HSA require a deductible of at least $1,300 for one person, so people have starting calling that a 'high' deductible from 2003 or so.
Before ACA you could by health insurance with a 15,000$ deductible as an individual. After, ACA the individual out of pocket maximum is $7,150 per year for an individual. So, now legally the maximum is below the old pre HSA threshold for 'high' deductible.
It is certainly insane to expect people who are incapable of paying for their own health care to be capable of paying for their own health care. But the health insurance market is not there for people who are incapable of paying for their own health care.
They need an effective government and socialized medicine. Charity is not a workable solution.
> It is certainly insane to expect people who are incapable of paying for their own health care to be capable of paying for their own health care. But the health insurance market is not there for people who are incapable of paying for their own health care.
Sure it is, that's exactly why it's there, hence the subsidies. It's a shitty system, better than it was, but still crap that needs to be replaced with socialized medicine.
Whether the charity comes through government or private organizations is not relevant to my point. The point is that they need someone else to pay for it, and not via a normal market transaction.
>Sure it is, that's exactly why it's there, hence the subsidies.
Allow me to rephrase: The health insurance market is not there to ensure everyone is able to afford to pay for their own health care needs. It is not broken because some people are not able to afford to participate in it. That is not its purpose. Judging it to be 'broken' or 'insane' because it doesn't do something that it's not intended to do is ridiculous.
The HSA-tied minimum was the old threshold for "high-deductible" since the HSA/HDHP pairing was created, which was several years before Obama was elected.
This also added a lot of confusion as what was considered normal was suddenly called high.
It's not 'people', it's the government, for what that's worth.
https://www.irs.gov/publications/p969/ar02.html#en_US_2015_p...
That depends on how you define "high deductible".
For example, let's start at https://secure.marylandhealthconnection.gov/AHCT/LoadExplore... then click "Get an Estimate". Put in a family of 3, ages 63, 61, 21, no pregnancies, no dental. Income $100k. You get a list of 21 plans. The very first one on the list has a $12,400 deductible and a $13,100 out of pocket max.
In fact, there is not a single option on this list with an annual out of pocket max below $9000.
Granted, these are family plans. Your cited number is for an individual; the number is $14,300 for a family. But note that there are plans on this list that have out of pocket maximums larger than $14,300 (e.g. "BluePreferred PPO HSA Bronze $6,550" has a $26,200 out-of-pocket max). How to reconcile that with your link, I don't know: the theory says they should not exist, but experiment says they do.
Note that I picked on Maryland because they allow you to get this data without creating an account.
In any case, most of the plans on this list would have been considered "high deductible" before the advent of the ACA.
Anyway, what's the definition of "high deductible"? The standard definition used for HSAs is $1300 for an individual or $2600 for a family, which is almost hilariously low in today's marketplace. And the maxium out-of-pocket max for HSAs is actually _lower_ than the overall caps. I have no idea how that $26,200 out-of-pocket plan is "HSA-qualified", as it's claimed to be....
> The ACA lowered the costs of people with insurance by reducing the pool of people without insurance.
That's not true. The ACA raised the costs of people with insurance by pooling them together with people who used to be uninsurable because their estimated care cost so much. This effect completely dominated the effect of adding healthy people to the pool. One reason for that is that for healthy people paying the penalties is way cheaper than actually getting insurance, so a lot of them stayed uninsured, but even that is not the full story. The main upshot is that caring for some people is _really_ expensive and the cost has to come out somewhere.
We can proceed to an argument about whether the tradeoffs were worth it, of course, whether there were other ways of achieving the laudable goal of getting rid of the preexisting condition problem, etc. But let's not pretend that the reason prices went up is just "gouging". Prices went up to a large extent because the risk structure of the insured pool skewed towards more risk.
Now there is certainly _some_ gouging going on, largely abetted by the restrictions on interstate sale of health insurance, which leads many states to have a very small number of companies providing insurance. For the Maryland case above, there are precisely 3 companies represented in the list. And only one of those companies offers PPOs. Which is why the price of the PPOs in Maryland about doubled in the last two years: no competition, why not? This is hardly a "free market" behavior, though; it's a highly regulated, in a dumb way, market, that encourages monopolist behavior. Which is what we get.
The cost to collect and the collection rates themselves are abysmal and the increase in deductibles has amplified the problem to the point that many hospitals are closing due to patients' inability to pay their bills.
Consider the percent of Americans who don't have ready access to $5000 (or even $500) for an unexpected medical event that causes them to hit their deductible. I work in patient payment technology and this is an all too common situation that providers are forced to accommodate.
So yea, for a tiny slice of the population ACA did make things worse, but frankly the tiny minority that where negatively affected don't really care about the new premiums either. Because, for most families having a 30k deductible is approximately the same thing as not having insurance.
PS: The ACA allowed some people without insurance because of health issues to get insurance. But, it also added a lot of young healthy people that would not have had insurance. The net gains and losses depended significantly on age. https://www.valuepenguin.com/how-age-affects-health-insuranc... So, people looking back on cheap insurance also look back when they where younger. New York and Vermont do not permit any use of age as a factor when determining health insurance rates, so younger workers do significantly subsidize older workers. Masschusetts limits cost increases to 2x so there is a significant subsidy.
For my hypothetical family with the ages I listed, insurance cost about doubled in the last two years in the state of Maryland for an equivalent (PPO) plan. Deductibles also rose significantly. I know a specific family like that, and they are _very_ unhappy about it.
> but frankly the tiny minority that where negatively affected don't really care about the new premiums either
Really? You think people don't care about $25k/year in premiums instead of $12k/year in premiums?
What makes you think this is a tiny minority? What I listed is a basic baby boomer family with one child still in college.
> The net gains and losses depended significantly on age.
Sure. I'm aware of all that. The upshot of the ACA is that people with preexisting conditions are _much_ better off (which is good), but people who are relatively healthy, independent of age, are generally worse off. This is almost a tautology, of course.
I should note that the price cited at your link is way too low for the states I know of, in the "64" age range, assuming you want a PPO. For an HMO, it's perhaps doable.
HSAs are from 2003 and it's overloading a reasonable definition with a new a silly one. You can see people in the mid 90's talking about high deductible and meaning something very different. ACA also capped out of pocket so you need to compare everything about a plan not just it's deductible.
PS: Find me a family plan with a 50k deductible under ACA. They used to exist.
We may be violently agreeing here. ;)
The limits are more sane than they used to be, but a lot of people that are getting subsidies aren't going to have an easy time coming up with $10,000 more in a given year. It's high enough.
The ACA lowered the costs of people with insurance by reducing the pool of people without insurance adn thus the free rider costs. Free markets however continued to raise prices just like they have for the last 30 years. http://www.motherjones.com/files/blog_premium_growth_2014.jp...