
White House urges 'geeks' to get healthcare coverage, launch startups - kldavis4
http://www.computerworld.com/s/article/9246907/White_House_urges_geeks_to_get_healthcare_coverage_launch_start_ups
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skolos
I tried that. It did not work. ACA is not designed for entrepreneurs. When you
are entrepreneur your cashflow projections are quite unreliable, and cannot be
easily deduced from your previous income. But when you sign up for ACA plan
you are asked all sorts of income questions to figure out what your subsidy is
going to be. And worse of all, if you don't have any income (which is normal
when you are starting a business), you cannot get any ACA plan - you are
referred to Medicaid, so ACA is quite useless in that situation.

In my case we are without income for more than a year. The marketplace did not
allow my family to sign up for any insurance and said to use Medicaid. However
we are running out of savings this year, so two things will happen - either
our business will pick up, or I find a regular job. I any case we will have
jump of income and will not be eligible for Medicaid or any subsidy with ACA.

In my view, ACA intentions are good, but it is realized in entrepreneur
unfriendly way and I cringe every time people say that how it is going to
boost startups in this country.

~~~
nknighthb
So... sign up for Medicaid. When you become ineligible for that, you can sign
up for a non-Medicaid plan. I fail to see the problem.

~~~
skolos
I think I was not clear - there is no problem with signing up with Medicaid.
The problem is - I don't see how ACA adds anything to entrepreneurs.

When I quit my job, we signed up for private insurance (family of 4 - $500 a
month with decent coverage). That was pre ACA time. All I've got from ACA - my
insurance got bumped to $680, which is OK and still much cheaper than any
comparable plan on the marketplace.

So my complaint is not about lack of options for entrepreneurs, my complaint
is that ACA actually made my life marginally worse, not better.

Also don't forget that jumping from plan to plan includes filling tons of
forms, which takes quite a bit of time and frustration, which I would rather
spend building my business.

~~~
nknighthb
I doubt you really got "decent coverage" at that price, and I expect even at
$680 the coverage will magically evaporate if shit hits the fan.

That said, you've taken your own unusually strong position, observed that the
ACA didn't change it, and extrapolated to all entrepreneurs. What does
"entrepreneur" mean to you, exactly? Is "healthy and financially secure" a
prerequisite in your view?

I also don't know what "tons of forms" you're talking about, since that hasn't
been the case in any situation I've personally observed since the beginning of
the year, but you've now said you're in Texas, which is actively trying to
thwart the ACA, so is even less likely to be representative.

~~~
jandrewrogers
Whether or not $680 is "decent coverage" for a family of 4 depends on age and
perhaps the state you live in. Assuming that the family is young, that would
buy one of the better pre-ACA plans in my state (Washington). I have no idea
how old the parent is.

Of course, that won't buy a comparable post-ACA plan. The ACA rather
dramatically increased the costs of insurance even for plans that were
unchanged by the ACA (~35% more at my current startup for the same plan).
Other startups I know faced similar cost increases, which makes the argument
that the ACA helps startups dubious.

~~~
gcb0
So you're saying that having a lower change of shit hitting the fan make for a
better case of buying plans that disappear when shit hits the fan?
Mindblowing.

------
joshfraser
Ironic, because the ACA has actually made things harder for early stage
startups trying to setup insurance.

"Under the ACA and California regulations, beginning January 1, 2014, small
businesses must have at least one "common law" employee who isn't the owner or
owner's spouse (or domestic partner) to be eligible for small group coverage.
As a result, the following will no longer be able to renew under a group
plan..."

[http://info.kaiserpermanente.org/html/hcr_ca/owner_only_busi...](http://info.kaiserpermanente.org/html/hcr_ca/owner_only_business.html)

------
jchrisa
As a founder I can say ACA will make my wife happier during the early months
of my future startup(s). Tying healthcare to employment is about the worst
thing you can do for innovation. I'm glad those days are over.

