeful (Nov 28, 2013)

Kal said:


> The contracts negotiated between the insurance company and the doctor often are not a good deal.  So doctors refuse to accept Advantage Plan coverage offered by that company.  The reasons for doctors refusing to accept the terms could be the level of payment, the time it takes to get paid or the volume of paperwork required to submit a claim.  Given those types of issues, one might question the reasons a doctor does accept unreasonable contract terms.  Doctors from the bottom half of their class might readily accept those terms.



Or not doctors, but NP. 

My independent general practice group used to have 15+ doctors with a onsite lab. It was busy from 7AM to 11PM M-F with Saturday hours from 7AM to 2PM. 5-6 years later, the group has "lost" all but 2 partner doctors, hired 2 replacement doctors JUST this month (for the 3 doctors who left at end of Oct) and 2 more NP (now up to 5 NPs). The other local doctors' offices - seem to have closed up - perhaps by selling out to "hospital clinics office in stripped shopping centers. Or thru "retirement" which is code for saving they were losing money and there were no buyers.

Again, these are my personal observations in my neck of the woods.


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## Kal (Nov 28, 2013)

vacationhopeful said:


> Or not doctors, but NP.
> 
> My independent general practice group used to have 15+ doctors with a onsite lab. It was busy from 7AM to 11PM M-F with Saturday hours from 7AM to 2PM. 5-6 years later, the group has "lost" all but 2 partner doctors, hired 2 replacement doctors JUST this month (for the 3 doctors who left at end of Oct) and 2 more NP (now up to 5 NPs). The other local doctors' offices - seem to have closed up - perhaps by selling out to "hospital clinics office in stripped shopping centers. Or thru "retirement" which is code for saving they were losing money and there were no buyers.
> 
> Again, these are my personal observations in my neck of the woods.


 
 The learning lesson for selection of ANY health-care insurance is to do in-depth research on all the various parameters.  Premium cost is just one of many considerations.  Remember, you get what you pay for.  A person might base their decision on cost then find the selection of providers to be extremely limited.  The doctor of your choice might not accept your insurance coverage.  Or, if you need medical service while travelling your only option might be the ER.  Travel outside the US and that's a whole different ball game.  Often the only option there would be trip insurance.

 Be careful out there!


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## Ken555 (Nov 28, 2013)

Kal said:


> The learning lesson for selection of ANY health-care insurance is to do in-depth research on all the various parameters.  Premium cost is just one of many considerations.  Remember, you get what you pay for.  A person might base their decision on cost then find the selection of providers to be extremely limited.  The doctor of your choice might not accept your insurance coverage.  Or, if you need medical service while travelling your only option might be the ER.  Travel outside the US and that's a whole different ball game.  Often the only option there would be trip insurance.
> 
> Be careful out there!



Great advice. I discovered this week that the very best (subjective, since it's not the most expensive) of the new ACA Platinum plans in Los Angeles - Blue Shield PPO - does not include in-network access to Cedars Sinai and UCLA hospitals, arguably two of the best hospitals in LA. My agent updated me (she apparently has been following this, and is yet another advantage to working with an agent - as far as I'm concerned, who needs a website to apply? ) and it seems they are still negotiating terms for 2014. I'm now looking at alternatives, since I want access to those hospitals, but unsure if this would stop me from going with this plan...either way, if it wasn't for my own research I wouldn't have known. From my perspective, it seems ridiculous that these two hospitals wouldn't reach agreement with Blue Shield, but the industry is changing.


Sent from my iPad


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## ricoba (Nov 28, 2013)

Ken555 said:


> Great advice. I discovered this week that the very best (subjective, since it's not the most expensive) of the new ACA Platinum plans in Los Angeles - Blue Shield PPO - does not include in-network access to Cedars Sinai and UCLA hospitals, ....



As a Kaiser member, I don't have access to those hospitals either and never have had, and I still "thrive"!   

(but you are probably right, if I were a platinum Blue Cross user, I'd want access to both  )


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## Ken555 (Nov 28, 2013)

ricoba said:


> As a Kaiser member, I don't have access to those hospitals either and never have had.
> 
> (but you are probably right, if I were a platinum Blue Cross user, I'd want access to both  )



Actually, I think Anthem/Blue Cross does have access (it's another data point I'm looking into...I have Anthem now) and Blue Shield does this year (I think...there's conflicting info out there) but it's all about 2014 now. As for Kaiser...well, that's an entire different game altogether and difficult to compare with any of the traditional insurers since Kaiser has it's own hospitals etc.


Sent from my iPad


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## Kal (Nov 28, 2013)

In one selection process I narrowed my choices to TWO insurance companies.  I called every one of my current medical providers to assure they would accept both companies.  My surprise was that my most important provider would not accept one of those two companies (Humana) and never will in the future.  The reasons were sound.  So that made my choice easy.  Humana's plan had the lowest premium.  The plan I selected accepted just about any provider I suggested so all is good.


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