# Understanding US Health Insurance



## Warrigal (Jul 20, 2017)

I readily confess that I don't understand what the ACA entails but I have read on this forum that it is a health insurance scheme, not a health care bill. I don't understand what is wrong with it although I have read that there is a problem in some states with a lack of choice of provider and that it is expensive. I understand that one of the good aspects is the removal of a pre-existing conditions test and also that there is some coercion on young healthy people to take out insurance.

I don't understand the ACA and have no clear idea about how it differs from the legislation that has been presented to Congress to replace it.
If anyone can explain it all in terms that an intelligent 12 year old could understand I would be grateful.

Today I saw several articles that question whether Donald Trump understands health insurance either. He has been talking about costs as low as $12 pa for a 21 year old that do not rise until the age of 70. He has also talked about premiums of $15 per month. It seems he is confusing health insurance with life insurance.

Here is one link http://www.vanityfair.com/news/2017...now-what-health-insurance-is-an-investigation

and another https://www.washingtonpost.com/news...year-health-insurance/?utm_term=.c8c09e049dee

I welcome any clarification and/or personal experiences that will help me to understand this issue.


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## WhatInThe (Jul 21, 2017)

Over simplified but the ACA puts mandates, taxes & penalties on insurance companies, individuals, devices and/or plans. The problem with health CARE in the US all the legislation focuses on funding the insurance companies which in turn fund the providers. The problem is the providers exploit insurance company payouts and the insurance companies exploit the tax and premium payers. Patients and physical care get lost in the current US health CARE debate.

Also in the US INSURANCE is used like a service plan, not for individual catastrophic events INSURANCE was ment for.

One must be very careful when talking about the true cost of health care INSURANCE and ACA policies & premiums to include the tax payer subsidies.

There is no one practical or economical solution. Alot of different things will have to take place for care and insurance costs to come down.


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## Grumpy Ol' Man (Jul 21, 2017)

The ACA was a plan whereby all Americans would purchase health insurance at affordable rates.  The insurance plans would be required to cover pre-existing conditions.  The insurance companies would be able to still make their typical profits since millions more would be enrolling, most of them the healthy younger adults who were low risk.  Everybody was required to purchase the ACA plans.  If they did not purchase insurance through the ACA exchanges, a penalty would be assessed on their yearly income tax forms.  Businesses who employed a certain number of people were required to offer affordable health care and pay a portion of the insurance cost.  On the surface, it sounded like a good theory.

Healthy adults found the penalty assessed for not enrolling was less than the insurance premiums.  So, the would wait until an accident or illness and then enroll.  This dramatically cut the 'pool' of enrollees and insurance companies were only seeing the higher risk folks enrolling.  The government rec'd the penalty in the form of a "tax".  The insurance companies were forced to cover the ill if and when they enrolled.  To cover "only the sick" premium cost shot through the roof.  With the Republicans in Congress wanting the ACA to fail, there was no effort to raise the penalty so the insurance companies could make their usual profit margins.

Businesses followed suit.  Many small businesses found the penalty for not offering insurance to employees was less of a financial cost than paying a portion of the premiums.  Therefore, the employees would go without insurance until something catastrophic hit.  The employee would then enroll in the ACA and the insurance companies would be required to cover the costs.

Once it became evident the insurance companies were only seeing the ill and high risk folks enrolling, again the premiums soared in cost.  More people could not afford the escalating premiums and would pay the penalty and wait for an illness or accident.  As more and more faded from the rolls of premium payers, insurance companies began dropping out of the exchanges providing insurance to the ACA.  

Congress could have worked together to fix some of the problems.  The GOP would not allow any discussion about the ACA to come to the floor of Congress.  The GOP wanted to see the ACA fail 1.) because it was an accomplishment of President Obama and 2.) they wanted to use 'repeal and replace' as a means of winning upcoming elections.


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## BobF (Jul 21, 2017)

Warrigal said:


> I readily confess that I don't understand what the ACA entails but I have read on this forum that it is a health insurance scheme, not a health care bill. I don't understand what is wrong with it although I have read that there is a problem in some states with a lack of choice of provider and that it is expensive. I understand that one of the good aspects is the removal of a pre-existing conditions test and also that there is some coercion on young healthy people to take out insurance.
> 
> I don't understand the ACA and have no clear idea about how it differs from the legislation that has been presented to Congress to replace it.
> If anyone can explain it all in terms that an intelligent 12 year old could understand I would be grateful.
> ...



OK, you got in your shot at Trump now let us look at the Obama care problem.   Even Obama recognized that Obama care was in trouble and commented such in the months before he left.   So to begin with, it was one of the problems left for the next government.

