What does 'affordable' mean? (re: Health Insurance)

[Cal Carpenter]

I'm trying to get handle on this. I've googled, I've asked supporters of the current bill, I've gotten nowhere.

This word is used over and over in the summaries and speeches I've read.

What is meant by 'Affordable' Health Care in relation to the HCR bill? Is there a formula? A chart?

And if anyone can answer that, my next question is - does it only refer to premiums, or does it also take into account co-pays, deductibles and co-insurance?

It seems to me that the whole premise of this bill is "affordability", but frankly I don't trust that those writing the bill have the same financial struggles as many of us, so I'm just wanting to be clear what is meant.

Anyone?

[Romulox]

1. "or ELSE". nt

[Echo In Light]

6. +1

[dkf]

2. Wasn't the example using $8,000 dollars a year?

I laughed when I saw that. Its a joke.

[2Design]

4. some people don't make that much a year

[HughMoran]

15. My small companies premiums for a family of 4 are $36,000/year

That is NOT affordable.


The Kaiser foundation has estimates based on the bills and I'll be paying $15,000/year for the same coverage. That IS affordable to me, though a lot more than I paid when working at a large corporation.

[slipslidingaway]

18. Just so people know the Kaiser calculator is based on a 70% actuarial

value plan.

If you decide to purchase a higher AV plan, the difference has to be paid by you alone, no subsidies.

Various link here...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6916987&mesg_id=6916987

""...The best private insurance available today – employer-sponsored health plans – have an actuarial value of 80%. That means that the insurance pays 80% of the covered costs of health care and patients are responsible for the other 20%. Patients also are usually responsible for out-of-network services and for services and products that are not benefits of the plans.

The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."

[inna]

20. Thanks for the excellent link! nt

[slipslidingaway]

21. You're welcome, hope people are comparing apples to apples :) n/t

[slipslidingaway]

25. Is your current plan a 70% AV plan? Thanks n/t

[dkf]

27. Yeesh, you must be paid very well to afford that.

I guess a small company has to compensate employees even better than large ones to make up for the higher expenses. Just another way large companies benefit over small ones. This country has it all bassackwards.

[2Design]

3. free or $10 a month

[Cal Carpenter]

8. I should have been more specific

I meant 'in the U.S.'

[Donnachaidh]

5. from the figures being tossed around *affordable* is TEN PER CENT of your annual income

You really didn't need that money for anything else now, did you?

[dflprincess]

9. And that's just for the premiums

don't forget to add in out of pocket expenses for copays and deductibles and all those expenses your insurance company will deem "not covered". And adults will still be paying for vision and dental (either other premiums or right out of pockets) expenses as the insurance bill does not require those be covered.

[slipslidingaway]

16. EXACTLY !!!!!! ...

finding out first hand now bad our insurance has deteriorated over the last couple of years.

Sorry for the caps, I want people to read your post.

:)

[Cal Carpenter]

12. Is that the answer?

Damn.

Before taxes?

That's the closest thing to a hard number I've seen.

Well, thanks. I hope some of the bill's supporters show up to refute or defend. I can't get a solid answer from anyone who is telling me to support this bill ('it's better than nothing' is sadly the strongest argument I've seen, and if what you say is true, given the whole mandate aspect, I think that argument is bunk too)

[mdmc]

22. 10%? I think I might be able to swing that without have any spending money left

but at least it is better then my current deal.

[FBaggins]

7. "Less than I pay now"

Just like "living wage" is a term that is relative to the person speaking.

[Cal Carpenter]

11. Well, that relativity seems to be the problem

I've encountered when trying to find this answer.

But I know, for example, in 'affordable housing' there is a specific formula based on the average income of the area and so forth, to determine what it means.

I imagine there has to be something similar in these HCR proposals but I can't figure it out. Neither, apparently, can this NYT blogger, heh: http://economix.blogs.nytimes.com/2010/02/12/what-is-affordable-health-care/

[guitar man]

10. On my salary?

About half of what I'm paying now.

[leftstreet]

13. Render unto Aetna that which is Aetna's n/t

[RedRocco]

14. I made $8,256.19 last year, what can I afford?

[druidity33]

17. that's a very good question...

my experience with a government subsidized mortgage for first time home buyers that is considered affordable (our mortgage payments are tied to our income... they say it's "30%") is that they make the payment amount such that it is just above the very most you'd be able to pay. They try and always leave you scrambling. And the amount of paperwork involved to change anything can take months. I live in Massachusetts and i think i understand what this HC bill would mean to the rest of the folk in the country, because the end result would be somewhat comparable. Truth is, the system will totally screw you more often than not. At one point in the past three years my family was paying $48 a month (we hit the sweet spot, income bracket wise) for Healthcare... at another point it was $1,250 a month. All because our income changed by $4,000 a year (thanks for the raise, boss) and we moved into a new "bracket".

It'll be a clusterfuck, no doubt....


:shrug:

[mdmc]

19. This is how I define it.

If I am able to afford rent, transportation, clothing, food, and medical treatment, then it is affordable.

If I cannot afford all these things plus medical treatment, then the medical treatment is not affordable.

For the record, rent and transportation are pretty expensive, but I don't have rent insurance or transportation insurance that exists to help me secure housing and transportation. I do have full health insurance that does not allow me access to affordable medical treatment.

I had no beef with my medical insurance until I got sick and needed to use it. Then I realized just how worthless for profit health insurance is when you are ill and need medical treatment.

[Cleita]

23. Doublespeak.

What we want is access to health care regardless of ability to pay. By switching the argument from access to a basic need to the ability to pay for it, pollutes the whole concept. Very clever these corporatists are with their doublespeak.

[inna]

24. You might find this info useful:

"Formula"/calculator:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7341458&mesg_id=7342555


Much more info on affordability in this thread: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7338574

[Lars39]

28. The total risk as % of income for every single level is simply unacceptable.

Even after the reform.

[Cal Carpenter]

29. Thanks for those links

They are the most helpful thing I've seen.

[inna]

31. You're most welcome! Glad you found them useful.

:hi:

[blindpig]

26. It's just a new way of saying...

"stand and deliver."

[kenny blankenship]

30. It's an offer you can't refuse.