Unaffordable Care Act Third Open Enrollment Nothing to Celebrate

The third Obamacare Open Enrollment period began November 1st. As a result, many families are faced with a tough choice: purchase coverage they cannot afford with few tangible benefits, or pay an equally unaffordable penalty and hope they do not become sick. The Internal Revenue Service determined that 7.5 million individuals opted to pay the penalty rather than purchase health coverage in 2014, far more than originally projected. The penalty for going without coverage in 2014 was only $95 or one percent of income, whichever was greater. Yet the tax year data found the average penalty paid was double the minimum. This suggests it wasn’t the poor who were going without coverage; the poorest individuals either qualified for generous subsidies, Medicaid or got an exemption from the penalty. Many of those who paid the penalty were likely individuals who did not qualify for subsidies and could not afford Obamacare coverage due to the costly mandates. To make matters worse, the costs are rising fast.

According to data from the Kaiser Family Foundation, premiums for coverage in Alaska, Colorado, Hawaii, Idaho, Minnesota, Montana, Oklahoma and Tennessee, for example, will rise by about one-third in 2016. Rates in Arizona, Delaware, Nebraska, North Carolina, Oregon, South Dakota and West Virginia will increase by 20 percent to 25 percent. Residents in Iowa, Kansas, Louisiana, Nevada, North Dakota, South Carolina and Utah will see increases of above 10 percent or more.

No one will escape these rising costs. Americans with employee health plans also experience rising premiums when insurers are forced to sell bloated policies in unprofitable markets. Individuals who forego insurance and chose to pay the penalty will face a greater fine. In 2015, the penalty more than doubled from 2014; in 2016, it will increase yet again. Those failing to obtain health coverage in 2016 will face a penalty of $695 or 2.5 percent of income, whichever is higher.

Americans were led to believe the Affordable Care Act would save the average family about $2,500 per year. That dubious claim was actually just a sound bite with no basis in fact. Unfortunately, in a health reform debate about complicated insurance regulations, a simple assertion that families would save a couple hundred bucks a month resonated more than wonky counterarguments about adverse selection, moral hazard and rising deficits. The Obama Administration would ultimately be proved wrong about cost savings; it recently acknowledged that the “Affordable Care Act” is not affordable for many individuals. An “I told you so” may be in order, but it hardly makes people saddled with high insurance premiums feel any better.

These premium hikes are significant for several reasons: 1) the Affordable Care Act is anything but affordable for taxpayers, who have to subsidize these costly premiums; 2) moreover, the Affordable Care Act is unaffordable for many despite generous subsidies. Finally: 3) many of those who have Obamacare coverage are concluding it’s not a good value for the money.

Take the case of a self-employed professional I know. She always purchased coverage through her business. Since Obamacare became the law of the land, her premiums shot up even as the quality of her coverage deteriorated. Her retirement savings effectively meant she was too rich for Obamacare subsidies. In order to have affordable health coverage, she had to settle for a $6,000 annual deductible — a threshold so high she would never even approach it. To make matters worse, many of the services her pre-Obamacare health plan used to pay for were no longer covered. Many of her doctors were no longer in her network. Her compounded drugs were no longer covered. She calculated the only benefit she received from her $389 monthly premium was one “free” well-woman preventative care visit each year. She concluded that $4,668 in premiums provided almost nothing of tangible value; and that her well-woman visit was far from free. Two days before 2016 open enrollment, she called her health insurer and canceled her coverage for the final two months of the year. She reasoned the $778 she will save by dropping coverage for two months would be well worth the risk. She will not have to pay a penalty for a coverage gap that lasts only two months. In a few days she could sign up again for coverage to begin January 1.

Apparently, she is not alone. Nearly one-in-five enrollees drop their coverage before yearend. Moreover, people expected to pay their own way are few and far between. The data shows the only people likely to enroll in Obamacare exchange plans are those eligible for generous subsidies; nearly 80 percent of enrollees receive subsidies.

In October Health and Human Services Secretary, Sylvia Burwell, admitted that 2016 enrollment in the Obamacare exchange was expected to hardly change from 2015 levels. That’s less than half what the Congressional Budget Office estimated not long ago. But that may be overly-optimistic. As the sheen wears off of subsidized health coverage, and more Americans find they are paying hundreds per month for coverage that provides few benefits, they too may decide to sit this one out.

An earlier version of this Health Alert appeared in Town Hall.

Comments (68)

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  1. Perry says:

    I think people are figuring out they ain’t getting much for their money.

  2. Ron Greiner says:

    Healthcare.gov is full of lies. A 60-year-old couple in Ames, Iowa has the smallest premium of $1,163 a month. To pay a penalty this couple would have to earn $174,450 a year. Everybody selling insurance tells you before they show the price:

    Just a friendly reminder: If you don’t buy coverage by January 1, 2016, the government will fine you $1,625 next year.

    It’s not true because the income I used was $65,000, about 1/3 of the income that would generate a penalty. Notice how they use the income to generate the fine? $65,000 X .025% = $1,625. When you can’t trust the Feds who can you trust?

  3. Barry Carol says:

    Devon – Was your self-employed professional friend’s previous policy a better deal for her because it didn’t cover maternity benefits which she presumably didn’t need if she’s past her mid to late 40’s? If so, are you suggesting that the only people who should have to pay for maternity benefits are younger women who may need them? That doesn’t seem fair.

    The pre-ACA individual health insurance market didn’t work so well either, especially for lower income people who made too much to qualify for Medicaid. 45-50 million people who lack health insurance looks like a market failure to me. Even if you subtract the 10-12 million illegal immigrants who aren’t eligible for ACA subsidies, it still looks like a market failure.

    I think the ACA could have offered a catastrophic insurance option that had an actuarial value closer to 40 compared to the Bronze plans’ value of 60. However, if we really want to make health insurance more affordable for more of the population, with or without subsidies, we need to find ways to reduce the cost of healthcare, especially hospital based care. Health insurance is expensive because healthcare is expensive.

    • Devon Herrick says:

      Barry, I agree with your third paragraph. I do believe the ACA should have allowed health plans with benefits more limited than the current law. And, part of my criticism of the PPACA is that it did nothing to improve the incentives of medical providers to compete to bring medical costs down. (it didn’t encourage HSAs, it didn’t encourage reference pricing, it did encourage high-deductible plans in the exchange, but that was not the intention.

      I will quibble with one thing you said. Yes, I do believe that women beyond childbearing age, those incapably of having children and those who have ended their childbearing should not subsidize the natural process others choose. Our society has turned birthing into a medical event, costing as much as a late model used car. When people pay cash they somehow managed to reduce the cost to a few thousand dollars.

    • Of all the people in our society deserving subsidies from others, young, healthy, fertile women do not rise to the top of my list, I’m afraid.

