2y ago

GOP push to get more Americans into high-deductible health is dividing Democrats

www.politico.com

For thrifty consumers, there’s a lot to like in high-deductible health insurance. The plans offer low monthly premiums and those fees fully cover preventive care, including annual physicals, vaccinations, mammograms and colonoscopies, with no co-payments.

The downside is that plan participants must pay the insurers’ negotiated rate for sick visits, medicines, surgeries and other treatments up to a minimum deductible of $1,500 for individuals and $3,000 for families. Sometimes deductibles are much higher.

Let’s keep it civil.

16 comments

- That's the most infuriating part. You pay for it no matter what. You're gambling that you won't get sick and you can keep yourself healthy. But the thing this always ignores is the human body ALWAYS breaks down over time. We all need healthcare at some point, whether it's for a surprise tumor, a pregnancy, or just getting old. You can do everything right and at some point you will still need to engage the system, either for yourself or for a loved one. You're still going to pay for it.
  But heaven forbid you pay for it out of your (shudder) taxes.

Let’s keep it civil
Oh, in that case I don't have a comment on the American healthcare system.
- Oh, you scoundrel.
  Seriously, this is one of those topics that can head South quickly, since the legislation on its face is helpful to people with these plans because it expands coverage. On the other hand, the overall situation is ripe for abuse. I can already see the GOP pushing these on folks who can’t afford the deductible as a ‘solution’ and then use it as an excuse not to consider any real reform. It is understandable that Dems are split.

Wow, the number of comments that are just "oh, yeah, these are great, I have one" is... Wow...
No wonder you guys are fucked. Too many of y'all are spending your time supporting shit like this when you could be screaming about single payer, like the rest of the developed world has.
- I mean. yeah single payer is nice, however that's really not even on the horizon for the US. For most Americans, especially those who actually have to know how to fully utilize their insurance (if lucky enough to have it), there's no benefit for them to worry too much about a single-payer or socialized system. They have immediate needs and immediate solutions. They need to get their prescriptions, their surgeries, and their doctor's appointments. It's not "supporting" it, as so much as it is the devil you know.
  Practically speaking, compared to standard PPO/HMO insurance, HDHPs are pretty good. If you are low-maintenance health-wise, you don't pay for your physical, are going to spend maybe couple hundred bucks on sick care and maintenance meds. If you have chronic illness, you will only pay the deductible before your care is 100 percent covered, so a hospital stay would be enough to meet your out-of-pocket max, and everything else is covered 100% by your insurer (whereas the traditional plans have 6-10k limits, the HDHPs are much lower at 1-2k for a person and 2-3 for a family). Especially with HSAs, which are savings/retirement accounts for medical expenses, that some employers will pay into, so basically free money to pay copays, prescriptions, even stuff like aspirin and bandages.

I have an ACA high deductable plan. It is like a no brainer for me. In my state if you pay full cost, it comes down to how you want to phase in costs. High deductable is cheaper if your healthy or if your are very sick and reach the out of pocket max. In between it will depend on your exact details.
- My girlfriend just got on a high-deductible plan for the first time and it's the worst plan I've ever seen due to her need for many medications. She changed jobs which is what triggered it and the new plan means her real new income is much less than her old, which we were not expecting since plan details were not available during recruitment. Feels like a bait and switch.

I thought that high-deductible health insurance plans were already the norm.

These are smart plans. They usually come with an HSA and most employers contribute to it. Combined, it means for me I never come out of pocket for healthcare costs. But it also means I can negotiate cash prices with providers when it makes sense and purchase health related products and services with tax free money without getting pre-approval or talking to an insurance company.
- I think the HSA is a big attraction for the GOP - tax advantaged encouragement to get more people investing more money in stocks. Practically, though it also means more people effectively self-insuring. My deductible is $6500, but I'm allowed to put $3500 into HSA, so 2 years' HSA savings covers the deductible. Fine, for individuals that are reasonably healthy, but it reduces the pool of money that insurers have to pay benefits to people who do have claims.
  Essentially incentivizing individuals to sabotage the system.
  
  I've not had a HDHP with a higher deductible than the annual HSA max (for my family), but I agree if you end up in that boat it's just self insuring for smaller claims which is frustrating. I think there should be a max deductible on the plan that matches up with the HSA max contribution so there's not a self insuring gap.
  But I think there are benefits to having control of my smaller, regular healthcare purchases. I don't need approval to go to physical therapy, and I can buy over the counter stuff, eyeglasses, etc. without asking Anthem, Cigna, or Huamana for permission. So I favor the plans that bring control to consumers as long as they don't leave people with big coverage gaps.
- The best time to negotiate your medical care is in the emergency room!
  
  But HDHP plans cover you for catastrophic issues. The only gap is paying the deductible which is no problem if you have a funded HSA.
  For instance, if you go to the hospital and get a $50k bill.
  on an HDHP plan, you might have a $2500 deductible, but you also have a $2500 set aside tax free in your HSA. You pay the deductible with the HSA money and the rest is covered by insurance. Out of pocket $0.
  on a regular plan, you may have a $1000 deductible, but no HSA. You cover the deductible out of pocket and the insurance comes out for the rest. Out of picket $1000.
  Now you may also have worse coverage.
  on an HDHP plan you might have a $10,000 deductible. You have the maximum set aside in an HSA this year (and you've never saved anything into your HSA in xears past) so you only have $3850. Out of pocket $6150.
  on a regular plan you might have a $5000 deductible. You have no HSA. Out of pocket $5000.
  I agree the second kind of plans should be restricted, but they are the more affordable ones. But being able to negotiate for smaller issues and being covered for catastrophic ones by insurance is the way we handle most other things.
  For instance, you handle your own oil changes, car washes, and tire rotations. Insurance only steps in when you wrap the car around a tree. If those services were all included, car insurance would skyrocket.

16 comments