> Previous to the ACA people would buy "health insurance" with a deductible so high they realistically couldn't use it anyway.

I talked to the CEO of a small rural non-profit hospital and asked if ACA had helped since they traditionally wrote off a lot of the care they provided. I figured that everyone being required to have insurance would really help them stay afloat.

She said it actually hurt them because they had an influx of people coming in with subsidized insurance that never paid any portion of the deductible. So the hospital was now struggling even worse than before because they were writing off more than previously.

For me, this was a counter-intuitive result of ACA that I hadn't expected.

I'm failing to follow what's happening here.

If the patient doesn't pay the deductible, does the insurance company not pay anything at all?

My assumption would be that the insurance company has to pay, and then has to work out the deductible payment with the patient. What's the point of asking for an insurance card if the patient can simply not pay anyways?

Insurance companies don't pay the deductible. Patients pay the deductible directly to the doctors. Deductible as it's defined is the money the insurance company won't cover. Insurance companies won't front the money for the patient.

OK so the patient doesn't pay the deductible, but the hospital will get the rest from the insurance company right?

I fail to see how the amount uncollected could go up from this interaction. Before, uninsured people would have to pay full price (hospitals tend to charge uninsured people more), now they only have to pay a deductible...

Though chances are any time the uninsured rate goes down, the default rates of insured people will go up. Newer insured people are less likely to have their finances intact after all. So anything that lowers the uninsured rate will cause this issue I suppose

Maybe new healthcare revisions should offer FDIC-style insurance for deductibles for hospitals. Wouldn't want people refused from hospitals despite having insurance.

Only if the cost of the services is above the deductible. Let's say you have a $2500 deductible, and go in for a CAT scan that, coincidentally, works out to a cost of $2450. That all comes out of your pocket, if you're doing this on Jan 1 and haven't used any of your deductible yet, with the insurance company paying nothing. If your pockets are empty, the hospital doesn't get paid without hounding you, working out a payment plan, or going to collections.

As a sidebar, it's awesome when you have a situation as described, and then never go to the doctor again for the rest of the year, and so get no cost reductions on anything, despite paying out-of-pocket for the services you did use, plus whatever your premiums are.

Deductibles instead of percentage of service are one of the sillier ways to implement insurance.

I understand that this saves people who go way over, but if the deductible is $2500, what's to stop a $25000 operation from becoming a $35000 one?

There's the hospital-insurance relation but given how flexible hospitals end up being on pricing it sure doesn't feel like enough

Most insurance companies have deductibles AND a percentage of service over the deductible (coinsurance) AND a copay that you always pay and doesn't count towards your deductible.

I won't ever use mental health services. Personal choice. The old plan didn't offer that. I could get another plan to cover that. Why should I be forced to purchase something I have no intention of using?

Insurance, as a product, was highly customizable. You could get riders and other policies to cover various risks. You see this all the time with fleet insurance. Health insurance use to be the same.

The ACA set a floor on the offerings. If you don't those features, you can get a non ACA approved plan. You then have to pay the tax penalty. Now the penalty is an oddity. There is no lean. The government removes from your refund $X until you either pay the penalty or have no refund.

I looked at such a plan. Best I found was $438. Assuming an income of > $100,000 (I thought that 2017 insurance rates were set using 2016 actual income, I was wrong), the penalty was north of $3.5k total for my wife and I. This made the ACA plan cheaper since I didn't have to worry about filing quarterly estimates since I always have a refund (I'm giving a price to the time and effort required to file).

So the subsidies make the ACA plan cheaper that the non-ACA plan. I went with that. The question I pose to society is "Should we require government, funded through taxes, handout to make medical costs affordable?"

You don't want to purchase mental health coverage. So, when something changes in your brain and you completely lose it, the rest of us can pick up the tab for you?

I don't buy that "I won't ever use" thing. People change their minds, and sometimes you're not capable or competent to decide for yourself.

I've had chronic, sever depression. Never went to a doctor. Stopped drinking and changed my diet and prayer. Fine now. My wife is a social worker who worked with kids with emotional issues. She issued the depression test to me once a month. All in house.

> People change their minds, and sometimes you're not capable or competent to decide for yourself.

