
The Affordable Care Act: Who Was Helped Most - brandonb
http://www.nytimes.com/interactive/2014/10/29/upshot/obamacare-who-was-helped-most.html?_r=0
======
DennisP
Anyone who wants to work freelance or do a startup, rather than work for an
employer, and who has any sort of preexisting condition, is definitely helped
a lot.

People here are complaining that their insurance got pricier. The reason is
that insurers aren't allowed to exclude sick people anymore. If you ever get
chronically sick, you'll appreciate this change.

~~~
Someone1234
It actually makes health insurance worth a damn now.

Before if you had minor medical stuff insurance was there. But as soon as you
got legitimately sick (e.g. cancer) they quite literally went back through
every form you ever filled out looking for an error, typo, or omission in
order to cut you.

Worse still they actually designed forms to increase the chance of error for
exactly this reason. Did you ever wonder why you have to sign it three
different times on different pages? That is why.

Plus if you got laid off previously you were in deep trouble since your new
employer's insurance company would reject you and you'd struggle to work while
sick regardless.

Honestly Obamacare improved things decently. Only short-sighted greedy people
are unhappy. Next challenge: Unlink health insurance completely from
employment.

Health insurance from your employer is bad for everyone. It reduces consumer
choice (e.g. you have the "choice" to either go with the company your employer
picked or nothing), and it makes SMBs much less competitive than large
corporation.

Startups in particular struggle to offer employees health insurance even if
they can afford to offer a competitive income (as they pay disproportionately
more for health insurance than a much larger company).

At least an argument can be made for why the "public option" (nationalised
health care) is a bad idea, I've heard no good arguments for why unliking
employment from health care is. Except "I get really good healthcare right now
and I am too lazy to shop around for it."

The only organisation that should be allowed to offer their own health
insurance/care is the US military, and that is more for practical reason.

~~~
humanrebar

      Only short-sighted greedy people are unhappy.
    

The polling numbers disagree with you:

[http://kff.org/interactive/health-tracking-poll-exploring-
th...](http://kff.org/interactive/health-tracking-poll-exploring-the-publics-
views-on-the-affordable-care-act-aca/)

~~~
Someone1234
That neither agrees nor disagrees with what I said.

But if you want to make broad sweeping statements about political party
affiliation and views on social good Vs. personal wealth/greed, then it more
supports what I was saying than anything (see political party Vs. views on
Obamacare graph).

~~~
humanrebar
OK, then the majority of independent voters are short-sighted, greedy people.
Your polemics undermine your arguments.

------
incision
If your rates went up, but your previous coverage was never actually put to
the test in a serious way you might want to consider the very real possibility
that the old plan never would have paid out [1].

 _" Since insurance companies now won’t be allowed to collect premiums while
you’re healthy only to yank coverage when you get sick, they have no choice
but to pre-emptively cancel plans that wouldn’t be financially beneficial to
actually pay out."_

1:
[http://www.slate.com/articles/business/moneybox/2013/11/obam...](http://www.slate.com/articles/business/moneybox/2013/11/obama_said_you_can_keep_your_plan_an_unwise_promise_that_the_president_was.html)

~~~
alukima
Yep. My employer based insurance was cheap but they dropped me when I got
cancer. They wouldn't have covered much anyway I later found out.

------
jordanpg
I don't know much about the politics or economics of the health insurance
industry, but I'm pretty sure if you're posting on HN, you're not part of the
group the law was enacted to help. It was never claimed that it would make
healthcare cheaper or better for everyone. We have options.

Yes, I'm sure there are some true rags to riches stories around here; but
we're talking about right now. I am grateful and lucky to have the background
and skills to be able to take for granted that I can afford health insurance.
Moreover, since it's not socialized, I'm happy to pay for it. I don't worry
about finding bottom dollar on this particular thing.

~~~
tptacek
Wow is this ever wrong. Guaranteed issue is an enormous win for entrepreneurs.
When you work for your own tiny company, you obtain insurance on the
individual private market. Prior to the ACA and its guaranteed issue rule,
insurers routinely denied coverage to family members based on cryptic "DO NOT
COVER" condition lists. Coverage denial didn't merely mean the insurer
wouldn't cover a particular worrisome condition (which is bad enough) --- it
was a blanket denial of _any coverage at all_.