    • Francisco Machado says:

      Insurance – of any kind – has the purpose of protecting the insured against unexpected high expenses, the cost being calculated on probability tables based upon the incidence of those occurrence over a large number of people insured. If there is no probability of pregnancy for an individual insured there is no potential liability to the insurer for that. What is unfair about not requiring insurance against an impossible eventuality? Should flood insurance be mandated on a hilltop house? For that matter, should flood insurance be required at all – or should the owner of the house have the option of risking the financial loss? Consider the ongoing destructive effects, particularly on health, of being compelled by law to spend money you cannot afford. If the expenditure on mandatory flood insurance leaves no money for necessary maintenance on the house its deterioration is certain. Mandatory health insurance, particularly given astronomical deductibles, may negatively affect the health of the insured – leaving less money for healthy food, for heat, clothing, transportation, utilities. $500 a month is considerable – $1200 can be utterly destructive. And the government cannot give money to the private sector it has not taken from the private sector, now or – as we are seeing – in the future. in short, the government is already too big and is doing too much at a cost to the people for whom it is doing it. How would being mandated to eat at an expensive restaurant every night (for your own good, of course) – and being compelled to pay for it work for your budget?

      • Devon Herrick says:

        How would being mandated to eat at an expensive restaurant every night (for your own good, of course) – and being compelled to pay for it work for your budget?

        It’s worse than that. It’s like being mandated to join a exclusive, private club that you cannot afford to actually eat at. You’re paying for the privilege of eating there if you choose, but the actual food is extra — and expensive.

        My health coverage, and that of my wife, each has a deductibles above $5,000. The cost for coverage next year will be approximately $10,000. That means for us to get any benefit from our coverage, we will have to collectively spend $22,000 (including premiums and deductibles) before our plans pay for anything other than two annual exams.

        The only tangible benefit from these policies is: 1) not paying a penalty; 2) in the unlikely event one of us does become desperately ill, we won’t bankrupt our life savings paying the bill in a dysfunctional system where those without insurance are asked to pay list prices that are 300% of cost (on average) and sometimes marked up 1000%. If I were uninsured and fell ill, I’d probably get on a plane for Costa Rica or India if possible.

  4. Michael Gorback says:

    I definitely sympathize with the woman whose situation you describe.

    I live in Harris County in Texas. There are NO individual PPO plans for 2016, only HMO and EPO. I was surprised at the number of EPOs. I don’t accept any private HMO contracts nor do I participate in EPOs. Now I’m stuck as a patient in one of these miserable products.

    Even if you get a PPO now there are often no out of network benefits.

    Bottom line: We’re being herded into narrow networks.

    By some incredible coincidence, all but a handful of the plans I’ve seen have a maximum out of pocket of $13,700. All you get to pick is how you want to roll the dice, i.e., what combo of co-pays and deductibles you want.

    I saw a catastrophic coverage plan offered and I think that’s what I’ll do. After all, insurance is to cover you for unexpected calamities, right? Not every little expense. Sometimes we forget that. I’ll bank the savings for a rainy day or use it for my medical expenses. I’d put the savings in an HSA but none of the plans offered are HSA-eligible.

    I hope there’s a special circle of Hell reserved for anyone who had anything to do with this mess.

    • Ron Greiner says:

      Micheal, a 50-year-old couple with 2 children in your county will cost $757/month with $13,700 maximum out of pocket from Community Health Choice HMO Bronze 003 – HMO. That means $6,850 for a single.

      I sell a PPO (PHCS.com) with a $3000 max out of pocket per person and a max penalty of $6,000 for going out of network with a $1,000 accident benefit plus a 15 month rate guarantee for less than 70% of the above priced HMO.

      The trick, medical underwriting is REQUIRED!

      Another trick, you will pay the penalty if you earn more than $113,550 (the above family). If you are older you can earn more and if you are younger you can’t make this amount. The most important thing is to tax those young people to spread the risk fairly. The Feds always want to be fair.

      Last trick – NO tax free HSA.

    • Izzy says:

      what was the catastrophic coverage? I’d be interested in that plan

  5. Jimbino says:

    The penalty has no teeth. All you need to do to avoid it is to leave no funds of yours on the IRS withholding table in anticipation of a tax refund. You just need to adjust your W-4 withholding exemptions and allowances so that, at years end, you will have paid in withholding between 90% and 100% of your tax due. You can have withheld as little as last year’s tax, if it was less than you will owe this year, without penalty.

    The mystery is that blogs like this one don’t advertise how to avoid over-withholding. Just like nobody explains the virtue of jury nullification to jurors.

    • Devon Herrick says:

      “The mystery is that blogs like this one don’t advertise how to avoid over-withholding. Just like nobody explains the virtue of jury nullification to jurors.”

      I need to check into the penalty further. What if you’re self-employed and owe the IRS (as I always do)? Do penalties not carry over?

      I agree about jury nullification. I’ve heard that judges tend to get rather agitated with attorneys who explain to jurors that they, in fact, they are the ultimate decision-maker about justice — not the judge.

    • We do not give personal advice to people. However, if we did, there is still a huge margin of error in your approach. The people in question have highly variable incomes, and cannot anticipate their tax due very well.

  6. Devon Herrick says:

    As a thought experiment, I entered my own data into Healthcare.gov MarketPlace to see what is available for families like mine. There were only two policies I could obtain for less than $500 per month. One was a $6,750 deductible for $387 per month that paid nothing under the deductible and had excessive cost-sharing above the deductible. The other was almost as bad. For my wife, there was nothing under $400 and only four in total under $500.

    Except for two worthless annual physical exams, these policies would not pay a dime towards my family’s expected costs next year. Basically, Obamacare proponents wants my family (besides paying excessive taxes) to needlessly spend an extra $10,000 per year on health insurance so insurers can cross-subsidize the care for others. When Obamacare was passed, I predict it would not work as well as its backers hoped. But even I didn’t anticipate how bad it could become.

    • Fred S says:

      Just curious – why would the annual physicals be “worthless” to you and your wife?

      Fred @ http://www.veterinarytechnicianinfo.com

      • Devon Herrick says:

        Academic research has found little evidence that an annual physical for asymptomatic people is of any medical value.

        Here’s Zeke Emanuel writing in the New York Times, “Skip Your Annual Physical”. Here’s a quote,”There is only one problem: From a health perspective, the annual physical exam is basically worthless.”

        A couple years ago I was trying to get healthier, started going to the gym and began trying to lose some weight. The weight just fell off despite the fact I wasn’t really doing enough to prompt it. I decided it was time to see a doctor (for the first time in 10 years). I had some lab tests done, and found a new doctor since mine had long since retired. I scheduled an appointment and took the results with me. We basically chatted for a few minutes, the doctor told me to keep doing what I was doing. He ordered one more test and sent me on my way. He sent a bill to Aetna, who debited my HSA for $120, which was the cost of a new patient visit. It was probably good to get to know a new doctor, since I no longer had a primary care provider and had not seen one in a decade. But there’s no reason to go back year after year, and have the same conversation.

  7. Bob Hertz says:

    Devon, I do not know your age and the state you live in –
    but if you and your wife could get bronze plans for under $400 or $500 a month each, that might actually be cheap for Obamacare. At my insurance agency, we see states like Wisconsin where a 55 year old couple might have to pay $1200 in total for the skinny plans you describe.

