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evilweasel
Aug 24, 2002

Jan Brewer, the governor of Arizona, is actually vetoing every single law the legislature passes until they agree to the medicaid expansion.

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Paul MaudDib
May 3, 2006

TEAM NVIDIA:
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Deteriorata posted:

Because the premium is a fixed cost, the deductible is variable. If you don't have any major medical issues, you'll never hit the deductible cap. You may pay only a couple hundred bucks over the premiums in a given year.

We talk about the cost of a car typically in its sales cost, or perhaps the monthly payments. The total cost of ownership (including gas, maintenance, insurance, etc.) is not what is meant by the cost of a car.

Cars generally are not expected to incur expenses of several times their sales price in a given year before you can operate them (many locations have lemon laws specifically to prevent this). And yes, people do talk about the cost of a car like that, "I can't afford a car" doesn't mean you just can't afford the purchase price.

esquilax
Jan 3, 2003

Dr. Gaius Baltar posted:

Willa, do you mean that the cost for you would be $500/month for a bronze plan?

For anyone who wants to play around with the numbers, here is the federal government's actuarial value calculator. Here is my idea of the perfect gold plan. It would be hard for people to go medically bankrupt when most of their health care costs are less than $10, I figure.

A $6,000 gold plan means that, on average, a member would pay $1,200 out of pocket per year. By decreasing the copays on routine care as you've done you INCREASE the likelihood of medical bankruptcy, since you need to make up those savings by making sick people pay more to get back to the $1,200. Your example doesn't pass that smell test at all, which means that either you're misinterpreting how to use the tool or the tool gives awful answers (which it does in many other cases).

Willa Rogers
Mar 11, 2005

Dr. Gaius Baltar posted:

Willa, do you mean that the cost for you would be $500/month for a bronze plan?

No, it was around $575/month for the silver-plan premiums in California, based on the average among regions. And the region I live in is toward the top of rates for the state, which means it'd likely be more than the calculator's showing statewide.

So, that's actually closer to $7,000/year in insurance costs, with an additional $6,000/year in "cost-sharing," for a grand total of $13,000/year spent toward healthcare costs before you're off the hook. And that's for the outrageously high income of $49,000/year.

Deteriorata posted:

Because the premium is a fixed cost, the deductible is variable. If you don't have any major medical issues, you'll never hit the deductible cap. You may pay only a couple hundred bucks over the premiums in a given year.

We talk about the cost of a car typically in its sales cost, or perhaps the monthly payments. The total cost of ownership (including gas, maintenance, insurance, etc.) is not what is meant by the cost of a car.

Except you're not purchasing insurance for $7,000/year; you're leasing it, on a month-to-month basis, into perpetuity, for that price (and the increases that are built into the lease). So the "cost-sharing" is having to pick up the $6k maintenance cost, annually, when you don't even own the car, on top of the $7,000/year leasing cost.

Willa Rogers fucked around with this message at 22:18 on May 25, 2013

mastershakeman
Oct 28, 2008

by vyelkin
I'm very interested to see the real bronze plan premiums for young single males who used to be the cheapest to insure before the reduction in age and gender pricing gaps. I had a 5k deductible plan from 09 to 12 in Chicago, with premiums starting at 70/mo and going up to 130/mo by the time I left it for employer provided insurance. 500/mo would surprise me but 300 wouldn't.

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!

esquilax posted:

A $6,000 gold plan means that, on average, a member would pay $1,200 out of pocket per year. By decreasing the copays on routine care as you've done you INCREASE the likelihood of medical bankruptcy, since you need to make up those savings by making sick people pay more to get back to the $1,200. Your example doesn't pass that smell test at all, which means that either you're misinterpreting how to use the tool or the tool gives awful answers (which it does in many other cases).


I don't think I'm misusing the tool, I've read the instructions and it's fairly self-explanatory so long as you're familiar with insurance jargon. It could very well be that the tool gives awful answers, but I'm just taking them at face value because it's not like I have a better actuarial value calculator. Of course, if the federal tool is rubbish, then I would love to have a better tool to tinker around with. I'm not going out of my way to come up with inaccurate examples.

