This is one of those “All I know is what I read in the papers” (cowboy hat-tip to Will Rogers) posts. The AP has an article on current ACA/Obamacare enrollment in Arizona which is full of informative facts and figures. Unfortunately, the AP headline, which is factually true, leaves a skewed impression of what’s actually happened.
The AP headline reads:
That’s true, but it’s misleading. My longer headline, I think, summarizes the information in the article more accurately:
Let’s look at the numbers in the article. Here’s the overall picture for the state, according to the article.
Overall, Arizona saw a 3.3 percent enrollment decline in marketplace plans that are a key component of former President Obama’s heath care law, to about 196,000 people.
By the way, though it doesn’t mention it in the article, that number is only for those buying insurance on the ACA marketplace. It doesn’t include adults and children on Medicaid, which totals about 400,000.
A loss of a bit more than three percent of participants in the ACA marketplace? That doesn’t sound anything like the Republican “Obamacare on life support” meme we hear so often, which often uses Arizona as a prime reason for pulling the plug. It sounds more like a reasonable yearly ebb and flow. However, the loss is far higher among those who don’t qualify for tax credits. It’s 23 percent. If you’re a family of four, you pay the whole ACA cost when your income hits $97,000. If I’m reading this correctly, that $97,000 figure is the family’s Adjusted Gross Income, which is total income minus deductions, meaning a family’s actual combined salaries plus other income sources would be considerably higher, certainly over $100,000. According to the article, only the top 20 percent of Arizonans who get their insurance through the ACA marketplace pay full price. While no one wants to pay the full cost of ACA health care, which averages $611 a month, the top 20 percent who make over a hundred grand can manage it.
If I did my math correctly using figures in the article, and I think I did, the top 20 percent of ACA users fell about 1,200 people, and the other 80 percent of users rose by about 5,500, meaning Arizonans taking advantage of the ACA who are least able to afford health insurance actually increased. [Please, math people, check my figures if you wish. According to the article, there are currently 196,000 Arizonans in the ACA marketplace, down 3.3 percent from than last year. The people who get no tax credits decreased from 52,797 to 40,537.] Some readers might not see that as a positive tradeoff: more lower income people, fewer high income people getting ACA medical insurance. Me, I think it’s a very good tradeoff.
True, the cost for the top 20 percent increased, but for the others, it went down 13.3 percent.
Nearly 80 percent of the 196,521 people who chose plans on the exchange this year in Arizona got subsidies, however. They’re paying an average of $104 per month, an actual decrease from last year’s $120 a month.
In other words, the big rise in ACA insurance costs in Arizona weren’t borne by the lowest income Arizonans using the marketplace since their tax credit subsidies covered the increase, and the number of people using the plans didn’t fall precipitously. Sounds to me like Obamacare-Arizona’s annual checkup yielded areas of concern but no serious loss of health. Add a few of the modifications to the program Democrats have been pushing for since the ACA passed, and the program would be quite healthy. Change it to single payer/Medicare-for-all, and it would be . . . but that’s another post entirely.
This article appears in Mar 16-22, 2017.
I’m paying $1045.89/month in Maricopa county for a plan with a $7000 deductible. I am pro-ACA, but very angry about having to pay such a high price for catastrophic policy. It feels like extortion to pay for other peoples’ coverage. I’ll probably stop paying any month now, and be uninsured for the first time in my life.
The author fails to see the whole picture because of the blinders, politically speaking that he wears. he fails to factor in the lost income that could have grown our economy. But then the architects of the ACA were asked to solve a major three pronged problem with a single action. So they opted to focus on insuring the masses, and yet avoid discussing the real costs and the new economic hardships created by such a short sided solution.
It will forever be the Obama legacy. All talk and bad actions.
We have a $10,000 deductible and our premium is over $1400 per month. We don’t qualify for any subsidy. Before this fraud started our premium was $520, and our deductible was $500. This is breaking us.