    It is indeed dismaying to see that an insurer will collect $4800 a year from you and your wife in premiums, plus another $13,500 in two deductibles, before that insurer has to pay anything at all (except a few preventive services, and some drug copays.)

    And yet, the carriers which offer these policies are in many cases losing money. This was proven in the documentation they provided each state for rate increase requests (I have read some of these requests.)
    There must be a big influx of very large claims, which is the natural result of guaranteed issue.

    Let me make two other smaller points:

    a. Several conservative reformers have urged that the age ratios holding down premiums for older persons be scrapped. My gosh, if a 3:1 age ratio produces awful policies like the ones you quoted, then a 6:1 ratio will produce even worse policies for those over 50. I think this is very short sighted on the part of the reformers like Avik Roy.

    b. And Ron Greiner, what is this magic PPO plan that requires underwriting? I work with short term insurance that requires underwriting, and maybe that is what you are referring to. But I see a lot of health plans at my agency, and since 2010 there are absolutely no qualified plans that require underwriting. Let us in on the secret!

    • Devon Herrick says:

      a. Several conservative reformers have urged that the age ratios holding down premiums for older persons be scrapped. My gosh, if a 3:1 age ratio produces awful policies like the ones you quoted, then a 6:1 ratio will produce even worse policies for those over 50.

      That’s a good point. I’d rather have to go through medical underwriting than be subjected to an actuarial sound age band. But then, my wife and I have gym memberships, watch our weight and eat healthy.

      Something that might be a better compromise is guaranteed issue/community rated policies that only pay for care between $10,000 and $250,000. If you want coverage below $10,000 or more than $250,000, you would have to be subjected to underwriting and pay extra for the coverage.

      • Michael Gorback says:

        Between the age band compression and the gender neutrality the worst thing to be from an insurance standpoint is a young healthy man. The age band compression shifts the burden to younger people and the gender neutrality shifts the higher health care dollar consumption of females onto males. The lowest risk group is shouldering a disproportionate share of the financial burden. We have turned the concept of insurance upside down and inside out.

        • Ron Greiner says:

          Micheal, Obamacare raised the premiums on young women to be just 1/3 of 64-year-old men. Obamacare raised the cost of women over 50-years-old because now there is no gender discount for them. Women used to cost more than men until 50-years-old then men became more expensive. This is what I call Obamacare’s WAR on women.

          Micheal go to http://www.phcs.com and put in your zip code for a list of PPO medical network providers in your area.

          Devon, lets not REFORM the Life Insurance industry with your grand ideas of fairness. Younger people still cost less in Life Insurance, thank goodness. A 30-year-old female can purchase $1 million in Life Insurance that will pay up to 90% of the death benefit NOW for ovarian cancer for only $50 a month. See how cheap real insurance is? When we transform health insurance into a healthcare delivery system you can’t charge enough.

          It’s not fair that when a 30-year-old women gets ovarian cancer she can’t buy $1 million dollars of Life Insurance for just $50 a month when she needs it most. We need some government regulator to fix this problem.

          • Michael Gorback says:

            According to the data for 2010 at CMS, here are the cost distributions by age and gender:

            Males 45-64: 15%
            Males 65-84: 11.4%
            Males 85+ : 2.6%

            Females 45-64: 16.3%
            Females 65-84: 13.8%
            Females 85+ : 6.1%

            Per capita expenditures:

            Males 45-64: $8,154
            Males 65-84: $15,920
            Males 85+ : $31,670

            Females 45-64: $8,577
            Females 65-84: $15,805
            Females 85+ : $32,296

            Looks like older women consume more health care dollars per capita and in the aggregate.

            • Devon Herrick says:

              I’ve heard doctors say they often times don’t see middle-aged men until the man’s wife makes him go to the doctor.

              • Michael Gorback says:

                It’s like being trapped in a room moderating The Newlywed Game except with people who have been married for thirty years.

                Me: Where’s your pain?

                Man: The left leg.

                Woman: It’s the right leg.You’re always complaining about your right leg.

                Man: It’s my leg, I should know!

                At that point, I use the Shawshank maneuver. I have a secret tunnel behind a poster and crawl out through it.

            • Ron Greiner says:

              I would not pay attention to the CMS. I would look at the rates. I charge a 60-year-old woman $279 a month for health insurance and a 60-year-old male will cost $324 a month.

              Same is true for life insurance a 60-year-old male will cost more than a 60-year-old female.

              Maybe these actuaries pricing insurance products are wrong and the CMS is right but I don’t think so. It’s always been this way since I have been in insurance.

              I have some Doctor clients and boy were they confused until I came along. One had coverage with his group of docs that he would lose if he couldn’t work. Bam, immediately he had bone cancer and had a stroke in his 1st surgery. He was done working and would of lost his insurance so he is lucky I saved him. He lived in a bubble for 6 weeks TWICE and the total bill was $2.5 million.

              I have never met a doc that knew too much about health insurance. But I have met a bunch that knew nothing. They always put their own employees on health insurance that the employee loses if they become too sick to work 30-hours-per-week. But docs never care about that they only care about the price. Those employees are just second class citizens anyway.

              • Michael Gorback says:

                So your point about the CMS data is that if the facts don’t conform to the theory they must be disposed of.

                You only think you understand insurance. In reality you understand premiums, co-pays, deductibles and whatever, but that doesn’t really describe the product being sold.

                Health insurance is best described as an incomprehensibly complex moving target where you don’t know what you’ve bought until you try to use it.

                There is no way in the world anyone can know in advance what benefits they will need.

                You can’t know in advance what kind of cancer you’ll get so you can’t possibly know which chemotherapy coverage to look for.

                You find out that your coverage includes only 10 sessions of physical therapy with a $50 co-pay per visit AFTER you’ve had your stroke.

                You find out that the medication your doctor says you need isn’t covered AFTER it’s prescribed. Even if you check in advance to be sure that your current meds are covered by a certain plan, that can change at any time. I have had patients who have been stable on their meds for years suddenly receive a letter telling them they have to change to a different one. It happened to me with the BP medication I had been using for 6 years.

                Treatments that were covered last year might not be covered this year so if you need a repeat, too bad.

                It’s a Nancy Pelosi sort of deal: you have to buy it to find out what’s in it.

                • Ron Greiner says:

                  Micheal, you wrote, “So your point about the CMS data is that if the facts don’t conform to the theory they must be disposed of.

                  NO NO, I said that women cost less than men after 50 years old for health and life insurance and you whipped out these CMS stats which mean NOTHING, sorry.

                  I did notice how your so-called FACTS included 45 – 50 year old women that messed up your argument. Couldn’t you find CMS “facts” about women over 50?

                  • Michael Gorback says:

                    Once again, your argument boils down to unsubstantiated claims that the CMS data are bad.

                    I note a complete failure on your part to provide data to the contrary other than what you charge people.