~~~
skolos
I am curious about your experience. Have you signed up for a ACA plan?

I have tried, and it was frustrating waste of time - since, as a founder, I
didn't have any income I was not allowed to get any ACA plan. I was told this
after I spent several hours filling out forms.

~~~
nknighthb
As of January 1st, I'm on a non-exchange plan that I'm only able to get
because of the ACA (I was previously uninsurable on the individual market due
to preexisting conditions). I'm off-exchange because the best plan for my
particular situation isn't offered on the exchange on my county, and I
wouldn't be eligible for a subsidy anyway. (You do know that if you really
don't want medicaid and can afford the premiums, you could just go to an
insurer off-exchange, right?)

I have family with limited income who went through the quick signup process on
Washington's exchange site and got put on Medicaid. Card and related
information showed up soon thereafter. No big deal.

Seems like you've got some sort of mental block. Your comments haven't
mentioned any practical problem, yet you seem unable to get past some unstated
obstacle.

~~~
skolos
It might be just my situation. I had private plan before ACA. When exchanges
opened I spent half a day filling out forms to see if I can get anything
better than my private plan. Because of no income, they did not allow me to
even check what price from exchange would be, they just said that we'd get
Medicaid. Since we never got any information on how to get it (I am in Texas),
I assumed I need to go through whole form filling again. That's where I
resigned and decided to stay away from exchanges.

So it looks like just my special circumstances.

~~~
hugs
"they did not allow me to even check what price from exchange would be"

Go to [http://healthcare.gov](http://healthcare.gov) and click the big link
that says "See plans before I buy". Answer some questions, and it will guide
you through. (This workflow is anonymous and does not require creating an
account and logging in.) More importantly, though, when you see a question
that asks "Is employer coverage available to anyone in this household?", look
right above for a link that says: "No thanks, just show me plans in my area. I
can find out later about help paying for coverage." You'll then see all the
plans.

[side-note: I was a member of the "Tech Surge" team that helped fix the
website in late 2013.]

------
cobrausn
Wait, so the goal of the ACA is to get young, 'healthy' people to buy
insurance to subsidize the rest of us as we get older and less healthy. Geeks
who launch startups pretty regularly end up without any income for a while,
and as has been stated in other threads many times, this means you end up on
Medicaid. Isn't this counterproductive? Wouldn't the ACA be better off if they
get healthcare coverage but don't launch startups?

~~~
angersock
Not only that, but these same young people (as we saw in the "kids in the
valley" Times article the other day) are also supposed to cure cancer for
these folks!

Joy!

(wait, what's that, you also need to pay rent? and student loans? and
healthcare costs? but but but why aren't you ~-= innovating =-~???)

------
kldavis4
The logic of this argument seems flawed. I assume the goal here is to get
young, uninsured people to buy health insurance. The argument here is that by
buying an ACA plan, individuals will be more free to start their own business
because they won't have to worry about getting sick without insurance. If I am
risk averse, I will simply pursue full time employment that include health
insurance benefits. If I am young and willing to forgo salary and benefits for
a startup, why would I weigh the risk of getting sick while uninsured any more
than the other risks involved in a business venture. Based on what I've seen
of the costs of ACA plans, it seems like someone working in a ramen profitable
startup would not even be able to afford the insurance offered.

~~~
avoutthere
> I assume the goal here is to get young, uninsured people to buy health
> insurance

The goal here is to get young, HEALTHY people to buy health insurance in order
to pay for those with preexisting conditions who can no longer be denied
coverage.