This means one of two things. 1st, I should be able to upgrade my policy or pickup a secondary one. 2nd, my family will have to live with the results of my earlier decision to not include mental health in my coverage. Decisions have consequences. The government shouldn't force me to pickup coverage just because they think it might be a bad decision to forgo it.

If you change your mind due to coming down with some condition, then you won't be able to upgrade your policy or pick up a secondary one, because that will be a preexisting condition.

So, one of a few things will happen. You may forego treatment and recover, in which case great. You may forego treatment and remain ill, meaning we all lose out due to the loss of a productive member of society. (Or, worse, you hurt a bunch of people.) You may seek treatment and be able to afford it, in which case great. Or you may seek treatment and be unable to afford it, meaning the rest of us get to pay for it for you.

That last one in particular is why we like to force people to have insurance. It's basically the same as forcing you to have liability insurance for your car. You can end up costing others a bunch of money, so we want to make sure you're able to pay it back.

Decisions have consequences. So long as the consequences remain confined to the person making the decision, I don't care much. But once they start impacting others, there's trouble.

By that logic everyone should have the cadillac plans since they cover the most things. Where do we draw the line at required?

I've volunteered at hospitals when I was a teenager. The guys with the Cadillac plans got the same medical treatment as everyone else but they had a single bed penthouse suite closer to a hotel in accouterments than a hospital, a larger meal selection, insuite TV and telephone.

You do a disservice by calling everything you don't agree with cadillac coverage. Clearly you've never had it.

The line would be stuff you need rather than just want, and which can be expensive enough to bankrupt you.

> 2nd, my family will have to live with the results of my earlier decision to not include mental health in my coverage. Decisions have consequences. The government shouldn't force me to pickup coverage just because they think it might be a bad decision to forgo it.

You must be wonderful to have as a family member.

Mother: Hey, crazy cousin virmundi is coming to stay with you because he does not have mental health insurance and there is no government social safety net!

Me: Uh, what!?

Mother: Can you clear the guns and knives out of your house?

Me: Uh, what!?

> I won't ever use mental health services. Personal choice. The old plan didn't offer that. I could get another plan to cover that. Why should I be forced to purchase something I have no intention of using?

You are ignorant and heartless.

In the worst and most expensive cases, patients do not even have a choice.

And your subtext is completely clear here.

No, you should not get to pick and choose what conditions are worthy of treatment because you don't have them and don't think they are legitimate, and therefore make coverage more expensive or unobtainable for others.

Guess what? I never thought I'd use that "massive fucking brain tumor" coverage I had. Especially not at 25years old and in great shape, and in perfect health. Nothing about that was fair, I did everything right and still ended up with my skull cut open.

I thought brain tumors were for old people and people who didn't take care of themselves. If you asked me at the time I got the tumor my odds of a brain tumor were zero.

It's not a "personal choice" to get sick. You can only prevent illness to an extent.

>Why should I be forced to purchase something I have no intention of using?

I don't intend to ever use the liability coverage I purchase. In fact, I hope I never have to use it. I don't mind I have to purchase it though because it makes society better off as a whole. I would hope if someone caused me injury they would be insured just the same.

I find your attitude extremely disturbing.

And yes mild to moderate depression can often be treated on your own with lifestyle changes. I'm glad that worked for you (honestly) but not all mental health issues are mild depression.

From what I've seen in my volunteer work I doubt you had severe depression,as rarely can severe depression be treated soley with diet and prayer (unless substance abuse was the underlining cause). Let me ask you, were you able to sleep? Eat? Get out of bed? Shower? Dress yourself? Go to work? Leave the house? Brush your teeth? Get through the day? If so your depression was mild to moderate.

Not that dietary change and prayer aren't useful in treating depression, they absolutely are! Depending on the patient we would encourage both as part of recovery. It's just very few severely depressed patients are able to "pull themselves up by their own bootstraps."

Check out Accident and Long Term Care illness insurance; They are typically ~ $10/month and tack on coverage for things that you have no existing condition or family history of.... and are generally otherwise low risk for.

> I won't ever use mental health services. Personal choice.

I don't blame you there, it's probably a wise decision. I don't think I would ever want to have that listed in my medical records, for fear that it would be used against me in some circumstance down the road.