                    I didn’t deliberately include women under 50. CMS provided the age brackets as 45-64. As an approximation for age 50 it serves pretty well,

                    • Ron Greiner says:

                      OK Mike, name one insurance company that charges more for a woman at 55 years of age than a man the same age.

                      Good luck Mike.

                      I’m sure the CMS has all the data and stats you need.

                      Next you will say that the men are just falling over dead before they get to the hospital so that is why women are using so much more healthcare. It should be illegal for docs to talk about insurance.

                      Maybe it’s Mutual of Omaha that is charging women more for life insurance Mike.

                    • Michael Gorback says:


                      The plural of anecdote is not “data”.

                      Still waiting for your DATA.

          • Devon Herrick says:

            Ron I wasn’t referring to life insurance. Proponents of the PPACA backed it because they thought it an injustice that people in poor health could not buy “affordable” coverage. Their solution was guaranteed issue/community rating, sliding-scale subsidies and an individual mandate (to force young healthy people to overpay for health plans so the sick could get a better deal). The result was insurance that is only a good deal if you are very sick. My point was that instead of requiring guaranteed issue/community rated policies with unlimited benefits, a compromise could possibly be that only a small portion of a health plan’s benefits be guaranteed issue/community rating. The benefits below a $10,000 deductible would be risk rates, while the benefits above $250,000 would be risk rated.

  8. Izzy says:

    I’m trying to find out if there are any other married couples out there who can not get a tax credit (subsidy) because they can not file jointly?

  9. Izzy says:

    My husband and I are in the correct income bracket to receive a tax credit, but can’t because we have to file separately. If I can prove what our incomes are, why do we have to file jointly?

  10. Izzy says:

    Additionally, my husband and I are in our 60’s. We were both unfortunate to lose our careers with medical benefits. Now we find it albeit impossible to be hire at our ages in the typical 9-5 jobs we easily captured in our 40s and 50s. I feel like we are in a “medi-gap”…waiting for Medicare, squeezed because we have less income ( I have a temp job without benefits and he is waiting indefinitely for disability ), and denied the subsidies for reasons I’d rather not disclose, are unable to file together ( second and third marriages…you know, old people baggage…prenups, marital asset problems, etc. ) Obamacare was supposed to allow us to work at jobs we could find, and allow us to live somewhat comfortably with affordable premiums. Without the subsidy, our payments are over 1,200 a month, which we can’t afford. Why can’t single people, or people who file separately, be on Obamacare? Why are they so narrow in their categories of who qualifies for the tax credit?

  11. Barry Carol says:

    There are a number of things that bother me about this debate and string of comments. First, we have resentment among healthy people about the cost of health insurance even with a high deductible when they rarely need to visit the doctor. Their attitude is what the heck am I paying for when I almost never need to visit a doctor? Then we have older people complaining about age rating even though the 3 to 1 rating limit under the ACA doesn’t fully reflect their actuarial risk. Finally, there is the issue of why anyone other than women of childbearing age should have to pay for maternity benefits.

    I get that under medical underwriting, healthy people can buy health insurance for a lot less than they can under the ACA’s community and guaranteed issue rules modified by age and smoking status. Under underwriting, young healthy people can even buy a mini-med plan and pay next to nothing for a policy that covers next to nothing. There is no question that medical underwriting is a great deal for the healthy until it isn’t. Even young people can get a cancer diagnosis or break their neck or back in a diving, skiing, car or motorcycle accident. They can develop an alcohol or drug abuse problem and require expensive rehab. They can develop mental illness. Once any of those issues appear, insurers will no longer be interested in selling you a policy except maybe at an astronomical premium that nobody but the very wealthy could afford. Then what?

    As for young women of childbearing age, it’s not the maternity care per se that’s so expensive but the huge cost of caring for low birthweight premature babies, especially multiple births. These costs can easily run into the seven figures. We could provide maternity care for less by using nurse midwives and maternity clinics like the French do, but the baby probably won’t make it if a NICU is needed quickly. We have that access in the U.S. but it doesn’t come cheap.

    If healthy people were prepared to say that if they buy a cheap underwritten plan and then get sick and can no longer afford the premium or pay for their care out-of-pocket, they will just be allowed to die because of their choice, that would be one thing but we don’t do that in this society. I think the healthy significantly underestimate the consequences of being wrong when they argue for being allowed to buy a cheap underwritten plan.

    The only viable alternative to the ACA model, which includes subsidies up to 400% of the FPL income level, for the sick to get affordable insurance is through heavily subsidized assigned risk pools. However, as noted in the past, politicians were never willing to spend the money that it would take to make them work as it would be expensive.

    In the meantime, we need to find ways to reduce the cost of actual healthcare. That means price and quality transparency tools, sensible tort reform that can hopefully reduce defensive medicine and better choices around end of life care. Instead of complaining about the ACA and greedy insurance companies, we should be focusing on ways to reduce the cost of care. If we do that successfully, the cost of health insurance will follow.

    • Ron Greiner says:

      Barry, you said, “If healthy people were prepared to say that if they buy a cheap underwritten plan and then get sick and can no longer afford the premium or pay for their care out-of-pocket, they will just be allowed to die…”

      You Obamacare people are confused. Everybody I have ever sold health insurance to have been medically underwritten since 1987. Nobody has ever lost their health insurance because it was Individual Medical (IM) that doesn’t TERMINATE insurance because they were too sick to work like employer-based health insurance does.

      Pasco County School Board is selling Life Insurance to the teachers that they lose if they become too sick to work. I meet with them on Tuesday and you can bet that I will point that out to the lawyer that is the head of HR. I will also point out that I looked her up and she is not licensed to sell insurance. Then I am going to point out that charging a poor teacher $720 a month to add a child to the school’s PPO is ABUSIVE. But they have Blue Cross of Florida Inc so you have to expect that sort of thing from that non-profit.

      • Barry Carol says:

        Ron – What good is individual medical coverage if you get too sick to work and can no longer afford the premium? Are you telling me that the insurer will waive the premium in that case? Also, if you can’t pass underwriting or have a disease or condition that results in an unaffordable premium, that isn’t worth much either. Is it? I’m glad you’ve had a successful career selling health insurance to people who can pass underwriting but what about those who can’t or who could pass it before but can’t pass it now? When you are diagnosed with a serious disease or condition or are badly injured in an accident is when you need insurance the most. Just as we can’t buy fire insurance after our house burns down, we should buy health insurance before we need it and, if we get too sick to work and can no longer pay the premium, subsidies should kick in to help.

        Under the ACA, young and healthy people are shunning coverage in droves and paying the modest penalty instead because they don’t think it’s worth the money and they would rather spend their income on other things. At the same time, if they get sick, they know they can buy a guaranteed issue exchange plan during the next open enrollment period. That’s why there is so much adverse selection in the exchange plans.

        • Ron Greiner says:

          Barry, you said, “I’m glad you’ve had a successful career selling health insurance to people who can pass underwriting but what about those who can’t or who could pass it before but can’t pass it now?

