Get Covered
November 1, 2017 7:36 AM   Subscribe

It's health insurance time again. Open enrollment season starts today in the United States for individuals. Need to sign-up? It's time to get covered on HealthCare.gov by December 15th. The marketplace offers lower costs for most Americans this year, yet "daunting obstacles" and widespread confusion persist amid sabotage attempts, causing much higher costs for some. And a grassroots group works to do what the government won't to Get America Covered. More details inside, in increasing levels of wonkery.

After a nine-month Republican effort to repeal the law and create uncertainty, misconceptions about the state of the Affordable Care Act (Obamacare) abound, with some now wrongly believing the law has been repealed or the marketplace would not be open. A few key facts:
  • The deadline for most of the country is December 15th, an enrollment period half as long as last year. Get started early, so you have time even if you have questions.
  • Many Americans qualify for financial help to get insurance, even if they didn't last year. Many who qualify for subsidies will pay less than they did this year.
  • Specifically, 80% of HealthCare.gov consumers will have at least one choice costing less than $75/month. Depending on your income and ZIP code, some plans may be free. Those who do not qualify for subsidies may see significant increases in costs depending on where they live.
  • It pays to shop. There's a good chance that the plan you had this year will not be your best choice this year. Make too much to qualify for subsidies? Your best deal in some states may be found "off-exchange" (from insurance brokers or directly from insurance companies, not on HealthCare.gov).
  • There's free help available. localhelp.healthcare.gov will connect you with a certified local navigator to help you evaluate options and answer questions. Or you can call 1-800-318-2596 anytime. The Kaiser Family Foundation has prepared an FAQ with answers on everything from tax credits to women's health.
Once you've got yourself covered, it's time to spread the word. The Administration has cut the enrollment period in half and reduced outreach and support for this year, slashing the budget for advertising and assistance, and even ordering its staff not to participate in enrollment events. Former government employees have worked to launch Get America Covered, a grassroots effort to do what the government won't: ensure everybody gets coverage. Their website has sharable graphics for social media, fact sheets, and printable posters and postcards; you can sign up to join a street team to get this information out to your friends, relatives, and community.

***

So what's going on with premiums this year, anyway? The bad news is that a Kaiser Family Foundation analysis of the 39 states that use the federal marketplace found premium increases of an average of 17%, 35%, and 19% for bronze, silver, and gold tier plans, respectively. The good news is that, paradoxically, many Americans eligible for premium tax credits will see reduced premiums, down to $0 in some cases, because the amount of the credits is pegged to the cost of insurance. American families making more than 400% of the federal poverty level (up to $98,400 for a family of 4 in the continental US) do not receive subsidies and so will bear the brunt of the increases directly, as a bipartisan stabilization bill remains stalled in Congress.

The President's decision to halt cost-sharing reduction payments led insurers to increase premiums significantly. A KFF analysis breaks down the impact by state and insurer. An Oliver Wyman analysis found just a 5-8% premium increase as a result of increased cost of care, with the bulk of this year's increases coming from the suspension of the CSR payments and uncertainty over enforcement of the insurance mandate (which the IRS says will be enforced). The Administration has adopted a "Jekyll And Hyde Approach To Obamacare Sabotage", undermining enrollment and attacking the law on the one hand, while supporting efforts to keep it going on the other. This attempted sabotage of the ACA has had an unusual impact on the marketplace, increasing the amount of subsides and making insurance more affordable for millions of Americans, raising costs to unaffordable levels for those ineligible for subsidies in some areas, creating uncertainty and confusion among insurers and the public, and generating paradoxical rates, such as gold plans that are cheaper than silver plans in many areas.

***

In other US health care news, Congress allowed the Children's Health Insurance Program (CHIP), a federal program that provides health insurance to, *checks notecard*, children, nine million of them in fact (and pregnant people in some states), to expire one month ago, with several states set to run out of money and begin kicking kids off their insurance by the end of the year unless Congress acts.

