The cost to employers of very good plans massively increased after ACA went into effect. When this changeover happened, I was running a company where we paid 100% for one of the best healthcare plans available in the state for both the employees and their families -- people really appreciated this benefit. This was the polar opposite of a "crappy plan", and it wasn't inexpensive to begin with.

After the ACA, this plan became so expensive so quickly that continuing this plan became nearly untenable financially and now these types of plans have become increasingly unavailable in any case due to that cost escalation. If you were formerly on one of these plans, of course the post-ACA environment seems like a big step backward. This happened in one of the deepest of blue states; the Republicans can't be blamed for the destruction of health insurance benefits here because they were never involved. The cost of healthcare here has not risen nearly as fast as the cost of providing top-tier healthcare benefits did.

This happened to me. I had what is considered a "Cadillac plan" which my employer offered generously as a benefit. After ACA, the government began to tax that plan and our public company could not justify that while other companies in our market were offering much lower quality plans. Thus my medical spending rose by thousands of dollars per year (also thanks to an unfortunate @$3000 hospital stay but that would have cost me $250 on my old plan). The old plan did of course come with a lifetime max but obviously was not a factor at my age yet.

I think the ACA does good things for people who needed it. And generally I've been against repealing it, but only because there has not been an adequate replacement as part of the repeal, only "trust us, we'll do something great".

What was the lifetime max on this plan? It probably would have left people out in the cold when they most needed it. I don't think it's wrong to expect insurance to cover people when they most need it, which was largely not true with million dollar lifetime caps.

Even with the ACA, employers have the best of both worlds. Expensive older people are covered by the government, and anyone who gets to expensive can be shuffled off with a little cover and the joy of "at-will" employment.

The lifetime max was multiple millions, I don't remember the exact number. As I stated, it was just about the best policy available for any amount of money. There is no credible way to spin this as actually being worse for those employees. I like to hire "expensive older" engineers, so dialing healthcare benefits up to eleven was intended to attract that kind of employee.

All insurance policies have implicit lifetime maximums, unless the laws of economics and finance have been repealed.

> What was the lifetime max on this plan? It probably would have left people out in the cold when they most needed it. I don't think it's wrong to expect insurance to cover people when they most need it, which was largely not true with million dollar lifetime caps.

Note that lifetime caps are a lot more generous than what they have in say the UK, where you don’t get treatment if it costs more than $50-75k per year of extended life. (So to blow through a million dollars, the treatment would have to be expected to produce 15-20 years of extra healthy life. Most treatments offered when people “need it the most” can’t make that sort of promise).

> Note that lifetime caps are a lot more generous than what they have in say the UK, where you don’t get treatment if it costs more than $50-75k per year of extended life

Do you have any data for that? Sounds odd.

https://www.bbc.co.uk/news/health-28983924. It’s not odd at all. It’s a basic thing that makes the UK’s health system work. US insurers (in the past) would piss away a half a million or a million on uncertain treatments. (And then the family would go out of pocket, go broke, and there would be an article on medical bankruptcies.) The UK doesn’t do that. Instead, it’s very aggressive about justifying costs with expected outcomes.

This happened with my employer as well. And this is/was before the "Cadillac tax" came into effect (I believe it's been pushed back to 2020 now).

This is exactly the point I was trying to make in my original comment. Really good healthcare plans (with minimal deductibles and great coverage) used to be a benefit that employers could reasonably provide. Employees/family members who got sick would get good coverage without going broke. Now the cost is of providing that kind of coverage is completely untenable.

I don’t see what the purpose of pointing out the fact of health insurance being cheaper when it doesn’t have to provide coverage for people who actually used healthcare. Goal is to provide all of society with healthcare, problem is voters didn’t want to pay with their tax dollars. Now they get to pay with their insurance premium dollars. There never was a free lunch, only people who were unable to get health insurance.

The parent comment is exaggerated, but I think the point is that prior to ACA, employer-provided plans tended to be cheaper and have lower deductibles largely because insurance companies were able to drop or deny coverage whenever they felt like it for individual plans to keep their margins up. While logically true, this is roughly equivalent to hearing from an old coworker that South Africa was a great place to be white under apartheid...

I think it's also worth exploring how much of the difference in financial cost of health insurance plans is due to time + annual overall increases in healthcare cost in the US. ACA was passed 9 years ago. Even under the previous 9 year annual percentage increase averages, you would expect healthcare costs to be at least 20% more expensive than they were in 2010, regardless of ACA.

It's more extreme than your example. The parent is ignoring the fact his great healthcare experience is predicated on them being able to drop him the moment they could, when his illness became too expensive.

Ending pre-existing conditions was the game changer in the AMA. Treating people is obviously more expensive than not treating them.

That's just not how it worked with employer insurance. Perhaps they could drop your whole company, but the insurer couldn't unilaterally cancel a single employee's plan.

I know someone who pre-ACA had employer insurance who was dropped by that insurance after they got skin cancer. The official reason was lying during the application process (10+ years earlier).

They forgot to list childhood Asthma on their application form ten years earlier.

Would the ACA prevent that kind of scam? I genuinely don't know.

The incentive is gone, since preexisting conditions are no longer a disqualification.

The incentive is still very much there. You just can't use a preexisting condition as your excuse anymore.

I would argue that the incentive was implicit and fundamental to the nature of the business, because it provided agents with a method to pick and choose their clients.

By inducing lapses in insurance coverage, insurance companies were able to convert illnesses under active treatment into preexisting conditions.

You aren't required to complete an application form when you sign up anymore, so they don't even ask you medical questions.

There were plenty of cases where they would raise an employer's premiums and let them know why, and sick people lost their jobs and their insurance.

Witness all sorts of horrible behavior, like employers saying "Sorry, all, no raises this year, because one of your coworkers was using so much of our health insurance pool that they raised our rates!"

No, but sick individuals, or those with sick family members are lousy employees... wink... wink..

Yes: if you go back in time, health care costs go down, because they've been rising rapidly over the past 20 years. But the only thing that happens at the point in time when the ACA passed is that the rate of growth in cost falls.

That's not really true, though. Costs as a % of GDP went down from '05-06 and went up slightly from '06-07.

In real numbers, in 2008-2009, the increase in overall cost per year was actually lower than in 2014-2015, when the exchanges opened.

You're right that the rate of growth in Medicare cost fell after the ACA passed, but that's much more specific than overall cost delta.

Something very relevant happened in 2008-2009.

It also impacted prices all the way into 2012, by moving people out of full-time employment and onto COBRA, and by reducing the number of young people on health insurance plans.

> There's a weird narrative where any event is tied to the ACA while they ignore what the healthcare system is in the US overall.

The ACA fundamentally shifted the landscape for the whole healthcare system with minimum coverage mandates (including employer plans), guaranteed issue, etc. It's also led to higher demand for medical services (ie because more people are covered - a good thing) at a time when the number of doctors has stayed fixed. The net result is that health coverage is simply more expensive. One way that could have played out would be employers eating the higher premiums themselves (which is essentially giving everyone a raise.) Anecdotally, it seems the way it's played out is that employers have kept paying roughly the same amount while employees have either paid higher premiums or received higher deductibles.

The trend of higher and higher medical costs, employer plans trending down as far as benefits and up as far as costs was established long before the ACA.

My employers have been complaining about skyrocketing health insurance costs since my first job in 1998. This all predates the ACA by at least 20 years.