My example is based on plans run by Blue Cross Blue Shield, called HealthyBlue, which offer low or no cost-sharing for routine care, and a deductible for emergency care. There are several of these plans in Maryland's small business exchange, I've noticed one in the Federal Employees Health Benefits Program if you're in the Maryland area, two of them will be in the individual Maryland exchange next year, and I'm sure they're available nationwide as well. Medicare operates on the same principle, with a $1,184 deductible for hospital stays, and a $147 deductible for routine care. It makes sense from a long-term economic sense as well, if you have extremely low cost-sharing for routine care, then you're much more likely to catch an ailment while it costs $500 to cure, rather than waiting until it costs $200,000 to cure.

Again, this is me taking the tool at face value, but I don't see it increasing the out of pocket costs of desperately sick people relative to the California gold plan. In that plan, there's no deductible for hospital stays, but you pay a copay of $600/day for up to 5 days per admission. In my example there's a $1500 deductible, then $150 copay per admission, and my example has lower cost drugs. The California plan is low-end gold (78% AV) and my example is high-end gold (82% AV).

One possible explanation is that the $1500 deductible that I entered in my example applies to medical care other than what's specifically listed in the user-enterable fields. Unclassified care.

Willa Rogers
Mar 11, 2005

mastershakeman posted:

I'm very interested to see the real bronze plan premiums for young single males who used to be the cheapest to insure before the reduction in age and gender pricing gaps. I had a 5k deductible plan from 09 to 12 in Chicago, with premiums starting at 70/mo and going up to 130/mo by the time I left it for employer provided insurance. 500/mo would surprise me but 300 wouldn't.

Youngs (not sure of the age cutoff) will have the option to purchase a catastrophic plan with lower premiums + higher out-of-pocket costs, such as a $10k deductible, on the exchanges.

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!

Willa Rogers posted:

No, it was around $575/month for the silver-plan premiums in California, based on the average among regions. And the region I live in is toward the top of rates for the state, which means it'd likely be more than the calculator's showing statewide.

So, that's actually closer to $7,000/year in insurance costs, with an additional $6,000/year in "cost-sharing," for a grand total of $13,000/year spent toward healthcare costs before you're off the hook. And that's for the outrageously high income of $49,000/year.


Except you're not purchasing insurance for $7,000/year; you're leasing it, on a month-to-month basis, into perpetuity, for that price (and the increases that are built into the lease). So the "cost-sharing" is having to pick up the $6k maintenance cost, annually, when you don't even own the car, on top of the $7,000/year leasing cost.

I think it will end up being cheaper than $575/month when all tax benefits are factored in. If you're self-employed, then your premiums are deductible from your payroll and income taxes, so assuming a roughly 45% marginal tax bracket (payroll + federal income + state income), your tax-adjusted premium would only be 55% of the list price. Plus it seems like premiums will be lower than $575/month for a silver plan, given that the California booklet says that proposed rates average about $294/month unsubsidized for a silver plan for a 40 year old. It could even be that you will be <400% of FPL and not even know it, since the calculation they use to determine one's income is "modified adjusted gross income", which may mean AGI minus half of your payroll tax, which would put your "income" not at $49,000, but at $45,250 or so, thus ensuring that your premiums don't exceed 9.5% of MAGI.

But it's all a wait and see kind of thing. I'm hoping that the HealthyBlue plan that I want will come in at $250 or less, and can't wait until October 1st to get the good or bad news.


mastershakeman posted:

I'm very interested to see the real bronze plan premiums for young single males who used to be the cheapest to insure before the reduction in age and gender pricing gaps. I had a 5k deductible plan from 09 to 12 in Chicago, with premiums starting at 70/mo and going up to 130/mo by the time I left it for employer provided insurance. 500/mo would surprise me but 300 wouldn't.

