Insurance and the Election

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aypues

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Now that we know what we are getting in the White House, I am worried. I always had insurance even before Obamacare, and just continued buying it because with Crohn's there really is no choice, no matter how expensive it is. My concern is that Trump has said Obamacare will be repealed and replaced. With what?!? This is anxiety producing. Do I need to get a desk job with employer paid health care? I like my work/life balance now and I don't feel too stressed out, which as anyone with Crohn's knows is optimal. As a self employed person I don't have to go into work everyday like most other people. Sure I pay a lot in insurance, but I just grin and bear it as the true cost of my treatments is outrageous and completely unaffordable. I hope Trump can get us some sort of universal health care (as he previously supported) that everyone can get behind, even Republicans. If we go back to the days of pre-existing conditions, and this and that, it may be disastrous for us.
 
The key thing is as you note is Obamacare replace it "with what?" If the replacement a comprehensive program that addresses real needs things might work out okay. If it's just go back to letting the insurance companies call all the shots then we might be in for a pretty rough ride. Let your congressman and senators know your concerns
 
I'm terrified of this too. If they bring back the previous things like lifetime caps on coverage and not covering pre-existing conditions, I think a whole lot of people are going to be absolutely screwed.
 
I'm in the UK and I was talking to my consultant last week about how lucky we are here. We wait longer for appointments and perhaps have more hoops to jump through but emergencies are dealt with immediately and it's all free at the point of use.

My thoughts and love are with you all, I can't imagine what this must be like. You guys with your population desperately need an NHS.
 
Yes, anxiety inducing. We won't know until they decide something.
I agree with Scipio, write to you local reps and even to the new president. I think handwritten notes expressing concern are the only input we can give....
 
I didn't watch the election coverage that much over the last year. From what I took there was the typical politician talk of more health care services, more "life saving" drugs to be approved, then calls to repeal Obamacare. In some respects I thought the mentions contradicted themselves.

Already about 18% of our nations GDP goes toward health care costs. Other western countries pay half, around 7 to 8% of GDP, and typically experience better health outcomes.

With 2017, the ACA was no longer to cover insurance and hospital losses for treatments. As a result I saw some hospitals were saying they would no longer take patients that had ACA exchange insurance. Instead those patients, if he/she wished to make an appointment would need to buy insurance outside the exchanges and pay the government penalty.

The typical medical mess overall I though.

This past weekend, after being told earlier my insurance company was dropping me again, and I would need to find new insurance with much higher costs, I opted to go the Christian Health Sharing route.

It isn't insurance. It works similar. Having it does exempt me from the government penalty. I can see and go to what ever hospital I wish. I could not be turned down due to pre-existing conditions. The main requirement was that I needed to live a Christian life, including avoiding recreational drug, avoid tobacco, limited alcohol intake, etc. Costs are reasonable too. On the negative, it can be more work for me.

I've read good reviews with the Christian sharing plans. I'll be finding out if they are true going forward.
 
Beach said:
Already about 18% of our nations GDP goes toward health care costs. Other western countries pay half, around 7 to 8% of GDP, and typically experience better health outcomes.
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I found out that Humira costs the NHS (UK) £352 per dose; that's about $850 per month. I've seen here and can find elsewhere that it costs more like $4000 in the US. It shows how much profiteering and middle men are involved in healthcare.
 
DEmberton said:
I found out that Humira costs the NHS (UK) £352 per dose; that's about $850 per month. I've seen here and can find elsewhere that it costs more like $4000 in the US. It shows how much profiteering and middle men are involved in healthcare.
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Wow that's ridiculous! We are very lucky here, although Virgin are picking up NHS contracts now and privatisation is starting to happen.

Me and my type 1 diabetic friend are incredibly fearful of having a system like the USA :-/
 
DEmberton said:
I found out that Humira costs the NHS (UK) £352 per dose; that's about $850 per month. I've seen here and can find elsewhere that it costs more like $4000 in the US. It shows how much profiteering and middle men are involved in healthcare.
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Interesting. I'm not surprised.

Not long ago we had a disturbing or humorous, it depends on how one looks at it, situation with buying prescription drugs out of Canada. If you lived near the Canadian border, for awhile many Americans would cross the border to buy their prescriptions out of Canada. Prices were significantly cheaper there. Americans would even go on drug buying holidays into Canada. There were bus tours put together for making medical visits to our neighbor to the north.

When this was learned, the government and drug companies worked to put a stop to the practice of Americans buying prescription drugs in Canada. The excuse given was that the Canadian drugs are unsafe.

The bizarre part is that often the prescription drugs were made in America. Shipping the made in America drugs over the border into Canada and then return the drugs to Americans buyers was causing the medication to become unsafe. That is/was the official stance of our government.

We have a great many problems with our medical system in America. I'm not a fan of what we have. The problem is that most Americans are proud of our medical system. It is viewed as having perceived value.

