Out of curiosity, I went and looked up the plans in NJ for a 32 year old person(56k salary). This is someone in a lower risk pool. The bronze plans are in the upper ~280$/month and include a $6000 deductible. There are three plans out of 36 that are ~380 a month that have a $2500 deductible. Everything else is more. This is NJ, one of the better states and definitely not a shitty state. These plans are garbage. Every time someone on HN extols the virtues of Healthcare.gov, I recheck my options and they always come back much worse than what I get working for a private employer (typical S&P 500 corp). I wish people would look up their possible plans on Healthcare.gov before tossing it out as something other than a scam.
When I got quotes for insuring my employees in NJ, they all matched up with the premiums on healthcare.gov, also seen here:
https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...
ACA compliant health insurance pricing is pretty commodified since all the rating factors are codified in law (age, location, smoking status, and that is it I think).
Edit:
>These plans are garbage
The plans simply reflect the cost of healthcare. The companies that sell the healthcare have profit margins in the sub 5% range. Mechanisms to bring the cost down would be to have taxpayer funded medicine in the public domain so the medicine is sold without patent, increasing number of doctors by greatly expanding residency positions and reducing training requirements so that you can start practicing before age 28, reducing the need for "certificates of need" so more hospitals can open and compete, etc.
Anyone who works in healthcare and looks at billing can tell you this is not actually the case, prices are not based on any reasonable metric and are rarely actually paid by insurers anyway.
>The companies that sell the healthcare have profit margins in the sub 5% range.
Point of contention here, these companies aren't selling healthcare, they're reselling it. Which is a service which should ideally not have any profit margins, and would be best suited for a large, collective entity that everyone paid into according to their financial ability, as opposed to smaller social-class exclusive pools.
Seeing as how that is not politically possibly, middlemen with sub 5% profit margins was the compromise. Obviously not the best situation, but still better than before.
Is there any evidence that these companies are concluding to increase revenue by making the system less efficient?
Low profit margins plus multitude of competitors generally means there is not much juice left to squeeze.
>Seeing as how that is not politically possibly
Basically every other liberal democracy has taxpayer funded healthcare, and even many US states have successful programs. It's extraordinarily silly to call that impossible, or to call what we have now a "compromise" rather than a clear case of corporate welfare being put before the welfare of the citizens.
https://www.commonwealthfund.org/publications/newsletter-art...
Seeing as how Republicans have zero interest in taxpayer funded healthcare, and they have held enough Senate seats to stymie any Democrat led effort for the past 20 years and probably next 20, I do not see why it is “silly” to call it politically impossible.
Yes but they get to deduct this, unlike an individual for whom no such deduction exists. Repeat after me: "a tax deduction is a subsidy." That is, welfare. An extremely biased, discriminatory welfare at that.
You can also buy a platinum level BCBS health plan yourself, without an employer, and get the same low deductible and low oop max.
https://www.healthcare.gov/choose-a-plan/plans-categories/
It is evident then that health insurance is NOT tied to employment. Buying it with pre tax dollars is tied to the type of employer you have.
NJ has a very nice pdf where you can basically see how much your insurance will cost based on your age and level do coverage you want:
https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...
Furthermore you cannot use the exchanges if your employer offers plans IIRC. So your employer can control which plans you have access to.
The subsidies should just be given directly to the person who needs healthcare. There is no need to involve a third party. It just complicates the situation for no gain.
I do not think this is true. Everyone can sign up on healthcare.gov. Employers will want you to opt into the subsidized plans they offer, especially if you are a lower compensated employee, in order to pass their non discrimination testing requirements, but they have to make the portion they are paying for high enough to make it enticing enough, they cannot force you.
> The subsidies should just be given directly to the person who needs healthcare. There is no need to involve a third party. It just complicates the situation for no gain.
Absolutely. The whole employer tax benefit situation should be abolished, and all individuals dumped on healthcare.gov. Same with retirement benefits. Employers should not receive any beneficial tax treatment for providing benefits, and it would make compensation much more transparent and easier for employees to compare from one employer to another.
What employers do have is the ability to sell you health insurance with pre tax dollars, which is also available to self employed individuals. But the people who are screwed are those who are employed by employers that do not offer health insurance. They have to buy insurance with post tax dollars.
There is similar bullshit with retirement funding, where employer sponsored retirement account limits are drastically more than individual ones (401k vs IRA), and especially if you are a married couple with 1 spouse with 401k access and one spouse without.