Young male entrepreneurs didn't run into this problem because they were male,
which conveniently dodges more than half of the "DO NOT COVER" list, and
because they usually don't yet have families. But cross 30, get married, have
a kid, time travel back to 2007 and try to insure your family. You'll see,
like I did, how helpful the ACA is for startup founders.

~~~
jordanpg
Fair enough. I was responding to commenters that I felt were being glibly
dismissive of the ACA. I am a strong supporter of it for a number of reasons.

------
rdl
I mostly got burned by ACA -- I had $80-120/mo HSA+HDHP which was awesome, and
then got forced into $280/mo inferior coverage (a "Bronze" plan) with fewer
doctors. (I ended up canceling all coverage a month later, getting a $750k
"insurance, temporary" plan for 364 days at $30-60/mo, and ended up having a
job with employer care before that expired.)

Now I have employer-provided health care which is "free" but objectively the
worst insurance I've ever had (in terms of number of doctors, etc.) HRA rather
than HSA, so not very useful there, either.

I hate the idea of employer-provided healthcare. If I had "interesting"
medical issues, I'd probably just pay for insurance out of pocket vs. sharing
health data with an employer. I'm pretty sure my coverage costs employer more
than $300/mo, too.

~~~
itbeho
Similar experience for me. Had insurance I was happy with. Had the plan
forcefully cancelled out from under me. Then found less benefits for more
money. Now I can't see one of my doctors without paying cash [1]. Nothing
affordable about this for me.

[http://www.huffingtonpost.com/2014/04/10/obamacare-
patients-...](http://www.huffingtonpost.com/2014/04/10/obamacare-patients-
without-doctors_n_5044270.html)

~~~
tptacek
If you're young and relatively healthy and you're _not_ paying out of pocket
for at least most of your first year's worth of medical expenses, you're
paying too much in insurance premiums. You want an HSA-qualifying high
deductible plan, and you want to manage the pool of money that finances the
deductible yourself, rather than signing it over to an insurer as a higher
premium every month.

~~~
snuxoll
This.

I'm only saving $100 gross per month right now by getting a HDHP+HSA through
my employer, but they also contribute a sizable portion to my HSA each month
for the cost they save. Assuming nothing catastrophic happens in the next few
years, I will have a sizable pool of money set aside in my HSA earning
interest, and I can choose to lower my monthly cost at that point if I want.

I should point out that I am also married and have a single child, since
routine care is covered even under HDHP thanks to the ACA I don't expect to
need to spend much out of my HSA unless something major happens.

------
hackbinary
Young, healthy people will get screwed by any mandatory government healthcare
system, but my view in general is that having strong government oversight of
healthcare is just a good thing. With reference to this Guardian article, the
US spends $8,362 (Private individuals, Government, and insurance combined) per
person. Contrast that to the UK which spends $3480 per person. While I hate
paying taxes just as much as the next person, I do think I get very good value
for money for my National Health Service.

Universal healthcare is just a good thing.

[http://www.theguardian.com/news/datablog/2012/jun/30/healthc...](http://www.theguardian.com/news/datablog/2012/jun/30/healthcare-
spending-world-country)

~~~
deciplex
Please define "screwed". Paying more than you take out does not count,
provided older people are paying less than they take out (I hope I don't need
to remind you that young people eventually turn into old people).

I mean, it sounds like you're just pointing out that, if health
insurance/coverage is mandatory, then you are getting 'screwed' if you don't
use the healthcare system. That's like saying I'm getting 'screwed' by public
transportation if I own a car.

