White House urges 'geeks' to get healthcare coverage, launch startups | Hacker News Reader

White House urges 'geeks' to get healthcare coverage, launch startups

computerworld.com

24 pointskldavis448 comments

I tried that. It did not work. ACA is not designed for entrepreneurs. When you are entrepreneur your cashflow projections are quite unreliable, and cannot be easily deduced from your previous income. But when you sign up for ACA plan you are asked all sorts of income questions to figure out what your subsidy is going to be. And worse of all, if you don't have any income (which is normal when you are starting a business), you cannot get any ACA plan - you are referred to Medicaid, so ACA is quite useless in that situation.

In my case we are without income for more than a year. The marketplace did not allow my family to sign up for any insurance and said to use Medicaid. However we are running out of savings this year, so two things will happen - either our business will pick up, or I find a regular job. I any case we will have jump of income and will not be eligible for Medicaid or any subsidy with ACA.

In my view, ACA intentions are good, but it is realized in entrepreneur unfriendly way and I cringe every time people say that how it is going to boost startups in this country.

Yeah, but if you qualify for Medicaid now based on your current income then you should enroll, as it's expansion (increasing the income levels) was part of the ACA too, assuming you're in a sane state. At the point in which your income goes above the Medicaid cut-off you should still be eligible for some subsidies up to a certain point. After that, depending on what state you're in your monthly premiums on an exchange plan will be very very reasonable. Anywhere from $50 - $300 for Silver plans, again based on your state, and if you qualify for a subsidy then obviously that's reduced.

Don't quite understand why you think it doesn't work for entreprenuers. I myself left a cushy job around 10 months ago to do a new start-up and I signed up on the NY exchanges nicely, with a monthly outlay of a very reasonable $150.

Especially compared with the prior situation which was that as a freelancer, if you were lucky you could get individual coverage for around $500+... assuming no pre-existing conditions.

In NY, it was illegal to discriminate based on pre-existing conditions, which meant it was higher there than other states in which it was legal. I used to live in NYC and was under Freelancers Union insurance, which ran about $400 a month with a $10k deductible and 30% coinsurance. Moved to Nashville and was able to get better insurance for about $200 a month. (I'm insured through an employer now, so I have no idea what it looks like post-ACA).

I had individual coverage as a freelancer for $130 per month.

I got coverage under the ACA as a freelancer for myself and my wife at $420 a month.

> Yeah, but if you qualify for Medicaid now based on your current income then you should enroll, as it's expansion (increasing the income levels) was part of the ACA too, assuming you're in a sane state

Do they care why your income is low? For instance, if I lose my job, and decide to take a year off before looking for another job, could I go on Medicaid for a year? Or is it like unemployment benefits, where they get testy and stingy if you aren't trying to get a job?

So... sign up for Medicaid. When you become ineligible for that, you can sign up for a non-Medicaid plan. I fail to see the problem.

I think I was not clear - there is no problem with signing up with Medicaid. The problem is - I don't see how ACA adds anything to entrepreneurs.

When I quit my job, we signed up for private insurance (family of 4 - $500 a month with decent coverage). That was pre ACA time. All I've got from ACA - my insurance got bumped to $680, which is OK and still much cheaper than any comparable plan on the marketplace.

So my complaint is not about lack of options for entrepreneurs, my complaint is that ACA actually made my life marginally worse, not better.

Also don't forget that jumping from plan to plan includes filling tons of forms, which takes quite a bit of time and frustration, which I would rather spend building my business.

I doubt you really got "decent coverage" at that price, and I expect even at $680 the coverage will magically evaporate if shit hits the fan.

That said, you've taken your own unusually strong position, observed that the ACA didn't change it, and extrapolated to all entrepreneurs. What does "entrepreneur" mean to you, exactly? Is "healthy and financially secure" a prerequisite in your view?

I also don't know what "tons of forms" you're talking about, since that hasn't been the case in any situation I've personally observed since the beginning of the year, but you've now said you're in Texas, which is actively trying to thwart the ACA, so is even less likely to be representative.