***

More links:
- When Silver Costs More Than Gold: How Trump's Actions Have Scrambled Insurance Prices
- County-by-county maps on how premiums are changing
- With Obamacare ad dollars slashed, expect lower enrollment
- The Four Sons of CSR Loading: How millions can save thousands in Silver Load & Silver Switcharoo states
- CMS approved Iowa's request to end retroactive enrollment for Medicaid, to the dismay of hospitals.
- One plan before Congress, buried in a CHIP reauthorization bill, would shorten the grace period for insurance premium payments to just 30 days. A CBBP analysis showed this would result in up to 688,000 losing their health insurance after falling behind on payments.
- Joshua Holland on single payer health care
posted by zachlipton (43 comments total) 54 users marked this as a favorite
 
Thank you zachlipton!

I've signed up with Get America Covered to get the word out about ACA signups. What I've found is that many people think that "Trump shut down Obamacare." A cab driver I spoke to was SO HAPPY when I told him that he can get health insurance.

Please help spread the word. Imagine what a difference you can make if you help just one person get health insurance.

And DM me if you'd like PDFs of posters/fliers and JPGs of graphics for social media.
posted by mcduff at 7:41 AM on November 1, 2017 [6 favorites]


Also, a great resource for people who don't speak English is connector.getcoveredamerica.org. You can search for help by zip code and language.
posted by mcduff at 7:43 AM on November 1, 2017 [4 favorites]


From the department of "not my job anymore," Barrack Obama has now done more to get people to sign up for health insurance than the actual current President, who is currently starting another Twitter rant about undermining the ACA.
posted by zachlipton at 8:05 AM on November 1, 2017 [6 favorites]


From the "much higher for some" link above the fold: But higher earners like Taylor don’t benefit. He makes just short of six figures, so he doesn’t receive subsidies to help with premiums.

Almost six figures? Fuck off. I'd feel a little bad if he were in the Bay Area but he's in Oklahoma.
posted by AFABulous at 8:07 AM on November 1, 2017 [4 favorites]


Thank you so much for this excellent post, zachlipton. Especially this bit:

Their website has sharable graphics for social media, fact sheets, and printable posters and postcards; you can sign up to join a street team to get this information out to your friends, relatives, and community.

...which will allow us to spread the word ourselves.
posted by zarq at 8:07 AM on November 1, 2017


I'm personally caught in the mess in California that was made when Anthem Blue Cross, one of the biggest insurers, decided not to be in the market this year. I can afford the insurance and I'm healthy, but I'm dreading the confusion and pain in the ass of choosing a new plan. And California is one of the best places in the US, the state is really doing its best to help insure its citizens. But with the Republicans hell-bent on sabotaging healthcare in the US with no alternative plan to offer, it's all fucked.

The US is the stupidest possible country when it comes to healthcare.
posted by Nelson at 8:15 AM on November 1, 2017 [9 favorites]


AFABulous, as a self-employed person I get my insurance through the ACA. Because I make above the cutoff, I don't get subsidies and my premiums have gone up 30% this year. Luckily, this won't break me. I certainly don't think I should get subsidies (and I am, frankly, DELIGHTED, that my tax dollars go towards subsidizing healthcare). However, the reason the rates have gone up so much this year is because of the GOP fuckery (refusing to pay CSRs, etc.).

So, no, don't feel bad for me. But it is important to note how the GOP is screwing the middle class for absolutely no reason.
posted by mcduff at 8:17 AM on November 1, 2017 [7 favorites]


Almost six figures? Fuck off. I'd feel a little bad if he were in the Bay Area but he's in Oklahoma.

His health insurance premium in 2017 was over $20,000. I'm sure he can pay that with the change he finds in his couch cushions. Or rather the change his butler finds in the couch cushions, given how he is rich and all.
posted by COD at 8:49 AM on November 1, 2017 [13 favorites]


Finished enrollment this morning in TN and I was glad to see still a choice between 2 providers (after the "choice" of 1 provider the first year or two of ACA). Got a better plan for less than last year with the subsidy, though the total premium is up significantly.