For sake of competition to encourage insurance companies to compete, there is no cross state insurance competition allowed, no multiple insurance companies and even no insurance companies in some states.   Per the constitution these should be for the states to decide, not the federal and if states agree for competition between states for insurance deals best for the people, why not?

Other internal areas of the Obama care need corrected or replaced also but so far the Democrats will not work with the Republicans to rewrite Obama care.    Shumers 'our way or no way' blocks any ability for co operative efforts.   Trump has invited such effort publicly but got no response from the left.   So efforts were to move without the left and so far several attempts have failed.   Change Obama care failed to pass, rewrite and release a new plan to replace Obama care lost twice now?   Currently a movement to allow Obama care to just continue to fail on its own merits.   

Dangerous thing to do as it brings reality back to the people which is what the US had until after WWII when employers added health care to employee benefits.   Obama care came on and pretty much destroyed those benefits and now I no longer get full heath plan that my employer had set up for its retired employees.   Rather than continue to pay for my health care and dental and eye glasses I now have access to my employers funds for insurance purchases up to a point.   Once I achieve that I am on my own for anything else.

So what Obama attempted to achieve has not happened.    What was attempted was blocked by internal squabbles in the Republican congress and we now are waiting for the entire congress to wake up and grow up and do their jobs and forget about pure party actions.   These Representatives and Senators are here to govern for the districts wants and the country in general but are not here to represent political parties often far biased wishes, neither conservative or  liberal.


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## Warrigal (Jul 21, 2017)

Thanks for replying Bob. My responses in blue



BobF said:


> OK, you got in your shot at Trump
> Hang on. I did not mention Trump or Obama and deliberately referred to ACA, not Obama Care.
> If the links mentioned either of them it is not surprising, and not something I can control.
> That's why I didn't cut and paste. I'm bending over backwards here to be uncontroversial so that I can get sensible answers that explain it all.
> ...


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## Grumpy Ol' Man (Jul 21, 2017)

One of the "biggies" that the right uses to justify the failing of the Affordable Care Act is "If they would only have allowed insurance companies to compete across state lines."  This is a bogus argument, put forth with zero factual foundation.  

1.)  The right wants the Federal government out of the health care/insurance business.  "Let the states handle it."  Currently, all insurance companies must adhere to the customer protection laws of each state in which the operate.  If you want them selling across state lines, wouldn't the Federal government then need to set a "standard" and enforce it?
2.)  If the right doesn't want the Federal government involved and insurers allowed to compete across the Country, they are going to "headquarter" in the states with the lowest possible standard of customer protection.  You might live in a State where you are protected now from scams and insurance companies failing to pay for stated care.  You purchase insurance from a company in another State that does not have those protections.  You have your first claim and find there is fine print whereby the insurer pays nothing.  What a zoo!
3.)  Insurers now are located in many states.  Blue Cross/Blue Shield.  Aetna.  Numerous insurers do business in many, many states.  The difference?  Each must abide by the insurance regulations and consumer protection requirements of the state in which the policy is sold.  And, we want that changed???
4.)  Insurers spend big dollars putting together their groups of doctors and medical facilities.  Each provider must agree to abide by the payment restrictions of said insurance company.  A company based in Kentucky, operating out of a single office and selling policies across the Nation isn't going to spend money meeting with providers in the other 49 states.  

Maybe I don't see the "big picture".  If not, tell me just how competition of health insurers across state lines will lower health care costs without endangering the current protections of the policy holders.


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## BobF (Jul 21, 2017)

Warrigal said:


> Thanks for replying Bob. My responses in blue









 Originally Posted by *BobF* 

 

                 OK, you got in your shot at Trump 
Hang on. I did not mention Trump or Obama and deliberately referred to ACA, not Obama Care.
If the links mentioned either of them it is not surprising, and not something I can control.
That's why I didn't cut and paste. I'm bending over backwards here to be  uncontroversial so that I can get sensible answers that explain it all.

Now let us look at the Obama care problem.   Even Obama recognized that  Obama care was in trouble and commented such in the months before he  left.   So to begin with, it was one of the problems left for the next  government. You are talking about ACA?

I am talking about Obama care, or ACA, its official name.   But even Obama called it Obama care.

For sake of competition to encourage insurance companies to compete,  there is no cross state insurance competition allowed, no multiple  insurance companies and even no insurance companies in some states.    Per the constitution these should be for the states to decide, not the  federal and if states agree for competition between states for insurance  deals best for the people, why not? Any idea why people can only take out insurance in the state where they live? Is this new or did it happen pre ACA?

