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Re: “One aspect of Obamacare attracts a crowd

Hi Steve,
The ACA was created out of a need to regulate the insurance market, reign in some high healthcare costs, and expand coverage where possible. It does not create a single payer system (unfortunate in my opinion), but it was created on a notion (a Republican one at that), that healthcare is a personal responsibility, and based on your income, you will be expected to pay a certain percentage of your healthcare costs.

The ACA was designed so that if you do not have access to affordable insurance through your employer (established as 9.5% of your income), then you will have access to the plans available in the Marketplace. In this case, you will receive subsidies up to a certain percentage of the federal poverty line (I believe that a family of four making a little over 90,000 will still qualify for a subsidy.) However, if affordable coverage is not available to you, you can be exempt from the personal responsibility requirement (this means that if you have to spend more than 8% of your income on your premiums, you can seek an exemption.)

Having said this, I agree with you that the plans on the marketplaces are expensive and have high deductibles and out of pocket costs. Those making up to 250% of the FPL may be eligible for Cost Sharing Reductions, which are meant to help reduce such costs. In addition, insurance companies are not allowed to spend less than 80% of their revenues on claims reimbursements. And if they do so, they are required to send their policy holders a rebate. Still, many policies are still expensive because yes the ACA has set a very comprehensive essential benefits package which insurers must cover. However, the idea is that with time, with enough healthy individuals buying into the coverage pool, prices will lower and stabilize. That is why the individual mandate is an essential piece of the ACA. However, in my opinion, to truly bring costs down and make comprehensive and quality coverage available and affordable for all, one of two things needs to happen: 1. A public option should be introduced or 2. health insurance companies should not be allowed to operate for profit.

I think that a discussion around the value of insurance, and of quality and well regulated insurance is needed to emphasize the fact that just one ER visit can quickly help a family meet it a deductible of 5,000 (as most bronze plans have). Yes, insurance is health expensive, but so is auto and home insurance, yet we still purchase those policies because we understand their value. Now we just need to apply the same thinking to health insurance :) Let me know if you would like further resources or the sources for my info

Posted by annonymous on 11/20/2013 at 4:34 PM

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