Professional Woodworkers and The Affordable Care Act

[Mel Fulks]

Won't that percentage of income thing result in more unreported income? Feds say its a big deal now.

[Dave Sheldrake]

Our Drug costs are £7.80 (about 11 bucks) per class of medicine, I take Warfarin (and will do for life) but as the different pills are just different weights of the same thing I only pay £7.80 every 3 months when I get a new prescription from the Doc. Cancer sufferers are exempt from any drug costs no matter how much or what they need.

The system there (with your new law) makes some sense, when Mom broke her Femur, off to the hospital, 9 inch metal plate installed and 19 weeks recovery (she was 72 at the time) in her own room in the hospital. Didn't cost a "dime". For hospital or *needed* medical treatment here there is no reducing period before things change. What you get on day one is what you always get.
Sure if you want nice shiny teeth with fascias on them or cosmetic things like that then it's paid for but nothing with any medical need is charged.

I never really knew anything about the US system, I just see the News Media over here saying that President Obama is coming under fire over it all (but none of the media actually say why)

best wishes

Dave

[Scott Shepherd]

The system there (with your new law) makes some sense, when Mom broke her Femur, off to the hospital, 9 inch metal plate installed and 19 weeks recovery (she was 72 at the time) in her own room in the hospital. Didn't cost a "dime". For hospital or *needed* medical treatment here there is no reducing period before things change. What you get on day one is what you always get.

Didn't cost her a thing? Sure it did. She paid into it (if she pays taxes) for a long long time. In fact, she's probably paid a lot more in taxes than the bill would have been. I worked in the UK for a short period some time ago. There was no shortage of taxes. If you tax me and then tell me something is free, that's not true by any means. Let's be honest, NOTHING is free when it comes to services provided by any government. I also remember working with a senior citizen that had trouble swallowing. I asked him why did didn't have surgery to correct it. He told me they wouldn't do the surgery because it wasn't life threatening. It would take him 1 hour to each a small sandwich. To him, his quality of life was not so good, to them, he was still eating so it wasn't life threatening.

The system here worked Dave. Most people had private insurance and most people's employers paid for it. In an effort to take care of those that didn't have insurance, we tore apart the system that worked for everyone else instead of figuring out a solution for those without insurance. For the final cost of this all, we could have paid for private insurance for all of the people that didn't have it and come out way ahead. We've now created so many new federal systems and departments, all those costs could have just been giving directly to people to buy them healthcare many times over.

[David Weaver]

Won't that percentage of income thing result in more unreported income? Feds say its a big deal now.

I guess it depends on what the definition of is is.

It looks like they are specifying the subsidies as non-income items. I tried to log in to healthcare.gov the first day it was up, because the price of the policies has huge implications for my work. Of course, you couldn't get information at that time at all, but had you been able to, it would've required personal information and an SSN from last year to determine the subsidy amount. Then you would get a premium quote, I guess, tailored to your prior year's AGI.

The conclusion being that you pay the price for coverage on the exchange and the implicit combination of paying for insurance and receiving a subsidy is ignored. I'd imagine calling it taxable income would have been unpalatable.

[Mark Bolton]

Didn't cost her a thing? Sure it did. She paid into it (if she pays taxes) for a long long time. In fact, she's probably paid a lot more in taxes than the bill would have been.

Maybe true for that single accident but likely not true for a lifetime of care and definitely not true for a lifetime of care for the vast majority of the US who are in the doctors office on a regular basis.

Some seat of the pants math would say an average employee working 45 years paying perhaps an average of 20k+ (likely high for average employees especially if they have family deductions) per year in state and federal taxes over their working lives. That about 900k total. If 10-15-20 percent of that went to health care you may only be talking 100-200k over a lifetime.

I know many seniors today who have put 200k in health care coats in their rear view mirrors years ago and are still scheduling multiple doctors appointments per week.

I know the systems outside the US usually run on a higher percentage of tax but my rough numbers are based on average people I've known. Probably averaging 50k+/year over their careers, single for a lot of it, and healthy. They are the highest payers into the system most of which average close to 40% in annual taxes (my gf pays about 38%).

Doesn't take into account the fact that the majority raise families and pay less taxes than that.

It would be interesting to know what the average US citizen uses in total health care dollars over a lifetime.

[Mark Bolton]

Extremely impressive thread. Have read it from the beginning and headed back for a re-read. What a wealth of knowledge.