Technically, the site hung once needing a reload, and there was a rather confusing question about tax return reconciliation that I don't remember seeing before, that I needed to search tax return pdfs to answer, which seems like the kind of thing the website should be able to do for you.
posted by joeyh at 8:56 AM on November 1, 2017 [2 favorites]


I've started my hunt. My choices are the various offerings of only two insurers this year. All the majors have pulled-out of the Indiana marketplace, including my current insurer IU (yes, as in the university) Health. The IU Health pull-out is especially galling as they have been on a statewide expansion spree, building hospitals and clinics, or buying existing facilities in order to be the state's largest healthcare network. And, yet, much of it will be out-of-network to individuals like me.
posted by Thorzdad at 9:11 AM on November 1, 2017 [2 favorites]


> The US is the stupidest possible country when it comes to healthcare.

It's not that we're stupid. It's more that we haven't yet effectively organized against the predators who use our need for health care as a vector for ripping us off.
posted by You Can't Tip a Buick at 9:17 AM on November 1, 2017 [15 favorites]


For the first time ever this year, I got through signing up without the site breaking down or telling me I had to read a document it couldn't produce or that I had to be rejected by Medicaid first or whatever nonsense. That only makes me more sure the system is doomed. (Not to mention that the only ACA plan provider and the main care provider in my county are at war.) This system is terrible. But it's still far better than what we had BEFORE the ACA.
posted by rikschell at 9:26 AM on November 1, 2017 [4 favorites]


Yeah, sadly Indiana made things worse by choosing a particularly stupid strategy to deal with the lack of cost sharing reduction payments thanks to Trump: dumping the increased costs across all plans instead of just on-exchange silver ones. This means everyone bears the higher costs, even people who were never going to receive the CSR subsidies anyway.
posted by zachlipton at 9:34 AM on November 1, 2017


Thanks for the great post for anyone who wants to deep dive into the subject!

My husband is self-employed and we buy our health insurance for our family of 4. We make too much money to qualify for an ACA subsidy. The insurance company we've had for 8 years has left the individual market, so we're shopping for a new plan. For 2017 we paid $1425/month ($17100/year). For a comparable plan in 2018, it looks like it will be around $1900/month ( $22800/year). We're not even that old (thirties). It's our largest cost, surpassing our mortgage and office rent.

I imagine the Republicans would love to have us on their team - upper middle class white voters who pay six-digits in taxes. But they don't offer anything positive for our country - they aim to screw over everyone and everything: the poor, the elderly, children, sick people, the middle class, veterans, the environment, worker protections, and democracy.

We want single-payer health care.
posted by stowaway at 9:44 AM on November 1, 2017 [8 favorites]


Thorzdad, I'm losing my IU Health coverage too. I only have one insurer to choose from, though, here in the southwestern pit of the state, and I'm going to have to get a new doctor, because only insurance option I have is with a different hospital system.

When I looked at my options last week, my premium for a silver plan wasn't going to be that much higher than this year, but I am beyond pissed that all the Trump fuckery resulted in my "choice" of insurer being a choice of one or nothing.
posted by minsies at 9:55 AM on November 1, 2017 [1 favorite]


My insurance company has notified me that with the same subsidies, my current plan will mean me paying three times as much on premiums next year. At the same time, I have fewer dependents, so my subsidy will decrease by $100 a month. My monthly bill will go to 25% of my income, so I sure hope that the sole company servicing my area offers a catastrophic-only plan. I am pulling hard for Medicare For All, but will age into it (or die) before that happens.
posted by Miss Cellania at 10:09 AM on November 1, 2017 [1 favorite]


If you have a "qualifying life event" after open enrollment closes Dec. 15, the "Special Enrollment Period" still exists for sign-ups. Documentation requirements (in case there's an event looming on the horizon).
posted by Iris Gambol at 10:18 AM on November 1, 2017


Am I understanding correctly that literally, the minimum essential coverage is coverage that ONLY covers diagnostic screenings? No coverage at all for any other doctor visits, like if your screening actually reveals something?
posted by nakedmolerats at 10:43 AM on November 1, 2017


No. The 10 essential benefits include doctors visits, prescription drugs, hospital care, surgery, etc... Things to treat conditions found in said diagnostic screenings.