One positive way to look at our health care system in America is that it creates many good paying jobs. In many ways it could be thought of as a make work program. I'm sure that is how some politicians view it to some degree.

It would not be difficult to reform our American medical system to be less expensive, and to have good health outcomes compared to other western countries. We could cut costs in half I imagine without to much effort. To do so though will cause a reforming of our economy. Not to mention howls from the political opposition of job losses and people not being cared for medically. Rationing is the word often mentioned

I see the stock market is rallying again today. It is said to be an election rally. I believe the main stocks going up in value are in the health care sector.
 
BTW it costs me £8.20 every 4 weeks for Azathioprine which it turns out is a little more than it costs, so they actually make a profit.

By all accounts the US healthcare is very good for the people that it does treat, whereas we offer equally bad treatment to everyone. I have family in France and theirs is far superior, but then they have a system where you pay a small fee but crucially serious or chronic conditions are covered so you don't end up being bankrupted by being ill.

OTOH UK healthcare is so hung up on the principle of being free it ends up not working well for anyone, but the NHS is such a political hot-potato nothing ever happens to improve anything. I think both the UK and US should have a good long look at what happens in France and Germany because they do seem to have struck a much better balance.
 
DEmberton said:
BTW it costs me £8.20 every 4 weeks for Azathioprine which it turns out is a little more than it costs, so they actually make a profit.



By all accounts the US healthcare is very good for the people that it does treat, whereas we offer equally bad treatment to everyone. I have family in France and theirs is far superior, but then they have a system where you pay a small fee but crucially serious or chronic conditions are covered so you don't end up being bankrupted by being ill.



OTOH UK healthcare is so hung up on the principle of being free it ends up not working well for anyone, but the NHS is such a political hot-potato nothing ever happens to improve anything. I think both the UK and US should have a good long look at what happens in France and Germany because they do seem to have struck a much better balance.
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I think the problem is that so many people in the UK, often the ones who are chronically ill are living on the breadline. Another benefit cap has just come in, bedroom tax etc. Even just a tenner to see a GP could be too much.

There was a time in my life when I was a student and I couldn't afford all my prescriptions so I was trying to stretch my inhalers as far as I could and I just ended up with chest infections. If it hits those on a lowest income the hardest (which it will), their condition would potentially end up going unchecked, becoming serious and requiring more serious measures such as hospitalisation to control. That's just a lot more expense.

I don't know enough about France/Germany's health or benefit system to comment further but I do fear losing the NHS would make life incredibly difficult for a lot of people here, myself included.
 
These days I have a pre-payment certificate at £10.40 per month for as many prescriptions as required so that makes a huge difference. It's just a shame I didn't know about it then!
 
Humira is insanely expensive here, but there's a savings program through the manufacturer. I believe it ends up being $5 per injection if you qualify for the savings program. So that's obviously much better than $4000!

It's like that for a lot of meds. I'm on Lialda, which would be about $500 per month before insurance. After insurance it's $75 per month, and I also have a savings card through the manufacturer, so in the end I pay $10 per month. There's no way I could afford it at $500 per month. So yes, it sounds scary at first but once you get discounts and savings then it's not bad.
 
My health insurance here in the U.S. is actually quite good. The insurance pays all but a small co-pay (after my deductible) and like CAT said, Humira ends up costing me $5.00/month, with the co-pay assistance program. All the expensive meds like Humira have their own co-pay assistance programs. With this, the prescription expenses are not bad at all.
 
So how does it work there guys? My understanding is that some jobs provide health insurance but if not you have to take it out yourself, is that right? If it's through your job do they still cover pre-existing conditions and does the employer actually pay or is some of this taken from your wage?

Are the prescription costs on top of insurance premiums or included? Does it depend on the insurance? Just trying to get a feel for how this all works :)
 
For example here in the UK obviously we have the NHS, but you can still buy private health insurance. However the doctors you see privately are most of the time working for the NHS too so they're not 'better' if you see what I mean.

You wait a lot less time for appointments, but some companies offer something as little as £1000 outpatient cover which is pretty much one consultation and a full set of blood work. As you all know that's nowhere near enough to diagnose IBD. Furthermore if I bought private health insurance now it wouldn't cover anything pre-existing.
 
Many employers do offer insurance, especially larger companies. Small companies, I think if they have less than 25 (?) employees, then they aren't required to provide insurance. I do get insurance through my workplace as I work at a large company, but my husband is a chef in a restaurant so he is not offered insurance (he gets coverage through my plan through my workplace, I'm allowed to add dependents to my plan such as my spouse). My workplace pays a big chunk of my health insurance premium and I pay a smaller amount, I end up paying something like $200 per paycheck which is automatically deducted.

For prescription costs, there is usually a co-pay associated. With my insurance, typically generic meds are $10 per month out of pocket for me and name-brand meds are more, so I always go with generics whenever possible. My Lialda is only available in name-brand, so that's why I have to get the savings card to bring the cost down on that. But other things, like pred, ranitidine, etc are all $10 per month with my insurance and birth control is free under the Affordable Care Act. Oh, and yes, it does vary from insurance to insurance and maybe even from pharmacy to pharmacy. It's a super confusing mess sometimes!

