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Tuesday, October 8, 2013

Me and ACA

 

I tried a bunch of times to get on NYS’s health exchange last week. Dead end. The site went down for ‘repairs’ over the weekend, but as of 8 AM today it was up and running.  Some thoughts.

The first step is to get a user ID. For those familiar with this type of registration process the Captchas etc. are not a big hurdle. But two 8 digit codes (no spaces please) are required on step one. My guess is that there are fair number of people who will struggle with this. The same could be said for the password requirements (eight digits, two numbers and one capital letter).

The NYS exchange wants more than the standard ID info of address and SS#. I was asked a series of questions to ‘prove’ my identity. I was asked to identify a financial institution that I had opened an account with in the past two years. Five banks were listed, and one of them was the bank I had in fact opened a new account.

Another question blew my mind. I have never purchased pet insurance, so this was a trick question that required the response “None of the above” to continue with registration.

 

snifferdoodle copy

 

These questions prove that the exchanges have access to a great deal of information about who is signing up. I suspect that the need for the servers to go out and gather the individual’s data so that these questions can be posed, is the reason that the exchanges went down the first week. The plumbing for this can easily get clogged; the data bases for this type of info are huge. NYS has access to my IRS data, the pricing I got reflected the fact that my income was above the subsidy levels in the prior year.

Once you exist, the rest is straight forward. I’m single, 63; I’m a headache for ACA. Obamacare needs young healthy people to enroll. For every one of ‘me’ ACA will need a half-dozen twenty-year olds to balance the costs. I looked at the cheapest plan (Bronze – $360/mo) and the richest (Platinum – $620/mo). The difference between the two extremes is the annual deductible:

 

bronze2

 

platinum2

 

This pricing structure is flawed. For the Bronze plan I would pay $3,684 per year and face a$5,800 deductible. If I get sick, my all-in cost goes to $10,120. If I pay the high monthly premium I would pay $7,740 a year, but incur no deductibles. Therefore, in the event I need the insurance I would ‘save’ $2,380 by opting for the Platinum plan. At my age the Bronze plan is a bad bet.

I can easily envisage an age cohort of mine who opts for the Bronze plan, gets sick and then is stuck with a $5,800 bill that can’t be paid. These very high deductibles are going to be a disaster for Obamacare. Who is going to eat the losses that will surely come from those with cheap plans and mega deductibles? The taxpayer will foot this bill….

I have medical insurance today that has similar features to the Platinum plan. It costs me $1,100 per month for the insurance. So I’m looking at a real savings of $5,760 per year! This is great news for me, and some will point to this and say that Obamacare is doing what it’s supposed to do. The fact that I am now in a group that includes lots of younger people who will not need the insurance has brought down my costs.

This is going to fail. I should not be getting a subsidy from Obamacare. My investment income the past few years (thanks to ZIRP/QE) puts me in the top 2% (Income greater than $175k = top 2%). Why in hell should I be getting a subsidy? And if I’m getting a subsidy, who is going to pay it? Those twenty-somethings are going to save me $5,800 a year?? Why?

 

In spite of the large savings that I would realize from from signing up for Obamacare (a free one-month trip to Europe!) I did not hit the button. There is a catch in this for me. Can I keep the doctor that I have been seeing (and trust) for the past 25 years? There is no way to determine that. There is a field that allows you to check if your traditional doctor is covered by the plan. But when you ask, you get this:

 

doctor

 

Okay, this bug will get fixed someday, and when it does I will sign up for Obamacare (provided my Doc is in the group). When I do, I will save a bundle, but there is no way that this should be happening. Why is Obamacare putting big bucks in the pockets of geezers who are top 2%?

My conclusion is that the exchanges are setting the initial cost for insurance at rates that are artificially low. These are teaser rates that are designed to get folks to sign up. A year or two from now the insurance companies will be getting big increases. Whatever you think of Obamacare today, wait two years, you will come to hate it.

 

old-people-bird

 

Comments

  1. You called your dog “Snifferdoodle”?

  2. Will any revenue shortfalls in ACA be totally covered by future premium increases, or will they be passed on to the general debt obligations of the US?

  3. Where Have All the Leaders Gone says:

    great piece as always BK, too bad one of the choices wasn’t Michelle the dog

  4. just got a letter from a cardio MD who treated a family member in the ER a year ago inviting to “enhanced access” to their heart guys for $500, $1800, or $7500 yearly upfront fee. They mentioned that Medicare reimbursed them $110.74 in 2009 for an evaluation, now $69.18.
    My concluding paragraph saying she wouldn’t be participating ended with “ALL Americans are facing a substantially lower standard of living than we, and our predecessors, have gotten used to.”

  5. LonelyLibertarian says:

    I am surprised you are not considering being “self-insured”. At you income level health insurance is only a good investment if you have significant ongoing medical costs.

    • 1999 – got sick out of the blue. One month in intensive care at Cornell in NYC. Cost = 275,000.

      So self insurance can be a bad bet. But even worse, If I had not had “good” insurance at the time, I never would have made it to Cornell, and I would have been dead 14 year ago.
      bk

  6. backwardsevolution says:

    A few days ago someone said:

    “I hate to drag out the poor old dead horse [once again], but until people stop trying to get something for nothing [printing money...creating and transferring debt...de-frauding...taxing...levying...outright stealing...and all the rest], not one thing is going to change.

