Obamacare

Mandate Delay Aside, Obamacare Plans Are Shockingly Unaffordable For Many

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Healthcare.gov
U.S. Government

President Obama moved the goalposts a tad, promising that the individual mandate won't be enforced against people who missed the Obamacare enrollment deadline because the federal health care website is a poorly designed, worse-implemented piece of garbage. How that wee bit of mercy will be done remains a mystery, as Peter Suderman, points out, but good intentions and all that. Don't get your hopes up for swelling ranks of enrollees, though. USA Today ran the numbers and found that, in much of the country, Obamacare plans are so expensive that many people who make too much to qualify for subsidies are exempt from requirements that they purchase insurance under the Affordable Care Act.

For USA Today, Jayne O'Donnell and Paul Overberg write:

More than half of the counties in 34 states using the federal health insurance exchange lack even a bronze plan that's affordable — by the government's own definition — for 40-year-old couples who make just a little too much for financial assistance, a USA TODAY analysis shows.

Many of these counties are in rural, less populous areas that already had limited choice and pricey plans, but many others are heavily populated, such as Bergen County, N.J., and Philadelphia and Milwaukee counties.

More than a third don't offer an affordable plan in the four tiers of coverage known as bronze, silver, gold or platinum for people buying individual plans who are 50 or older and ineligible for subsidies.

Those making more than 400% of the federal poverty limit — $47,780 for an individual or $61,496 for a couple — are ineligible for subsidies to buy insurance.

Under the Affordable Care Act, you're exempt from requirements that you purchase insurance if "The lowest-priced coverage available to you would cost more than 8% of your household income," according to Healthcare.gov. This is a less than ideal situation, because many of these people might actually want coverage that has now been priced beyond their reach. That means, continue O'Donnell and Overberg, "the analysis clearly shows how the sticker shock hitting many in the middle class, including the self-employed and early retirees, isn't just a perception problem. The lack of counties with affordable plans means many middle-class people will either opt out of insurance or pay too much to buy it."

This situation comes about because, as health industry expert Kip Piper says, "The ACA was not designed to reduce costs or, the law's name notwithstanding, to make health insurance coverage affordable for the vast majority of Americans. The law uses taxpayer dollars to lower costs for the low-income uninsured but it also increases costs overall and shifts costs within the marketplace."

This is not a new revelation, by the way. In 2010, the Heritage Foundation's Joshua Wade warned:

Obamacare will succeed only at shifting the burden to taxpayers and the privately insured.  Americans with private health insurance will indirectly subsidize care received by those reliant on Medicare and Medicaid. It is for this reason that for many Americans, Obamacare will actually cause medical costs to rise.

Ouch.

Perhaps it's just as well. Those folks priced out of health coverage would have had a hell of a time getting in to see a doctor with one of the exchange plans, anyway.

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  1. Thank goodness we have Top Men to save us from our feckless ignorance.

    1. Whatever the law’s title says is usually the opposite of what you get:

      Affordable Care Act: overpriced health care plans with mandated “options” you don’t need.

      PATRIOT Act: unAmerican espionage on citizens.

      No Child Left Behind: all children falling behind

      etc.

      1. To be “fair,” if all children are falling behind, no child is getting left behind.

    2. I suppose this means the healthy middle class person, and not the person with pre-existing conditions.

      Even with the lowest Bronze plan, there are a bunch of preventive care things you get that are 100% covered!

  2. But…But…GOOD INTENTIONS YOU HEARTLESS KOCHSUCKER CHILD MURDERING RACIST!!!!

    1. I know that’s hilarious sarcasm, but all kidding aside, the law didn’t have good intentions for the middle class.

      “The law uses taxpayer dollars to lower costs for the low-income uninsured but it also increases costs overall and shifts costs within the marketplace.”

      The ACA was meant to force the middle class to make sacrifices for the benefit of the high school drop out, convicted felon, public assistance class.

      It wasn’t even meant to help the working poor. It was meant to force the working poor to spend what little money they have on healthcare they don’t need–or else have the IRS sicced on them.