In the last year I have had to spend almost $7,000 on expenses that are still below my deductible. So if I do the math,on premiums we spent $1400 x 12 months, which is $16,800 plus the $7,000 which was not covered, for a total of $23,800 on minor medical expenses and premiums.
This alone explains the working class voters that left the Democratic Party. I want the same healthcare plan that Congressman Grijalva gets for free.
My premiums would be $9000 per year with a $4000-$5000 deductible. No subsidies at my estimated income. You have to guess what your income might be by Jan 15 at the latest, and it doesn’t matter how little you’ve earned in the past. The only insurance company that qualifies for ACA in Arizona (for those over 30–because they can indeed refuse people for the pre-existing condition of age) is a tiny little company with almost no doctors in its program, apparently none in Pima County, based on the fact that the website quits as soon as I enter my zip. At that rate, I’d be shelling out $9000 and paying all medical costs myself anyhow. Who can afford that? I’d have to cash in some IRAs just to pay the premiums. As the navigator said, “You obviously have assets.” Furthermore, insurance is supposed to be a long term thing, but in the ACA, you have to pick a new insurance company (and new doctors) every year. The ACA might work well in other states, but it doesn’t work at all in Arizona, which is why the anti-ACA folks are using Arizona as an example.
What I really don’t get is the fact that the major carriers in Arizona don’t qualify for ACA. This must mean that companies using those carriers don’t have to pay the penalty, and neither do their employees. But because I am self-employed, if I get my insurance through a carrier that costs less and has much better coverage where I live, I have to pay thousands of dollars in penalties for not going through the ACA! That’s totally screwed up.
That’s why I support repealing and replacing the ACA. You can’t help some by severely harming others. I think they did it on purpose. Can they be that ignorant?
We pay $1200 a month for a $5k deductible and $13k out-of-pocket max. It is more than our mortgage. We are both self-employed and we have a child. Because there is ONE ACA plan open to us here in Pima County, and it is AWFUL with no doctors in the network I would want to see who will take it, we also pay an extra $110 a month for a direct-care physician service. Not a single one of our doctors, which we had been with for almost two decades and our daughter since she was born eleven years ago, would take the ACA Health Net plan offered in Pima County. Not a one. I had no interest in going to some random person this year only to switch again next year. So we made the decision to build a relationship with the direct care practice ON TOP of paying for regular health insurance that we don’t use for general services. We do not qualify for subsidies. Last year we paid $650 a month for much better coverage, and our doctors were in the network.
Our ACA plan is basically there in the event of a major catastrophic event, such as cancer or a hospital stay; otherwise, our direct care practice is what we use. I recommend it fully, same-day service, weekend visits, great communication, well worth the cost. My prescriptions through them are actually *cheaper* than through our insurance plan. Check out Skyline Direct Care.
We are supposedly the American dream, starting a small business that employs the two of us, but the costs of being self-supporting and not working for a large company are breaking us.
David, to completely ignore the deductible side of the cost metric is really inappropriate. Just because people have health insurance does not mean they have health care. There is a difference.
Until we have a non-profit health care system we will continue to spend twice as much for half the care. It does not matter who’s plan is in place. The issue is for-profit health care, not the ACA, not TrumpCare. Eliminate the profit structure, that is the only solution.
If you eliminate the profit structure, how long will it be before we see illegals performing minor surgeries? Doctors income would be the next thing to go. Then R&D for pharmaceuticals.
Have you ever considered that maybe we should not have messed with it? Perfection is impossible.
We are the only industrialized nation with a for-profit health insurance system. Some nations have public non-profit systems, other nations have privately run non-profit systems but most have hybrids. Is your contention that the rest of the world is using ‘illegal doctors’?
