
Ask HN: How does the ACA affect you and your work? - donohoe
I see this as a serious change that will affect small companies, individuals, and more. I&#x27;d like to understand the full impact to startups and individuals.
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mdip
Here's a take from an individual:

I was recently unemployed (January)[0]. I signed up for COBRA right away.
Within about a month, I had offers and I ended up narrowing it down to two.

I was having a really difficult time choosing between the two jobs. One was a
local company, not large, but not small that was doing really exciting things
but would end up with me taking an "in the office" position (I had been
working at home for about a decade up to now). The other was a very small
outfit, out of state, which was directly in my unique area of expertise. The
salary offers were the same but the smaller business was so small that they
didn't offer insurance so I'd have to buy it on "the exchange".

I ran the numbers. I was paying $1,500/mo[1] for COBRA coverage (family) and
discovered that because I had signed up for COBRA, I couldn't join an exchange
plan until November. This, alone was a deal breaker. I went back to the small
business and asked for additional compensation to cover it (and it was
offered). I ran the numbers again. Going off of this years rate, I could get a
plan for around $1,200/yr. This "plan" came with a $12,000 deductible.
Incredibly, it was _not_ eligible for a Health Savings Account. And the way
the laws are setup, _all_ of the monthly costs of coverage and the $12,000
spent toward medical coverage would be after taxes until it reached 10% of my
annual earnings. Very quickly, a well paying job became a huge downgrade in
salary from my prior position. And that was this year's rate. I anticipated at
least a 10% increase come November and that's probably low.

At the other job, I had three options for very good healthcare coverage that
was the cheapest I've ever encountered. One of them was a High Deductible plan
with the _minimum deductible required_ to qualify for a Health Savings
Account[2]. The cost of the plan was such that despite their initial offer
being exactly on-par with what I was making at my prior employer, I ended up
taking home a few thousand more every year. And the coverage is _better_ than
my last employer (and mountains better than the $12,000 plan ... from the same
health insurer ... the _exact_ same health insurer -- same state, same
administrative unit, same brand).[3]

[0] I mention this only for context, not as a judgement of the company. They
took great care of me and the circumstances behind the layoff had to do with
changing of the focus of the company to things that I wasn't working on. The
unique nature of the position I filled made it impossible for me to
effectively transition to this new kind of work without moving to another
country... something I cannot do.

[1] For those who are unfamiliar, COBRA allows you to keep your former
employer's insurance at the same price that it was at your former employer but
it's got one big gotcha. Your employer usually pays a percentage of that
monthly cost. In my case it was somewhere around 80% of that cost. It was a
good deal while I was employed, but turned into a pretty terrible one when I
was no longer employed. Companies often continue to pay/fund part of the COBRA
costs for a period of time after an employee is let go and because I'm not
entirely sure what I agreed to keep confidential with the NDA that I signed
when I was let go, and out of respect for my former coworkers/managers, I am
neither confirming nor denying that they helped out here. I certainly wouldn't
have expected them to if they did and wouldn't have been upset if they didn't.
Sufficiently vague enough?

[2] HSAs are pre-tax accounts that carry over to the next year (they work a
lot like a 401K that allows you to take money out any time for qualified
medical expenses). I love them both because they have always saved me money in
the long run and on the principal of them. I hate our broken healthcare
system. It's the worst kind of "fake capitalist" arrangement there is. Ask
yourself what the last prescription you filled _actually_ cost, or that last
trip to the doctor. Most people have no idea what doctor's visits,
medications, hospital trips, and medical tests cost so there's no shopping
around and therefore no reason for "the system" to optimize prices. A high-
deductible plan changed my behavior immediately. For unimportant things, like
"where I fill my prescriptions", I do my research (and _man_ does it take time
-- try to get the price of a drug out of the drugstore in less than an hour)
and I fill things where I know they are cheapest. I used to just go to urgent
care when I got sick, never realizing it's twice the price and half the
quality (at least where I'm from). I never realized that I could call my
physician and get a same-day appointment on week days (I've _never_ been
turned down and though I end up having to wait a little bit, it's never as
long as the wait at Urgent Care).

[3] I just want to clarify, I kept the discussion about healthcare due to the
post topic. This certainly wasn't the _only_ reason I went with my current
employer. They are really doing awesome things and I was very excited to have
been given an offer here. I'm also very glad that I took it. I can't say that
I wouldn't have chosen them, anyway, simply because the work looked (and
turned out to be) exciting. I mean that, though. I _really can 't_ say. The
healthcare issue was such huge thing that it took the other option completely
off the table.

