Number of uninsured U.S. adults hits four-year high

[ttwtt78640]

There are a couple of points. For those actually on the bottom, 200% of poverty or below, the ACA sets maximum OOP costs at $2,600/person or $5,200/family, without regard to the plan's stated OOP max. Over 200% there's still a lower limit ($6,300/$12,600) but it's not much help.

https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/

So, you get in a wreck and blow through the OOP max in the ER most likely, right about the time you enter the door if not before. If you then need surgery, you're still on the hook for the $5,000 or whatever (if you're below 200% of poverty - $2,600) but everyone else down the line gets paid in full, so the surgeon and hospital and anesthesiologist and all the rest get paid the rate negotiated with the insurer, which makes it a lot easier to get that stuff done. Surgeons like getting paid. So in the 'big medical event' scenario, that poor person is better off with insurance.

Where it kills those people is the more routine stuff, like drugs or maybe a bad cut, or a broken arm or whatever that is more than an office visit but won't exceed the OOP max, and if that stuff is annual, say for diabetics, well, the poor just cannot afford it and insurance isn't much help.

As you point out in another post, the problem is if you get OOP costs down low enough for the poor to afford them, then the cost goes way up. What's frustrating from our conservative friends is on Monday we'll see conservatives argue for HIGHER OOP costs and HSAs (which the poor can't afford as you said) then Tuesday complain about ACA forcing plans with high OOP costs that the poor cannot use. So the conservative argument can flip 180 depending on what's needed to conclude ACA is terrible....

It's an easy problem to fix - raise the subsidies, raise taxes. If we want to fix it, I'm good with that.

Are you kidding me? Congress critters won't even raise taxes enough to cover current federal spending and you want to add more subsidies.

 

[JasperL]

Are you kidding me? Congress critters won't even raise taxes enough to cover current federal spending and you want to add more subsidies.

Well, heck, I've said it before and only half joking, if we don't care about deficits when it comes to tax cuts for the donor class, and we don't, I'm fine with just adding it on the tab. As I've also suggested, we just need to draw a curve on a napkin that shows lower OOP max boost economic growth and pay for themselves and we're good.

More seriously, this is the problem with all these discussions. Mostly conservatives argue about how bad ACA is and point to the high OOP, but of course would bust a vein if it's suggested we pay higher taxes to fix it. So instead ACA opponents create what I've been calling the flying unicorn alternative, that only exists in our imagination, cheaper, better coverage, lower taxes, lower OOP, lower premiums, broader networks, cheaper drugs, etc.! to compare ACA to and find it wanting.

Democrats don't have a problem raising taxes to pay for this - they did it with ACA, one of the most fiscally responsible major bills in likely decades - added nothing to the deficit.

 

[phattonez]

There are a couple of points. For those actually on the bottom, 200% of poverty or below, the ACA sets maximum OOP costs at $2,600/person or $5,200/family, without regard to the plan's stated OOP max. Over 200% there's still a lower limit ($6,300/$12,600) but it's not much help.

https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/

So, you get in a wreck and blow through the OOP max in the ER most likely, right about the time you enter the door if not before. If you then need surgery, you're still on the hook for the $5,000 or whatever (if you're below 200% of poverty - $2,600) but everyone else down the line gets paid in full, so the surgeon and hospital and anesthesiologist and all the rest get paid the rate negotiated with the insurer, which makes it a lot easier to get that stuff done. Surgeons like getting paid. So in the 'big medical event' scenario, that poor person is better off with insurance.

Where it kills those people is the more routine stuff, like drugs or maybe a bad cut, or a broken arm or whatever that is more than an office visit but won't exceed the OOP max, and if that stuff is annual, say for diabetics, well, the poor just cannot afford it and insurance isn't much help.

As you point out in another post, the problem is if you get OOP costs down low enough for the poor to afford them, then the cost goes way up. What's frustrating from our conservative friends is on Monday we'll see conservatives argue for HIGHER OOP costs and HSAs (which the poor can't afford as you said) then Tuesday complain about ACA forcing plans with high OOP costs that the poor cannot use. So the conservative argument can flip 180 depending on what's needed to conclude ACA is terrible....

It's an easy problem to fix - raise the subsidies, raise taxes. If we want to fix it, I'm good with that.

It's interesting, and it's the same problem I note with housing and student loans. When you try to get more people to participate, you end up raising prices massively. Never in these proposals is there any cost containment measure. They just raise demand, which will obviously raise prices. How do we put downward pressure on prices in a medical system that's gotten out of control?