Seriously, your response had a heavy whiff of ‘Their gonna take out jobs’ crazy in it….. Hard to rationally respond to crazy but here goes…
As for Pharmaceutical R&D, more than half of R&D dollars in this country is already public money, take into account the tax credits they get on the other 40% and we are footing the bill for more than 65% of the R&D right now, maybe higher. That’s right you are subsidizing their profits. This is how it works in America. Wake the fuck up!
As to not messing with it, you are aware that the highest increases in health care costs by percentage occurred under George W Bush, before Obama care, right? Costs were jumping 40%+ per year. Obamacare was just frosting on an already shitty cake, and it was written by the industry. Just like this new bill.
Nobody is asking for perfection, we just want a system similar to those that are already working everywhere else in the world, where people get more coverage, more care and the pay far less. Their systems are not perfect, but they are much better than anything we have ever had.
To Your Average Jane Citizen,
Yes, they have us paying in alternate universes. We can’t afford to use our expensive health insurance so we buy memberships at Urgent Cares and, in your case, a direct care practice. The advertised numbers do not account for these additional costs, though I’m certain the government and corporations are fully aware of it since they are making big money from it.
I would not go to a doctor in my ACA network either. I went a couple times and that was enough. I would never trust them with a child.
I’m sorry you didn’t understand my comment humanbean. But there is no need to call me crazy. You see, you fall into the same trap that many liberals do. You focus on the outcome and then the process be damned, you want your outcome. But the end does not justify the means. And had you understood my “illegals” comment you would know that I did not coin the phrase “doing the jobs that Americans won’t do.” The left did, in trying to rationalize another “outcome” desire. The US health insurance industry subsidized R&D for drug makers with our premium dollars while foreign countries took advantage of much of that money spent to bring drugs to market. Our costs skyrocketed because of the FDA approval process.
My premiums are up 300% since the ACA was enacted. My deductible increased 40 fold. I didn’t realize how good I had it.
I want the old system back where I had choice. Right now I have little if no coverage, while spending mass amounts of premium dollars to subsidize another “outcome” forced desire.
The impact of the horror stories above from real people virtually priced out of the market with access limited to to a single provider and few doctors are far more compelling than Safier’s latest self deprecating attempt at policy analysis. The view from 40,000 feet is clear, the US is the only western democracy on earth with a health care system designed to generate profits at the expense of universal coverage and health outcomes consistent with the wealthiest nation on the planet. The answer to this dilemma is clear, you only have to remove the blinders and take a look at how other western democracies handle health care coverage and ask why the hell can’t we do the same?
Thank you Rick! A rational and intelligent analysis and response. Non-Profit health care is the only way to go. There are ZERO rational arguments against it. We need to wake people up!
I take huge issue with this statement in the article:
“While no one wants to pay the full cost of ACA health care, which averages $611 a month, the top 20 percent who make over a hundred grand can manage it. “
It is disingenuous to say what those who make over $100k can manage. You have no idea what our circumstances are, the sacrifices we have made to get to this place.
No, I do not want to pay $1400 a month in insurance premiums, not when I paid $650 last year for better coverage! Also, my husband and I built out business ourselves. It is what supports us. We took out no loans. We started it after my husband had been laid off three times during the recession. Our business is service-based, and our income can vary. It can be feast or famine some months. There have been months when we have had billables out but no income in. But we purposely dave money for these down times so we can ride it out. Why should we be punished for doing so?
All this to say, why should OUR long hours, weekends, no vacations, and time away from our daughter building a life to support ourselves and our family with no government aid be used against us? We choose to work these long hours so we can get ahead. We choose to live in a small house, one that we can actually afford rather than over-extend ourselves and take out more debt. We chose to pay off our student loan debt early rather than be burdened by it well into our forties. We choose to drive fourteen-year-old cars that are worth maybe $1500 rather than upgrade every couple years like a lot of those around us. The cost of our monthly premium could easily cover two new car payments each month! Why should our good work and the way we choose to save money for our retirement and daughter’s education be taken from us and used against us?
I am a supporter of universal healthcare. The only way to make it fair and right is for everyone to be taxed equally and have equal access to care.