Statewide, in California, a bronze plan for a 21 year old would cost about $177/month, and for the catastrophic plan, about $153/month, which would have a $6400 deductible. For a 40 year old, $226/month for the bronze plan. These are unsubsidized 2014 prices.

Source (page 32)

Dr. Gaius Baltar fucked around with this message at 23:22 on May 25, 2013

Sarion
Dec 24, 2003

One thing I didn't notice mentioned is that the subsidies are based on the second cheapest Silver plan. As a result, a single 34 year old making $20,000 a year should be able to get that lovely Bronze plan for close to $30/mo once the subsidy is applied. And then their out of pocket costs would also be subsidized to $2250 a year. For someone who currently has no insurance, a plan like that ($30/mo premium, $2250 oopm) is a vast improvement.

Unfortunately it breaks down the further up your income goes, until you eventually reach Willa's scenario which is at a :psyboom: level of stupid.



And for comparing plan costs, I think the best way is to use a best/worst case range. Best case being only the premium, worst case being premium + max out of pocket. So the plan I described above would have a cost of $360-$2610.


This is hilariously awesome. I can't stand Brewer but I can get behind this. Any idea what the motivation for this is? Why is she so vehemently supportive of the expansion when most other Republican Governors are opposed or lukewarm in their support?



edit: Also, Kaiser has significantly improved their subsidy calculator, so if you haven't checked it out recently its worth a look.

Sarion fucked around with this message at 23:35 on May 25, 2013

Lote
Aug 5, 2001

Place your bets
Someone in the other thread pointed out that Medicaid can fund nursing homes for poor seniors, but other than that, I can't really think of anything.

eSports Chaebol
Feb 22, 2005

Yeah, actually, gamers in the house forever,

Sarion posted:

Unfortunately it breaks down the further up your income goes, until you eventually reach Willa's scenario which is at a :psyboom: level of stupid.

It's like they took the nonsensical Republican fantasy where TAX AND SPEND means you're better off reducing your gross income to increase your after-tax earnings, only for healthcare, and this time for real instead of being a fevered delusion :v:

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!
They shouldn't have let the 9.5% cap on insurance premiums as a percentage of income expire the moment your income goes above 400% of FPL. Worst case scenario, if you're a family of 4 with 2 64 year olds and 2 children, making $95,000 in household income, and you get a $1,000 raise, then congratulations, you just got stuck with $13,000 more in insurance premiums. Better hope you don't get that raise.

Willa Rogers
Mar 11, 2005

^^^ I think the penalty for not having insurance hews to that metric no matter what your income is, but yah, coverage is still unaffordable.

eta: Since employers have to pay their percentage based on employees' income, does that mean that everyone in different income brackets will be receiving different dollar-amount employer subsidies? :confused: I'll have to look this up.

eSports Chaebol posted:

It's like they took the nonsensical Republican fantasy where TAX AND SPEND means you're better off reducing your gross income to increase your after-tax earnings, only for healthcare, and this time for real instead of being a fevered delusion :v:

Yah, we discovered that during one of the other PPACA threads: There's a "cliff" that, once exceeded by $1, means you lose thousands of dollars per year in subsidies. (I think Sarion mentioned this in the OP.)

Willa Rogers fucked around with this message at 00:17 on May 26, 2013

esquilax
Jan 3, 2003

Dr. Gaius Baltar posted:

I don't think I'm misusing the tool, I've read the instructions and it's fairly self-explanatory so long as you're familiar with insurance jargon. It could very well be that the tool gives awful answers, but I'm just taking them at face value because it's not like I have a better actuarial value calculator. Of course, if the federal tool is rubbish, then I would love to have a better tool to tinker around with. I'm not going out of my way to come up with inaccurate examples.

My example is based on plans run by Blue Cross Blue Shield, called HealthyBlue, which offer low or no cost-sharing for routine care, and a deductible for emergency care. There are several of these plans in Maryland's small business exchange, I've noticed one in the Federal Employees Health Benefits Program if you're in the Maryland area, two of them will be in the individual Maryland exchange next year, and I'm sure they're available nationwide as well. Medicare operates on the same principle, with a $1,184 deductible for hospital stays, and a $147 deductible for routine care. It makes sense from a long-term economic sense as well, if you have extremely low cost-sharing for routine care, then you're much more likely to catch an ailment while it costs $500 to cure, rather than waiting until it costs $200,000 to cure.