Whether or not $680 is "decent coverage" for a family of 4 depends on age and perhaps the state you live in. Assuming that the family is young, that would buy one of the better pre-ACA plans in my state (Washington). I have no idea how old the parent is.

Of course, that won't buy a comparable post-ACA plan. The ACA rather dramatically increased the costs of insurance even for plans that were unchanged by the ACA (~35% more at my current startup for the same plan). Other startups I know faced similar cost increases, which makes the argument that the ACA helps startups dubious.

So you're saying that having a lower change of shit hitting the fan make for a better case of buying plans that disappear when shit hits the fan? Mindblowing.

> I think I was not clear - there is no problem with signing up with Medicaid. The problem is - I don't see how ACA adds anything to entrepreneurs.

What is provides is better access to heath insurance plans. My employer's offering (UnitedHealthCare) is atrocious for $460/month for myself and my wife, so I went and got BCBS Illinois for $490/month, with much better coverage.

I could not do this prior to the ACA. Sorry if it makes your life marginally worse, but it makes people's lives marginally better when they could not get insurance before, or were paying large sums for pathetic levels of coverage.

Switching plans means: filling out forms, making calls, spending time on hold. Waiting for your mail to arrive to make sure everything is on track. Following up when something goes wrong. First with the insurance companies, then with every medical provider you deal with.

If you're healthy and insurance isn't strictly necessary, maybe this isn't so bad.

If you're like me, have a pre-existing condition and your well-being actually depends on receiving quality coverage, switching plans is scary. A few years ago I switched plans, and due to a bureaucratic mistake with a pharmacy relating to the transition, I ended up having to pay for a months supply of medication out of pocket, which cost me something like $4000 IIRC.

So excuse me if I don't want to switch plans every time I change income brackets.

By the way, as someone with a pre-existing condition, I strongly support the ACA. I think it's great. Understandably though, it isn't perfect.

Yeah I fail to see the problem. When I left my salaried job to start my own business I applied for our state provided healthcare (MA) as my income was almost non existent. As my income increased I got bumped from plan to plan adding cost along the way. If you actually have $0 in income, Medicaid or the like sounds appropriate.

To be fair to Skolos...

it does depend on what state he was in.

But I agree... entrepreneurs should not be living in certain states. They are just bad places to be launching a startup.

Didn't the Affordable Health Care Act essentially roll out nationally a model similar to the successful state models (like Massachusetts) making this a universal method? I claim ignorance here but was under the impression the systems worked similar.

Nope... states can opt out. So you really need to check the rules in your own state. Like any other thing when starting a business.

I am in the same boat as you. I am the founder of a small startup. My business income is highly variable. Most months I am below the medicaid cutoff, others above.

Signing up through the exchanges under this scenario sounded like a nightmare where if my income goes up, I have to change from one plan (medicaid) to another (private plan) and possibly back again if my income drops.

Instead of that nightmare, I opted to skip the exchanges entirely and sign up direct with a private plan. This disqualifies me for any subsidy, but as a person in his early 30s, my plan is only about $300/mo which I consider very affordable for the level of coverage I am getting.

On a separate note, I am very thankful that ACA exists, because I have a pre-existing condition with very costly needs. Being able to have any insurance at all, without discrimination and at a reasonable price, is a godsend. I hope they can create some more sane options for entrepreneurs, but even if they don't, I am very grateful that the ACA exists.

I was grumbling today about my new job and having to pay $30 a month for our Medicare levy. I can't even fathom how expensive your health insurance is, you poor bastards.

And yet despite that, startups are few and far between, despite our government happy to help us when it comes to our health, etc. Go figure on that one.

Ironic, because the ACA has actually made things harder for early stage startups trying to setup insurance.

"Under the ACA and California regulations, beginning January 1, 2014, small businesses must have at least one "common law" employee who isn't the owner or owner's spouse (or domestic partner) to be eligible for small group coverage. As a result, the following will no longer be able to renew under a group plan..."

http://info.kaiserpermanente.org/html/hcr_ca/owner_only_busi...

As a founder I can say ACA will make my wife happier during the early months of my future startup(s). Tying healthcare to employment is about the worst thing you can do for innovation. I'm glad those days are over.