The ACA removed the pre-existing conditions clause, and I have no idea how that's going to work now that old what's his face (I refuse to say his name) says he's going to repeal the ACA. That's the part that scares me the most. We'll just have to wait and see how that plays out. For the time being pre-existing conditions still legally have to be covered by all insurers.
 
Cat-a-Tonic said:
Many employers do offer insurance, especially larger companies. Small companies, I think if they have less than 25 (?) employees, then they aren't required to provide insurance. I do get insurance through my workplace as I work at a large company, but my husband is a chef in a restaurant so he is not offered insurance (he gets coverage through my plan through my workplace, I'm allowed to add dependents to my plan such as my spouse). My workplace pays a big chunk of my health insurance premium and I pay a smaller amount, I end up paying something like $200 per paycheck which is automatically deducted.



For prescription costs, there is usually a co-pay associated. With my insurance, typically generic meds are $10 per month out of pocket for me and name-brand meds are more, so I always go with generics whenever possible. My Lialda is only available in name-brand, so that's why I have to get the savings card to bring the cost down on that. But other things, like pred, ranitidine, etc are all $10 per month with my insurance and birth control is free under the Affordable Care Act. Oh, and yes, it does vary from insurance to insurance and maybe even from pharmacy to pharmacy. It's a super confusing mess sometimes!



The ACA removed the pre-existing conditions clause, and I have no idea how that's going to work now that old what's his face (I refuse to say his name) says he's going to repeal the ACA. That's the part that scares me the most. We'll just have to wait and see how that plays out. For the time being pre-existing conditions still legally have to be covered by all insurers.
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Thank you so much that's really interesting! Although $200 a month still sounds really high to me sitting here in the uk! I was until a week ago I was working 2 jobs but I had to give the second one up because I was constantly flaring and they were basically going to get rid of me anyway for absences.

Even before that this would have made life very tough for me. It sounds like a scary time for you all, hopefully your leaders will take these concerns seriously. It doesn't pay to have so many people unable to work through sickness but not able to afford the meds to manage their conditions. I've heard that Obama is moving to protect planned parenthood which hopefully he can do. I've seen a lot on the internet about women rushing to get IUD's while they still can, which on day one doesn't create much confidence in 'he who must not be named.'
 
I work for the State of Utah, which in itself is a large employer. My insurance premiums are paid entirely by the State of Utah, which is a nice deal, but we do accept get lower pay because of that. My wife is also covered by my health plan and, because she is disabled, Medicare covers her co-pays and deductibles.

The ACA requires that pre-existing conditions be covered, and The ACA requires that preventative screenings, like colonoscopies, be covered at 100% - no cost to the paitent.

If you have insurance through your employer, which the majority of Americans do, then things are pretty good. Where the problem still comes (even after ACA) is with the cost of having to pick up insurance on your own. ACA requires Americans to get insured or pay a penalty. Some people (who must have good health!) think it is less expensive to pay the penalty than to be insured.

I think the thing to do is to amend the ACA and fix the things in it that are not good. Insurance premiums are rising through the roof. I thought the ACA was suppose to be Affordable!
 
Sophabulous, that's actually $200 a paycheck, not $200 per month - I get 2 paychecks per month so that's $400 per month. To be specific, I just pulled up one of my paychecks to be sure of the numbers - if you add up medical, vision, and dental, I'm paying $235 out of each paycheck myself for those benefits. My employer is paying $467 each paycheck for those benefits. So I'm paying about 1/3rd and my employer pays about 2/3rds of what my benefits cost every 2 weeks. So, yeah, it's pricey, but it'd be a lot more pricey if I had to pay for that all myself!
 
For me, I've been buying health insurance through the ACA exchanges. Insurance costs have kept rising.

Before the ACA I was paying around $100 a month. This past year I was paying over $500 a month with a high deductible of $6000 I believe. With my insurance company leaving the ACA exchanges at the end of the year, new insurance through the exchanges was going to run me about $600 a month.

As mentioned earlier too some hospitals have indicated that starting in 2017 they will no longer see patients that purchased insurance through Obamacare.

You can still buy private insurance. it is relatively inexpensive. I believe it would cost me around $100 a month still for private insurance. On top of private insurance costs, I would pay a penalty from the government.

I don't take any medications. It's not from a lack of trying. :) None of the medications given me in the past were helpful. Thankfully for my colitis diet changes have improved my situation.

I recently signed up for a Christian Health Sharing plan. It costs me ruffly $45 a month. No government penalty is incurred. The plan is somewhat similar to the $600 plan I can purchase through the exchanges.
 
