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Comment by newguy1234 | Hacker News Reader

What I don't get is how do 37 million Americans not have health insurance when the ACA was suppose to fix that issue? All of the plans are adjusted based on your income level and you get a tax credit if you are low income. If you are very poor then you get free healthcare....

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If you have a reasonably middle-class income, the plans are prohibitively expensive and unbelievably shitty.

I'm only anecdotal, but by comparison, prior the ACA, my insurance for a family of 3 was $300/month with a $2500/year deductible. That $300/$5000 plan was considered predatory and high deductible.

The first plan offered to me under the ACA was something like $700/month with an $8000 deductible. Plans this year were ~$950/month with a ~$15,000 deductible. It's Cadillac pricing and one-star benefits.

Meanwhile, my "non-compliant, high deductible" plan from a private market is $400/month with a $5000/deductible.

I opted out of ACA - it made sense to opt out even when I had to pay the $2100/year penalty, because the premiums and the deductible were still less. I qualify as "underinsured", but that couldn't be farther from the truth. My plan can be irritating to use, but they have online self-service tools for providing healthcare, and I have never been questioned about paying for necessary treatments. I pay them, they pay the doc. Very simple.

For people who relied on private insurance and weren't destitute, the ACA has been a shit-show from day one.

The only highlight to the ACA for me is the hundreds of thousands in billables I've accrued helping institutions become "compliant" with the ACA.

I’m curious what kind of plan you have now. Where did you find it?

I thought plans had to be aca compliant.

Do you live in a state that rejected ACA funding?

CA resident here. My ACA plan for me and my son is 890 a month with subsidy and a 14k deductible per year. It’s bad.

Interesting I didn't know it had those issues

There are basically 4 groups of people without insurance (though note that the distribution is based on 2015 data):

1. 42% make too much to qualify for premium subsidies but elect not to purchase coverage, typically because it's unaffordable or just not worthwhile (the sibling commenters mentioning their expensive, crappy plans fall into this group).

2. 27% qualify for Medicaid, meaning that they could get coverage approximately free but they either don't know how or don't bother to sign up.

3. 22% qualify for partially subsidized coverage, but either they don't think the coverage is worth the money, they don't know how to sign up, or they just don't bother.

4. 9% are in the coverage gap - they live in states that didn't expand Medicaid and make too little to qualify for premium subsidies.

https://www.kff.org/uninsured/issue-brief/a-closer-look-at-t...

When I lost my job in 2018 and had to pay for health insurance myself, even a relatively low tier plan would cost me upwards of 400+ a month while still leaving me on the hook for a majority of the bills if I got sick or injured.

Thankfully the COBRA loophole meant I could avoid paying the costs if I ended up finding a job quickly, but during that period I was travelling with a check for the full amount of the insurance just in case.

Now imagine that but far worse for someone who couldn't actually afford any of those costs.

That’s not a loophole. It was the intention of the lawmakers who passed the law!

When I was working as a software development contractor, I went without health insurance for a year. I'm young and I don't have any medical problems, so I could get away with this.

Because I'm a software developer and I make decent money, I didn't qualify for any tax credits or discounts. The cheapest health insurance plan that I could find cost twice as much as just paying both the ACA penalty and the Massachusetts state penalty. It made more financial sense to just go without insurance.

I can imagine that a lot of young software developers and other people who do contract work find themselves in similar situations.

That may work but only if you don't have any significant assets. If you do then you risk getting a massive medical bill and then the hospital will go after all your assets.

If you're willing to gamble on your health, it's still much cheaper to pay the fine than pay for healthcare that isn't through an employer. When I was unemployed for a few months a couple of years ago, I opted to not get any healthcare coverage from the state exchange while I was looking for work because it was going to be over $1000 a month to cover my wife and I, plus it only covered a percentage of healthcare costs instead of 100% with a small copay like good insurance does. It also had a high deductible, around 10k I think, before they'd start covering the percentage.

Also the fine doesn't exist any more.

They scrapped the fine as of 2019.

You have to be really poor to get Medicaid in most states. Yes there are relatively cheap subsidized insurance options for people not quite poor enough to get Medicaid but the deductibles are so high that these same people will end up broke before the insurance even starts paying out so they see no point in buying it.

I don't believe anyone but the very impoverished get free health care, and I believe the subsidies vary by state.

See the bottom of this for a graphic: https://www.commonwealthfund.org/publications/issue-briefs/2... also the removal of the individual mandate probably contributed to the gap.

Tax credits don't help people who are struggling to pay day to day bills. What good is a tax credit they'll receive up to a year later? When your horizon is 2 weeks, you're going to prioritize food & accommodation before a health insurance plan.

The tax credit can be paid in advance directly to the insurance company on your behalf [0]. Basically, the federal government pays for your insurance.

[0] https://www.irs.gov/affordable-care-act/individuals-and-fami...

Thank you. I did not know that

It’s severely hampered in many states and healthcare isn’t even mandated nationally anymore.

Do you think they'll give me free health insurance as a 23 year old who lives with a parent? I don't have any interest paying a dime for health insurance because I could use that money to eat healthily instead and try to stay out of trouble. Otherwise, I'd starve or sacrifice my diet in order to afford the health insurance. It has never made sense to me.

You are risking bankrupting you and your parents for a single hospital visit. Friend had a heart arrhythmia scare at 28 years old. Lost consciousness, ambulance to ER, admitted and then stayed in hospital for three days. $67k in Billings that they negotiated down to about $50k. That’s why.

But the kicker with this is most young people don't have much in assets so they don't lose much in a bankruptcy. Meanwhile they get to immediately spend any cash they would otherwise be paying on health insurance. Also from what I've read...the lack of insurance penalty has been scrapped. Now it makes sense why so many don't get the insurance.

That's one of my fears indeed. But what if I have no job? Leaving my parent aside because there's no reason they should be legally liable to their adult child who lives their own life...they are going to have to enslave me or help me find a job if they ever want to see any of that bill paid. Otherwise, they could just kill me too, to repay my debt to the hospital with my life if that makes them happy.

Probably a very immature view on this, but still, I see no reason to sacrifice my health in terms of food and quality of life for health insurance. Won't that just increase the likelihood of me becoming sick and needing healthcare to begin with?

What happens whenyou get run over by a drunk driver? You don't get to choose when that happens, and there's little you can do to prevent it.

In that case, the drunk driver/his insurance would pay for the hospital fees, no? That is, in the more optimistic outcome where I actually survive.

What happens if you're out walking down the street and stumble, fall, and hit your head. Now you have a brain bleed, and need neurosurgery to relive pressure on your brain.

Reckless drivers may not have insurance, or enough assets to pay off your hospital bills.

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