    And the number one reason why nothing changes is that Elite cut the investing class in on the party by sharing the booty with them. 99.999…% of investing is simply legal theft and this is why nobody [with any power] says anything, nobody does anything, and why it will continue until it can continue no longer.

    Human greed simply knows no bounds.”

    • Where Have All the Leaders Gone says:

      Republicans = party of the rich; so what do they want; more rich people!

      Democrats = party of the poor; so what do they want; more poor people…

  7. No matter what you pay, think of the worker who went from full time to part time, losing 25% of his pay. And that’s before he or she signs up for a plan. And before the other shoe falls after the 2014 election

  8. Any idiot that voted for the Democrats and this crap called the ACA need a real mental health consultation referral. This plan is fatally flawed and will both devastate millions of decent Americans and eventually cost taxpayers trillions of dollars.
    We can expect poor health care, crummy service and tremendous cost overruns from this ACA government control of another huge part of our economy. Expect massive abuses of the system that will make the Social Security disability program and the NSA abuses of our privacy pale in comparison.
    Putting the IRS in charge of this gigantic nightmare will only make matters worse.
    Daily we hear of the IRS threatening to seize houses of honest Americans for IRS errors related to Identity Fraud. Fear this crap and pray really hard that this really defective plan, poorly administered by our ‘government’ gets tossed out ASAP by Intelligent voters and their elected representatives in 2014.
    Wake up America, wake up.

  9. Cancel all your insurance and if you get ill, fly to Mexico where FREE-ENTERPRISE doctors, labs, clinics and hospitals cost a small fraction of this. Private doctors can be seen for as little as $2. Lab-tests and medicines are very cheap and need no prescriptions. When I lived in USA, I often flew to Mexico for a vacation/dental work/surgery and saved a bundle.
    Examples:
    double-cataract operation $1400
    colonoscopy 150
    root canal job 45
    etc.

    • Alfred L "Mike" Moniot MD says:

      I have lived in San Miguel de Allende Gto. since 2003.
      Not all is as inexpensive as you imply. I paid US$374.60 for an inlay/overlay to repair a fractured premolar in June at my dentist of 9 years. No root canal required.
      I’ll be 69 in Dec and have Medicare A; B; D, and F supplement – monthly premiums are US$255.18 in 2013.
      I’m flying to Dallas in November for my triennial Internal Medicine and Ophthalmology appointments before my physicians either retire or refuse to see Medicare patients (hey, I’m an insider).
      I’m also seriously considering dumping my MC D and F (maybe B if the premiums increase beyond the SS COLA) and buying International (except US) health insurance.after Obamamama NON CARE becomes effective on 1 Jan 2014 as I want nothing to do with the IRS!
      ret expat MD: NBME; ABIM; ABNM; ABR w/spec comp NR and 46+ years in medicine

      • Mike:
        Sounds like a great plan to get the hell out of Dodge. What type of International health insurance are you considering? Where do you sign up? Is it only available in Mexico? Would you please expound on this.
        Thanks.
        Doug

  10. Bruce – may I email you offline? Have some very good info. Pls provide address. Thx.

  11. Small.Business.Guy.1 says:

    Saw this as a ‘summary’ (Hint: It’s sarcasm) of ACA ‘features’ posted in a comments section on a different blog. Was pointed to it by a ACA ‘navigator’ running a public health department:

    “Here’s more useful information about healthcare.gov:

    1) healthcare.gov allows you to write entire programs with a drag-and-drop interface! You no longer have to employ all those funny-smelling bearded IT guys.
    2) healthcare.gov uses the power of the Semantic Web to give you an up-to-date and accurate insurance quote, *even if you never succeed in logging in.*
    3) healthcare.gov is based on NoSQL technology because let’s face it, consistency is the hobgoblin of small minds. You’re not small-minded, are you?
    4) healthcare.gov will match any competitor’s price, no questions asked. Just kidding! What did you think this was, a carpet sale?
    5) healthcare.gov can easily and swiftly be changed to completely blend into its surroundings, making it a formidable ambush predator.
    6) healthcare.gov is powered entirely by a single diligent hamster named Stakhanov. If every hamster in the US worked this hard to provide us with health care, *we would all be immortal*.
    7) healthcare.gov produces error messages in strict compliance with ISO 9004.
    8) healthcare.gov captures its prey with a radial arrangement of barbed, muscular tentacles.
    9) healthcare.gov is completely backwards-compatible with legacy health-insurance plans, aside from a few minor API changes that won’t affect you if you’ve followed good coding practices. Of course you have, that’s a chap.
    10) healthcare.gov knows where you sleep.”

    They say if you can laugh about it, you can find a way to deal with it. Looks like we’re going to find out.

  12. Since no one else is using logic in this discussion I will share with you what I have heard from one of Oregon’s IT people tasked with getting this running. He informs me that there is a massive DOS attack targeting all of the web-sites for this. The republicans are making sure this doesnt work at all. If Obama really wanted this to work he would isolate the servers or perhaps use the resources in Bluffdale Utah (google it) and this problem is instantly solved. What ever happened to executive orders? BTW that rhetorical in nature.