The deductible and out of pocket max plus monthly premium are how we chose which package at work to take
Monthly premium is directly out of your paycheck and most include benefits package as part of the job offer so you know going in /consider it part of your salary
Ds has been on humira for 5 years
The copay assurance program through humira is not income based
They pay for almost all of it at the beginning the year we pay very little then Ds hits max out of pocket for prescription and all his prescriptions including humira are free for the rest of the year - so we actually pay very little at all a year
We just assume Ds will hit max out of pocket and switch over to 100% coverage and no copays . We add that to the premiums to figure out our yearly health costs for ds

Pre existing conditions or lifetime caps on insurance or coverage of kids to age 26 are my big concerns since the insurance we have covers everything we need
 
MLP, this is actually the first year (out of the 7 years that I've been ill) that I've met my out of pocket max! And that's only because I was hospitalized this year. For Sophabulous, if you're wondering how much it costs to be hospitalized in the US, the bill before insurance was over $27,000 for 5 days (after insurance, it was "only" $800!).

On a related note, I've been reading some scary things online saying that women should strongly consider getting an IUD before old what's his face takes office. They're not sure what old what's his face (or his even scarier VP) is going to do in terms of birth control, women's health, etc. I'm 37 and don't plan to ever have children so I just emailed my primary care doc to ask about getting an IUD. Hey, if I met my out of pocket max already anyway, it shouldn't cost me anything, so hopefully I'm just being prudent and not panicky. (Okay, I'm probably being both.)
 
Our insurance is a High Deductible Health Plan also. The deductible is $2,000 / person $4,000 / family. Our plan's fiscal year starts July 1st, and we usually have the deductible met by October. I had an option of staying on the traditional plan, but believe it or not moving to the high deductible plan is saving us about $6,000 - $8,000 a year over the traditional plan's co-pays, etc..
 
Cat a tonic
I would check with your gi as well about the iud
I know some have had minor gi things depending on material /hormones etc..

Ds has had imaging and scopes every year so not hard to max out
 
Beach said:
For me, I've been buying health insurance through the ACA exchanges. Insurance costs have kept rising.

Before the ACA I was paying around $100 a month. This past year I was paying over $500 a month with a high deductible of $6000 I believe. With my insurance company leaving the ACA exchanges at the end of the year, new insurance through the exchanges was going to run me about $600 a month.

As mentioned earlier too some hospitals have indicated that starting in 2017 they will no longer see patients that purchased insurance through Obamacare.

You can still buy private insurance. it is relatively inexpensive. I believe it would cost me around $100 a month still for private insurance. On top of private insurance costs, I would pay a penalty from the government.

I don't take any medications. It's not from a lack of trying. :) None of the medications given me in the past were helpful. Thankfully for my colitis diet changes have improved my situation.

I recently signed up for a Christian Health Sharing plan. It costs me ruffly $45 a month. No government penalty is incurred. The plan is somewhat similar to the $600 plan I can purchase through the exchanges.
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I am intrigued by the churchy health plan. I went to the website but it isnt laid out clearly, or i'm not on the right site. I asked for additional information. I too will be having to buy a $628/mo ACA plan next year unless I can find something else. It is a really good plan though - blue shield platinum, no deductible, 4k out of pocket max, etc. Curious what the religious plan will exclude besides sex reassignments and abortions, it isnt clear on their website. Will they exclude LGBT people too?
 
I had to quit working in 2014 & go on short term disability because I was so sick from Crohn 's.

I stayed on COBRA as long as I could afford to, which wasn't long at $700/month.

I had no insurance at all for a few months after my employer fired me, and I also had no income.

I would've been homeless if not for my sister letting me live with her.

When I was finally approved for Social Security disability, I got insurance through Affordable Care Act. I qualified for a subsidy & paid $94/month; $10-$15 or less for prescriptions.

In September 2016 it had been 24 months since I had to stop working, & I was automatically signed up for Medicare. The premium for it is $122 & premium for prescription plan is $66.
I went without my Entocort for over 2 weeks because I couldn't afford the $130 co-pay.
I just ordered 100 pills for $66 from an online Canadian Pharmacy; but the medication comes from India.

I did call the insurance company & ask them if I could just keep the "Obamacare" & they said no, the government won't allow it. So I'm paying 3 times what I was just for premiums, & all my medication is more for the co-pays.

I worry about price increases, which I've already been notified the prescription plan is going up, but my Social Security payment isn't being increased...

I just thought I was struggling before, now it's much worse.

And when I tried to use a discount card from the manufacturer for one medication, the pharmacy told me I couldn't since I'm on Medicare; they said all the savings plans are like that; invalid if one is on Medicare or Medicaid...

It really makes me feel hopeless, because I'm hopefully about to go on a biologic, & now I'm afraid I won't be able to pay the co-pay...