I am curious about your experience. Have you signed up for a ACA plan?

I have tried, and it was frustrating waste of time - since, as a founder, I didn't have any income I was not allowed to get any ACA plan. I was told this after I spent several hours filling out forms.

As of January 1st, I'm on a non-exchange plan that I'm only able to get because of the ACA (I was previously uninsurable on the individual market due to preexisting conditions). I'm off-exchange because the best plan for my particular situation isn't offered on the exchange on my county, and I wouldn't be eligible for a subsidy anyway. (You do know that if you really don't want medicaid and can afford the premiums, you could just go to an insurer off-exchange, right?)

I have family with limited income who went through the quick signup process on Washington's exchange site and got put on Medicaid. Card and related information showed up soon thereafter. No big deal.

Seems like you've got some sort of mental block. Your comments haven't mentioned any practical problem, yet you seem unable to get past some unstated obstacle.

It might be just my situation. I had private plan before ACA. When exchanges opened I spent half a day filling out forms to see if I can get anything better than my private plan. Because of no income, they did not allow me to even check what price from exchange would be, they just said that we'd get Medicaid. Since we never got any information on how to get it (I am in Texas), I assumed I need to go through whole form filling again. That's where I resigned and decided to stay away from exchanges.

So it looks like just my special circumstances.

"they did not allow me to even check what price from exchange would be"

Go to http://healthcare.gov and click the big link that says "See plans before I buy". Answer some questions, and it will guide you through. (This workflow is anonymous and does not require creating an account and logging in.) More importantly, though, when you see a question that asks "Is employer coverage available to anyone in this household?", look right above for a link that says: "No thanks, just show me plans in my area. I can find out later about help paying for coverage." You'll then see all the plans.

[side-note: I was a member of the "Tech Surge" team that helped fix the website in late 2013.]

You were living off savings, right? Couldn't you just lie and claim you had some small amount of income? It wouldn't even really have to be a lie -- just a projection of future business income.

Try out HealthSherpa[0]. It shows plans available by location instead of income.

[0] https://www.healthsherpa.com/

> Tying healthcare to employment is about the worst thing you can do for innovation

You reminded me of the Roman emperor who decreed that every man would inherit his father's job. This was mandatory.

The worst thing you can do (and that we've done!) is tying healthcare to material wealth.

Wait, so the goal of the ACA is to get young, 'healthy' people to buy insurance to subsidize the rest of us as we get older and less healthy. Geeks who launch startups pretty regularly end up without any income for a while, and as has been stated in other threads many times, this means you end up on Medicaid. Isn't this counterproductive? Wouldn't the ACA be better off if they get healthcare coverage but don't launch startups?

Not only that, but these same young people (as we saw in the "kids in the valley" Times article the other day) are also supposed to cure cancer for these folks!

Joy!

(wait, what's that, you also need to pay rent? and student loans? and healthcare costs? but but but why aren't you ~-= innovating =-~???)

The logic of this argument seems flawed. I assume the goal here is to get young, uninsured people to buy health insurance. The argument here is that by buying an ACA plan, individuals will be more free to start their own business because they won't have to worry about getting sick without insurance. If I am risk averse, I will simply pursue full time employment that include health insurance benefits. If I am young and willing to forgo salary and benefits for a startup, why would I weigh the risk of getting sick while uninsured any more than the other risks involved in a business venture. Based on what I've seen of the costs of ACA plans, it seems like someone working in a ramen profitable startup would not even be able to afford the insurance offered.

> I assume the goal here is to get young, uninsured people to buy health insurance

The goal here is to get young, HEALTHY people to buy health insurance in order to pay for those with preexisting conditions who can no longer be denied coverage.

This. I wish I could upvote 10x. As things stand, the mix of ACA enrollees is far too high in older and/or sicker people (who need insurance to pay healthcare costs) and they need more young and/or healthy people (who need neither). Many officials have described how, if the ratio doesn't change, the policy groups may end up with far higher premiums and/or go into a death spiral.

