Bloomberg: Health Insurance Costs Surpass $20,000 Per Year, Hitting a Record

I was trying to find quotes from this article to tweet and unfortunately there’s just too much depressing stuff here to handle so I came here?

Article: https://www.bloomberg.com/news/articles/2019-09-25/why-is-health-insurance-so-expensive-20-000-a-year-for-coverage

In firms where more than 35% of employees earn less than $25,000 a year, workers would have to contribute more than $7,000 for a family health plan. It’s an expense that Altman calls “just flat-out not affordable.” Only one-third of employees at such firms are on their employer’s health plans, compared with 63% at higher-wage firms, according to the Kaiser Family Foundation’s data.

Notably this graph:

Deductibles are rising even faster than premiums, meaning that patients are on the hook for more of their medical costs upfront. For a single person, the average deductible in 2019 was $1,396, up from $533 in 2009. A typical household with employer health coverage spends about $800 a year in out-of-pocket costs, not counting premiums, according to research from the Commonwealth Fund. At the high end of the range, those costs can top $5,000 a year.

While employers pay most of the costs of coverage, according to the survey, workers’ average contribution is now $6,000 for a family plan. That’s just their share of upfront premiums, and doesn’t include co-payments, deductibles and other forms of cost-sharing once they need care.

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I’ve apparently reached my free article limit for the month with them, but do they mention what impact ACA has had? Do they suggest any alternatives (beside “don’t have insurance and pray you never get sick”) or is the article just to say “Well this sucks”? What about the earnings reports for the various health insurers?

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I remember back in the day before the ACA when I could get a policy as good as the one I have now. It cost $40/month. I pay $1100/month now for it. The goggles… they do nothing.

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They aren’t suggesting things for individuals, as this is just a report on the trend and the Kaiser report.

They did say a lot of large employers have stopped asking workers to pay a larger proportion of costs.

Some large employers have reversed course on asking workers to take on more costs, according to a separate survey from the National Business Group on Health. In 2020, fewer companies will limit employees to so-called “consumer-directed health plans,” which pair high-deductible coverage with savings accounts for medical spending funded by workers and employers, according to the survey. That will be the only plan available at 25% of large employers in the survey, down from 39% in 2018.

They also mentioned that specifically the employers still need to attract and retain employees, so for all their hemming and hawing, they’re still figuring out other ways to keep health insurance coverage:

That leaves them less inclined to make aggressive moves to tackle underlying medical costs, such as by cutting high-cost hospitals out of their networks. In recent years employers’ health-care costs have remained steady as a share of their total compensation expenses.

I mean, that’s awesome for you. And I’m sorry how outrageous it’s gotten, for everyone. But was that really the same policy? Through the same employer? Does it cover the same things - did it cover the ACA essential benefits (free annual physical, routine testing, free vaccinations and preventative care)? Did it have a maximum it would pay out? (I knew people pre-ACA who thought they had great insurance and blew through their $1,000,000 coverage limit when they had a premature child or a cancer diagnosis).

Warning: I’m gonna go on ACA defense squad here, which is funny, because I genuinely believe while it made things better as far as receiving care, it’s a fucking broken overall system, with flaws highlighted by the ACA.

The ACA is definitely the driving factor in the rising costs because it opened up coverage to people like me without fixing the deep (market-based) flaws in our health care system.

I didn’t have $40/month health plan before the ACA, because I didn’t have any coverage available to me at all. Even my full-time employer didn’t have any health insurance options because we were only 6 staff and not big enough to buy insurance. I couldn’t buy insurance anywhere because I was uninsurable with a pre-existing condition.

What the ACA did was allow me to get health insurance to treat my illness, that otherwise would’ve cost everyone more in the long run, since the average person with my disease progression used to end up claiming disability in their 40s before the new drugs came out.

What the ACA didn’t plan for was how many people like me there were - nor did it build in cost controls for the newest class of drugs - biologicals, which mostly treat autoimmune disorders, some cancers - so I was built into the modeling as a “young health person” who would pay into the system and barely take out of it, but instead, I am a “broken young person” who requires the most expensive class of drug which has tripled in price FOR NO REASON (no formulation or production change, they simply have a monopoly) the past five years. Meaning I raise the costs for everyone else. You (and five other people who pay what you do) have to subsidize my $5,800 per month drug.

Not to say that people like me aren’t also affected by the premium hikes - plans are eliminated from the exchange every year and I have to change. Objectively, I have a “crappy plan” - it’s a $9000 out of pocket max, and $6500 deductible (the maximum allowable under ACA) but still costs $300 a month. But at least I now get assistance with paying that, as a low-income person. Before there was nothing. Medicaid was only for children and pregnant women.

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The ACA was a financial disaster for me, but as a person I’m very happy it passed, even if it is borken. Close friends of ours would have died, or their children would have died, before the ACA. Just premium shock over here is all. Me personally, my 2 years in a children’s hospital on chemo and frequently on life support ran through my parent’s insurance pretty quick. Things were touch an go moneywise for a while.