Dana B.
 
aypues said:
I am intrigued by the churchy health plan. I went to the website but it isnt laid out clearly, or i'm not on the right site. I asked for additional information. I too will be having to buy a $628/mo ACA plan next year unless I can find something else. It is a really good plan though - blue shield platinum, no deductible, 4k out of pocket max, etc. Curious what the religious plan will exclude besides sex reassignments and abortions, it isnt clear on their website. Will they exclude LGBT people too?
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From what I found there are many different Christian Health Sharing plans. They all have their different qualifications. Here are the qualifying sections of two different plans.

http://www.chministries.org/whocanbeamember.aspx

https://www.libertyhealthshare.org/do-i-qualify

Here is an article comparing 3 different plans.

http://www.kitchenstewardship.com/2015/12/01/review-comparison-healthcare-sharing-ministries/

When I signed up with one of the groups on line, no questions were asked of me on what was my sexual preference. They do ask people to live a Christian life. Different churches have different beliefs. It is mentioned in some plans attending church is not necessary but preferred. If not attending religious services, to read the bible on your own. I have to admit I haven't attended church or been in a temple in decades. I'll be more open to doing so in the future.

They all seem to ask people to avoid tobacco, recreational drugs, limit alcohol, basically avoid addictive substances. Participation in exercise is asked for.
 
So sorry Dana.

It is true, if you are on Medicare these savings plans you cannot be a part of. I think it is stupid, but it was part of the agreement the politicians made with the pharmaceutical industry to get their support for Obamacare. It is one of the things that needs to be fixed, in my opinion.
 
Saw this today.

Donald Trump, in exclusive interview tells WSJ He Is Willing to Keep Parts of Obama Health Law

http://www.wsj.com/articles/donald-trump-willing-to-keep-parts-of-health-law-1478895339

excerpt:

...In his first interview since his election earlier this week, Mr. Trump said one priority was moving “quickly” on the president’s signature health initiative, which he argued has become so unworkable and expensive that “you can’t use it.”

Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the health law after the president asked him to reconsider repealing it during their meeting at the White House on Thursday.

Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies....
 
My son has to come off his dads insurance by the end of the year due to him turning 26 this year. He was looking into Obama Care and private insurance plans...but now wondering if Trump does away with Obamacare ...how soon is that going to take place. What happens if he signs up for a plan with Obamacare and in the first 100 days he changes things. Has anyone heard if the changes will be for 2017 or 2018? I'm thinking 2018...but not sure what to do at this point?
 
Trumps doing an interview on 60 Minutes to night. I think he has stated there or in another interview that there wouldn't be lag between the repeal and the replace. Meaning you wouldn't be left uninsured if you had a market place plan.

But even after saying all that, I have to imagine it would take some time before things were actually even moving in that direction.

I think it is true that because Obama created some mandates by executive order that trum could repeal them with out the help of Congress and instead in budgetary measures and the like. But, I don't believe that this is something that will be taken lightly or as a knee jerk reaction.

I believe we will learn more and more about his exact plan and implementation time frame as this year comes to a close.

He has also made the statement he would like to keep the previous existing condition mandate as well as the parental coverage of children up to age 26. I think we'll see more info on these as time progresses.
 
If they repeal it, they will need to replace it immediately or there will be a backlash. As far as I can see, no one has a realistic plan to replace it but time will tell.

My son (23) is on his father's insurance plan. My son is working full time but doesn't get health insurance at work so we also are anxiously waiting to see what will happen...
 
Beach said:
I didn't watch the election coverage that much over the last year. From what I took there was the typical politician talk of more health care services, more "life saving" drugs to be approved, then calls to repeal Obamacare. In some respects I thought the mentions contradicted themselves.



Already about 18% of our nations GDP goes toward health care costs. Other western countries pay half, around 7 to 8% of GDP, and typically experience better health outcomes.



With 2017, the ACA was no longer to cover insurance and hospital losses for treatments. As a result I saw some hospitals were saying they would no longer take patients that had ACA exchange insurance. Instead those patients, if he/she wished to make an appointment would need to buy insurance outside the exchanges and pay the government penalty.



The typical medical mess overall I though.



This past weekend, after being told earlier my insurance company was dropping me again, and I would need to find new insurance with much higher costs, I opted to go the Christian Health Sharing route.



It isn't insurance. It works similar. Having it does exempt me from the government penalty. I can see and go to what ever hospital I wish. I could not be turned down due to pre-existing conditions. The main requirement was that I needed to live a Christian life, including avoiding recreational drug, avoid tobacco, limited alcohol intake, etc. Costs are reasonable too. On the negative, it can be more work for me.