[Dave Sheldrake]

Hiya Scott,

I meant on top of the contributions via tax Mom had always made. Tax is very high here, but I don't mind paying it in reality, I get back so much for what I pay and even if I pay over the top compared to what I use I try to remember the overflow will go to those less lucky than I have been.

From the very little I understand about the new US system there seems to be two split sides, those who think it's better and those that think it's worse with no real middle ground.

best wishes

Dave

[Andrew Joiner]

Originally Posted by Mel Fulks
Won't that percentage of income thing result in more unreported income? Feds say its a big deal now.

I guess it depends on what the definition of is is.

In Oregon ( I assume all states will be the same) the application asks for your income in 2014. So your subsidy is based on 2014 income! No mention of taxable income or gross income, just income.

I just met with the only agent in my area that will get me started on health coverage. The agent said if you overestimate your income you pay more for coverage, if you underestimate you pay less for insurance but no penalty. You may have to pay back the discount you got on coverage if your 2014 income is way off.

I was a self employed cabinetmaker but now I'm retired and live off investments. My income varies year to year.

I have a 5K deductible health insurance policy. I've had it over 30 years. It's never paid a dime for medical costs. At 62 I'm healthy but couldn't shop around because of pre-existing condition rules. I considered it bankruptcy insurance to cover major medical bills. I pay 3k a year and it hasn't been cancelled (yet).

A big benefit of the new law is colonoscopies and yearly exams are preventive care and cost nothing out of pocket. In the past colonoscopies (family history) and yearly exams have cost me a lot. In my case I will probably pay about 1k a year with the new law and pay way less for my actual medical costs.

[Scott Shepherd]

Maybe true for that single accident but likely not true for a lifetime of care and definitely not true for a lifetime of care for the vast majority of the US who are in the doctors office on a regular basis.

I think if that math was true then there would be no such thing as car insurance, health insurance, life insurance, extended warranties for appliances or cars.

The math points in the opposite direction, that the vast majority of people will never use what they have paid in. Any other reality and those systems mentioned would cease to exist.

[Ty Williams]

The system here worked Dave. Most people had private insurance and most people's employers paid for it.

I can tell you that if you think the system here worked you were among the fortunate and (comparatively) affluent. It never worked for me. When I was a kid, I was on my mom's insurance (nurse at a major hospital) and things were fine. Then I got out of college and had several full time jobs, none of which offered benefits and I couldn't afford it on my own because I was working full time in a supposedly middle class job and was still hovering around the poverty line. I got sick and didn't have insurance. Because I wasn't insured, the doctors flat out told me that they couldn't treat me, I had to go back home and wait until it was life-threatening before I could come back and they'd be able to treat me. Of course, after that I had a pre-existing condition and no insurance would touch me even when I offered them good money. Finally, I got married and my wife has good insurance via her work (research scientist at the same hospital my mom worked at, actually). Now, the insurance company calls the pharmacy and changes my prescriptions without asking my doctor. The insurance also tells me that I'm only allowed to go to PT fewer times than what both my doctor and my physical therapist think I need. I have to schedule over a year in advance for an EGD. I waited over 9 hours to be seen the last time I had to go to the ER.

The "old" system in the US didn't work for a lot of people. I personally don't think the new system will work any better, but that's a different problem.

[Scott Shepherd]

I can tell you that if you think the system here worked you were among the fortunate and (comparatively) affluent. It never worked for me. When I was a kid, I was on my mom's insurance (nurse at a major hospital) and things were fine. Then I got out of college and had several full time jobs, none of which offered benefits and I couldn't afford it on my own because I was working full time in a supposedly middle class job and was still hovering around the poverty line. I got sick and didn't have insurance. Because I wasn't insured, the doctors flat out told me that they couldn't treat me, I had to go back home and wait until it was life-threatening before I could come back and they'd be able to treat me. Of course, after that I had a pre-existing condition and no insurance would touch me even when I offered them good money. Finally, I got married and my wife has good insurance via her work (research scientist at the same hospital my mom worked at, actually). Now, the insurance company calls the pharmacy and changes my prescriptions without asking my doctor. The insurance also tells me that I'm only allowed to go to PT fewer times than what both my doctor and my physical therapist think I need. I have to schedule over a year in advance for an EGD. I waited over 9 hours to be seen the last time I had to go to the ER.

The "old" system in the US didn't work for a lot of people. I personally don't think the new system will work any better, but that's a different problem.