~~~
hackbinary
Yes, exactly. Similarly old people get screwed by the public Education system.
And publicly funded universities and colleges.

~~~
deciplex
Yes, and when your economy is a smoking crater because half the population is
illiterate, you can at least take some comfort in the fact that you're not
getting screwed by a public education system.

------
trebuchette
I'll be the dick. On paper, it's helped me, yes (girl problems that would have
run $16K by June just mainly for tests): I met an OOP early (yay! Didn't even
know what OOP=out-of-pocket WAS!), so after that I didn't have to pay anything
until next year! (Who's heard of such a thing?!)

But the hospitals/docs didn't file right, or didn't get preauths? Basically,
providers aren't getting paid; and while AHCA says "ignore bills you've met
your OOP!", I'm seeing bills from people I've never seen before because while
a doc was "in coverage area", their test readers weren't, and I've actually
been served a DEBT WARRANT (by the police!) now. So basically, I'm paying what
AHCA said NOT to pay because I don't want to be sued (hire lawyer, get tripped
up in legalese, ...it's just cheaper to PAYOLA); plus, I figure radiologists
or labs did their job and should get paid (plus their phone calls are scary).
I find the entire thing ridiculous, but the debt warrant is scary. NGL.

~~~
lawnchair_larry
What is a debt warrant? Isn't this a civil matter?

~~~
trebuchette
I have no idea; IANAL. All I know is a "local" (not really) doc says I owe him
money for some tests he ran on a sample, and nobody will pay him. I pay my
bills, but I didn't take the sample, wouldn't have known who to send it to
even if I had taken the sample, etc. I spent months faxing copies of bills to
the doc who took the sample AND to my insurance, then finally the "claimant"
had this debt warrant hand-delivered by the po-po to my home! I'm supposed to
show up in court (albeit no time soon). I faxed copies to doc and insurance,
and (though I wasn't going to, but I chickened out) I gave it to my lawyer.

------
anesmike
My rates increased 40 percent for a HDHP+HSA bronze care plan with no
preexisting. So, you can say I'm am one of the ones that really got screwed
with ACA.

~~~
infinite8s
No you didn't. Just that your future risk was finally accurately priced into
your premiums (whereas before you would likely have just been dropped if
something drastic happened).

------
paul9290
So as a freelancer I was paying $140 a month with a $500 deductible.

Now with Obamacare I am paying $260 for the same level of coverage.

How is that helpful to me? I'd love to hear some positive stories, because I'm
just paying more and making less in my pocket, while people who don't work are
getting health care for free.

~~~
alukima
About 5 years ago, at age 25, I found out I had a thyroid tumor for the second
time in my life. My employer based coverage dropped me citing a surgery I
received at 16.

Not only was I employed full time, I was restarting school. I lost everything.
Tuition I paid, loan privileges, I had to sell everything, my credit sucks.
Until the ACA went into affect I avoided doctors, even for big stuff because I
was terrified of getting my family dropped.

I can go to the doctor and many people I know from cancer support groups can
get insurance now, I'm not just talking about those who don't work, it was
really hard to just get a company that would cover you when you've had cancer
multiple times.

I know it sucks for some people but it's helping so many people who really
needed the help.

~~~
tptacek
This is a story about rescission, which, thanks to the ACA, is now illegal
across the entire US.

------
marknutter
Didn't it really just increase the number of insured people primarily because
of broad expansions of medicaid and medicare?

------
schnable
As the map clearly shows, the people who were helped most are all the new
people who joined Medicaid when it was expanded.

------
bluthru
Compare this map to states that accepted or refused Medicaid expansion:
[http://i.huffpost.com/gen/1119617/thumbs/o-MEDICAID-
EXPANSIO...](http://i.huffpost.com/gen/1119617/thumbs/o-MEDICAID-EXPANSION-
UNINSURED-570.jpg?1)

------
oldspiceman
Have any states attempted to take control of medical care and negotiate doctor
wages / drug prices? Works reasonably well for Canadian provinces. There's got
to be a reason it hasn't been done in the states. What is it?

------
etrautmann
I'm skeptical of the existing comments in this thread - they strike me as too
on message to be four separate individuals with identical concerns.

~~~
defen
You think the person with 27,254 comment karma on a 2,304 day old account,
with identifying info in his profile is posting anti-ACA comments as part of
some conspiracy?

~~~
phkahler
I have not looked at this particular case, but if you have an agenda to push,
it makes sense to take time to establish a solid looking reputation. Also,
high "comment karma" means lots of activity. There have been times on HN when
I noticed similar things and wondered...

------
ethana
Whenever a congressional law passes, just take the opposite view of the Act
name and it shall be true. For example, there's nothing affordable about the
ACA. My old healthcare plan was eliminated and replaced with a more expansive
and less beneficial because of ACA regulations.