I've read good reviews with the Christian sharing plans. I'll be finding out if they are true going forward.
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I'm not sure I understand what you mean by hospitals not being covered for hospital losses? The ACA has barely been rolled out and thanks to o gridlock in congress we haven't fixed the broken stuff and so we haven't even begun tackling the actual costs.
The ACA is health insurance from private insurance companies. Some plans are narrow in their networks but to my knowledge nothing has changed in terms of subsidies to people on the ACA and whatever insurance companies negotiate e hospitals is their business. The ACA doesn't dictate what the insurance companies pay per service. Of course that could change in 10 weeks.
I'm like you. I'm self employed and so I'm in my wife's health plan. She is covered almost fully. I'm not subsidized so we are playing $2000 a month. It sucks but I don't see a way out. I need to know my dr is here for me. I was in a r hospital for 4 days a few months ago. The hospital bill was $34,000. That's just the hospital. Drs bills are extra. I didn't pay anything. I hate the way this works but am greatful I have health insurance that doesn't require jumping through hoops
 
Echodog said:
I'm not sure I understand what you mean by hospitals not being covered for hospital losses? The ACA has barely been rolled out and thanks to o gridlock in congress we haven't fixed the broken stuff and so we haven't even begun tackling the actual costs.
The ACA is health insurance from private insurance companies. Some plans are narrow in their networks but to my knowledge nothing has changed in terms of subsidies to people on the ACA and whatever insurance companies negotiate e hospitals is their business. The ACA doesn't dictate what the insurance companies pay per service. Of course that could change in 10 weeks.
I'm like you. I'm self employed and so I'm in my wife's health plan. She is covered almost fully. I'm not subsidized so we are playing $2000 a month. It sucks but I don't see a way out. I need to know my dr is here for me. I was in a r hospital for 4 days a few months ago. The hospital bill was $34,000. That's just the hospital. Drs bills are extra. I didn't pay anything. I hate the way this works but am greatful I have health insurance that doesn't require jumping through hoops
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My mention was on some hospitals no longer willing to accept exchange insurance. As some examples from close to where I was staying when I learned of it. I saw other city hospitals locations being similar.

I've also seem mentions on back door bailouts on Obamacare insurance/ hospital losses.

You can read some about that ~

Major Chicago Hospitals Not In 2017 Obamacare Marketplace Plans"

https://www.wbez.org/shows/wbez-new...ce-plans/f55d6c23-d9b1-452f-8c75-73635bd83d07

excerpt:

Some of Chicago’s largest hospitals said they will not be part of any Cook County Affordable Care Act marketplace plans in 2017.

University of Chicago Medical Center and Rush University Medical Center both said they don’t plan to be in network for any Obamacare marketplace plans next year.

The change means patients with doctors at those hospitals will either need to find a plan off the marketplace, and lose Obamacare subsides, or find a new doctor.

Northwestern Memorial Hospital said it will also be out of the marketplace, but will have exceptions for some of its partner hospitals.

Suburban hospitals in the Northwestern system, like Delnor-Community Hospital in Geneva and Northwestern Medicine Central DuPage Hospital, will be in network for some plans. Patients with a primary care doctor at one of those locations will be able to access specialist throughout the entire Northwestern system, according to a Northwestern spokesman.

Alexandra Eidenberg, who runs The Insurance People, an agency that helps people find plans, said it’s “alarming because the vast majority of people, especially people who are sick, pregnant and in need of benefits truly need those leading hospitals.”...

&

The latest sneaky attempt at an Obamacare bailout

http://www.cnbc.com/2016/09/30/the-latest-sneaky-attempt-at-an-obamacare-bailout-commentary.html

excerpts:

...All of this mess is a result of three very crucial broken promises. The first promise was one the health insurers bought from the Obama administration, and as such, perhaps it's poetic justice that they're now paying for their gullibility and naiveté. But they believed the White House when it said the fines imposed on people not signing up for approved health insurance plans would surely lure enough young and healthy Americans to sign up for those plans to avoid those penalties. But it turned out that promise didn't materialize, and overall enrollment is still less than 50 percent of the projected total of 24 million people this year.

The reasons for the enrollment flop, especially among the young, is simple: It costs too much when you factor in the high deductibles. And relying on people who never showed enough responsibility to sign up for health insurance before to financially bolster an insurance system for millions of older and sicker people is like asking the average American teenager to pick up the check for the whole family at a fancy restaurant. Perhaps it was political pressure and not just a financial miscalculation that forced the insurers to buy this ridiculous premise, but they did either way....

....The second broken promise was one the Obama team made to the insurers. They told all of them that if the healthy new enrollees' premiums didn't exceed the costs of any one of the insurers having to take on older and sicker customers, the companies that were doing better and clearing a profit would pay into a fund to make the less lucky insurers red ink go away. Well, that didn't happen either as there simply haven't been enough profits to go around. Some of the ACA-participating made some financial gains, but not nearly enough to cover the losses suffered by those 175 companies in 2014 alone. So much for "sharing the wealth."

But the Obama administration's extreme efforts to help the health insurers and keep bad Obamacare publicity and massive ACA exchange collapses from exploding all over the front pages resulted in a third broken promise. The White House told the money-losing companies they would still get their money back, this time from the taxpayer funded budget of the Department of Health and Human Services. But Republicans in Congress, led by Senator Marco Rubio and then-House Speaker John Boehner passed a bill in late 2015 blocking that bailout plan, too.