          I used to run the largest agency in the United States for TIME Insurance Company, America’s oldest health insurance company in 44 states, more than any competitor. Then the tax-free Medical Savings Account (MSA) was passed and I wrote the 1st one, a 24-year-old paying $24 a month. That was 19-year-ago last month. To this day I have NEVER made a penny on an MSA or HSA because they are FREE. I didn’t get rich driving 5 hours to sign up a 30-year-old couple with 2 children for $78 a month. But, it was the right thing to do.

          PHD Devon Herrick says that Golden Rule wrote the 1st tax-free MSA but that’s not true. Golden Rule didn’t have their plan on the streets until December of 1996. TRUST ME, I have not gotten much glory for setting thousands of people tax free and saving them with Individual Medical (IM).

          My own son was diagnosed with Crohn’s Disease at 17-years-old. He had a $250,000 surgery last year at 31-years-old and he has the same plan as he had at 17. Even dependents could keep my health insurance because we didn’t TERMINATE them at 26 like everybody does today because of OBAMACARE. By the way, in that surgery they brought in a doc that was out of network and he billed $35,000 for his 2 hours. Lucky my son had insurance that paid out-of-network charges unlike these HMOs that Obamacare is forcing everybody into.

          My 1st tax free MSA in Chicago got ovarian cancer 1 month after I enrolled her and it took 4 years for her to die. She is so lucky she didn’t have to work 30 hours a week to keep her health insurance. I have saved a lot of people Barry.

          I think I’m going to give the Pasco County School Board’s top guy on health insurance an award for the highest priced health insurance for children in America. They are charging these poor teachers living paycheck to paycheck $720 a month for 1 child and $1,168 a month for 2 children. What is funny is the head guy runs the Blue Cross of Florida Inc agency in the county, too funny.

          Trust me again Barry, if my son didn’t have health insurance at 17-years-old and we were strapped financially and couldn’t send his older sister to college, because of his medical bills, he would have killed himself. I was really worried back then because this Crohn’s never goes away. You wouldn’t believe all of the children that have gotten sick that I have insured and still have their coverage. I just talked to one in IOWA and it’s an old MSA and the kid today is in a wheelchair. His Mom is worried because their best doctor they like is in Minn. and TIME is closing up shop because Obamacare has KILLED America’s oldest health insurance company. That was the plan though wasn’t it?

          • Barry Carol says:

            Ron —

            For the record, I have no problem with MSA’s as long as the employer health insurance tax preference remains in place. If it were up to me, though, I would get rid of the preference, lower other rates to make the tax change revenue neutral, and everyone would buy health insurance with after tax dollars. I would also point out that many lower income people probably can’t afford to contribute to an MSA. There is clearly a role for premium subsidies, in my opinion.

            Second, perhaps you could flesh out how underwritten insurance is priced. Let’s say 10,000 or 20,000 people pass underwriting and buy a similar policy in 2015. Are they age rated to determine their initial premium and does that population become a block of business for which the premium will increase each year based on the experience of the block? Is it guaranteed renewable no matter how sick you are or how high your medical bills are?

            Third, regarding Southern Florida, my understanding is that there is a culture of very aggressive treatment there which drives up healthcare costs. In the case of the Medicare and Medicaid programs, there is also lots of fraud. Medicare’s per capital spending in Miami-Dade County, FL is, by far, the highest in the country. So, I think the medical community has a lot to answer for in that geography.

            Finally, regarding shedding sick people or making it unattractive for them to sign up with your company in the first place, there was a recent article in Health Affairs on this. Some carriers will deliberately not contract with the best cancer and heart centers. For other conditions that cost them too much, they deny or postpone care and maybe provide deliberately lousy customer service. Drug and alcohol abuse and mental illness fall into this category. Since the risk adjustment mechanism in Medicare, in the end, still overpays for the healthy and underpays for the sick, carriers have an incentive to try to game the system any way they legally can.

            • Ron Greiner says:

              Barry, you won’t like Marco Rubio then. Marco said, “One that puts you in charge in your health insurance decisions, not the government. Or not at the mercy of an employer.”

              Rubio did further assert, “Why are they fighting so hard? Why do they do so much advertising for your auto insurance business?

              Because who controls your auto insurance purchases? [[Does your employer control it?]] Does the government control it? You control it. And so now there are going to be hundreds of millions of Americans who control their own healthcare purchases.”

              Barry, every single parent mother is paying payroll tax on every dollar earned. There is no payroll tax on employer HSA deposits. Money that is never taxed will last longer for medical, vision and dental expenses for her and her child.

              I had a woman employee walk up to me and say, “I have more money in my HSA than all of my other bank accounts added together.” I asked her how much she had in her HSA and she said, “$10,000.” I then asked her how much she had in all of her other bank accounts and she sad, “Nothing.”

        • Michael Gorback says:

          One of the nasty tricks I’ve seen insurers play with underwriting is when a patient starts to be too expensive. Then they request medical records from every doctor and sift through them trying to find something the patient didn’t disclose so they can void the policy. I haven’t seen that in quite a while but for a few years I saw it several times a year.

          I think young healthy people who decide to forego coverage are just playing the odds on a cost-benefit consideration, but as the saying goes, hope is not a strategy.

          Its not true that if they get sick they can just wait until the next enrollment period. Not many illnesses are that cooperative. If you have new onset diabetes your blood sugar isn’t going to wait for coverage, nor will the knee you blew out playing soccer.

          I understand the concept of trying to keep people from gaming the system by limiting the enrollment period but this is like the police raiding a hotel and arresting the good girls along with the bad. It punishes people who have benign intentions.

          I’ve had patients who lost their jobs, couldn’t make their premium payments and lost health coverage, who subsequently found new employment but were locked out of health insurance until the next enrollment period.

          When I became incensed with my insurer I wanted to change policies but had to wait months for the next enrollment period. ObamaCare prohibits two willing private parties from entering into a contract at any time other than that window.

          • Ron Greiner says:

            You are correct Mike. If these hospitals in Florida get their hands on an uninsured child they will bill 10 times more than a child with insurance. When Donald Trump says it’s impossible to hit Obamacare deductibles he is confused because an uninsured child will fly by $10,000 in expenses the 1st day in the hospital.

            I enrolled 2 docs in Colorado on the same day. One got Bone Cancer 22 months after his start date and the insurance company looked at his medical records and everything was fine and they paid out $2.5 million. The other doc, my best friend, got throat cancer 3 months later which was after the 24 month look back period for rescinding the policy so they didn’t even look at medical records and his treatment only cost $250,000.

            I have never had a client lose their health insurance but I also didn’t lie on the application. I just look at them when they are un-insurable and say, “Sorry, I can save everybody else in the family but you have to look at more expensive options.”

            • Michael Gorback says:


              These people didn’t lie on their applications. They forgot minor things in the remote past.

              I’ve done that myself when providing my history to doctors and I have seen it countless times when taking a history. But for insurers it’s a golden “gotcha”.

              You’re technically incorrect about the hospital billing. Hospitals bill everyone the same; what’s different is what they try to collect. If you have your appendix out the bill will be perhaps $20,000. If you’re uninsured they’ll try to collect the full amount. If you’re insured they do a contractual write-off.