~~~
BrandonMarc
This. I wish I could upvote 10x. As things stand, the mix of ACA enrollees is
far too high in older and/or sicker people (who need insurance to pay
healthcare costs) and they _need_ more young and/or healthy people (who need
neither). Many officials have described how, if the ratio doesn't change, the
policy groups may end up with far higher premiums and/or go into a death
spiral.

~~~
kldavis4
The problem is that even with the tax subsidies these plans are too expensive.
I was looking at them with my currently uninsured brother and the plans for
his family of 5 start at ~$400 / month with the subsidy. These "cheap" plans
have a $12k deductible. Unless something catastrophic occurs, he is
essentially paying a minimum $4800 more per year and still having to pay the
deductible for all his regular doctor visits. At this point it looks cheaper
for him to just pay the penalty and out of pocket medical costs. It's
basically a chicken and the egg situation. The only way out I can think of
resolving this is dumping the ACA completely or going to single payer.

~~~
tzs
What would it have cost to get a comparable plan for your brother and his
family before ACA? $400/month for a family of 5 is about 1/3 of what we have
where I work through our employer-sponsored group plan.

What I've seen is that for single people (or rather, people who only need to
insure one person) who make enough to not qualify for any subsidy, the ACA
plans where I am (Washington) that are close to our group plan cost about the
same but provide less coverage (no dental and no vision).

For those whose income is low enough for a substantial subsidy, or who have
family members that would be on the plan, it looks like the ACA plans beat the
employer group plan (except for the dental and vision coverage--although I
believe some do offer that for children at least).

~~~
kldavis4
Yeah, I am not sure what he would have to pay for a comparable plan before
ACA. My point is that he is now legally obligated to drop $5k on something
that essentially only provides benefits if something catastrophic occurs.

------
chris_mahan
All I know is I have business degree from California State university, I also
worked at Health Net (an HMO provider in California, and Tricare provider at
the time in the East coast) and did medical analytics systems that helped
improve patient outcomes, both for facility care and chronic care. I now work
for Bank of America and I work in the department that is untangling the mess
of the toxic assets (I technically work for Countrywide, if that helps). Oh,
and I develop software for a living.

I have not the foggiest idea how health care works in America anymore. It has
become so complicated, so byzantine, that there's no possible way it could be
fair, as some get lucky, and some don't, and there's little anyone can do
about it anymore. All I see it doing is feeding a massive bureaucracy, at
inordinately high costs.

And this is supposed to be the solution?

~~~
penguindev
The ACA arguably makes a few things more 'fair' but it's still profiteering
sick care via cost shifting.

Drug companies seem to have an incentive to get $5000/yr treating type 2
diabetes (i.e. carb intolerance) rather than telling people to stop eating so
many carbs. The doctors and insurance companies just go along with it, as
there doesn't seem to be an economic disincentive for them. I know first hand
that is bullshit, so I have to wonder how many other things are rotten
(statins vs diet).

If we actually cared about health in this country, we'd probably ban most of
the current food production 'technologies' and stop subsidizing/pushing carbs
[edit: for everybody; some people can handle them]. But healthy people don't
grow GDP, having bypasses and perpetually treated diseases grows GDP, and god
knows all this country cares about is the GDP number.

~~~
zanny
> But healthy people don't grow GDP, having bypasses and perpetually treated
> diseases grows GDP, and god knows all this country cares about is the GDP
> number.

I get that this is supposed to reflect the "for profit healthcare industries
are fucking you over to make their buck" but the reason every first world
nation on the planet has single payer is _because_ it grows your GDP to not
have a perpetually ill populace that consumes extremely expensive hospital
procedures as last resorts before declaring bankruptcy on a million dollar
bill while being prescribed a half dozen drugs they don't need by profiteering
big pharma companies being subsidized and given monopolies by a corrupt state.

------
beat
Love the guy at the end who assumed "geeks" are too stupid and introverted to
be the "business leaders" that can be "entrepreneurs".

------
kldavis4
Odd.. this post was #16 on the front page and suddenly dropped to #78 within a
minute or two

------
puppetmaster3
Obama (a racist IMO, see 'Trayvon could be my son') is selling
[http://en.wikipedia.org/wiki/Karen_Ignagni](http://en.wikipedia.org/wiki/Karen_Ignagni)
project.

What can I do not to help?