That said, the system we have now is bananas and for those of us who are self-employed, getting no subsidies, working long hours, and not getting a break, it is not right or fair that my hard work should cover others in this manner. We purposely choose to live a frugal, saving lifestyle. I do not want to be punished for it. Or heck. I guess I could just choose to cut back our hours and work, buy two new cars (which I could afford with the cost of our monthly premium), and take a vacation. I could really use a vacation! Or even a trip to the doctor’s office without having to worry if that sonogram my husband needs will even be covered!
Your Average Jane Citizen
Thank you for your illuminating post! ACA was a start that is now fizzling out, especially for people like you and your husband. Republicare will more than likely make matters even worse for hardworking families leaving a single payer option the only obvious solution for those who are being gutted by healthcare costs. A personal note: I am pushing 70 and on Medicare. In July I suffered a life threatening heart attack and survived due to some fantastic care at Banner UMC. The total bill was pushing $85K and we wound up with out of pocket costs of less than $2,500. We wish every one had access to this sort of coverage allowing them to live full lives without the fear of impending financial doom or bankruptcy. This healthcare scam in the US is sickening – literally.
Rick your story is absolutely amazing. Congratulations my friend.
I have to wonder though, when Part B medicare is $109 per month, how many $85,000 procedures they can fund. Do you fully understand and trust the US Government’s accounting procedures and ability to deficit spend?
They can’t trim a tree branch using a cost effective method. Need I mention simple road repairs? I see bigger problems coming, because of lack of discipline and honesty.
Rick,
Wasn’t your life saving procedure worth the 85k? If it’s not worth you paying it sure isn’t worth it to me.
What, Again,
I often wonder about the derivation of your name. What Again? Or is it Again What? Is that British? Scottish? Welsh? OK I’m kidding, I know lots of people who are afraid to sign their names to posts.
Like I said, we (my family and friends) are glad I made it and wish every one had access to this sort of coverage allowing them to live full lives without the fear of impending financial doom or bankruptcy. The only way to get there is to join the rest of the free word (not a pun) and provide a single payer healthcare system. Or else we could just let folks who can’t afford insurance drop dead.
But with a majority of US households unable to weather a $5,000 emergency much less one approaching $100 grand I’d say the procedure is certainly worth the money and hope anyone going through this sort of crisis is provided the care needed to save his/her life.
Even you, What, Again… or Again What.
Much to my chagrin but even the government (us) can’t afford $85,000 procedures for very many for very long. Maybe they could open their own insurance company. Why not, our Social Security contributions are in a lock box. (LOL)
Tax payer trust is the biggest stumbling block for a good reason.
I had a minute to think through the proposition of the government paying unlimited amounts of money to keep us alive. On the other hand every one that were to die prematurely would save Social Security a ton of money. I guess that explains that term “death squads.” They are better of if we die.
I personally want to go back to a doctor that I choose that has a profit motive that helps keep me alive.
That $85k procedure would cost less than $35k (or even less) in any other industrialized nation. These trolls can’t see the forest for the Trees Rick!
Pharmaceutical companies spend 3 times as much money on advertising than they do on research!
There is so much unnecessary waste in our system. Health care cost were going up before Obama care at a higher rate than they were after Obama care, and people want to go back to that? Fuck that mess, fuck Obamacare and fuck Trumpcare. Non-profit is the only solution!
To those worrying about how many $85K procedures the government can pay for, please look closely at your paychecks. We are all paying for those, and Rick prepaid his proceedure with a lifetime of medicare deductions from his paycheck, matched by his employers’ contributions. For those of us who are sel-employedm our payment is double (we pay both the employee half and the employer half).
Medicare withholding is 1.45% of you income. Employers match the 1.45 for a total of 2.90. So if Rick prepaid it he earned 24 million dollars in his earning years and has now used up all his prepayments? You folks really don’t understand the math.