Then for people who are forced into ACA plans, they'll have their rates raised
conveniently after the Nov 4 midterm elections...

~~~
herge
> more expansive and less beneficial

Really? Reporters and politicians have searched for these mysterious slighted
people who have had their premiums go up for the exact same plan. You should
call the O'Reilley factor, you could be a star!

A lot of people could not buy crippled insurance plans with insanely high
deductibles and severe limits on coverage, because those were outlawed by the
plan. Also, some people were bumped from subsidized plans to fend on the open
market, but that's shitty employers taking advantage of their employees, and
not the fault of the ACA.

Finally, with the heavy subsidies to your premiums, the same plan usually cost
less under the ACA. You could however talk about the cost of insurance in 5
years when the subsidies start to wear off, but, hey, I imagine the republican
leadership has plenty of ideas to help the common folk with that.

~~~
WarDekar
I would imagine most/all young (under 35 - I'm 30, personally, and had same
experience as GP), self-employed people making a decent amount of money (such
that they don't get subsidies) have had this experience. The plans never match
up fully, but I had a high deductible "catastrophic" plan pre-ACA and for the
equivalent coverage I a.) had to apply for an exemption to even _get_ the
"catastrophic" plan through ACA and b.) it still cost _significantly_ more for
a _higher_ deductible.

Now as you note I do get certain benefits with this plan I didn't get with my
other one- namely a couple doctors visits a year when my other one was only
one every 2- but I had a catastrophic plan for a reason and my premium more
than doubled under the ACA. Beneficial to me (and likely the GP) is being able
to pay only for coverage we actually want- not additional "benefits" that we
don't plan on using and would rather pay out of pocket for.

~~~
herge
What about yearly or by incident payout limits? Like max 20000$ per year in
treatment or the like. That's what most of the plans canceled by the ACA were
limited by.

~~~
rdl
My plan had no lifetime limits, generally awesome coverage, HDHP, and was
ended. I don't believe it's because it was non-compliant, but because it was
no longer economic to underwrite with 1) guaranteed issue 2) substantial
minimum/preventive benefits paid per year (so, essentially a guarantee of
$300-400 in reimbursements on a $1200 premium per year, with some odds of
$100k or $1mm or whatever payouts in rare cases too.)

My insurer got out of the individual market.

------
sarciszewski
I can tell you who it hasn't helped: Me.

Why? I couldn't afford insurance before, and I sure as heck can't now.

For the sake of fairness, it also hasn't hurt me any either.

So basically, before the ACA if I got sick, I was doomed. And now if I get
sick, I'm equally doomed. But in the long run, things will supposedly get
better. Here's hoping for the best.

------
BrianEatWorld
Seems like either a poor headline or the wrong metric.

I am insured now, but as someone who was rationally uninsured, I don't think I
am better off. While I am only one person, the assumption that insurance
necessarily makes someone better off seems a bit spurious.

Are there any metrics on whether the cost of insuring the same person has gone
down? Wasn't that meant to be one of the benefits?

Edit: Did some digging and it looks like a more comprehensive review of the
stats can be found here: www.nytimes.com/interactive/2014/10/27/us/is-the-
affordable-care-act-working.html

As for my own question, it does look like the majority of the markets will see
prices increases.

~~~
tptacek
Did you have $20,000 socked away to cover appendicitis? (If you've already had
appendicitis, insert any of 100 other relatively common highly tractable
medical emergencies you haven't had yet). If not: your policy of rationally
forgoing insurance was being financed by everyone else in the market.

(The $20,000 figure comes from my friend, whose teenager had appendicitis a
couple years back).

~~~
brightsize
About five years ago my brother had appendicitis and, since he'd decided not
to buy insurance (which he could have easily afforded), the $17K came out of
his hide. So your $ number is about right. Fortunately he was wealthy enough
to afford to pay up, but I have no idea what someone for whom $17K was a
year's after-tax income would have done.

~~~
maxlybbert
Indigent care. Please note, "indigent care" only applies to people who truly
can't afford the care they need. If you could afford the care you need by
moving into a tiny apartment and eating nothing but Ramen noodles for a
decade, then you would be expected to do that.