Again, this is me taking the tool at face value, but I don't see it increasing the out of pocket costs of desperately sick people relative to the California gold plan. In that plan, there's no deductible for hospital stays, but you pay a copay of $600/day for up to 5 days per admission. In my example there's a $1500 deductible, then $150 copay per admission, and my example has lower cost drugs. The California plan is low-end gold (78% AV) and my example is high-end gold (82% AV).

One possible explanation is that the $1500 deductible that I entered in my example applies to medical care other than what's specifically listed in the user-enterable fields. Unclassified care.

The problem is that you're taking the answer from the tool at face value, and the tool's answer doesn't make sense at all. Using the $6,000 cost assumption, if the plan designs are different by 3% ARV (it's 79%), the differences need to be worth $180 a year. Between the California gold plan and the one you made, it looks like everyone will be saving more than that, which means the results are mathematically inconsistent. This is probably the tool's fault, since it gives really lovely answers in other circumstances.

Sorry I can't help with a better actuarial pricing tool, all the ones I know of are proprietary. In one that I have, your plan was an 91.3% and the California plan is 77.8%, and that difference actually makes mathematical sense. Try not to use the HHS tool too much, it doesn't really reflect reality.

Willa Rogers posted:

^^^ I think the penalty for not having insurance hews to that metric no matter what your income is, but yah, coverage is still unaffordable.

eta: Since employers have to pay their percentage based on employees' income, does that mean that everyone in different income brackets will be receiving different dollar-amount employer subsidies? :confused: I'll have to look this up.

The employer CAN give different dollar subsidies to different income people (as long as it's nondiscriminatory), but are not required to under PPACA.

How it works from that side is: the employee applies for a subsidy on the exchange, and if they get a subsidy then the government goes to the employer. The employer either appeals by showing that they are taking advantage of a safe harbor rule (shows that paycheck premiums were below 9.5% of W-2 wages, e.g.), or they pay $3,000 per employee receiving a subsidy.

esquilax fucked around with this message at 00:25 on May 26, 2013

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!

esquilax posted:

The problem is that you're taking the answer from the tool at face value, and the tool's answer doesn't make sense at all. Using the $6,000 cost assumption, if the plan designs are different by 3% ARV (it's 79%), the differences need to be worth $180 a year. Between the California gold plan and the one you made, it looks like everyone will be saving more than that, which means the results are mathematically inconsistent. This is probably the tool's fault, since it gives really lovely answers in other circumstances.

Sorry I can't help with a better actuarial pricing tool, all the ones I know of are proprietary. In one that I have, your plan was an 91.3% and the California plan is 77.8%, and that difference actually makes mathematical sense. Try not to use the HHS tool too much, it doesn't really reflect reality.

Maybe the problem is having a deductible that only applies to a few unclassified things, plus hospital and nursing. Is this actually close to 82.0% AV? No deductible there.

esquilax
Jan 3, 2003

Dr. Gaius Baltar posted:

Maybe the problem is having a deductible that only applies to a few unclassified things, plus hospital and nursing. Is this actually close to 82.0% AV? No deductible there.

No, it's a bit lower than your other one but it's certainly not de minimis from the California gold plan. I'm not sure why you're trying to design an 82% plan, but you're not going to get any value out of just playing around with the HHS tool until the numbers line up. Further, I'd expect the plans on the exchange to be closer to the bottom end of the de minimis range because plan premium will be at the forefront of every shopper's mind, and an extra $50 per month for a different plan still labeled "Gold" will probably get passed over.

