Just got done with a BCBS webinar. Some interesting nuggets:

1. If there is more than one person on a policy, it is considered a "family" policy and the family deductible will apply. So if you choose a bronze plan with $5k individual deductible, the family deductible will be $10k. In the current market, deductibles are usually per-person with a max of two per family. As an example, the "best" bronze plan from BCBS has a $7,500 family deductible and $12,700 OOP maximum. The "best" silver plan has a $3,000 family deductible and $11,000 OOP maximum. The "best" gold plan has a $1,500 family deductible and $7,000 OOP maximum.

2. This may only be for BCBS, but for ALL of their plans (including gold), specialist visits are subject to deductible.

3. Catastrophic and bronze plans require deductible to be paid before any prescriptions are covered.

4. Silver and gold plans have $15 copay for tier 1 drugs, $40 for tier 2 drugs, and deductible/co-insurance applies to all tier 3 and tier 4 drugs. All of the expensive drugs are tiers 3 and 4, of course.

5. If you are under 250% of FPL and qualify for cost-sharing subsidies, you have to choose the silver plan in order to receive the cost-sharing subsidies.

6. Platinum plans are not being offered due to high cost, very few people in focus groups said they would pay the rates for platinum plans.

7. Most of the silver and all of the bronze plans only have 2-3 office visits per year with a copay, subject to deductible after that

Haha yea it's the Dems that need to reach out to fix these small glitches because the GOP would totally be on board.

100% of any Obamacare amendment bills that come out of the senate will come out of the House as repeal bills.

Can I get a plan with no out of pocket? I just wanna pay the monthly bill and then rack up lots of stuff.

Do you not understand how the cloture rule works? Or are you just pretending in this post not to understand how it works?

#7 sounds god awful. Back when I had health insurance I used to like going at least once every week and a half or so on the off chance that the hot pharma sales rep might be stopping by that day.

People with kids usually aren't a fan of plans with limited office visit copays

Are you on crack?

The idea that republicans would ever do anything to help make Obamacare better is the most delusional statement itt.

Ha, so the ACA is a conservative bill where we cut health care expenditures by sharing more costs with consumers of healthcare and make health expenditures more sensitive to market signals.

1. I've had family plans before with two people (myself, my spouse) and the family deductible applied then as well (through BCBS of FL in fact). Is this actually something new? I don't actually remember if it was called "family deductible" but I do remember it being higher once I added her than it had been previously when it was just me.

2. I've always paid more for specialist visits, in fact the co pay on the most recent BCBS plan I had was even higher than the emergency room copay if you can believe that. If always subject to deductible that is indeed a step backward and would be a good reason to choose an insurer other than BCBS which offers better terms.

3, 4. As for prescriptions, higher "tier" drugs are currently expensive, no? Does this make them MORE expensive? If not then how is this inherently worse than status quo? Are so-called Tier 1 drugs essentially generics? I get generics at my local Walgreens and Wal Mart for like $4 so I wouldn't even use my insurance for those and pay a $15 co pay. Hell, Publix gives many generics away for free here, especially antibiotics.

5. Tell me how this is bad? Or worse than status quo? This is useless without pre-subsidy and post-subsidy cost data.

6. They're not even offering platinum plans for people who want them and are willing to pay? Really? I'm having a "Fry Shut-Up-And-Take-My-Money" moment here.

7. You advised

What about people with kids and pre-existing conditions who can't get health insurance at all and pay 100% for all office visits out of pocket? Any data on how they will feel about this? Are they better off or worse off under the ACA in your estimation?

In fact can you just link us to the documentation supporting all of this? No offense but you seem determined to find something wrong with virtually every aspect of this law so I'd like to read the details for myself.

Well he does have a point, I mean remember how open and willing to compromise Senate Republicans were on Bill Nelson's proposal to curb the 1099 reporting requirements included in the ACA?

They're reasonable people br0seph you just gotta give 'em a chance.

Very possible there is an adverse selection problem here that makes it unprofitable to offer. Ive heard this in my travels from multiple people about the really high end plans.

I would like to know more about this.



I thought the platinum plan was like the "Cadillac" plan, I would assume that they have all that adverse selection stuff factored into their pricing

By crappy I meant someone with an hourly job that pays for their health insurance (~$35k/yr). Obviously someone working part time jobs to get by isn't going to have health insurance. A better example might be a father who supports his family. Before the ACA he got a family plan through work, but because of the ACA (or maybe his employer is just using it as an excuse) he now only has health care for himself.

This is just pedantic. If enough people are affected and complain perhaps something will happen, but until then nothing is changing.

Part of the ACA is that companies have restrictions on pricing for individual customers since you have to price within bands Since everyone is sort of feeling around a little bit on how to price these things to start, its very possible that insurance companies cant find a price where its low risk/profitable enough to offer the plans.

The ACA is focused on having healthy'/younger people buy into the system to sort of offset the cost of older/sicker patients, right?

If most of the differences in Platinum plans are just co-pays and deductibles rather than things like catastrophic coverage, its very possible that most of the people interested in that level of coverage are the people who have circumstances where they know they'll be making a lot of visits or flying past the deductible. There's too few health/younger people to balance that out, and you are limited in how much more you can charge the older/sicker people. The platinum market functions sort of like the ACA would with the mandate sripped out i.e. an adverse selection issue.

Also possible more plans get introduced over time. Part of it is that insurance companies dont have as much/as good data as they are used to when pricing these plans.

Look guys, the political debate about this is over. It's happening and no one is stopping it.

So just tell me how to get the most bang for my buck, please.

If you arent offered employer health insurance, go onto either a state or federal exchange and find the health insurance product that best fits your needs after taking into account costs and potential subsidies?

Its not that complicated.

Get health insurance, develop bone cancer, pocket the savings.

I think the next phase of this is Republicans not understanding, post implementation, why trotting out individuals with sob stories is ineffective.

"Yes, we get that 40 million poor people now have insurance, and that the vast majority of people have experienced no change, but goddammit we found a middle class white guy whose premium went up! And his network is smaller!!!"

WSJ: Let It Fail

I pretty much agree with the author that a collapse of Obamacare could be a crippling blow to the credibility of the entitlement state.

"The public's dislike of ObamaCare isn't growing with every new poll for reasons of philosophical attachment to notions of liberty and choice. Fear of ObamaCare is growing because a cascade of news suggests that ObamaCare is an impending catastrophe."

uh

Yeah let it fail just like social security and Medicare. Seniors hate that ****.

Except we have plenty of examples of other nations implementing national health care systems that work., If it fails it will not be a crippling blow. Other programs like SS and Medicare will keep chugging along.

"Obamacare failed so it's totes cool if we get rid of medicare, right?"

Seems like a winning message to me.