It’s very hard to do the math here. It’s largely invisible to me how much my employer is paying in health insurance premiums and it’s unknown that they will add that sum to my salary.
https://www.irs.gov/affordable-care-act/form-w-2-reporting-o...
Grandfathered plans are an absolutely screaming deal. You can do an HSA plan with a $2000 deductible and low OOP max, fully fund the HSA ($7,200) and come out way ahead at modest cost. This let's you do things like vision / dental / chiro / accu / whatever day to day stuff on the HSA, then keep costs controlled (after 2K) for a major issue. If you don't end up using the HSA you can basically use it in retirement.
The obamacare bronze HSA plans (which actually cost a bit more) have a $4,800 ind deductible and something like a $13K (!!) out of pocket max and something like a $9K+ family deductible limit. And they cost more. This is totally unworkable absent the subsidies.
I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate?
One area where govt care is better priced is for the elderly. The grandfathered / free market type plans get expensive at 60 years +. The obamacare plans are more of deal here (relatively). At the 20 year old range obamacare is horrible for the coverage if you actually have to pay for them.
It would be kind of similar to forcing auto insurance carriers to afford coverage to cars they didn’t previously insure after they had already been in an accident.
Bigger than denial was recission, where if you ended up with an expensive to cover condition, your insurer would fine-tooth-comb your history for evidence that you had a preexisting condition that has not been revealed, cancel your coverage, and leave you uninsured and uninsurable; recission for reasons other than proven intentional fraud was prohibited by the ACA, which is a pretty big deal.
Since the insurance companies now have to cover pre-existing conditions, and don't want to do that, they came up with another plan: don't answer the phones except during open enrollment. I tried calling several insurance companies (major carriers) just to get quotes for health insurance, and none returned my call. Some had phone trees that went in a circle so you could not get to a person. I did get one broker to talk to me, and he said pre-existing conditions weren't covered for 24 months. First, that's a lie, and 2nd, it's illegal (ACA outlawed this practice).
By only accepting applications during open enrollment, the insurance companies have effectively done an end-run around the law against pre-existing conditions.
Note: this is for an individual to get insurance. I'm sure companies can get insurance for their employees any time they want it.
Follow-up: it turns out that if I did have PPO insurance and was covered at Mayo, then with the same bill from Mayo it would have cost me $8000 more with coverage than it did without insurance, paying cash. That's truly f'd up!
And the requirement that 80% of premiums paid had to go to paying for care was supposed to prevent insurance companies from jacking up prices to increase profits.
Neither actually made an attempt at fixing the underlying problem of health care being expensive.
That's an easy one, Obamacare mandated that insurance companies couldn't charge more than X times as much for their most expensive plans vs. their cheapest plans, The people pushing it were either tremendously ignorant or outright lying and claimed that this would make plans cheaper, while critics rightly predicted that instead of making the most expensive plans cheaper they would make their cheapest plans more expensive.
[1] https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In...
The distinction is subtle, but in my mind having it structured as an individual paid income tax would yield better results for edge cases and not incentivize bad corporate behavior like running 1099 contractors instead of FTEs.
Well, if they didn't, you could just change jobs. The old benefit of working for an employer that paid all of your premium would be gone, so that wouldn't be a reason to stick with them.
I'm pretty sure I do know the answer to that question...