Report on Obamacare in a State that's Resisting It

[snot]

Last edited Sun Dec 1, 2013, 02:55 AM - Edit history (1)

I live in one of those states and would just like to share my experience during the last few days.

My state did not adopt the Medicaid Expansion or set up an exchange, so we had to use healthcare.gov. Because of the much-advertised problems the website was experiencing, my spouse and I didn't even try it until this last Wed.

We'd also heard that a local hospital was helping people sign up, so we went there first.

We went early and spent the better part of the day on a computer there. They had people to help us get through it and answer questions, and they were very helpful to us. The website worked fine except, as they advised us, it tended to stop working 11:45 - 1pm Eastern time, when it got overloaded -- that did happen. We spent the better part of the day there but got fully registered, learned we're eligible for a subsidy and what Obamacare plans were available to us, and got on the phone with the company one of us is covered with to get some info for comparison.

I spent most of the day today digging further into the details of the coinsurance %'s, deductibles, maximum out-of-pockets, copays, premiums, doctors in-network, etc. of the Obamacare and non-Obamacare offerings from the company we think we like best. An insurance agent I'd contacted previously had sent some info about the non-Obamacare offerings but nothing about the Obamacare offerings; and I assume he has no incentive to sell the latter.

Until this last year, we'd had insurance through an employer, but for various reasons, that was going away. So we weren't super-familiar with the insurance terminology and how the various coverages and limitations work together, and I had to spend some time just figuring all that out; and I'm still trying to confirm some of the details.

But if I'm understanding things correctly, it looks like Obamacare is going to save us a couple of thousand and give us better coverage than we could get otherwise.

One thing that emerged from my efforts to analyze the offerings, including the non-Obamacare offerings, is that it seems pretty clear that the insurance company has fine-tuned things so that, although they're offering lots of policies, they'll all most likely come to the same economic result for the company.

The only really meaningful variable is, how good is the customer at guessing what their likely expenses will be? If you guess wrong, either way, the company wins -- either you pay a little too much in premiums, or you pay a lot too much for medical expenses. Either way, there's virtually no risk to the company; they are well-equipped to assess the risks, and their profits are protected by the averaging of the pool. If you guess right, good for you; you'll have paid no more than necessary to assure the company a minimum profit. But you are not well-equipped to assess the risks, and if your guess is wrong in the smallest degree, you lose.

And realistically, a majority of the population probably are not well-equipped to guess which option might be best for them, because this stuff is just goddawfully complicated, so if you're not super-smart or -educated, or you don't have several days to devote to figuring it all out, it's going to be even more of a crap shoot.

And let's not even talk about the economic and intangible losses incurred by our society as a result of requiring so many billions of man-hours to be devoted to dealing with all this, on the part not only of customers but also doctors, hospitals, insurance company administrators, et al. Hours that could be spent actually producing some kind of material benefit to someone, or helping kids with homework, or something, anything other than pushing paper around and making our brains hurt.

So, as so many others here have already observed, we need single-payer.

[babylonsister]

1. Sigh. So it basically sucks, but you'll be

saving money?

I wish my state wasn't so republican, but will take what I can get.

Obamacare will be a godsend to me, and I won't have to figure anything out. I will most likely go with the cheapest plan. I will try to document when I sign up in GA; should be fun.

[snot]

2. Sucks compared to what? Compared to single payer,

yeah, it sucks. Compared to private insurance or none, it's great.

I'm just trying to share the facts as I've found them.

[Fridays Child]

3. Thank you for sharing your experience

I'm glad that it looks like you'll be saving money.

But, instead of calling it the ACA, we should call it the HICWA--Health Insurance Company Welfare Act. This is a bottomless goldmine for them.

You are absolutely right. We need single-payer health care. Period.

http://www.pnhp.org/publications/united-states-national-health-care-act-hr-676

By the way, why did Alan Grayson (one of the most outstanding members of the House) withdraw his co-sponsorship of HR 676, in favor of his own version that includes premiums as high as $500 a month for people over 60?

[snot]

4. Don't know.

But I will say that pre- ACA, I was looking at private insurance premiums of nearly $800 for a single, under-60 person, if insurance could be gotten at all.

I'm no apologist for anyone with any responsibility for this mess. Just saying, my household is experiencing a noticeable improvement, and it's still not what it should be.

One possible plus from all of this is that a lot of people may, like me, be pushed into becoming better-informed about how insurance in the U.S. works, which may help pave the way for further reform.