              Until you hit your deductible insurance is really nothing more than a third party negotiator that haggles down your prices in advance.

              I don’t recall Trump saying hitting your deductible is impossible. What he did say – with typical florid Trump rhetoric -is that you’d have to get hit by a tractor before your deductible was met.

              Now, the liberal MSM had a field day mocking Trump for thinking you need to be hit by a tractor, but everyone else knew exactly what he meant.

              • Ron Greiner says:

                Mike, you wrote, “These people didn’t lie on their applications. They forgot minor things in the remote past.”

                So, no insurance agent has EVER lied on an insurance application to make a buck or two, lol. Is that 100% of the TIME?

                I spent 5 days in the hospital and the bill was $57,000 until it was repriced and dropped to $7,000. These hospital CEOs need to be behind bars. They sell their debt to collection agencies who use computers to call and call these poor uninsured people and force them into bankruptcy. It’s price discrimination and you probably are doing it too Mike. You just keep telling yourself that it is ethical but I won’t buy into that faulty thinking.

                Donald Trump has been selling health insurance to Florida employees (young women) that if they get cancer, lose their hair, he just slams them on a Short-Term-COBRA for insurance TERMINATION and laughs all the way to the bank. Like Trump says, “I’m just using the law!”

                Mike, don’t all of TRUMPS Florida employees lose their health insurance when he screams, “You’re FIRED!”?

                The law says he can sell health insurance to his own employees with non-licensed HR BOZOS without Full and Proper Disclosure. A licensed insurance agent is required to provide Full and Proper Disclosure and anything short is a serious ETHICS violation.

                I’m not saying that all pain management docs are bad apples but there are a few that get people addicted, like Rush Limbaugh, and some (lots) patients end up dead. We have way too many of them here in Florida.

                Trump likes tax free HSAs though. Somebody told him to say that.

                • Michael Gorback says:


                  You would know better than I would if there are dishonest insurance salesmen. If there are salesmen who deliberately lie on applications as you imply that’s not unexpected. Liars cone from all walks of life.

                  I haven’t called you out when you said doctors are ignorant about insurance and that they screw their employees on their health plans. But now you are impugning my ethics and accusing me of price discrimination because I am legally bound by contracts YOUR industry sells through PEOPLE LIKE YOU. The hypocrisy is overwhelming.

                  Why is it price discrimination on MY part when I am bound under contracts from YOUR company by products YOU sell?

                  Your comments about pain doctors are irrelevant to this discussion and yet another of your gratuitous insults against physicians.

                  I gather you think you are Doing God’s Work and “saving lives”. Well I’m not a theologian so I won’t address your Blankfeinian fantasies but I do know what saving lives looks like and you are not doing any of it.

                  • Ron Greiner says:

                    Calm down Mike. You did not sign a contract with my company so that’s not true. Just another of your statements that are not true.

                    I did not make you sign a contract to bill uninsured people more than your Blue Cross contract. You did that all by yourself Mike.

                    I have a very good 54-year-old friend, a doctor, who is now in a nursing home because of pain medication. He went through a lot of people like YOU. My father spent the night in the hospital before a Medicare surgery and when the bill arrived he asked the doc why there was a list as long as your arm for medications when he took nothing. The doc said, “Why do you care?” My father said, “Because you are stealing from my country.”

                    I’m still waiting for you to produce the name of an insurance company that charges 55-year-old women more than 55-year-old men for either health or life insurance.

                    When it comes to insurance don’t ever get so confused that you think that the stuff you spew is as relevant as somebody who actually knows what they are talking about.

                    When we have clients that are not getting their medical expenses paid we have to research it for them. Usually, I kid you not, it’s the doctors office sending all claims to Blue Cross no matter what insurance company the client has. I have had to deal with a lot of doctors’ offices and I know exactly how PEOPLE LIKE YOU operate. Compared to the holy doctor the rest of us are second class citizens.

                    • Michael Gorback says:

                      This goes beyond your usual level of ignorance. I do not bill anyone more or less. Everyone gets the same charge. When I send my bill to companies like yours they take a contractual writeoff. These are products YOU sell. If you believe these arrangements are unethical why do you enable them for a living?

                      Your friend is not in the hospital because of people like me. It beggars belief that you can say such stupid and outrageous things about people you don’t know.

                      It’s obvious you have issues with physicians but try to keep your personal baggage out of the discussion.

  12. Bob Hertz says:

    Regarding Izzy’s comments about unaffordable health insurance for persons over 60:
    A single person making $40,000 a year can get a subsidy of about $200 a month. This would lower the net cost of a $550-month silver plan to about $330 a month…not too horrible I would think.
    But the subsidies have these hideous “cliffs” built in.
    At about $47,000 the subsidy is zero.
    A person making $47,000 has after tax income of about $3000 a month. Paying $550 a month for a health policy that has a $3000 deductible may be impossible if the person is still renting, has car payments, child support obligations, et al.

    Not that I am in love with ObamaCare, but this dilemma is fixable. Just let the subsidies decline slowly and take away the “cliff.” My understanding is that the federal government is spending less than $20 billion a year on subsidies, since the exchanges are not as popular as projected. If taking away the “cliffs” costs an extra $6 billion a year, we should do it.
    Republicans will resist this, because they want to see the ACA go down in flames. Democrats in some cases seem too dense to propose this, as it sounds like ‘welfare.’

    One last comment on the whole issue: the ACA designers like Jon Gruber knew full well that premiums in the individual market would go way up with guaranteed issue and guaranteed maternity benefits.

    But Gruber especially sat behind his own Cadillac employer-paid policy at Harvard or MIT, and said that subsidies would ease the pain. The assumption in Washington was apparently that someone making $47,000 a year is rich enough to handle any kind of health insurance. In many parts of the USA, that is painfully untrue.

  13. Bob Hertz says:

    One quick amendment — a single person aged 62 csn get a subsidy of $200 a month. A younger person making $40,000 a year may not get a subsidy at all.

  14. Barry Carol says:

    Correction: I meant to say high risk pools, not assigned risk pools.

  15. Barry Carol says:

    Bob – I agree that the income limits for health insurance subsidies should go, especially if we could do it for a relatively modest $6 billion per year.

    Interestingly, a lot of workers with comprehensive employer provided health insurance, especially in the public sector and the old line private sector unions, are effectively paying significantly more than 10% of their income for health insurance but they don’t know it because they don’t feel it. That makes if OK I presume even though the amount the employer is paying on the employee’s behalf is now disclosed in Box 12c of their annual W-2 form. There is also huge resistance to any concessions on that front from both the United Autoworkers Union and the United Steelworkers Union. Apparently, they value their health insurance very highly.

  16. Izzy says:

    Thank you Bob H. for clarifying what a single person can receive in subsidies. Perhaps if and when my husband receives disability, I can have an individual plan for myself. However, it does not address the problem of filing separately. I was just curious if other couple have the same problem.

