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Comment by drakaal | Hacker News Reader

Obama Care "costs" more than their calculator because the "$100 a month plan for those making under $50k" cost $1,200 but doesn't give the plan holder anything until they incur $10k in expenses.

Basically you Lose $1,200 that you could have spent on healthcare. That $1,200 is a lot when you consider that many of the people with out healthcare end up at the Emergency Room for simple things like Strep Throat and end up paying $500 instead of $80 for a doctor's visit.

The best analogy I can think is like the Poor who opt to be unbanked. Many of the unbanked do so because the fees in banking are greater than what the fees are at the Check cashing places because a single overdraft charge.

Obama care is really just bankruptcy insurance, and that is kind of what bankruptcy is a way to not lose everything if you can't afford it.

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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.

How many poor people are going to use the preventive services? What do you think a Physical and an annual check up prevents?

You have generations of thinking that the Doctor was where you went when you are about to die, and suddenly expect them to get check ups.

The response is "but they might find something" and that would cost money.

I can't address your speculative claims on how lower-income folks think about health care, but to give a concrete example of a positive preventive outcome:

- A 55 year-old woman making $30,000 a year purchases insurance through the Exchange. She pays:

-- $2,512 for the year's premiums ($209 per month)

- She receives a preventive breast exam (no cost) that is positive for breast cancer.

- She receives comprehensive treatment costing $60,000.

- Because she is at 261% of the federal poverty level, she stops paying out of pocket at the maximum of $2,975.

- Her total costs paid for the year are $5,487.

($2,975 in cost-sharing [2] + $2,512 in premiums)

[1] http://kff.org/interactive/subsidy-calculator/#state=ca&zip=...

[2] Note: the out-of-pocket will be somewhat higher because of the OOP maximum is in 2010 dollars.

She was probably already getting her breast exam free if she was earning less than $50k a year.

http://www.komencanaz.org/understanding-breast-cancer/about-...

She would have gotten the treatment anyway. Filed bankruptcy and as a renter lost nothing, except her next car costs 5% more because her interest rate is higher.

Charities often have strict income limits regarding those who they will serve. Some of the charities your link mentions state they can only serve a limited number of patients. Many of the programs are in a single county. You may end up having to call around to many programs to only find out you don't qualify for any of them. If you have insurance through your employer, it may have a huge deductible and even if it does cover a mammogram it may not cover treatment. These factors all discourage people from getting preventative medicine done.

Bankruptcy should never be regarded as a valid solution for medical care costs. What if her state has rules that don't allow her to keep her car(or certain other items) when filing for bankruptcy? What if she had already filed for bankruptcy the year before?

That assumes the costs all fall with in the fiscal calendar year... Or is there a rolling year?

I grew up pretty poor. We used preventative services regularly. I've actually gotten worse about that at the same time my income has grown dramatically.

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.

Then an easier law that even republicans would have supported is to have the government subsidize HDHPs and be done with it. Instead they needed 1200+ pages that the lawmakers didn't even read. Government wasn't after protecting the 'uninsured'-- they wanted to control an industry that makes up 5% of GDP.

Republicans supported the ACA until Obama did. It's based on their own blueprints from the 1990s fight and Massachusetts.

And if you're going to whine about the length of the bill, get it right. It's 906 pages with legislative formatting (huge margins, lots of other whitespace). The PDF is trivially googleable.

I read it. You should too. It is not as long as the page count makes it seem.

What industry are you referring to? Healthcare? Or insurance?

True.

Is this true?

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