      There are some voters out there who had good intentions, but it’s not like the ACA was popular with them when it was passed or that the Republicans ran someone against Obama in 2012 who was incontrovertibly anti-ObamaCare–so I’m not sure we can blame the voters either.

      Anyway, the Obama Administration didn’t have good intentions–not for the middle class. This isn’t something that happened because they didn’t understand economics. This is what they wanted to happen. This was the intended result; they just didn’t want the messy transition.

      1. It’s kind and charitable to call it “hilarious” but it’s less sarcasm and more mind-melting frustration.

        Watching Obamacare unfold and it’s supporters cheer it on is like watching an alcoholic friend or relative slowly destroy themselves. No, it’s like being Kevin McCarthy in the penultimate scene of “Invasion of the Body Snatchers”. Screaming the obvious and no ones listening.

      2. The working poor who happen to have full time jobs get doubled fucked.

        Your employer offers you insurance for being full time, but subsidized insurance is cheaper.

        Guess what you get to pay 9.5% of your income for the employer provided insurance.

        Catastrophic plans have shot through the roof too. While I was previously paying $70 for a $5,000 deductible plan. That plan is now only $20 cheaper than the $160 bronze plan with a $4300 deductible.

        Where exactly am I saving money here? Free office visits that only cost $50 at most anyways?

        1. Where the hell is an office visit only $50?

          1. I live in Mid-Michigan so it may be different elsewhere, but office visits are dirt cheap here.

            Shit I walked into a clinic for a pulled shoulder muscle.

            I think I spent $100 total and that was with an X-Ray, motrin, and some muscle relaxers.

            To be fair UHC probably talked them down, but still.

            1. To be fair UHC probably talked them down, but still.

              That was the biggest unheralded benefit of being on a catastrophic plan. You still had the insurance company negotiating rates, even if you had to pay out of pocket. When you have to pay cash without being on a plan, generally you will get raped.

              But…oh well…all praise the Messiah and his cost shifting!

              1. It really wasn’t a bad deal, but I wish I could get other people to understand this.

                People seem to have this idea that catastrophic plans we’re just leaving individuals out die when in reality they saved you money in the long run.

                It’s much better to save that extra $150 or so just in case you need to pay towards your deductible rather than piss it away on premiums and never seeing it again.

                No but people think they’re being saved money by paying $300 to avoid a scary looking yearly deductible number.

                1. out to die*

                2. My spouse didn’t like being on a high deductible plan because then she felt like she had to make cost based choices.

                  Well…duh. But I never realized before that statement how much people were comforted by the security of all encompassing plans and how irrational they could be in regards to evaluating different plans based on cost. It didn’t matter to my spouse that on net the all inclusive plan was more expensive, even if you maxed out the deductible on the catastrophic. No…the security of being free from deciding was also (in my view irrationally) worth the cost.

              2. It can’t be! A private corporation helping its customers? Why?

          2. My doctor gives me 40% discount for paying cash, so I pay $60 instead of 100. I then use my HSA to pay for it, so it is even cheaper being tax-free money.

            1. Cash payments to independent practitioners are nice when you can find them. Ever try to pay cash for services where the doctor is part of a health care agency? Or worse, paying cash to a hospital? For a hospital, it’s almost best to let the bill fall into arrears and then negotiate a cash payment. That’s really the only way to get the billing dept. to give you the time of day.

              Our health care system is completely fucked up. Now, with Ocare, it’s fucked up squared.

              1. This was through the clinic that was run by the hospital, and I never been to the hospital. Do not get me wrong, I agree 100% with you, before Obamacare kicked in I had high deductible plan plus HSA. Only thing I had to pay was for the amount of money to be placed in the HSA account. Last four years my premiums become higher, the coverage worse.

            2. Fortunately for the middle class, Obama cut the FSA limit in half. Oh wait…

    2. Also:

      MARKET FAILURE!!!!!!!!!!!!!!!