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!

esquilax posted:

No, it's a bit lower than your other one but it's certainly not de minimis from the California gold plan. I'm not sure why you're trying to design an 82% plan, but you're not going to get any value out of just playing around with the HHS tool until the numbers line up. Further, I'd expect the plans on the exchange to be closer to the bottom end of the de minimis range because plan premium will be at the forefront of every shopper's mind, and an extra $50 per month for a different plan still labeled "Gold" will probably get passed over.

drat, oh well. I was trying to design an 82% AV plan because I wanted to see what the perfect gold plan would look like. I do a lot of thinking about the costs of single-payer, with and without cost-sharing.

esquilax
Jan 3, 2003

Dr. Gaius Baltar posted:

drat, oh well. I was trying to design an 82% AV plan because I wanted to see what the perfect gold plan would look like. I do a lot of thinking about the costs of single-payer, with and without cost-sharing.

You're thinking about it the wrong way, there is no such thing as a 'perfect' gold plan. Between two gold plans, there will be people who win in Plan A and people who win in Plan B, but if you aggregate the wins and losses it should always come out close to zero. If you find one gold plan that is a lot better than another gold plan then something is wrong.

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!

esquilax posted:

You're thinking about it the wrong way, there is no such thing as a 'perfect' gold plan. Between two gold plans, there will be people who win in Plan A and people who win in Plan B, but if you aggregate the wins and losses it should always come out close to zero. If you find one gold plan that is a lot better than another gold plan then something is wrong.

"Perfect" in that the greatest number of people get routine care for ailments before they become dangerous and costly, due to lower cost-sharing. The gold plan that would result in the lowest possible health care cost growth.

Party Plane Jones
Jul 1, 2007

by Reene
Fun Shoe

Sarion posted:

This is hilariously awesome. I can't stand Brewer but I can get behind this. Any idea what the motivation for this is? Why is she so vehemently supportive of the expansion when most other Republican Governors are opposed or lukewarm in their support?

From what I recall Arizona was the state that took people off the transplant list when they cut Medicaid, which ended up killing several people. Having the feds pay for Medicaid would be a big boost. Ironically Brewer was one of those people who pushed the cuts in the first place.

Ardennes
May 12, 2002
Yeah one of the very many issues with the PPACA is that there is significant cut off between 400% over the poverty line and 401%. Someone making $46000 dollars a dear would get $1,000 in subsidies for $5,370 dollar silver plan (still pretty pathetic all things considered), while even that subsidy evaporates when you hit that line.

Really, the PPACA helps with some affordability if you are at low brackets (either through medicaid expansion or more significant subsidies) but for the most part leaves a pretty giant hole in affordable coverage. Obviously this could be easily fixed, but it obviously isn't.

Sancho
Jul 18, 2003

These numbers are sort of depressing. I guess if I'm middle class, the most cost effective way to go is pay the penalty for no coverage, save cash and go to Mexico/Thailand for major surgery! USA!

Sarion
Dec 24, 2003

Ardennes posted:

Yeah one of the very many issues with the PPACA is that there is significant cut off between 400% over the poverty line and 401%. Someone making $46000 dollars a dear would get $1,000 in subsidies for $5,370 dollar silver plan (still pretty pathetic all things considered), while even that subsidy evaporates when you hit that line.

Really, the PPACA helps with some affordability if you are at low brackets (either through medicaid expansion or more significant subsidies) but for the most part leaves a pretty giant hole in affordable coverage. Obviously this could be easily fixed, but it obviously isn't.

Yeah, it really fucks older people the hardest though, people who are at an age where they're starting to need a lot of care but are too young for Medicare. Someone in their late 50's or early 60's is looking at a Silver plan that costs ~$12,000 with an ~$8,000 subsidy. Let's say this year they get their subsidy, but they end up making $20 too much in December. Now when their tax returns come around they have to pay back that $8,000 subsidy because they earned $20 too much. AND they lose their subsidy for the following year, even though that year they may end up making less money which means they should have qualified.

The system works!

Double Punctuation
Dec 30, 2009

Ships were made for sinking;
Whiskey made for drinking;
If we were made of cellophane
We'd all get stinking drunk much faster!
Wait, I'm confused. Where does the law say you're totally barred from using the exchanges, even if you make under the FPL and aren't eligible for the subsidy? Also, are plans that aren't on the exchange free to deny coverage based on pre-existing conditions and such?

