Does HCR address the concerns of out of pocket expenses for health care?

[Cleobulus]

Let's forget premiums for a second, and coverage in general. Even after you get coverage you are not in the free and clear, under the basic plan for health insurance that the HCR bills require, its still a 70% actuary value plan, called silver in the senate bill.

I ask because I have a preexisting condition, but I do wonder how useful the HCR bill will be to me because, under the plan, even though the insurance companies would have to pay the claim for my condition, I still will have to pay out approximately a quarter of my income to get treated, about 5,000 dollars or so. Given that I make too much to qualify for Medicaid under this plan(by a whole 7%) I still have no way to treat my medical condition, I'd have to go to an orthopedic surgeon, which is expensive, and I'd have to pay the deduct before the insurance kicks in just to do that.

The difference between not having insurance and having it is the size of the bill I get, assuming they will even let me in through the front door to get treatment, but whether its 5,000 dollars or 50,000 dollars, the result is the same, bankruptcy.

[Arkansas Granny]

1. That's a very good question and one that the proponents of HCR don't really answer.

According to the calculator for subsidies that someone posted yesterday, my premiums would be about $2,600.00 per year. I could afford that without too much trouble, but if I also had to satisfy a $5,000.00 annual deductible (which seems to be pretty standard for a single person) I would be paying for coverage that I can't afford to use. Altogether, the premiums and deductible would be more than 25% of my gross income.

[Cleobulus]

2. I noticed, believe me, I noticed, they harp on coverage, but not on getting care...

Hell, you sometimes have to pay BEFORE you get medical treatment, so what would I have to do, set up a bake sale to get medical treatment?

[dflprincess]

3. For a single person the House bill allows an annual deductible of $1,500

with a maximum out of pocket of $5,000 ($10K for a family, I don't remember the family deductible amount). Only covered expenses apply to the annual out of pocket so (adult) vision and dental won't count toward it. Premiums you pay also do not count toward the max out of pocket nor does any expense your insurer decides is not covered by your policy (a decision often made based on the fact that the majority of people don't contest denials of coverage even for expenses that should have been covered).

The out of pockets maximums may increase annually.

And I agree, these amount do nothing to improve access to care and access to care, not "coverage" is what we need.

[Cleobulus]

4. So basically once this bill passes, I'll have to pay 50 dollars a month, including subsidy...

for insurance I can never afford to use, wow, I'm so impressed! :eyes:

[ecstatic]

5. cancel your internet and cable.... No plan (not even single payer or public option) is free

And $50 a month will be a hell of a lot cheaper than what most people have to pay.

[Cleobulus]

6. Also food and housing, they are optional too, right?

Fuck you, I shouldn't have to pay a QUARTER of my yearly salary just to get medical treatment.

[ecstatic]

9. Your yearly salary is $2400? If so, you should apply for medicaid

and I'm sure you would get it.

[Cleobulus]

11. Treatment, NOT coverage, there's a difference...

I can afford the 50 dollars a month easily, I cannot afford the 5,000 dollars I'd have to spend to get TREATMENT. Jesus, are you that dense?

[spotbird]

14. They pretend that insurance is the answer

to ignore that affordable health care is the answer. No one that actually uses medical care is as dense as these answers pretend.

[ecstatic]

I have spent over $3000 this year on medical care

for an emergency room visit and then surgery. One hospital charged over $7,000 for one night and the other charged over $33,000 for surgery and one night. Then all the doctors and anesthesiologists had to get paid as well.

My out of pocket expenses maxed at $3,000. It REALLY sucks but it DAMN SURE beat having to pay the $50,000+ I would have been stuck with had I not been insured.

[Cleobulus]

21. You can afford to absorb that cost, good for you, I can't unfortunately...

So basically its a "I got mine, fuck you" situation for you, isn't it?

[ecstatic]

16. You don't know yet what the out of pocket max would be... and

I'm sure it'll be based on your situation. But lets say it is 5,000--you still have a choice, and if in your world there is no difference between $5,000 and $50,000, just don't participate. See? Problem solved.

[Cleobulus]

19. Its mentioned in the bills what the out of pocket maximum is.

Did you even read either version?

[riderinthestorm]

20. Everyone will be forced to participate. Pay the health insurance companies or pay a fine.

Either way it sounds as though the OP will pay about the same amount and won't be able to afford health care.

[spotbird]

12. I don't know what you pay for cable

but around here it's one hell of a lot less than $10,000 a year.

[dflprincess]

But, based on what it costs in another countries

what is paid in taxes for universal care is cheaper than mandated premiums to cover for profit insurance. Of course the difference is that when one is paying a tax to access medical care most the money goes to care. With the "system" we have way too much of the money paid goes to line the pockets of the crooks who cause this mess and continue to profit from it.