That's exactly the problem Ty. You needed the help and the system had a flaw that prevented you from having the care you needed. We could have fixed that without wrecking the system that did work for hundred's of millions of people. You might have it now, but my parents have now lost their doctors because of it. So who won? You? Certainly not them. So instead of fixing it so it worked for everyone, we've created something that works for people like you, but them causes havoc on others. I don't consider that a win.

I spend a lot of my adult life problem solving and following great leaders in that field. This problem is, and always was, fairly easily solvable. It's been solved many times over in small scale test markets and it worked great. However, there doesn't seem to be anyone interested in actually solving the problem.

[David Weaver]

Ty - when you got out of college, there was very likely major medical insurance available for very cheap - especially given your age. The trouble is most people looked at the insurance situation and decided since major medical only covered major events (though some policies had little kickers in them for certain routine things, or drug plan cards, etc - I had a relative with that type of plan, it offered major medical coverage and two free dr. visits a year), they would just forgo it entirely (or didn't even go that far and never contacted any indpendent agents, etc, to see what coverages they could get for cheap).

IIRC, when I got out of college, major medical only cost me about $50 a month 15 years ago. I've heard of others in different regions with major medical only/ high deductible plans that were in the $60-$70 a month range. Those policies likely won't ever pay you any benefits unless you have something really major, but what they do manage to do is get you negotiated prices for standard services and in more recent times, access to set up an HSA.

Because of the limitations to age ratings under ACA (which significantly favors pre-medicare aged older individuals, but works conversely for younger individuals) and the removal of pre-existing condition exemptions, etc, it would actually be much more expensive to get coverage now at the lowest level than it would have been to get major medical or high deductible coverage before and pay an average years' expenses out of pocket. And you'd still end up paying most routine care out of pocket on top of the cost of care. So you're probably right, if you're the average person coming out of college and gainfully employed, it may be a worse situation now. The provisions of the bill are the way they are to try to get younger individuals into purchasing coverage because the economics depend on it when, for example, a person age 60 is paying only half of their expected cost of claims in terms of premiums (based on the rates I've seen so far).

[Curt Harms]

I'm wondering if employers aren't using ACA as an excuse to reduce healthcare costs. My employer is offering the same healthcare plans as they have since 2009 and the employee premiums are exactly the same for 2014 as they were for 2013.

I don't quite understand what changes the ACA made that would cause an employer to go from covering 100% of a family plan to dropping coverage altogether. Why wouldn't they do something like cover 80% and have the employee cover the other 20%?

The kick for many will come in 2015. I purchase my own health insurance. I have a PPO from Aetna with a $2500 deductible. If I renew that by around Thanksgiving, I can keep it for one more year with a premium increase of about 10%. If I don't renew, my premium for the replacement Aetna plan will go up about 125% and my deductible will double, to $5000. As things stand now, I'm delaying the inevitable by one year. I haven't looked into alternatives yet.

[Brian Elfert]

Are colonoscopies always going to be considered preventative care now? My health insurance considers it preventative care and covers 100% if I schedule a routine colonoscopy without symptoms. If I go to a doctor with some sort of symptom and he/she refers me for a colonoscopy I have to pay 20% and my deductible applies.

I had a small business from 1996 to 2000 with four young single full time employees. It cost me around $100 a month per person for full comprehensive medical insurance. It was cheap because everyone, including myself, was younger than 30 years old at the time and all males so no maternity costs. I paid 100% of the cost because it was so cheap.

[Paul Wunder]

"Are colonoscopies always going to be considered preventative care now? My health insurance considers it preventative care and covers 100% if I schedule a routine colonoscopy without symptoms. If I go to a doctor with some sort of symptom and he/she refers me for a colonoscopy I have to pay 20% and my deductible applies."


The following is taken from the Health and Human Services website. PSA's are covered as a preventive service @ 100%, colonoscopies are not. (Some Marketplace plans may cover it @
100%

Under Medicare, Colonoscopies for screening are covered at 100%. If the Doctor finds a polyp during a screening, it becomes a Surgical procedure covered at 80%. Weird!

Free preventive services

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.

1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol Misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
    
    
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus
    • Influenza (Flu Shot)
    • Measles, Mumps, Rubella
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diphtheria, Pertussis
    • Varicella
    
    
12. Obesity screening and counseling for all adults
    
13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
14. Syphilis screening for all adults at higher risk
15. Tobacco Use screening for all adults and cessation interventions for tobacco users

There is a separate list for women