Having taken the last week to feel a lot of umbrage over the “if you like your plan, you can keep it” lie as it is exposed, today I’m feeling more sympathetic to the goals of Obamacare. It’s probably fleeting, but we’ll go with it so far as it allows for some exploration.
Big thing is, my paycheck deduction for health insurance is running about $1150 monthly. Say $13800 a year. To which the proper reaction is, “holy shit that’s a lot of money.”
Never mind that I’m not a ‘bootstrap’ absolutist in the Horatio Alger or Ayn Rand sense. My opinion could really be swayed if the law alleviated my cost in some way. Now, I earn a good (enough) living and don’t envy the disadvantaged for the social benefits they receive. So I’m mindful to disabuse myself of a crude selfish impulse here. But the fact of the matter is the disadvantaged could have been helped with a law less disruptive than ACA. I can be convinced to pay a tax for it. But for ACA, my price as a citizen for supporting it could be seen as a very reasonable demand that it provide a method to alleviate costs for middle class households like mine. Middle class households like mine number in the millions, and the treatment of this cost would benefit the economy at large. Given the ACAs scope, if it can’t do that… you ought to be easily understood to have a reasonable basis to question its efficacy and oppose it. It’s too big and doesn’t benefit enough people.
So does ACA help a household like mine? How is one to know? besides say reading MatttY or Wonkblog, where you may not get a sincere answer. I’m curious for a quote and also what subsidy amount I might be eligible for. Some math was in order.
Start with a baseline. As I said, my annual costs for membership in a group plan is $13800. My current enrollment is in a BlueCross Group Plan, 80/20 on negotiated rates, 1000 deductible, 6500 out of pocket maximum.
As everyone should be aware, it’s basically a given that ACA, with its employer, plan, and individual mandates, push rates up in general. It’s the premium subsidies that end up bringing costs down for enrollees. I used this tool at the Kaiser Family Foundation to make some basic calculations on subsidy eligibility for myself:
Note, right away I bump into something that limits the ACAs impact. If your employer offers compliant health insurance, you’re not eligible for a subsidy on the exchange. So I’m not eligible for the subsidy, and that calculation becomes theoretical for me. But I do it anyway, because I think we’ve lacked for practical example quotes in the at large ACA discussion. So here’s a real indiscreet income example for the subsidy calculation…. (and I have semi-anonymity. No one is reading, right?)
Subsidy calculation is performed off Modified AGI. I don’t know that mine is different from AGI, so I used that. Which was $88018 in 2012. This is a one earner household with a spouse and two dependent children. Remember the office park dad demographic? That’s me. I’m 44, wife is 41, we don’t smoke. 2 kids. With that and a zip code we get some numbers.
ACA premium subsidy is ostensibly specified up to 400% of the poverty line. Kaiser tells me I’m at 374% of 4x poverty. At first glance, it would seem I’d be eligible for a subsidy, but actual subsidy amount listed for me is 0. Nonetheless, my max cost for a silver plan (were I eligible) on the exchange is stated as $6491. That’s good. A lot lower than what I pay now. A shit-ton, as the wife is fond of saying. So where do I go to signup and save $7000? For me its MnSure.org. I can give the same information and get some rough quotes back for actual policies I can buy.
Keying my superficial data into mnsure.org brings back a selection of 20 silver plans with premiums that range from say $550 – $875 a month. We’re still on track to save big money, because that’s ostensibly the cost to me without subsidy. We’re no longer theoretical. Next process is to filter plans by preference features you’d like to choose from.
Here is where we separate the apples from the oranges.
The most important preference filter is the one for deductible. Now, you can choose to filter silver plans for a $1000 deductible, but none will come back. There aren’t any. For silver family plans, you’re invariably talking $4000 – $7000 deductibles. Those are the plans returned after you do the preference filter. Now this is by definition catastrophic insurance. Which sucks, right? I mean it’s a high deductible, and one of the main points of the national ACA debate was to ostensibly scold us all that high deductible, catastrophic insurance sucks. So I find this perplexing that people are being directed to high deductible insurance, and that providing more people a silver plan is a triumph of the ACA. What gives? In any practical event, those are deductible amounts that would break me were I to have to pay it. I wouldn’t buy silver insurance with the dollars I have to spend, which is at least what I’m spending now. What I want is a $1000 deductible plan for the money I spend now or less.
So it’s on to the gold plans, where there is a Medica PPO plan with a $300 deductible for $994 a month. Superficially, that’s a saving of maybe $1800 for me, but thing is I expect that it’s coming with the exclusion of a benefit I am probably getting now.
As I wrap up here for the time being, I will just say there’s no obvious evidence you buy more value with your insurance dollars on the exchanges. Deductibles tend higher. I’m certainly not sure exchange plans are the right solution for vulnerable populations, ie, the previously uninsured.
More to follow.