The problem is that even with the tax subsidies these plans are too expensive. I was looking at them with my currently uninsured brother and the plans for his family of 5 start at ~$400 / month with the subsidy. These "cheap" plans have a $12k deductible. Unless something catastrophic occurs, he is essentially paying a minimum $4800 more per year and still having to pay the deductible for all his regular doctor visits. At this point it looks cheaper for him to just pay the penalty and out of pocket medical costs. It's basically a chicken and the egg situation. The only way out I can think of resolving this is dumping the ACA completely or going to single payer.

What would it have cost to get a comparable plan for your brother and his family before ACA? $400/month for a family of 5 is about 1/3 of what we have where I work through our employer-sponsored group plan.

What I've seen is that for single people (or rather, people who only need to insure one person) who make enough to not qualify for any subsidy, the ACA plans where I am (Washington) that are close to our group plan cost about the same but provide less coverage (no dental and no vision).

For those whose income is low enough for a substantial subsidy, or who have family members that would be on the plan, it looks like the ACA plans beat the employer group plan (except for the dental and vision coverage--although I believe some do offer that for children at least).

Yeah, I am not sure what he would have to pay for a comparable plan before ACA. My point is that he is now legally obligated to drop $5k on something that essentially only provides benefits if something catastrophic occurs.

There have been studies that have shown that the number of businesses started after people qualify for Medicaid goes up. There's a little blip the year of qualification, as you no longer need to be tied to a job to get healthcare.

"Risk averse" isn't an on/off switch. It's a range, and removing "What happens if I get sick?" widens the range.

All I know is I have business degree from California State university, I also worked at Health Net (an HMO provider in California, and Tricare provider at the time in the East coast) and did medical analytics systems that helped improve patient outcomes, both for facility care and chronic care. I now work for Bank of America and I work in the department that is untangling the mess of the toxic assets (I technically work for Countrywide, if that helps). Oh, and I develop software for a living.

I have not the foggiest idea how health care works in America anymore. It has become so complicated, so byzantine, that there's no possible way it could be fair, as some get lucky, and some don't, and there's little anyone can do about it anymore. All I see it doing is feeding a massive bureaucracy, at inordinately high costs.

And this is supposed to be the solution?

The ACA arguably makes a few things more 'fair' but it's still profiteering sick care via cost shifting.

Drug companies seem to have an incentive to get $5000/yr treating type 2 diabetes (i.e. carb intolerance) rather than telling people to stop eating so many carbs. The doctors and insurance companies just go along with it, as there doesn't seem to be an economic disincentive for them. I know first hand that is bullshit, so I have to wonder how many other things are rotten (statins vs diet).

If we actually cared about health in this country, we'd probably ban most of the current food production 'technologies' and stop subsidizing/pushing carbs [edit: for everybody; some people can handle them]. But healthy people don't grow GDP, having bypasses and perpetually treated diseases grows GDP, and god knows all this country cares about is the GDP number.

> But healthy people don't grow GDP, having bypasses and perpetually treated diseases grows GDP, and god knows all this country cares about is the GDP number.

I get that this is supposed to reflect the "for profit healthcare industries are fucking you over to make their buck" but the reason every first world nation on the planet has single payer is because it grows your GDP to not have a perpetually ill populace that consumes extremely expensive hospital procedures as last resorts before declaring bankruptcy on a million dollar bill while being prescribed a half dozen drugs they don't need by profiteering big pharma companies being subsidized and given monopolies by a corrupt state.

(Honest question) What's the confusing part about health insurance?

I get a bill. What am I supposed to pay?

Anyway, I have dental, vision, medical, from my employer.

That's not that bad since they do all the paperwork.

I said "how health care works". It's more than insurance.

but but but free market privatization you cant let sick people get a free ride why do you hate america

( This appears to be the reasoning. It's completetly fucked in the head.

There is not a single angle you can look at healthcare from which does not make things look terrible. It is a fractal of sadness and poor decisions. )

Love the guy at the end who assumed "geeks" are too stupid and introverted to be the "business leaders" that can be "entrepreneurs".

Odd.. this post was #16 on the front page and suddenly dropped to #78 within a minute or two

Obama (a racist IMO, see 'Trayvon could be my son') is selling http://en.wikipedia.org/wiki/Karen_Ignagni project.

What can I do not to help?

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