The $40 plan was through a different employer. Still not my best plan ever. Best plan was $0 employee contribution, $0 deductible, only paid copay of $10 for an office visit, $5 for medication(even the stuff I had to take as a kid that cost $7.5k per pill), and $100/day for hospital stays or the ER (included overnight stays as long as you needed). But… yeah, Silicon Valley startups had cool perks.

Current plan, I dunno, the free stuff isn’t free? At least not the versions that actually do anything. Various cancer screens don’t start until many of our friends were already dead from cancer. I still pay for vaccines somehow? Nothing seems to be preventative enough to hit that category. So like i said, for my personal finances, the ACA was a nightmare. But I appreciate the places where it works.

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I’m currently reading An American Sickness by Elisabeth Rosenthal. I have to go slowly because it is so depressing / infuriating.

I think the basic problem is the free market without regulation breaks down for necessities without alternatives. @anomalily’s experience with the drug she needs illustrates that. If the price of some food item goes up, I can eat other things. If gasoline or fuel goes up, I can bike or carpool or work from home or move closer to work or vacation closer to home. If I need health care, I can pay what they ask and won’t tell me up front, or I can be sick and / or die, not an alternative most people wish to consider. It’s tough to shop around when everyone is paying the same game or there’s only one drug and that company has a monopoly. Under other conditions, I think a black market for health care would develop and perhaps because so many people are covered by either employer-provided insurance or aid programs, that hasn’t happened.

Health care costs were going up before ACA because business people had discovered this and were exploiting it.

One weakness of ACA and employer-provided health insurance is that there are deeper pockets with subsidies and costs covered by the government and it’s taking longer to reach a crisis. It’s a huge and unfair transfer of wealth, and I fear how far that transfer will go before we or more accurately our politicians begin to grapple with this problem and start implementing meaningful solutions.

I also think employer-provided insurance worked to the advantage of the insurance companies, because it weeded out adults who are not healthy enough to work or married to someone who is. And for those who pay premuims, they are not tax deductible until the exceed I think it’s now 10% of income, yet those with employer provided plans pay no tax on that benefit or their portion of premiums.

I’m curious to get to the solutions part of the book and see if they are still applicable.

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But the employer didn’t pay $40 per head, did they? No way!

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Do you want me to go FULL RANT on my drug? Well, if you don’t, tune out now.

My drug is the second oldest biological, which means it’s out of patent protection and has a follow-on (generic) available in many countries. The follow-on became available on the NHS this year and immediately saved the NHS $131 million fucking dollars.

In the US, it’s still under patent protection for 6 more years.

But here’s the particularly EFFED up part of it in the US: My co-pays are paid by the pharmaceutical company that makes the drug I take through the “co-pay assistance program”. They will pay $18,000 a year on my behalf via a debit card towards my co-pays. That means they pay til I hit my OOP max of $9,500.

This program means they get to prop up their own prices in a closed monopoly market after I hit my OOP max each year and they get to price-set at whatever they want. Most recently raising it from $2400 to $5800 per month.

They run co-pay assistance as a non-profit and get a tax write off for it.

Capitalism. Is. Not. A. Good. System. For. Health. Care.

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I’m currently writing the scripts for our health care month episodes, and I realized I have to take rage-breaks to release stress every 30 minutes or so, lol, otherwise I’m gonna make myself actually sick from stress.

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Sing it Sister!
The question is, how do we change it?
Are you familiar with the guy who wrote a book about disruptors in the industry? I have it requested from the library.
I also heard that Walmart is getting into healthcare because every dollar we spend there is a dollar we can’t spend on their stores. I hope they don’t just use the same practices that others are using to increase their profits but actually drive some change.

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I truly believe there is no private actor that can enter the current US health care system and improve things if they also have profits in mind.

Walmart especially has historically found ways to encourage their employees to get on medicaid and other public assistance programs, and has cut hours from employees without warning when their kids or spouse developed expensive conditions on their health care plan. They have a well-documented pattern of not paying for employee healthcare, so why would them entering the health care market improve it for people outside their “family of associates”.

I don’t know the disruptor book? Know the title?

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I’ll look it up when I get home.

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I ended up in a long discussion about insurance and medications at a party last week with someone extremely smart about numbers and very knowledgeable about US healthcare protocols, among others contributing to talk.

One of the things we touched on was the cost of researching and developing newer therapies is only going to make things exponentially worse if we continue using the same pricing model.

I’m on my phone and too annoyed with my typing to expand, but we all adamantly agreed healthcare should not be a for profit industry, including a few people that personally profit very handsomely for what they do within that industry.

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Here’s the book. I’ve not read it yet.