The part that's special about preventative health services and diagnostic screenings is that ACA plans have to offer some of them free of charge, no co-pays or deductibles apply.
posted by zachlipton at 10:51 AM on November 1, 2017 [1 favorite]


I'm Canadian and can't believe this is the case for the USA. How can every other nation in the world have social healthcare except for the USA? Even Russia and China has social healthcare.
posted by GiveUpNed at 11:22 AM on November 1, 2017 [2 favorites]


I'm Canadian and can't believe this is the case for the USA. How can every other nation in the world have social healthcare except for the USA? Even Russia and China has social healthcare.

Medical vendors, insurance companies and physicians rule the industry.
posted by zarq at 11:45 AM on November 1, 2017 [2 favorites]


Also, pharmaceutical companies. Can't forget those bastards.
posted by zarq at 11:45 AM on November 1, 2017 [2 favorites]


Also, pharmaceutical companies. Can't forget those bastards.

Don't leave out the pharmacy benefit managers!
posted by bassooner at 11:49 AM on November 1, 2017


My insurer effectively pulled out of the market and shut down completely 6 months ago in Chicago. Harken Health was an experiment by UnitedHealth Group and I thought it was wonderful. I had a personal relationship with my doctor and health coach. I could email or text them and I always got same day appointments, sometimes within the hour if I wanted.

When they decided to shut down for 2018 they closed all their clinics (where you have to go to see your doctor). So after July 1 I had no doctor. Technically I had to declare one for the rest of 2017 and they had to be in Network. Well... every doctor in a reasonable area of me/easily reachable by public transport had an 8 month waiting list for an appointment. Doctors offices told me I should go with one of the interns as my primary. Sure, I'm game, but those people are not listed in the Harken system so they can no be listed as my doctor. So, I have no doctor. Feels like being self-employed in 2006 all over again! Well, at least I have insurance. Back then I was considered prime baby makin' age by actuaries so they did everything to deny me insurance.

My first year with them it was sold on the exchange, but in 2017 they pulled out and only sold directly. I don't qualify for any subsidies so there's not a huge reason to buy on the ACA. This year I'm going to be extra careful that I'm not getting a non-ACA compliant plan, I don't want that. Any reason you guys can think of why I should buy on the ACA website in Illinois if I don't get a subsidy? I mean, as a self employed person I have no idea how much money I will make. It can fluctuate A LOT, but baring any big issues it should be over the $48k threshold for subsidies.

I took a brief look at Healthcare.gov a few days ago and it looks like I'm going to be seeing those big increases no matter what policy/medal level I choose. What surprised me was the Silver plans having a 50% coinsurance after deductible was met. I thought the coinsurance rate was legally determined by medal level, no? Oh, and deductibles are around $7,000 and are not considered high deductible plans.

Honestly, my biggest thing is the shrinking of networks. I'm lucky living in Chicago that there's about 25 plans available. However, all but 4 are HMOs and (I haven't looked this deep yet) but all insurers have put their ACA plans on crappy networks. What's the point of getting insurance when there's only 1 doctor who accepts it in a metro area of 10 million? I can't even buy my way into those better networks if I wanted to! I've already been paying my derm cash and said goodbye to all of my beloved doctors at Northwestern a few years ago. But, damn, it still sucks. I know people have it much, much, worse but it still sucks.

I wish I didn't care so much about Health Insurance but this issue has plagued me since I started working for myself 17 years ago and I don't even have any really serious issues.
posted by Bunglegirl at 11:51 AM on November 1, 2017 [2 favorites]


It's also that billionaires like the Koch brothers know that if health insurance is no longer attached to employment, workers will have much more leverage in negotiations and choice in jobs. Those billionaires donate millions and millions of dollars every year to get politicans elected who will do their dirty work for them.