Partly true but if this was known to be true it should have been addressed somehow in the bill.

Other internal areas of the Obama care need corrected or replaced also  but so far the Democrats will not work with the Republicans to rewrite  Obama care.    
Can you give one or two examples  of things that need to be improved?

The insurance problems and lack of competition to help hold down charges for sure and what ever Obama felt needed changed.

Shumers 'our way or no way' blocks any ability for co operative  efforts.   Trump has invited such effort publicly but got no response  from the left.   So efforts were to move without the left and so far  several attempts have failed.   Change Obama care failed to pass,  rewrite and release a new plan to replace Obama care lost twice now?    Currently a movement to allow Obama care to just continue to fail on its  own merits. Yes, I have observed all of this. Now  you are talking about two different things. 1. Repeal and 2 Replace. In  your opinion, why is the replacement bill better than the bill it is to  replace? 

Obama care really needs to be replaced with something that covers the main problems and any other improvement also.   Repeal with a long time span so nobody gets left with no help.   And the replacement one then needs to be sure it covers any who may get lost.

Dangerous thing to do as it brings reality back to the people which is  what the US had until after WWII when employers added health care to  employee benefits.   Obama care came on and pretty much destroyed those  benefits and now I no longer get full heath plan that my employer had  set up for its retired employees.   Rather than continue to pay for my  health care and dental and eye glasses I now have access to my employers  funds for insurance purchases up to a point.   Once I achieve that I am  on my own for anything else. 
So am I understanding you - pre ACA you had full cover for dental and  optical with a plan that was paid for by your former employer and now  you do not? Or is it that after you retired you had a better plan for  which you paid the premiums yourself and after ACA you have less  coverage for the same or greater cost?

Yes, I had coverage offered by my employer prior to retirement.   I then was set up with a locked program for health care for retiremenet.   That program included all health care in cluding eyes, and glasses, and dental.   When Obama care came on the employer changed their plan and offered a fixed amount of back up money to allow me to find and buy additional insurance to cover what Obama care did not offer.   So I am able to buy glasses and dental and certain other items that Obama care did not cover.   Not sure about drug limits in Obama care.   But as long as I stay within the allowance my employers retirement plan insurance fund pays for me.

So what Obama attempted to achieve has not happened. Wasn't  one of the things that he wanted to achieve was the elimination of the  refusal of the insurance companies to cover pre-existing conditions, and wasn't that built in to ACA? 

That could be, but I don't know.

What was attempted was blocked by internal squabbles in the Republican  congress and we now are waiting for the entire congress to wake up and  grow up and do their jobs and forget about pure party actions.   These  Representatives and Senators are here to govern for the districts wants  and the country in general but are not here to represent political  parties often far biased wishes, neither conservative or  liberal.
I agree that something like the provision of a  quality system of health care and health insurance should be above party  politics.


Thank you.

And be careful of the next post as Grumpy is full Democrat on this topic and will twist and turn everything to make it become all Republican problems.


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## Trade (Jul 21, 2017)

BobF said:


> And be careful of the next post as Grumpy is full Democrat on this topic and will twist and turn everything to make it become all Republican problems.


:lofl:


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## Aunt Bea (Jul 21, 2017)

BobF said:


> And be careful of the next post as Grumpy is full Democrat on this topic and will twist and turn everything to make it become all Republican problems.





Trade said:


> :lofl:



I gotta admit it does conjure up a vision.






Just kidding Grumpy, I enjoy your posts!!!


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## Knight (Jul 21, 2017)

Warrigal a good starting place would be to ask if there is an understanding of health insurance and health care. 

To explain in terms a 12 yr. old would grasp that 12 yr. old would have to understand the way capitalism works. 

Insurance is a product sold for profit. No profit no insurance. 

The promise of "affordable" insurance didn't happen. It would at this point the various reasons "affordable" wasn't affordable a pre teen 12 yr. old  would probably be spaced out and on a cell phone texting. 

I can't imagine trying to explain the concept of mandates & penalties within the ACA.  Or that America has different population centers that require different facilities, yet the ACA was a one plan fits all.


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## Lon (Jul 21, 2017)

Having just spent three days in hospital I have no idea what it cost until I get my quarterly statement from Medicare and my Supplement.  It had to have cost a ton of money. The service, nurses, doctors and food was excellent. I have no complaints. Not that it matters but it was a Catholic Hospital  St. Agnes


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## Grumpy Ol' Man (Jul 21, 2017)

Aunt Bea said:


> I gotta admit it does conjure up a vision.
> 
> 
> 
> ...



Hey!  At least I still have hair!!!!!


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