And so, that's what's led us to this latest gambit. To be clear, the administration is clearly hoping it will be able to get away with tapping into a Treasury Department fund to make up for a blocked Health and Human Services payoff that was meant to make up for a failed shared-the-wealth risk-pool fund that was meant to make up for a shortfall in enrollees into a poorly planned and executed national health insurance plan. Got that?

Obamacare hasn't even been in effect for four years and it's already failing faster and more severely than even some of the most conservative and sober critics predicted it would. What's disturbing is seeing the lengths this administration will go to in order to plug the multiple holes in the ACA dike....
 
Echodog,

It will be interesting to see what ideas are put forward to try and fix current treatment options and the problem of high medical costs.

I've seen some argue that the ACA penalty for not buying insurance should be increased. Dr. Ezekiel Emanuel was recently arguing for this I saw. Dr. Emanuel was one of the creators of Obamacare.

Politically I imagine this would be a difficult idea for politicians to get behind and support. Political parties, Republicans and Democrats, would know that raising medical taxes on largely younger voters is likely to cause a loss of future votes.

As the article I posted above mentions, the President is trying to take money from one government department to supplement the ACA. Politically that is unpopular.

America does spend a great deal of money on health care. As I originally mentioned around 18% of our GDP goes toward health care spending. This is more than double the cost compared to what other western countries spend on health care.

There is a good deal of waste and fraud in our medical system in my opinion. I imagine it would be possible to take moneys spent toward one sector of our health care system that is not helpful toward another such as Crohns treatments. (of course what one finds wasteful spending is another mans source of income.) There are lots of examples with this, from the small to the big wasteful medical spending. As some examples that I've read about:

Dr. Emanuel has written about skipping the annual doctor check up. It costs billions yet has not been found to improve people lives.

"Skip Your Annual Physical"

http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html?_r=0

One of the top selling drugs, statins, have not been found to increase life spans and comes with many side effects.

"Statins do not help you live longer – or do anything much else for that matter"

https://drmalcolmkendrick.org/2013/...ger-or-do-anything-much-else-for-that-matter/

Something argued about on TV by doctors, and in the printed press is how heart stents have not been found to prevent heart attacks. Yet despite the evidence against, stenting remains a common medical practice. You can read about that here:

"Why do doctors sometimes ignore medical evidence?"

http://www.drbriffa.com/2011/07/12/why-do-doctors-sometimes-ignore-medical-evidence/

The discover of PSA, Dr Richard Ablin, argues as do others that our current prostate cancer screening measures are ineffective and causes a good deal of pain and suffering, frequently causing impotence and incontinence.

The Great Prostate Mistake

http://www.nytimes.com/2010/03/10/opinion/10Ablin.html

I'm not sure what direction we're heading with health care and insurance coverage. As a result of the current system not being supported by many in the public for various reasons, change is coming is my guess.
 
Beach
Thanks for clarifying. That's the problem with the ACA as it sits now. I live in New York City and most people I know on the ACA have been quite happy. Of course most don't have a chronic disease that requires a ton of drs visits, meds etc. In New York the plans have very narrow choices in drs and hospitals. The good news is that the quality of the care is quite good. The bad is that you don't have your choice of any hospital or dr you want. That said, it is working for many. Since we run our own exchange, we should be okay (as you said, as long as we get healthy people on the books)
I would urge anyone reading this to check out Steven Brill's book "the Bitter Pill" . It takes about the history or the ACA and why we are where we are.
What I took away was that President Obama wanted 2 things- get everyone health insurance and bring the astronomical cost of health care down (which in turn would lower premiums)
Zeke Emmanual is one of the brightest people imaginable in regards to health care policy and the economics of it all. He felt that the priority was to get costs under control first whereas Obama wanted to get everyone on the books. I believe his thinking was that if everyone was insured first, it would be easier to work on the costs which is why the subsidies exist.
Emmanual disagreed and apparently can be difficult to work with. Since Obama didn't want to do it his way, Emmanual walked away.
And that leaves us where we are today, with an ass-hat coming into control in January and no one knows what's going to happen .
As I said before, my premium is $2000 a month and it's killing me. I'm a self employed musician and as I said, if I go on the ACA I am faced with a narrow choice of drs and hospitals. My Crohns is bad. I'm averaging 2-3 hospital stays a year over the last few years and 4-5 surgeries for fistulas. I have a great plan that has allowed me access to the drs I need to see. I can't just go to a GI, my case is complicated. I go to a Crohns specialist.
There are a million ways to cut costs but part of the problem is congress (the blame can go around to the insurance companies and hospitals as well). If those idiots we elected chose to, they could fix some of the problems with the ACA instead of spending all of this time voting to repeal it. It angers me. I work so hard and have nothing to show for it. I have a roof over my head but at the end of the day, I can pay the insurance company $24,000 a year or take my chances with a plan with limited access and end up spending 24,000 on things not covered. It's all so frustrating
 
Cat-a-Tonic said:
I'm terrified of this too. If they bring back the previous things like lifetime caps on coverage and not covering pre-existing conditions, I think a whole lot of people are going to be absolutely screwed.
Click to expand...