  17. Ron Greiner says:

    WRONG Mike – I love doctors. One saved my son’s life last year. My best friend is a doc. I told you about my 54-year-old doc friend in the nursing home because of pain meds. Dr. Lee Heib, past president of American Physicians and Surgeons (AAPS) is a friend of mine. It was the AAPS VS Clinton lawsuit that stopped HillaryCare in the 90’s. Dr. Edward Annis was a Florida surgeon who served as president of the American Medical Association and as president of the World Medical Association. He was one of the most foremost critics of the United States Medicare program. Dr. Annis was on the board of my family’s company Physicians Planning Service (PPS)on Madison Avenue in New York. My little brother was in charge of the loan program to the docs and little George, my nephew, said the Dr. Annis was like a father to him after his dad died.

    Dr. Annis debated JFK on Medicare in Madison Square Garden and won. He correctly predicted, ” “This bill would put the government smack into your hospital, defining services, setting standards, establishing committees, calling for reports, deciding who gets in and who gets out, what they get and what they do not get, even getting into the teaching of medicine.” “And it will serve as a forerunner of a different system of medicine for all Americans.” (socialized medicine).

    JFK lied and said that Medicare has nothing to do with doctor’s bills it only pays hospital bills. Dr. Annis said, “The public is being BRAINWASHED!”

    Watch the JFK VS Dr Annis Madison Square Garden Smack-down


    • Barry Carol says:

      Ron —

      In the early 1980’s Princeton professor, Paul Starr, wrote the famous book, “The Social Transformation of American Medicine” which chronicles the history of medicine in this country from revolutionary war times until the early 1980’s. In it, he describes the guild mentality among physicians with their lobby attempting to stifle competition at every turn for decades. Even today, there is plenty of physician resistance to, for example, allowing nurse practitioners to practice at the top of their license without physician supervision. They are also not too enthusiastic about retail store clinics staffed by NP’s either. The AMA, which far fewer doctors actually belong to these days, still has plenty of political power in Washington on medical issues.

      As for the passage of Medicare and Medicaid in 1965, it’s important to note that the marketplace wasn’t serving seniors very well as many were poor and couldn’t afford a lot of healthcare or health insurance for that matter. Moreover, there wasn’t nearly as much that medicine could do for us patients as compared to today. I would have long since died if all I could access was the medical technology that existed in 1965 for the treatment of heart disease. There have been huge advances in technology from medical devices to imaging equipment to prescription drugs. Hospitals in this country no longer have open wards as far as I know and the trend in new hospital construction is toward single rooms which reduce infection rates and improve the healing process. All of that comes at a pretty high cost.

      While I’m all for high deductible health insurance plans for those who can afford them as well as Health Savings Accounts for those who can contribute to them and I think at least the upper half of the income distribution should be able to pay for most of their primary care out-of-pocket, people need health insurance for the big stuff and for most hospital based care.

      I have no idea what you think health insurance should cost, especially for people 50 and older who have health issues. For example, I had a quintuple CABG in 1999 and my gall bladder removed in 2000. That was followed by a TURP in 2004 and a DES in 2005. Suppose I applied for health insurance through your firm in late 2005 at age 60. With my medical history, I would have been declared uninsurable and you would have wished me good luck. But hey, a healthy 30 year old couple with a couple of kids could buy an underwritten family plan for a very reasonable price. The free marketplace is really great except when and until it isn’t. By the way, I always had very good employer provided insurance until I retired at the end of 2011 by which time I was eligible for Medicare. Without Medicare, the free marketplace wouldn’t have had any interest in insuring me after I retired unless they could charge a huge premium which I probably couldn’t afford to pay.

  18. Ron Greiner says:

    Barry, if you have no gall bladder you should be cheaper because the docs will never be able to remove it again. I suspect on Tuesday we will hear the Republicans talk about how to fix Obamacare. Bush, Cruz, Rubio, Jindal and Santorum all have a clue. I don’t know why Rand Paul has not mentioned Obamacare in months. Cruz and Rubio are starting to demonize employer-based health insurance in a very soft way. They say your employer doesn’t choose your auto insurance and neither does the government. Cruz comes right out and says he wants to de-link health insurance and employment.

    No matter who wins a Republican President will sign legislation that will include age-based tax credits for everybody with no mandates and people will be able to purchase any kind of health insurance that they want. Tax free HSAs should be de-linked from insurance so everybody can save for future healthcare expenses. The amount that may go into a tax free HSA will be increased to $7,000 for a single and $14,000 for a family that goes up by CPI exactly like the current law. They will throw in billions for those people that don’t qualify for medically underwritten insurance.

    Then insurance agents in the future will be able to whip out their laptop and say to a family, “With your tax credit you can have ZERO COST health insurance with a $2,774 per person deductible on sickness and a $100 deductible on accidents. You can have a $50 co-pay on Doctor Office Visits but that will cost you $88 a month, do you want to add that on?” The prospects always say, “NO,” when the program gives them that choice and they know how much it costs. This is much cheaper for the Feds than employer-based coverage today plus everybody gets tax relieve instead of just those with employer-based coverage like Donald Trump.

    Employers pay no payroll tax, workers comp or unemployment on HSA deposits so they love them when they figure them out. It’s compensation without taxation. So employers get out of the health insurance business and into the tax free HSA business where they belong.

    Then when your grand child gets married at 25 and they have $14,000 a year going into their tax free HSA with a mutual fund option they will be much better prepared for 21st Century Medicare than us Baby Boomers showing up today with a big fat ZERO balance.

    Don’t expect any Republican on Tuesday to say, “Republican healthcare reform targets wealth to the poor!” Or, “With a Republican administration America’s middle class will save premium, eliminate taxes, build wealth and become empowered!” Or, “HSAs have tax free deposits, growth and withdrawals, AMEN! Total tax FREEDOM”

    They will get better by the TIME they are debating Hillary.

  19. Bob Hertz says:

    Who is going to put in the $14,000 per year for the 25 year old grandchild? Plenty of 25 year olds barely earn $14,000 in wages, much less HSA bonuses.

    Actually I like the drift of Republican proposals for age based tax credits. The ACA’s current attempt to link the credit to one’s precise annual income has been awful. This is what made the exchanges so cumbersome to use in 2013, and it leads to repulsive income recaptures on tax returns for those who got “too much” in subsidies.

    But if I remember, the ACA alternative plans by Coburn and Hatch and others had some pretty small credits in mind, which is understandable given the national debt. By small I mean about $1,000 a year for young persons, tiering up to $2500 a year for older ones. Ben Carson I believe proposes
    $2000 a year.

  20. Ron Greiner says:

    Bob, I didn’t say Grandparents make the HSA deposit, geez. In New Hampshire the Community College System is spending $2,624 per month to Blue Cross for family GROUP insurance. That is $31,488 a year for a 25-year-old employee with a spouse and baby. The IRS loses payroll tax and income tax on this over-priced insurance, about $10,000 a year. The age-based tax credits for this family would be about $4,000 ($1,500 each for the parents and $1,000 for the child). So, the IRS saves $6,000 and the employer saves $31,488 a year but Blue Cross (The Giant Fascist Monopoly) loses everything. So be it.