Konstantin
Jun 20, 2005
And the Lord said, "Look, they are one people, and they have all one language; and this is only the beginning of what they will do; nothing that they propose to do will now be impossible for them.

dpbjinc posted:

Wait, I'm confused. Where does the law say you're totally barred from using the exchanges, even if you make under the FPL and aren't eligible for the subsidy? Also, are plans that aren't on the exchange free to deny coverage based on pre-existing conditions and such?

If you're under the FPL you obviously can't afford using the exchanges without a subsidy, unless you can somehow spend the majority of your income on health insurance. The way the law was written you would be covered by the Medicaid expansion, but the Supreme Court screwed that up by making it optional. Plans that aren't on the exchange do have to cover pre-existing conditions though.

Double Punctuation
Dec 30, 2009

Ships were made for sinking;
Whiskey made for drinking;
If we were made of cellophane
We'd all get stinking drunk much faster!

Konstantin posted:

If you're under the FPL you obviously can't afford using the exchanges without a subsidy, unless you can somehow spend the majority of your income on health insurance. The way the law was written you would be covered by the Medicaid expansion, but the Supreme Court screwed that up by making it optional. Plans that aren't on the exchange do have to cover pre-existing conditions though.

I'm in kind of a weird situation. I'm between 21 and 26, and I'm going to be in college the latter half of this year. I'm living with my parents. The household makes just over the FPL combined, but my father is a smoker, so we'd have to pay higher rates if we got a family plan.

Right now, I'm paying $145 a month for the temporary high-risk pool plan that expires at the end of the year. Are there any predictions out on how that would compare with rates on the private market after the new rules go into effect, or is it all just baseless speculation at this point?

Konstantin
Jun 20, 2005
And the Lord said, "Look, they are one people, and they have all one language; and this is only the beginning of what they will do; nothing that they propose to do will now be impossible for them.
What state do you live in? The Medicaid expansion covers families up to 133% of FPL, so you would be covered under that if your state opted in. If it isn't in a covered state, if nobody in your family will have employer sponsored coverage you can get insurance from the exchange, with a premium cap of 2% of household income.

Ardennes
May 12, 2002

Sarion posted:

Yeah, it really fucks older people the hardest though, people who are at an age where they're starting to need a lot of care but are too young for Medicare. Someone in their late 50's or early 60's is looking at a Silver plan that costs ~$12,000 with an ~$8,000 subsidy. Let's say this year they get their subsidy, but they end up making $20 too much in December. Now when their tax returns come around they have to pay back that $8,000 subsidy because they earned $20 too much. AND they lose their subsidy for the following year, even though that year they may end up making less money which means they should have qualified.

The system works!

Yep, they pretty much get screwed and 46k a year isn't exactly a princely sum all things considered. It would be so easy to fix by allow Medicare buy-ins with subsidy portability but our government is just way too broken for it to ever happen. The PPACA does very clearly leave members of the population completely out in the cold.

The PPACA has elements and pieces that could be a good thing but at this point is so fragmentary and uses its resources in such a inefficient manner that it is a complete mess. The real unfortunate part is that it may be quite a while before there is a congress and a president willing to fix it.

evilweasel
Aug 24, 2002

Sarion posted:

This is hilariously awesome. I can't stand Brewer but I can get behind this. Any idea what the motivation for this is? Why is she so vehemently supportive of the expansion when most other Republican Governors are opposed or lukewarm in their support?



edit: Also, Kaiser has significantly improved their subsidy calculator, so if you haven't checked it out recently its worth a look.

I have no idea, but I guess even horrible people can do a right thing once in a while.

Double Punctuation
Dec 30, 2009

Ships were made for sinking;
Whiskey made for drinking;
If we were made of cellophane
We'd all get stinking drunk much faster!

