Quick question for DU millennials re. the ACA

[RandySF]

How do we get more healthy young people to enroll? As much as I prefer a single-payer system, the ACA is probably the only game in town for a while. How can we get more of you to sign up and make it stronger for everyone?

[still_one]

1. Single payer won't work without a mandate

Last edited Sat Mar 25, 2017, 12:53 AM - Edit history (1)

[progree]

2. Interesting - basic Medicare is called single-payer and it has a mandate

Last edited Sat Mar 25, 2017, 12:59 AM - Edit history (2)

Part A is premium-free for all who have worked for 40 quarters, but Part B is not. People who don't sign up for Part B during their initial enrollment period get fined. Heavily, and for life.

https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html

Part D (prescription drug coverage) also has a heavy late enrollment penalty, but then it isn't single payer since it is sold only by private insurance companies.

Medicare Supplement, aka Medigap (really necessary for an older person, unless they get Medicare Advantage) also has a stiff late enrollment penalty. But at least from what I've seen, all Medicare Supplement plans are sold by private insurers, none by the government. (Ditto Medicare Advantage).

I haven't shopped for Medicare Advantage, but I know they require Part B coverage -- so MA customers are hit by the Part B late enrollment life-long fine if they sign up for Part B late.

Some people don't consider a financial penalty as a "mandate", but that's (a) bullshit, and (b) what the just-failed Republican plan had, and (c) what the ACA (Obamacare) has. There's no "mandate" in the ACA to have insurance other than to pay the penalty, but that's mandate enough for me.

[still_one]

4. I meant won't work WITHOUT a mandate. sorry, I will correct now. Thanks

[progree]

6. Whew. Thanks. :-)

[still_one]

7. .......................................................

[MichMan]

3. Raise the fines high enough that people will decide to participate

One major premise of the ACA was that everyone would buy in thus spreading the risk. This would ensure everyone had coverage and avoid people going to the ER for routine care. This was intended to ensure that a lot of healthy young people would be buying insurance that had not had it previously.

Instead a certain number of people have decided to pay the fine and go without since it is cheaper than buying insurance. Since the only enforcement method is losing your tax refund, it isn't that hard to make sure you aren't going to have much of one by altering your withholding. Of course, now if they need care, they still go to the ER same as before.

That has created the problem that without an influx of young healthy people enrolled in the exchanges, they have had to raise the premiums higher and higher for those that did enroll.

[butdiduvote]

5. Idk, I'm a millennial but not a very healthy one.

I enrolled because I've been in the position of not being able to afford healthcare, and it made me feel worthless, and I didn't want to wind up there again (unfortunately I'm somewhat there again because this year's marketplace plan doesn't provide very good mental health coverage, but anyway).

I think showing them how affordable it really is might help. The first year of my marketplace coverage, I paid $8 a month. Now I pay $26 a month. But of course, those who are making a lot of money will be expected to pay a lot more.

[Jamaal510]

8. I already have

health care, but as for others, I'm not sure what the Democrats can do to convince them. It's tricky because the Democratic Party can't force people to pay attention and do research on why health care is a necessity. People who are smart will get enrolled (if they haven't already) while others will have to learn the hard way.

[fescuerescue]

9. Make it equivalant to tax evasion.

Which it essentially is.

Add in a few high profile cases of celebrity evaders followed by jail sentence of those celebrity offenders.

It's a formula the works.

[white_wolf]

11. How is it evasion if they are paying the fine? n/t

[fescuerescue]

12. Well that's the change part.

Perhaps eliminate the fine as an alternative, or boost it to equal the cost of insurance.

[white_wolf]

10. Increase the subsidy range?

I do freelance contract work and my income varies from month to month. I started a long-term contract job in June of last year and was making decent money. That year, I made a bit over 30,000. So when I went to sign up for the ACA and calculated my income, I obviously did not qualify for subsidies. Were I still making that 4,000 to 5,000 a month, I'd be fine with paying $350-400 for health insurance. Unfortunately, the past few months have been really slow for me and this month I'll be lucky to cover my rent. I have significant savings and, but my job makes my monthly income uncertain. I just moved to a new state so I'm going to check on healthcare here and I'm aware that I'm in a better position than a lot of people. It's just that the nature of my line of work is really unstable and, honestly, I hope to move on to something full time.

That being said, I do think the subsidies have too low of a drop-off rate. Isn't it like 40,000 a year or something? That still isn't a whole lot of money and I think we can do better. I'd also like to see it tied to your location. NYC or San Francisco are much more expensive than rural areas.

Honestly, the repeal of the mandate probably would have benefited me, but I'm glad it didn't' happen. Too many people would have been hurt. I don't necessarily agree with the mandate on philosophical grounds, but right now the ACA is the best we can do. I really do hope we can add a public option one day. I think that would create real competition and provide more options for consumers. Plus, if younger people like me pay into Medicare or Medicaid and don't use it as much then it might actually provide more money for those who do use it.

[crazycatlady]

13. make it more affordable

Even with subsidies, you're looking at $400/month premiums.

The subsidies are paid in a lump sum, not per month.

[Trekologer]

14. You can bring a horse to water, but you can't force it to drink

Some people are always going to think that they don't need health insurance. How many renters don't have renter's insurance. In states that don't require auto insurance, how many go without? You can argue affordability in each of those cases but in each case an uncovered incident would ruin most people.

The best we can do it make it as affordable as possible and make it mandatory. So, how do we make it more affordable?

First, the situation were states didn't expand Medicaid needs to be addressed. There's an opportunity to use that as an issue to take back governorships. Failing that, perhaps extend the subsidies to below the level where they currently start?

Second, negotiate prescription drug prices. Most private insurance plans follow Medicare's reimbursement schedule so if Medicare drives down the costs of drug prices, we should see them go down across the board. This is something that has fairly broad support.

Third, insurance plans aren't competing against each other on prices right now, they're competing against the medical loss ration (currently 80%). We need to put an option into the market that isn't striving for that 20% cut off the top--a public option. One of the Republican talking points recently has been that 1/3 of counties have only 1 plan on the exchange. In those counties, put a Medicare buy-in as an option.

Forth, for individuals who purchase insurance on the exchange, and don't qualify for the current need-based credit, give them the age-based tax credit that the Trumpcare bill would have. This will make it more affordable at the top end.

[taught_me_patience]

15. Move to a 4-1 cost ratio to get costs down a bit

and offer cheaper HSA style plans with a tax credit going to the HSA account that you can keep.

If that doesn't work, then increase the penalties.

[BarackTheVote]

16. First, you can't squeeze blood from a stone

A lot of millennials are eking out a meager existence in the retail or service industries, or working other relatively low-wage jobs (I know a lot who work in warehouses, or who are substitute teachers). Piling onto their student loan debt with higher penalties for not having health insurance won't get you anywhere, and will further stagnate their future earning potential. Catch your flies with honey, find something better than a stick to get people to enroll.

Second, make enrollment automatic at 26, something you have to opt out of. Obviously, they should be enrolled into a lower/cheaper tier, and have to buy into a higher tier at their own desecration. This should be something under $40 a month, with government subsidies/tax refunds making up any difference. Also, make savings instant, fix the market. A lot of people can't afford to wait for a tax refund.

Basically, make it as easy as possible with as few hoops to jump through as possible. We have a bad streak of trying to force citizens to do things through punitive measures. If the actual intent is to help people, then help them.