[Cleobulus]

26. You know, I wouldn't mind paying the 50 dollars per month estimated....

for insurance if I could actually be able to use it, having a deduct or copay that is reasonable for an individual to pay. Most other countries that do charge such things do so at an extremely low rate for the UHC systems, not thousands of dollars a year.

[zipplewrath]

10. I have such a policy now

I have roughly this policy now. For folks without some sort of chronic condition, my personal survey suggests their "out of pocket" is about$800-$1200 per year (per family, mostly those with kids). If you have a chronic condition or if you have a troubled pregnancy, you can quickly be out upwards of $8000 per year.

They don't like to admit to this, supposedly we have a $5000 annual out of pocket limit. But, the things that DON'T apply to that are long. And my policy is cheap (for now). On the open market, it'd be a good $3000-$5000 a year. And no, that cost doesn't apply to the out of pocket.

[kestrel91316]

24. $5000 out-of-pocket right now would bankrupt me, except you can't bankrupt out of

medical bills anymore, right???

I will be one of the still-screwed.

[GinaMaria]

7. We are barely making it with an 80%

We already pay a fortune out of pocket. 80% doesn't mean every medication, procedure, visit is covered and I have a pretty good plan that is mostly paid for by my employer. We are breaking even right now. We aren't saving anything, but we've avoided debt. Encouraging companies to go to 60 or 70% might sink us :-(

[Greyhound]

8. First, this is not health care reform. It reforms nothing and enshrines the system

of plunder that has given us the worst health care in the industrialized world as the one and only access to health care. This is a mandatory insurance bill, nothing more.

This is how they're going to take even the inadequate Medicaid system away from the poor. It is going to be replaced with inadequate care that poor people cannot afford to avail themselves of.

All the feel good provisions (proscription of pre-existing conditions, rescission, caps, etc.) are only included to get this POS through the process and into the courts where we will see just how rich and powerful they are.

[thotzRthingz]

15. re: "this is not health care reform. It reforms nothing and enshrines the system"

Truer words were never spoken!

[dflprincess]

25. +10000

[thotzRthingz]

13. re: "Original Message Does HCR address the concerns of out of pocket expenses for health care?"

1. NO--not in any meaningful way (absent SINGLE PAYER, only a robust PUBLIC OPTION could accomplish this end).

2. The HOUSE already passed a PUBLIC OPTION ... now Pelosi refuses to send it back to the Senate, via reconciliation ... even though DURBIN said he would WHIP for it, if she did so (and even though there are 51 Senators who would support same).

3. All we're really getting (until several years out) is more PROFITS for the GREED-MONGERS (who contribute absolutely NOTHING to the health care of Americans) as some 31-million more Americans will be forced to purchase essentially FAKE & WORTHLESS (in Wendell Potters words) health insurance policies ... and what happens when those FOR-PROFITS don't play by the rules? Well, they'll be slapped with a $100 FINE (oh my, heaven forbid)!

Give us a ROBUST PUBLIC OPTION, or KILL THE BILL!

[mdmc]

17. my medical treatment will cost more this time next year

I know that this bill is of no help to the working poor that have full health insurance but cannot afford medical treatment.

[Political Heretic]

18. out of pocket caps (co-pays) - 11,900$ per year for family insurance (second 1402, Senate Bill)

It's 5,900 for single, no family.

If you are just above Medicaid threshold, but at 150% of FPL, you can get a decreased out of pocket cap. However, in a worst case medical year scenario - where you incurred serious medical costs such as surgery, hospitalization, rehabilitation, etc. - Keiser and the Center on Budget and Policy Priorities estimate you'd be on the hook for about seventeen percent of your total annual income. It's a literal 20% as you start getting up to median income or above...

[Cleobulus]

23. I'm at 157% of FPL, also my preexisting condition would involve the...

worst case that you mentioned, with surgery, hospitalization and physical therapy. It could be considered a chronic condition that I came down with, or an injury, I guess is the better word. Not life threatening, but painful, day in and day out.

[Political Heretic]

28. They under the Senate HCR bill - you are fucked. I'm truly sorry.

A lot of us have sweat blood trying to get something better than this. :(

[dflprincess]

27. So, in addition to no public option, the Senate bill allows higher out of pockets

than the House version. It just gets better & better doesn't it?

[kenny blankenship]

29. On the other hand, you will have already had your annual colonoscopy

-or it will feel like it anyway- so there's that expense already covered and out of the way. You give a little, you get a little.

[dflprincess]

30. Actually a colonoscopy, like other preventative (aka screening tests)

will be covered. The snag is that if the screening test indicates a problem, you won't be able to afford the follow up.

[kenny blankenship]

22. Yes it does: pay up or suffer in silence. Oh yeah, don't forget to keep paying your premiums on time

or the law will be after you and your family.