      Because of course, unless there exists a full blown absolute government runs single payer healthcare system, then whatever happens is entirely a market failure, regardless of how much government regulation, subsidies and mandates there are that hogties the market.

  3. The harder this hits the middle class, the more the politicians who voted for it will pay. Bring it on. Bring the pain!

    1. It is interesting to see what happens when proggie managed society programs make first contact with the enemy. It happens at least once every 20-30 years in a big way, enough so that progs have to appropriate some other label and live down their bad reputation for long enough so that people forget how awful they were the last time.

      On the plus side, I think the millenials are turning on progressivism in a big way. They won’t become doctrinaire libertarians anytime soon (which is probably a good thing), but they won’t buy into the fairytale, either.

      1. But millenials’ hatred for the Republican Party is so strong, and their commitment to a largely government-managed economy is pretty solid, that I can’t see them voting for anyone other than Democrats or some progressive third party.

        1. Hatred for the R party? Sure (though evidently less so than the 22-30 crowd).

          Commitment to government-managed economy? I don’t see it, at least not much more than the general population. The 18-22 crowd seems genuinely tired and cynical when it comes to the efficacy of government programs, even if they are equally cynical when it comes to market-based institutions.

          1. Trust me that people even in the 22-30 crowd can change their minds.
            The only reason they hated Republicans is because their ONLY political experience was with Bush. Who was preceded by big-government-is-over Clinton.

            They’ve never actually seen full on progressive socialism in action. And the reality is, if you were in college and voted in the 2008 election, you’re probably a young professional who has just been booted off his parents plan.
            Which means you are going to get socked with $200-$300/month insurance bills, right at the time you’re trying to pay down your student loans and save for a down payment for a house. All the young preppy white kids that voted for Obama are getting screwed over the worst. They’ve got no jobs, they are saddled with tends of thousands of dollars in student loans, and now they are going to be forced to shell out the equivalent of a car payment every month for health insurance they barely need.

      2. Generational collectivism is a waste of time. “Millenials” don’t do anything as a coherent whole, any more than anyone else does. Will a lot of people turn on progressivism because of these fuckups? Maybe. But it has little to nothing to do with generations.

        1. This generation is more in tune with technology than any previous generation, giving them access to more information than any previous generation. It all depends on what information they seek and how they use it.

          1. They’re not going to use technology to access sites like this. Many of them don’t read.

        2. Eh, there’s definitely a shared set of experiences that separate generations. IMO, the 22-30 crowd that grew into political consciousness during the awful Bush years and who supported Obama big-time will be the last to get off the bandwagon; that appears to be substantiated by polls and my anecdotal experience. For some reason, young professionals in that demographic seem particularly taken by this worthless President.

          The 18-22 crowd grew up smelling the shit and being told it was the aroma of roses. They don’t have that prior attachment, and they’re seeing the trainwreck happen before their very eyes.

        3. I definitely agree. Generational collectivism had some sort of meaning for the baby boomers, because they were a noticeable demographic group with distinct beginning and end. But aside from a faint boomer “echo”, the rest of the population is a continuum.
          Generations blend into each other.

  4. I thought the ACA’s whole purpose was to make health insurance more expensive and crappy for those who could “afford” it, and then using this wealth-transfer scheme to artificially lower costs for the sick and debt-laden. Forced charity – we’ll see how long the wealthy liberals will tolerate it.

  5. I’ve got a silver plan through my employer. Good thing for me they pay 75% or I’d be totally fucked. Total cost every two weeks is over eight hundred dollars. And it’s shit insurance. I mean, it only kicks in after four thousand dollars worth of medical expenses. The bronze is a little cheaper, but it doesn’t kick in until eight thousand bucks. That’s per year. What’s the point?

    1. The platinum plan would act more like traditional insurance, but it would also cost me about three hundred dollars a month more and I simply cannot afford it. These are family plans by the way. Which again is totally fucked because why should I with one kid have to pay the same as someone with five little rats running around the house?