    The employer doesn’t pay payroll tax, workers comp or unemployment tax on HSA deposits so they would prefer to make compensation in the tax free HSA than on the paycheck. The employee earns these funds tax free. So the employer makes the tax free HSA deposit and not the Grandparents and the employer cost is dropped by more than 50%.

    I can sell a 30-year-old couple and a baby insurance for $3,120 a year. So the age-based tax credit is more than enough to pay 100% of the Individual Medical (IM) health insurance cost. You are at the NCPA and you should know this but the PHDs here are a little slow on explaining Republican healthcare reform.

    Too bad we don’t have a Republican Presidential candidate that would say, “Republican healthcare reform will lift the heavy burden of health insurance off the backs of America’s employers and the economy will EXPLODE like never before!”

    I hope I went slow enough for you Bob.

    I knew about Republican Healthcare reform before I enrolled America’s 1st tax free MSA in October 1996. I asked the VP of HSA Bank on Friday what he thought of Ben Carson wanting to give every newborn in America a tax free HSA and he said, “Ron, I have no idea what he is talking about.” I said to him, “Ben thinks newborns have a tax problem.” I also said, “Isn’t it strange that no reporter asks him about his newborn HSA proposal?”

    This VP of HSA Bank always says, “Tax free HSAs turn high health insurance premiums into assets for employees.”

  21. Barry Carol says:

    Ron –

    You make it sound like Blue Cross is making extortionate profits from covering the NH Community College employees and their families. Assuming the insurance plan is experience rated, they aren’t as I’m sure you know. The group probably has lots of middle age and older employees many of whom have significant medical issues and claims. Every group has plenty of people who need little or no care in any given year and a small percentage of people with very high claims. Even within Medicare, the healthiest 50% of seniors account for only 4% of costs in any given year.

    You make the point over and over that young healthy people who can pass underwriting can buy a cheap insurance plan relative to what a community rated employer plan costs but you never address what the older and sicker people are supposed to do. It’s not like the NH Community College group is just going to give every employee a voucher equal to its average spending per covered life and tell them to go into the private market if they want or stay with the employer if they want. It would probably double their costs after all the healthy folks take the voucher and all the sick people stay with the current plan. That’s why they can’t and won’t do it.

    Health insurance has to work for everyone, not just the young and healthy plus healthy older folks who can pass underwriting who are all you seem to care about. We never hear any constructive ideas from you on how to cover sick people who had insurance and lost it or never bought it in the first place because they couldn’t afford it. A health insurance system that doesn’t work for the folks who need it most is an embarrassment. The tax credit idea, by the way, would be a cruel joke in an underwritten market especially for older and sicker people.

  22. Ron Greiner says:

    Barry, I didn’t say that NH Community College gives vouchers like you said. I said the Feds give age-based tax credits and NH Community College pays NOTHING for health insurance and instead makes tax free HSA deposits into the employees’ account at the bank. The older you are the more the “age-based” tax credit is. I also said, “They will throw in billions for those people that don’t qualify for medically underwritten insurance.” A 60-year-old couple would get $6,000 age-based credit ($3,000 X 2) to purchase insurance. I sell a 60-year-old couple for $6,960 a year so they will have to pay the additional $960 a year or $80 a month. Remember, the NH Community College is putting $14,000 a year in this 60-year-old couple’s tax free HSA so the employer has still reduced their cost by over 50%. If one of the 60-year-olds is sick then they will have to go to the High Risk pool and pay more, sorry. Or, they might choose a higher deductible. Or, they may say I don’t want maternity coverage and I don’t want MENTAL health to reduce my premiums.

    You Barry want to maintain and old WW-2 system that has failed. You want rich people like Donald Trump to get a 100% write off on his over-priced health insurance and the poor Pasco School teacher living paycheck to paycheck that has to purchase her coverage for children with after tax dollars and get no federal tax relieve at all and turn around and say that the current system is fair. This young poor teacher with uninsured children is paying an IRS fine and Medicare tax on every dollar earned so rich fat cat millionaires can float on their boats and scarf down free drugs on Medicare.

    Here is what Senator Marco Rubio just said in NH: “You can buy any health insurance you decide you need from any company across state lines that will sell it to you. That is a much better approach than this government¬ mandated system. One that puts you in charge in your health insurance decisions, not the government, or not at the mercy of an employer… Because who controls your auto insurance purchases? Does your employer control it? Does the government control it? You control it… We have no competition, no choice, no innovation, and the result is what you’re facing.”

    You just want young people to pay fines, be uninsured, and pay taxes for your Medicare like slaves.

    By the way, Anthems stock price in 2009 before Obamacare was $36 a share and this year it was $167 so you won’t have me crying over them. Just like the slave owners in the past were disappointed that they had to free the slaves after the Civil War you will be fine if today we free the young from over-paying to keep the giant fascist monopoly of Blue Cross from rolling in the dough.

    Young people need to show up to Medicare in the year 2060 with $5,000,000 in their tax free HSA because by then they will probably be able to do brain transplants and it may be an uncovered expense in Medicare.

  23. Barry Carol says:

    Ron –

    I’ve consistently said dozens of times for years that I support eliminating the employer health insurance tax preference. Lower income tax rates, raise the standard deduction and adjust the Earned Income Tax Credit to ensure that the change is revenue neutral. I don’t care about Trump and the change would have cost my family several thousand dollars per year in extra taxes while I was still working but I still supported it unlike most people who oppose changes that would affect them negatively. I also pay the IRMAA Medicare surcharge by the way which I’m OK with.

    I think people should pay for health insurance with after tax dollars just like they pay for auto, homeowner and umbrella liability insurance with after tax dollars. They should have regular savings accounts to handle unforeseen expenses including medical expenses with the deductible and coinsurance within the OOP maximum along with unforeseen car and home repairs and whatever other curve balls life may throw their way.

    I want a broad income tax base with the lowest possible rates. Like Carly Fiorina says, “Lower every rate and close every loophole.” A broad base and low rates improve both the allocation of resources and economic growth. With faster growth and more jobs, more people could afford health insurance without all these crazy schemes.

    We already have 401-K accounts which help people save for retirement and replace defined benefit pensions which are disappearing at least from the private sector. If we push Health Savings Accounts, where does it stop? How about House Savings Accounts and Car Savings Accounts and Furniture Savings Accounts?

    If we were starting with a clean sheet of paper, we would probably wind up with an insurance approach similar to what the Swiss have. Everyone buys their own insurance policy without a tax preference, there isn’t huge choice in the scope of coverage and premiums are community rated. I could live with it but I’m sure you and many others couldn’t.

  24. George Thomas says:

    The tax subsidy is based on the second lowest cost silver plan(SLCSP). According to Kaiser, Only 2 states will have an increase in the SLCSP greater than 10%.


  25. George Thomas says:

    My mistake. That was the 2014 to 2015 increase. I will post 2015-2016 increases as soon as I find them.

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