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I still see hope for how it could play out. I forget the details, but I think states have the ability to experiment with their own alternate exchanges. Like they can experiment with state-run single-payer. And if it proves to work well, more people will switch to it, and other states could grudgingly switch to similar approaches, etc.

Compared to what? It's not like people and employers weren't paying for health insurance before.

(Okay, there's some low-risk folks who don't pay for insurance now, but they're basically offloading their catastrophic health risk onto society.)

Yeah, well...there were several different single-payer proposals in the mix, but none made it out of committee, because they were "too radical" to pass the House. And once Scott Brown was elected, anything that even remotely smelled like "socialism" (i.e. simpleton socialism, not real socialism) was off the table.

There are no solutions to this problem that don't involve either making consumers aware of how much they're spending on health care (thus aligning economic incentives), or removing the profit-seeking entity from health care altogether. So long as we have consumers who don't know/care what they're paying, medical and insurance companies who have a profit motive, and physicians who have no incentive to consider cost of care, we have an economic recipe for health care hyperinflation.

The "conservative" propaganda machine has thoroughly brainwashed our poorest and most vulnerable people into voting against their own economic self-interests on this issue. I don't know what's going to fix it, but until that day, we'll get "free market solutions" that make health corporations richer and don't do anything to fix the underlying economic incentives that are causing the problems.

There is a provision in Obamacare that went into effect a couple of years ago that forces smaller insurance companies to spend at least 80% of their costs on actual healthcare costs and for larger insurance companies that number is 85%. That means that for insurance companies only 15-20% of revenue can go to employee salaries, building rent, other administrative costs, advertising, CEO pay, profits, etc. So I'm not sure if this is actually going to make more billionaire CEOs. While more people will be buying health insurance, at the same time, CEOs are now limited in what they can pay themselves. The only way they can pay themselves more is to reduce administrative costs or cover more customers, which means making their own health insurance company more lucrative than their competitors to consumers, which is a good thing.

Yeah, it's pretty much bullshit.

But this is the price you pay to have the best health care in the world!

I find it weird that you don't blame the employers for dumping an employee, to avoid paying 2000$ penalty.

Yeah, but that's a small price to pay for every single person in the country to get excellent best-in-world health care for absolutely free. Right? . . . . Right. . . .?

At any rate, the NPR calculator only works if you enter the number of people registering for the "Exchange". So, am I to understand that if you're not registering for "The Exchange", then you will bear no additional costs? I had hoped they'd have some crazy complex calculator that would estimate how much your premiums and taxes and other things would go up with existing HMO plans and so on.

The federal premiums will be available on Oct 1.

California's premiums are already available here: http://www.coveredca.com/

Is this true?

Yeah, that is how high deductible plans work.

But if you are in a car accident and need to be airlifted, have a heart attack, etc etc, it is much better for you to at least have some cap on your out of pocket.

To clarify 2 points:

- The annual out-of-pocket maximum for any Exchange plan can be no higher than $5,950 for individuals and $11,900 for families (2010 dollars, so will be higher now). [1]

- The out-of-pocket maximums are lower for people with incomes less than 400% of the federal poverty level, specifically:

-– 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);

-– 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);

-– 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family). [2]

- All preventive services are covered at no cost, and are not subject to the deductible. [3]

[1] http://kaiserfamilyfoundation.files.wordpress.com/2011/04/80... (page 5, search "out-of-pocket")

[2] Ibid.

[2] Ibid, page 10 ("Coverage of preventive services" section)

EDIT 12:31 PM PT: Added note on income-indexed annual maximums.

Because you would be eligible for Medicaid.

something does seem wrong - up that to 11k and you get 'better' numbers (more intuitive) - they may not have tested with numbers as low as you put in???

Also, fwiw, you only had 1 family member, but 2 enrolling, but that didn't seem to affect the issue.

TL;DR: In states where Republican governors are choosing not to accept federal money to expand Medicaid, the very poor are getting screwed.

From the calculator: "If your state does not expand Medicaid You will not be eligible for subsidies in the exchanges because your income is below 100% of the federal poverty level."

The reason for this is that the law provided federal dollars to states to expand Medicaid coverage (pretty much free coverage for enrollees) to all people making < 138% of the federal poverty level (FPL), and so the EXCHANGE SUBSIDIES were only written to apply to folks above 138% FPL.

Problem is, the law didn't say that these (very poor) people could receive subsidies for the Exchanges if the Governor refused to accept federal dollars to expand Medicaid -- basically because no one thought governors would be so brash as to refuse free money to pay for the health care of the very poor.

So, yeah. Kinda sucks to live in a Republican state right now if you're poor and uninsured.

>(which is more complicated and more expensive than just picking up the phone and calling BCBS.

Source?

>The other 50% will raise hell they are not paying $500 to the IRS, Obama will feel like a bully and Obamacare will be history.

I am not sure how you make that leap.

I think a lot of people will go for the subsidy. Especially people with kids. Two people who together make $30000 with three kids will pay $600/yr for coverage while the fine would be $1000. It only makes sense.

What are the hoops you think you have to jump through to get a subsidy? The way I understand it is that the exchange website where you shop for plans already has your 2013 income tax return's MAGI figure and will automatically present you with the subsidy based on that. You can tweak it if you predict your 2014 income will differ significantly, and when you file your 2014 tax return there will be a true up if you actual income is really different from the prediction your subsidy was based on.

This is just a calculator. A real individual health insurance application would probably also ask for weight, which is the other important statistical indicator that you're likely to be expensive to insure. Most of the other dangerous, life-threatening activities you're thinking of are more likely to simply kill you than to require an insurance company to spend 10 years paying 150x the costs of a typical policyholder.

I'd assume what "counts" is any tobacco use. If you smoke when you go out a couple nights a week, you're a smoker.

Per the CMS regulations:

"Under the final rule, “tobacco use” is defined as the use of a tobacco product or products four or more times per week within no longer than the past 6 months by legal users of tobacco products (generally those 18 years and older) and includes all tobacco products."

Source: http://www.cms.gov/CCIIO/Resources/Files/Downloads/market-ru... (page 3)

Yes -- subsidies are tied to income, not assets (specifically, modified adjusted gross income [MAGI]).

There are reasonable arguments around the equity of this, but, as you describe, it actually opens a big door for wishing to try a more entrepreneurial venture -- especially for those with health conditions.

The deductible is sort of smeared into the out of pocket maximum and actuarial value (but for lots of people it would amount to quite some more than $500).

The cheapest plans in the US tend to have a deductible of ~3-6k with coinsurance up to a set fixed amount per year, usually close to 10k.

Which one? As soon as you pick "adult or child" then it asks if you use tobacco.

What kind of idiot would answer yes, to questions like "Do you use Tobacco?" or "Do you use marijuana?" when applying for health care?

If your MAGI is above a certain level, that's kind of the point.

My estimate was 3 times what I'm paying now, for my own non-subsidized plan.