A group of large GOP donors explicitly said they would shut off all campaign donations until the GOP killed the ACA and delivered enormous tax breaks to the rich.
posted by mcduff at 11:54 AM on November 1, 2017 [2 favorites]


How can every other nation in the world have social healthcare except for the USA? Even Russia and China has social healthcare.

If anyone is interested in this, you won't find a better answer than Elisabeth Rosenthanl's An American Sickness. It's in-depth, but still very accessible.

Source: Currently paid to fight the good fight for health care.
posted by matrixclown at 11:58 AM on November 1, 2017 [1 favorite]


I don't know if people who get their insurance through employers know how limited the plans/choice is out there, money aside.

mcduff, I truly believe that until health insurance and employment is uncoupled we will never see change in the healthcare system.
posted by Bunglegirl at 12:00 PM on November 1, 2017 [3 favorites]


I just lost my job and I would have to pay over $1000/month to keep the spousypants and my self covered with COBRA — so I checked out the marketplace plans for comparison. I found some cheaper plans, but none of them cover any of our doctors or our prescriptions and the ones that do cost way more than the COBRA option. I think we're just going to have to stay healthy for a bit and figure out how to pay for our meds out of pocket.
posted by thedward at 12:45 PM on November 1, 2017


i can't fucking wait to twirl my lanyard while i set up a spreadsheet to model the financial properties of various health plans and tax credits on offer through the marketplace of one private insurer. god help the people without a STEM degree trying to deal with this shit.
posted by indubitable at 12:59 PM on November 1, 2017 [4 favorites]


Is that another way of saying, a STEM degree guarantees permanent employment and sufficient disposable income to purchase health insurance at any price?
posted by marycatherine at 2:37 PM on November 1, 2017


Is that another way of saying, a STEM degree guarantees permanent employment and sufficient disposable income to purchase health insurance at any price?

i think it's more a wry observation that advanced study in mathematics and/or years of practice with spreadsheets is required to run a halfway-decent analysis of the deeply confusing options available to the consumer in this godforsaken and broken system
posted by halation at 2:46 PM on November 1, 2017 [10 favorites]


Is that another way of saying, a STEM degree guarantees permanent employment and sufficient disposable income to purchase health insurance at any price?

i think it's more a wry observation that advanced study in mathematics and/or years of practice with spreadsheets is required to run a halfway-decent analysis of the deeply confusing options available to the consumer in this godforsaken and broken system


I read it as deferring the conjecture STEM disciplines are, by default, more capable of rationally and mathematically framing a complex issue than say, someone with an English or Philosophy degree, and suggest such conclusion suffers from confirmation bias to bring into question assumptions about recent trends in hiring and the general defunding of "soft" social sciences.
posted by lazycomputerkids at 3:38 PM on November 1, 2017 [2 favorites]


it's because i had to build numerical models in spreadsheets and FORTRAN the last time i had a job and i'm still not 100% on which is the "correct" plan to choose. it's an unbelievably halfassed system compared to universal single payer healthcare that's free at the point of service. just give everyone the same coverage and take it out of my tax bill.
posted by indubitable at 3:52 PM on November 1, 2017 [6 favorites]


I have no difficulty interpreting indubitable's thrust, nor do I believe I misinterpret marycatherine's issue with a final qualifier (well intentioned or not): god help those not so mathematically inclined.

The latter is seemingly less generous and acerbic, but it does not lack comprehension as another poster interpreted.

Yah, it is a failing "system" because its compromises actively threaten capital investment and projections of any tax base sufficient to fund single payer are not compelling to a status quo of concentrated wealth.
posted by lazycomputerkids at 4:05 PM on November 1, 2017


The company we worked for was bought out by venture capitalists, who fired everyone unwilling to sign a five year global non compete. So, were sort of forced into the marketplace, because there are no private policies that we can find in texas. Even the broker who did my insurance when I was self employed said there was nothing he could do.