Konstantin posted:

What state do you live in? The Medicaid expansion covers families up to 133% of FPL, so you would be covered under that if your state opted in. If it isn't in a covered state, if nobody in your family will have employer sponsored coverage you can get insurance from the exchange, with a premium cap of 2% of household income.

I'm in Oklahoma. Go figure.

According to the Kaiser subsidy calculator, the tobacco surcharge isn't subsidized and can be up to 50% of the premiums, but it averages 20% nowadays. If the plan rates are 20%, that wouldn't be much more than what I'm paying now, but at 50%, that would be a massive price increase, and we wouldn't be able to afford anything near that amount. (To be fair, it would still be far cheaper than if all three of us were insured now.)

Edit: Does the tobacco surcharge apply to electronic cigarettes? I don't think I could get my father to stop smoking, but if I got him to switch, would those still count as tobacco use?

Double Punctuation fucked around with this message at 18:05 on May 26, 2013

Sarion
Dec 24, 2003

Konstantin posted:

What state do you live in? The Medicaid expansion covers families up to 133% of FPL, so you would be covered under that if your state opted in. If it isn't in a covered state, if nobody in your family will have employer sponsored coverage you can get insurance from the exchange, with a premium cap of 2% of household income.

This isn't entirely true. The 2% premium cap is expressly applied to people/families who make over 100% FPL. From what I read, it sounds like dpbjinc's household makes less than 100% FPL for a household their size. This means their only choices are to get insurance at full price (plus the smoker penalty) or Medicaid. And since it's Oklahoma, the odds are poor on the Medicaid front :(


There's two glaring gaps of coverage in PPACA, one for the very poor (in anti-Medicaid States) and one for the "slightly too middle class" at the other end of the spectrum.

Sarion
Dec 24, 2003

dpbjinc posted:

Edit: Does the tobacco surcharge apply to electronic cigarettes? I don't think I could get my father to stop smoking, but if I got him to switch, would those still count as tobacco use?

I've never seen them mentioned anywhere, I think it's always just "tobacco use". But the FDA has issued health risk warnings for e-cigarettes so it seems kind of iffy at best.

Double Punctuation
Dec 30, 2009

Ships were made for sinking;
Whiskey made for drinking;
If we were made of cellophane
We'd all get stinking drunk much faster!

Sarion posted:

From what I read, it sounds like dpbjinc's household makes less than 100% FPL for a household their size.

No, we make over 100% FPL. However, none of us make over 100% FPL individually. Therefore, we'd have to sign up for a family plan and pay the tobacco surcharge or pay full price for individual plans. My father's a few years away from being elligible for Medicare, and his health isn't too bad despite being a smoker, so he doesn't want to pay for insurance for himself. It's looking like I'll just have to work with him to get him to stop smoking for us to afford the coverage anyway.

Willa Rogers
Mar 11, 2005

dpbjinc posted:

No, we make over 100% FPL. However, none of us make over 100% FPL individually. Therefore, we'd have to sign up for a family plan and pay the tobacco surcharge or pay full price for individual plans. My father's a few years away from being elligible for Medicare, and his health isn't too bad despite being a smoker, so he doesn't want to pay for insurance for himself. It's looking like I'll just have to work with him to get him to stop smoking for us to afford the coverage anyway.

Yah, it's a perfect example of the "household penalty" that was discussed upthread.

As far as I know, ecigs don't qualify as tobacco use, because they don't contain tobacco, only nicotine; it'd be like penalizing people who wear the patch or chew nicotine gum. And ecigs seem particularly efficaceous in getting longtime smokers to quit tobacco, so it's worth a shot with your dad. Maybe get him a variety of disposable ecigs to try out, to show him the range of options when it comes to delivery and taste.

The PPACA applications I've seen to date for exchange enrollment only ask about current tobacco usage, so if he can quit before the fall enrollment, you all should be able to avoid the tobacco penalty. Also, some states have legislated against smokers' penalties when it comes to insurance, and I believe that those laws override PPACA's tobacco penalty, so check your state laws on this.