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Not sure if this is the place. I can start a new thread if it isn’t but my spouse’s doc wants to prescribe a biologic. Looks like list price is $3k+ for a month. We plan on talking with insurance to see if its covered or what steps we need to do to get it covered. Were you able to get on it with just your docs say so or was it an escalation process? Also how does the copay assistance work on your end? I know all insurance plans are different but I’d rather go into this prepared.
On a less money note but still important how quickly did it work for you? Also were the results significant for your baseline comfort or did it just mitigate flair ups? Any odd quirks or anything we should ask that may not be readily apparent? I’m looking for anybody with any biologic experience to contribute.

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Honestly, it has in some ways. This is at least a small part of the fascination with alternative health. Not all of it, for sure, or even the biggest part of it, but I absolutely have talked to people who have said that they can’t afford health care for their (sometimes kinda serious) problems, but they CAN afford a different diet or a few herbal tinctures or something similar.

(ETA: Not a classic “black market” but still – unlicensed healthcare going on for sure with a lot of herbalists, etc)

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Hey @Gilly I’ve happily decided to derail this thead but I put it under the cut:

My experience with biologicals content warning: medical

Depending on your insurance or your state, you may have to have your doctor submit “fail first” proof - otherwise know as “step therapy” showing that your spouse hasn’t had success on any other (cheaper) drugs used to treat your disease. This is usually just having your doc submit medical records to insurance. In my case, I tried every other standard drug (methatrexate, Sulfasalazine, etc) and had no luck with those drugs so I had the documentation. So the next one was enbrel (entercept).

I’ve switched insurance plans now 5 times since I’ve been on this (YAY AMERICA) drug and while I have had to make sure the drug is on the formulary when I shop for insurance plans (usually it’s on the “specialty medications formulary” which is a SEPARATE formulary), it’s mostly been pretty easy to get it covered without a fuss. The HMO I was on covered it with only a $40 copay per month in 2014, though they didn’t take the co-pay assistance card. Every other one has has sky-high prices, but that amount is covered by the co-pay assistance.

I don’t even deal with the main insurance company at my current PPO, everything is done through the specialty pharmacy that only handles specialty drugs. So once a year, I call in to the co-pay assistance line, get recertified (swearing I’m not receiving medicaid/medicard mostly) and get a card in the mail. I then call the specialty pharmacy, give them the co-pay assistance card number, and they take care of the billing and everything for me. Because of that I hit my OOP max in Feb each year and the rest of my healthcare is “free” to me the rest of the year (that’s why I can afford to go to a therapist, and was rather nice when I broke my wrist this year and racked up a $25,000 bill that I didn’t have to pay because I hit my OOP max).

It’s delivered to my house via courier once a month (in way too much packaging on dry ice, I have feelings about it). I used to be able to pick it up at the specialty pharmacy on my HMO, but on the PPO it has to be delivered.

The co-pay assistance card is SUPER easy to use. They have a debit card version that you can swipe if you do have to go pick it up, but since my specialty pharmacy only deals with biologicals, they handle everything for me (usually biologicals have to come from the specialty pharmacy.) You usually apply through the copay assistance website. It usually comes with other weird perks, like a nurse hotline and sometimes fancy travel bags.

Oh, mine is not an infusion, it’s a self-injector shot. It does hurt much more compared to a “normal shot”, but I got really used it real quick because it’s only once a week. Also now I don’t even NOTICE other shots, they are like bee stings. One downside is that it needs to be in refrigeration, so there’s a lot of planning if you travel frequently like me and you need to have a sharps disposal container.

Some biologicals you will have to go and get an infusion administered by a nurse, usually a facility, sometimes a chemo center.

As far as how it worked for me- extremely well - I call it Miracle Drug. I went from unable to use my hands well, with flare ups most days, to 99% symptom-free. My current “flare ups” would’ve been a good day before I was on the drug.

I couldn’t hold a pen for 8 years due to my claw-hands, or open jars, and had inflamation in all my small joints and my knees. I took a gram of naproxen (aleve) daily for almost a decade. Most days I couldn’t straighten my elbows beyond 60 degrees. Now I can write pages longhand, and I can figure skate and do double jumps. I can open jars (mostly).

Other than being on a mild immunosuppressant (therefore more susceptible to colds) and a slightly heightened risk of lymphoma, I pretty much have no adverse symptoms. It started working within 3 weeks for me after getting on it, every other drug had felt like a placebo for months. It’s also reversed some long-term damage in my joints. Now I take 0 Aleve and have better function than I did for most of my 20’s.

I think @HaH might also be on a biological if she’s willing to share.

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It totally has! They’re called Christian Health Sharing ministries. They’re unregulated “insurance” companies.

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Oh @Gilly one last thing I thought of: I do have to get a CBC every ~8 weeks to get my prescription renewed, which is super easy since I life close to the clinic and it takes 3 minutes to draw blood, but with my travel schedule can sometimes be annoying. It’s actually less annoying than having to get my liver levels checked every 4 weeks like I did on MTX.

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Ugh I completely forgot about those – I know way more witchy woowoo folks than I do Christian folks, so I was thinking about herbalists and the care itself (versus paying for it).

How I wish we just had a sensible single payer system.

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