    2. The point is that now you have universal healthcare, which covers such things as pregnancy by bus.

      1. It covers pregnancy once the total cost of that pregnancy exceeds four thousand dollars. We’re still responsible for that first four thousand out of pocket.

        1. Heh, yeah my employer also changed our healthcare plan on us in a similar manner.

          I’m also paying slightly more out-of-pocket.

          Surely an example of Obama’s beneficence.

          1. My plan went up about a hundred dollars a month, and we’ve been on a pay freeze for three years. Things are starting to suck.

            1. Mine went up ~$70/month and I lost my doc. My co-pay is also higher.

              1. My premium didn’t go up at all because I enrolled in medi-cal. Your tax dollars support me. Ha ha (Nelson laugh)

        2. In the past five years, I’ve needed to use my insurance a total of once. The total ER bill came to about $2,500. If you add in the two out of pocket visits to specialists, you don’t even pass the $3,000 mark in total medical spending over that time.

          If the $800 every 2 weeks is accurate (pre-employer contribution) that’d be a $20,800 annual price tag. I can’t graps the idea of shelling out even 25% of that when it’ll never kick in.

          1. I’ve basically had to budget a couple hundred dollars a month to go to hospital bills now that I’ve got more expensive insurance that doesn’t cover anything.

        3. If people on employer-based plans end up with deductibles that don’t kick in for lab costs or maternity, the Democrats will be murdered.

          Most employer-based plans allow you to cover routine medical care with nominal co-pays. If you start having to meet a large deductible first people are going to freak the fuck out. And one “free” annual “preventive” visit is not going to make up for it.

  6. Obamacare is like the mobsters in Goodfellas:

    “Now the guy’s got Paulie as a partner. Any problems, he goes to Paulie. Trouble with the bill? He can go to Paulie. Trouble with the cops, deliveries, Tommy, he can call Paulie. But now the guy’s gotta come up with Paulie’s money every week, no matter what. Business bad? Fuck you, pay me. Oh, you had a fire? Fuck you, pay me. Place got hit by lightning, huh? Fuck you, pay me.”

    In the end, the mobsters burn down the restaurant and collect the insurance.

  7. Let me see. At 70k, 8% of my income is 5600 per year. I’m not sure, do bronze plans cost more than $466/mo? (I have a state job, so my employer won’t be dropping the coverage, so I didn’t look) That’s a wide gap between $47,780 and $70k, is there anyone in that range actually required to hop on the death spiral?

    1. not sure, do bronze plans cost more than $466/mo?

      It varies. You’d have to look at your market.

      That’s a wide gap between $47,780 and $70k, is there anyone in that range actually required to hop on the death spiral?

      Every single one of them. Its a mandate, you know. If your plan comes from an insurer, rather than a self-insured employer, you are in the death spiral due to community rating.

      As a pubsec, your plan is self-insured and may be immune to the death spiral. For awhile. Here’s the thing, though: as the death spiral kicks in, more people go uninsured, shifting costs to all the insured, including those with self-insured plans.

      Enjoy the ride.

      1. According to the article, when the Bronze plan exceeds 8% of your income, the mandate shuts off.

        New York has had a community rating law for years, so we’ve probably already seen much of the effect. Another fact of note, the Empire Plan insures a number of people greater than the population of Rhode Island (we cover 1,097,000 people from all levels of government, counting dependants).

        Of course, that doesn’t render it immune to rising provider costs.

  8. If you can’t afford the plans, you’re not Obamacare’s target audience.

    1. Yes. This was always intended to appeal to upper middle class and wealthy liberals. A demographic that can absorb the costs easier. And yet maintain their liberal bona fides by boasting they voted for O, Pelosi, and support ACA.

      1. It may have been intended to appeal to them, but it wasn’t sold to them as “You’re going to be paying $5,000 more per year to help subisidze other people’s care.”

        The amount of money we’re talking about is not pocket change, even to people making six figure salaries.

        1. Yeah, lots of Obama donors at work got sticker shock even before these plans rolled out, when they lost half their tax-free FSA account, thanks to the guy they helped elect.