Dr. Gaius Baltar
Mar 12, 2008

I've been framed!
Does anyone know how to read this Blue Cross Blue Shield rate filing in Maryland? Go to page 2. What does "Average Current Rate PMPM" mean? If a plan is listed as $241.68, does that mean that the premium of someone who enrolls in that plan, who is of average age, will be $241.68?

Willa Rogers
Mar 11, 2005

Dr. Gaius Baltar posted:

Does anyone know how to read this Blue Cross Blue Shield rate filing in Maryland? Go to page 2. What does "Average Current Rate PMPM" mean? If a plan is listed as $241.68, does that mean that the premium of someone who enrolls in that plan, who is of average age, will be $241.68?

I got the impression it's the base premium used for calculating the MLR:

quote:

AV Pricing Values

Unlike metal AV where a bronze AV is calculated based on a different denominator than a platinum AV, when setting rates it is required that we use a fixed reference plan so that the denominator in all AVs is the same. To develop these pricing AVs, we developed an internal model based on MSGR claims data broken down by service category, and a continuance table of claims to estimate the impact of benefit richness. MSGR claims data is used as it is believed that the Individual pool will evolve into the MSGR market in regards to the ultimate risk profile. In addition to the pure cost differences (the % of claims that CareFirst pays given a fixed total amount), the cost-sharing design of the plan influences the total amount, independent of health status. A population of members of a fixed health status will have about 16% more total claims for a platinum plan than a bronze plan, because more discretionary services are used without cost-share barriers than with a large deductible. This 16% estimate comes from the federal AV calculator for metal levels.

The fixed reference plan for the pricing AV is the $0 deductible platinum plan, which is defined as a 100% pricing AV. The primary component is the actuarial value and cost-sharing design of the plan. Network has no contribution (all plans have same network in this filing) and non-EHB and administrative costs have a minor contribution.

esquilax
Jan 3, 2003

Dr. Gaius Baltar posted:

Does anyone know how to read this Blue Cross Blue Shield rate filing in Maryland? Go to page 2. What does "Average Current Rate PMPM" mean? If a plan is listed as $241.68, does that mean that the premium of someone who enrolls in that plan, who is of average age, will be $241.68?
Yes, that's their projected average per member per month premium across every member (adults and children) for that plan. Without more information it tells you almost nothing about the premiums that actually will be available on the exchange except that they will be the same as 2013 premiums.


Willa Rogers posted:

I got the impression it's the base premium used for calculating the MLR:

It is, though they use the aggregate number (the $218.11) for that. Also your quote has nothing to do with the MLR.

TVs Ian
Jun 1, 2000

Such graceful, delicate creatures.
If somebody's job offers insurance, but it's extremely expensive, would they be eligible for possible subsidies or skipping it entirely and buying something off the exchange? My wife and I are currently uninsured, and it looks like this is the situation we'll be in when she's eligible for insurance through her job in a couple of months. I know this stuff won't kick in until next year, but I'm just trying to plan and I can't really tell what applies to work-provided insurance.

DeceasedHorse
Nov 11, 2005
How bad are we talking about? Keep in mind that the employer will need to comply with the affordability requirement going forward (or drop their insurance entirely and pay the penalty, but you'd definitely qualify for the exchanges anyway in this scenario). Anyway, subdidies are available if the plan costs, for one member, greater than 9.5 of the employees income.. If your spouses employer provides lower contributions for spouses, which is fairly common already and will probably become more common, you might end up in a hard spot.

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Chokes McGee
Aug 7, 2008

This is Urotsuki.
Fairly typical scenario, my wife is unemployed and on my work insurance. Two people on my work plan is ridiculously more expensive than one. Two questions:


1) Does she qualify for the exchanges since she's unemployed?

2) If so, is it going to be cheaper for her to go solo instead of using my work insurance? I realize the answer is probably "it depends," so I guess I'm looking for a feeler of how much the work insurance pool will mitigate costs versus just going out and getting something from the exchange. From what I've seen so far, the premiums are terrible for more than one person. Like, more than if two people at work were on the same plan, which I don't understand at all.

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