Lifetime Caps scare me. But I listened to President-Elect Trump's interview on 60 minutes and he was very specific about wanting to keep the ban on not covering pre-existing conditions and keeping kids on their parents insurance until age 26. If he is willing to keep the ban on lifetime caps as well then I think we will be OK. If not, then we have a problem. Obamacare is not working as planned in cutting the medical costs and definitely needs to be fixed in that regard. If medical costs don't come down, then the cost of insurance will not decrease either.
 
Marketplace Insurance

I have been on self pay private insurance and now being kicked off as of 2017 in NY and only can get Obamacare which I'm being pushed into which will cost me more then my private insurance. I'm finding it a nightmare since I have a complicated case I need many doctors and now none or one or two are on them and actually no one knows what insurances they will be on until next year (I have to sign up by Dec 15) and I need surgery yesterday but am scared to start with my doctors now and then start over with new docs especially if complications like my last surgery. As of last week they have this insurance Oscar that's on plan. Doctors on list whereby their office told me they are not accepting even though on the list. My GI who is the most important person in my life now is not taking any insurances being offered to me.Yikes!!!! Also Mt Sinai on Oscar list but when speaking to a gazillion people at the hospital I was told to stay away since it's volatile right now. I find that very scary that everything looks great on lists of Obamacare docs, hospitals, etc except I would have to travel far to get an MRI etc since I live upstate and is difficult to do when I'm so sick. Not very organized and easy to manage necessary care.Hard enough to get to doctors and hospital in city. It's a mess as far as I'm concerned and extremely scary!!!!! Forget meds and infusions. They don't cover!!!!! I'm allergic, bad reactions and down to the last infusion that's not covered and thousands and thousands of dollars!!!!! So what am I to do die????
 
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I am very fortunate to have excellent insurance through my former husband, but I also live in Massachusetts, which has a good state public insurance system. I have a very good friend with some serious conditions who uses it, and has been very satisfied.
 
itsmebabs said:
I have been on self pay private insurance and now being kicked off as of 2017 in NY and only can get Obamacare which I'm being pushed into which will cost me more then my private insurance. I'm finding it a nightmare since I have a complicated case I need many doctors and now none or one or two are on them and actually no one knows what insurances they will be on until next year (I have to sign up by Dec 15) and I need surgery yesterday but am scared to start with my doctors now and then start over with new docs especially if complications like my last surgery. As of last week they have this insurance Oscar that's on plan. Doctors on list whereby their office told me they are not accepting even though on the list. My GI who is the most important person in my life now is not taking any insurances being offered to me.Yikes!!!! Also Mt Sinai on Oscar list but when speaking to a gazillion people at the hospital I was told to stay away since it's volatile right now. I find that very scary that everything looks great on lists of Obamacare docs, hospitals, etc except I would have to travel far to get an MRI etc since I live upstate and is difficult to do when I'm so sick. Not very organized and easy to manage necessary care.Hard enough to get to doctors and hospital in city. It's a mess as far as I'm concerned and extremely scary!!!!! Forget meds and infusions. They don't cover!!!!! I'm allergic, bad reactions and down to the last infusion that's not covered and thousands and thousands of dollars!!!!! So what am I to do die????
Click to expand...



I'm in NY also and am in a similar situation. My insurance is through my wife's employer but in subsidized. My premium is $2000 a month (yes 2 thousand !). I have a $1500 deductible (I did that in 1 month). So we have to put 24 THOUSAND dollars aside this year just for premiums. The reason I haven't gone on the ACA is for some of the reasons you mention. It looks like my Crohns dr is on most of the ACA plans but even with a platinum plan, the co pays for drugs gets out of hand pretty fast and I'm sure I will have more out of pocket expenses.
Being self employed, I have to itemize my medical deductions. I have a few perianal fistulas and I got trough a few boxes of gauze every week. At $15 a box, I'm spending close to $200 a month just for gauze. Methotrexate is $60 a month and copay's for my other meds average around $50-60 a month. So besides $24k for my premium, I'm dripping an addition $3200 for copays for med supplies and scripts. I've been dealing with depression most of my life. My part of hey bill comes out to $35 a week. So, I am looking at close to $30k a year that is just to keep me healthy. It's unsustainable and I don't know what I will do next year. Oscar may be what I do.its scary. Now republicans are talking about repealing but not yet. Of all things, it may be the insurance companies that save the ACA.
The ACA seems to work best for those that aren't dealing w a chronic disease. I don't think any of the politicians have thought about the people that are affected. They see numbers and graphs. They don't see a person associated with those numbers.
I would love to ask Trump "what do you think is an affordable premium for health insurance?" If I'm earning 70k pre tax should 30% of my salary go to health care? How can that ever work?!!
 

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