          1. The irony is the people who are going to get hurt the most are entirely the SWPL crowd. The very heart of the Obama fanclub in 2008.

  9. Obamacare plans are so expensive that many people who make too much to qualify for subsidies are exempt from requirements that they purchase insurance under the Affordable Care Act.

    This actually will help Democrats a little.

    I always thought their final apocalypse would come when the penaltax bills were imposed. But I failed to foresee that the plans available would be so truly horrible and wretched that they would, by their wretchedness, protect people from the penaltax.

    Talk about having so many problems that they start solving each other.

  10. “The ACA was not designed to reduce costs or, the law’s name notwithstanding, to make health insurance coverage affordable for the vast majority of Americans. The law uses taxpayer dollars to lower costs for the low-income uninsured but it also increases costs overall and shifts costs within the marketplace.”

    If you like your doctor, so what? If you like your health care plan, you can go fuck yourself.

  11. Mandate Delay Aside, Obamacare Plans Are Shockingly Unaffordable For Many

    This morning in Fox News, when confronted with the statement from the Whitehouse that there is a 10% true sing-up failure rate from the Healthcare dot gov website, Alan Colmes (author of “How Liberals Saved America”) said that “conservatives always wanted to make this law fail.”

    You be the judge. The competition for the “Head In Sand” award has many contenders within the American left.

    1. Democrats own this piece of shit forever. No one can be allowed to forget that. Not even a derpy milquetoast whipping boy like Alan Colmes.

    2. Democrats own this piece of shit forever. No one can be allowed to forget that. Not even a derpy milquetoast whipping boy like Alan Colmes.

  12. “….you’re exempt from requirements that you purchase insurance if “The lowest-priced coverage available to you would cost more than 8% of your household income,” ”

    Soooooo…if you tell your doc that you are exempt from Obamacare they wont send you a bill?

  13. Interesting. I hadn’t focussed on the mandate being lifted if no plan is “affordable.”

    So, here’s how this sets up:

    Millions are being forced out of their 2013 plans and are uninsured unless and until they buy new, more expensive insurance.

    Most of those getting “coverage” through the websites are actually going on Medicaid, meaning they aren’t providing support for the system but are actually putting more stress on it.

    Many of those who don’t qualify for Medicaid and were previously uninsured won’t buy insurance because they just don’t want it. That’s why they have been uninsured. So the pickup there will be minimal.

    Some (many?) who were previously insured won’t buy insurance because its just too damn expensive.

    I don’t see any way we wind up with more people insured after OCare than before. I’m even willing to say that the expansion of Medicaid rolls won’t offset the number who have lost insurance.

    Complete. Unmitigated. Failure.

    1. You know what the solution will be? Put everyone on Medicaid. Single payer. Of course then hospitals will go out of business since Medicaid saves money by not paying it’s bills, but that’s not the intention so it’s all good.

      1. I have always wanted to know just how Medicaid can legally get away with paying so little?

        1. Fuck you, that’s why

          1. As in – it helps that the people making the payments also make the law.

        2. Fuck you, that’s why!

          1. God damn your nimble fingers, SusanM! God damn them to hell!

        3. Because the government has guns, also known as FYTW.

    2. To your list I would add:

      Even people who succumb to the threats and buy insurance are socked with giant deductibles they can’t pay.

      Between these new underinsured and the continued existence of large numbers of uninsured, the amount of uncollectable medical debt balloons.

      The feds step in to make providers whole by buying the uncollectable medical debt, and then make it undischargeable in bankruptcy unless you’re in one of their favored constituencies (just like student loan debt).

      1. Seems likely. Of course, when the feds come to buy that uncollectible debt, the charitable non-profits will get hosed.

        Either its written off as charity and they can keep their tax exemption until they go out of business, or they can book it as a bad debt, sell it to the govt and lose their tax exemption because they aren’t providing charity care any more.