On the marketplace, I have a choice of three potential providers. Two of them do not have rheumatologist in network. Two of them do not have any labs or imaging within 100 miles of where I live. None of them have my doctors. None of them cover lupus drugs. Baylor Scott and whIte has purchased almost every major medical facility nearby, and they refuse to accept any aca plans. I know this because I called their corporate offices to find out what insurance they did accept now. None, if you are not on an employer plan, you are fucked.

And, I get to pay $24,000 dollars in premiums for the privilege of dying early because my lupus will be untreated when I run out of meds in a couple of weeks, because I can't pay the two grand premium and pay the two grand out of pocket to see a specialist and have the lab works required for taking these drugs, but I have to carry insurance because gods forbid something happen to the Boy.

Instead, I'm having my pharmacist help me draw up a plan to withdraw from the drugs as gracefully as possible. I don't know what is going to happen. None of us do. Except the republicans, whom I'm sure will be thrilled if I decrease the surplus population.
posted by SecretAgentSockpuppet at 5:21 PM on November 1, 2017 [10 favorites]


Sorry, SecretAgent. I wish it was different for you: this sucks really bad.
posted by wenestvedt at 5:50 PM on November 1, 2017 [5 favorites]


Oh, SecretAgent. I want to pick you up and move you where the help is. I'm so sorry. 24k premiums are ridiculous to begin with. I don't even understand this. What is wrong with this country?
posted by greermahoney at 8:31 PM on November 1, 2017 [1 favorite]


Is that a family plan, SecretAgentSockpuppet? 'Cause I was feeling pretty terrible that my premium (for one person) went up to $800 a month this year. But... compared to $2000 a month...

I mean, it's still ridiculous but it seems kind of ungrateful to gripe if yours isn't a multi-person plan.

Ah, hell, it's not a competition. Obamacare, yay, but still... $800 a month with no subsidy. Ouch.
posted by Justinian at 11:29 PM on November 1, 2017 [1 favorite]


Yeah, ours is to cover two adults and a kid, with no subsidy, based on income estimates, because they don't use unemployment benefits as current income, but consider us temporarily inconvenienced, income wise. Which, to be fair, gods willing, is true. That said, it's a lot harder to find a job as a 50+ woman in tech than one might hope, especially when one evidences physical disability.
posted by SecretAgentSockpuppet at 5:27 AM on November 2, 2017


Oh, and deductibles are around $7,000 and are not considered high deductible plans.

Hell, I'm seeing deductibles as high as $13,000.
posted by Thorzdad at 6:17 AM on November 2, 2017 [1 favorite]


Yeah, ours is to cover two adults and a kid, with no subsidy, based on income estimates, because they don't use unemployment benefits as current income, but consider us temporarily inconvenienced, income wise.

Huh, I wonder if that's a state thing, because they were fine with accepting proof of my unemployment income and I got a significant subsidy ($300; my part is $60). I'm single so obviously my costs are going to be different but I'm surprised you got nothing as a family of four. I'm at slightly less than 200% of federal poverty level and I qualify for food stamps.
posted by AFABulous at 9:16 AM on November 2, 2017


In 2018 I will be leaving the ACA marketplace for the first time since it opened. Only one insurer is offering plans in my county, the least expensive of which will cost $1273/month for Mr. Ant and me. This works out to just over $15k/year, which is fully 1/3 of the median household income for my county ($45,038). Note that this is for Bronze-level coverage, and does not include out of pocket expenses for deductibles, co-pays and the like. In 2017 similar coverage cost us $780/month.

We need Medicare for All, and we need it NOW.
posted by workerant at 12:38 PM on November 2, 2017 [2 favorites]


To clarify, the $24k premium is for a lower deductible plan, family max of 7k iirc. But, the 13k deductible plan still doesn't qualify for HSA, and is only $50 a month less. But none of them cover lupus pharmaceutical or treatment, and if you buy them out of pocket, you can't apply it to your deductible. And many, many healthcare organizations are unilaterally refusing to accept ACA plans, period.

Yes, Medicare for all. Now.
posted by SecretAgentSockpuppet at 1:54 PM on November 2, 2017


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