      2. the amount of uncollectable medical debt balloons

        Our plan has been dropped by every practice we went to except for the GP. For that very reason. And it’s fair. I mean, I’m still paying whatever I can afford every month on medical bills from last year and the year before that the insurance wouldn’t cover. I’m sure that I’m a chump for doing so, since most people will just let it ride and wait for Uncle Obama and Aunt Pelosi to pay for it. I just happen to be one of those oddballs who actually prides himself in paying what he owes.

      3. Lemme add this to our dismal future:

        As Ocare forces more and more hospitals out of business, they will go into receivership and become government hospitals.

        Let nothing impede the march of Nationalized Socialist Medicine!

        1. That’s just depressing.

        2. I see them keeping the hospitals going and destroying the private practitioners. They have to do that to properly restrain and ration the provision of care.

          That’s the entire point of Accountable Care Organizations, as far as I can see. To make the small private practice or independent specialist practice untenable, and drive all those providers into the arms of hospital-centered ACO’s. Once they’re there, you start slowly strangling their compensation. That allows you to restrain the growth of “costs” by making sure there just are no providers around to actually provide any care.

          1. That’s happening right now here in MA.

            Everything is being gobbled up by Partners health.

            1. You can say that again.

          2. That’s happening right now here in MA.

            Everything is being gobbled up by Partners health.

          3. Consolidation also makes it pretty much impossible for physicians to refuse Medicare/caid patients.

      4. OMG when you state it that way, this is just the housing bubble all over again.

        Which should make sense, because they’re recycling all the same old ideas that didn’t work in that market either.

        1. Cash for clunkers?

  14. I make just above the line to qualify for subsidies, but that’s not really much in such an expensive ass place like DC, where rent can easily be 40-50% of a person’s income. I’ve managed to find a deal and get mine down to about 30% of my income. And the completely terrible bronze plans would amount to about 5% of my income for honestly no real coverage to speak of. Oh, only 5%? Yeah 5% of gross, which is bullshit. Taxes alone take about 27%. And so it starts to be a tough sell for me to start shelling out $2700 a year for shitty insurance, which means I’ll do without and pay the fine. I guess if I ever get sick I’ll just get insurance then.

    But anyway, I have no idea if I’m now exempt from the mandate. I seriously doubt it. The exemption sounds like it’s supposed to apply to a lot of people, but it also sounds like there are many reasons why it actually applies to no one. So it looks like it’s all just bullshit.

  15. Just the other day, the NYT ran a shockface story about the effects on insurance consumers who fall just over (above) the magical income lines.
    Those people are going to take it in the shorts, in a major way.

    Huh. How surprising.

  16. Roman Johnson says no way dude.

    http://www.BeinAnon.tk

  17. Here in Mexico, we pay from $2 to $25 for a visit to a real doctor. Specialists cost around $40. No prescriptions needed for lab-tests nor medicines.

    It is called FREE enterprise and competition. Nobody I know here buys insurance–we just pay cash; like groceries, movies, bus fares, etc.

  18. And the liberal response? “I got cheap healthcare! So did the other poor!” If only you knew what it was like before the AMA…

  19. When fiscal conservatives called the ACA bad policy, we were called racists because the President who championed it is black. The inevitable collapse of this law will be followed by the inevtiable collapse of the dollar due to the unsustainable, accelerating debt that liberals still champion as the cure for a bad economy. I try to envision what this looks like in a political cartoon and I come up with am image of a man in a sinking boat bailing water Into the boat!!
    However, this is exactly the path Obama intended from the gitgo. In order for His Excellency to build a new world order, HE had to destroy the existing one. Megomaniacal? Absolutely. Hitler had the same ambition but underestimated people who were willing to die for freedom. Obama has made the same mistake. Yes, he is a fascist in every sense of the word. He will suffer the same fate.

  20. We had a non-compliant HSA for which we paid $525 a month with a $5000 deductible (which of course got canceled). Obamacare offered us $996 a month and $12600 deductible. We got lucky and found another grandfathered HSA that was like what we had lost. But it’s only good for a year. Who knows what we’ll do next year.

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