Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
April 19, 2014

Obamacare Plans Are Cheaper Than Employer-Backed Coverage

A new study from the Health Research Institute at PricewaterhouseCoopers reveals that health plans on Obamacare exchanges will on average be 20% cheaper than employer-backed plans.

National Journal: Insurers offering plans on the exchanges are able to keep their costs down because “the use of narrow networks, also known as high-performance health plans, allows insurance companies to increase competition among doctors and hospitals by being more selective about with which companies they include in their coverage.”

Ceci Connolly, managing director of the Health Research Institute: “We anticipate that the public and private exchanges are going to continue to foster greater competition and ongoing pressure to provide better value … Everyone’s going to be able to look at what’s out there and available on these exchanges. I think employers will turn around and ask insurers for similar good value, when they compare plan offerings and see if they’re getting what they want for their money.”

  • Cliff Johnson

    So….. teh Obamacare makes employer plans more expensive because Obama hates employers? I knew it!

  • dw

    Are we comparing like with like? Many of the Obamacare policies have higher deductibles/copays.

    • shaysite

      But the ACA has also eliminated a lot of copays/deductibles for preventive care that used to be everywhere.

      • Rick Caird

        No, ObamaCare has eliminated a tiny number of copays and deductibles. ObamaCare is fine if you don;t ever need it. Otherwise, copays and deductibles will be killers.

        • shaysite

          Bunk! Nothing could be further from the truth! Are you a paid right wing propagandist or just ignorant?

          What Types of Preventive Care Does ObamaCare Cover with no co-pay?

          While adults get 15 services covered for preventive care, women get 22 and kids get 26 covered services. These services include some of the most important types of prevention like immunizations, mammograms
          and wellness visits. Medicare patients also gain some new benefits under the ACA as the 2010 preventive health mandates apply to them as well.

          Adult Services

          Included in the 15 preventive services for adults are
          immunizations, screenings for depression, blood pressure, colorectal cancer, and high cholesterol. Diet and alcohol abuse counseling, though not screening services are also included as no out-of-pocket services.

          Children are entitled to 26 preventive services. These include a host of developmental and other screenings and immunizations.

          Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

          Alcohol Misuse screening and counseling

          Aspirin use to prevent cardiovascular disease for men and women of certain ages

          Blood Pressure screening for all adults

          Cholesterol screening for adults of certain ages or at higher risk

          Colorectal Cancer screening for adults over 50

          Depression screening for adults

          Diabetes (Type 2) screening for adults with high blood pressure

          Diet counseling for adults at higher risk for chronic disease

          HIV screening for everyone ages 15 to 65, and other ages at increased risk

          Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:

          Hepatitis A
          Hepatitis B
          Herpes Zoster
          Human Papillomavirus
          Influenza (Flu Shot)
          Measles, Mumps, Rubella
          Meningococcal
          Pneumococcal
          Tetanus, Diphtheria, Pertussis
          Varicella

          Obesity screening and counseling for all adults

          Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

          Syphilis screening for all adults at higher risk

          Tobacco Use screening for all adults and cessation interventions for tobacco users

          Women’s Preventive Services ObamaCare

          In 2012, women became entitled to benefits under specific provisions of the Affordable Care Act. These provisions include well-woman visits, counseling for domestic violence victims, domestic
          violence screenings, and contraception counseling and dispensing.

          Anemia screening on a routine basis for pregnant women

          Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer

          Breast Cancer Mammography screenings every 1 to 2 years for women over 40

          Breast Cancer Chemoprevention counseling for women at higher risk

          Breastfeeding comprehensive support and counseling from trained providers, and access to breast feeding supplies, for pregnant and nursing women

          Cervical Cancer screening for sexually active women

          Chlamydia Infection screening for younger women and other women at higher risk

          Contraception:
          Food and Drug Administration-approved contraceptive methods,
          sterilization procedures, and patient education and counseling, as
          prescribed by a health care
          provider for women with reproductive capacity (not including
          abortifacient drugs). This does not apply to health plans sponsored by
          certain exempt “religious employers.”

          Domestic and interpersonal violence screening and counseling for all women

          Folic Acid supplements for women who may become pregnant

          Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes

          Gonorrhea screening for all women at higher risk

          Hepatitis B screening for pregnant women at their first prenatal visit

          HIV screening and counseling for sexually active women

          Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older

          Osteoporosis screening for women over age 60 depending on risk factors

          Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

          Sexually Transmitted Infections counseling for sexually active women

          Syphilis screening for all pregnant women or other women at increased risk

          Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

          Urinary tract or other infection screening for pregnant women

          Well-woman visits to get recommended services for women under 65

          Children’s Preventive Services ObamaCare

          Autism screening for children at 18 and 24 months

          Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

          Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.

          Cervical Dysplasia screening for sexually active females

          Depression screening for adolescents

          Developmental screening for children under age 3

          Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

          Fluoride Chemoprevention supplements for children without fluoride in their water source

          Gonorrhea preventive medication for the eyes of all newborns

          Hearing screening for all newborns

          Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

          Hematocrit or Hemoglobin screening for children

          Hemoglobinopathies or sickle cell screening for newborns

          HIV screening for adolescents at higher risk

          **Hypothyroidism screening for newborns

          Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:

          Diphtheria, Tetanus, Pertussis

          Haemophilus influenza type b

          Hepatitis A

          Hepatitis B

          Human Papillomavirus

          Inactivated Poliovirus

          Influenza (Flu Shot)

          Measles, Mumps, Rubella

          Meningococcal

          Pneumococcal

          Rotavirus

          Varicella

          Iron supplements for children ages 6 to 12 months at risk for anemia

          Lead screening for children at risk of exposure

          Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years ,11 to 14 years , 15 to 17 years.

          Obesity screening and counseling

          Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.

          Phenylketonuria (PKU) screening for this genetic disorder in newborns

          Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk

          Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years.

          Vision screening for all children.

          • Rick Caird

            It is you who is shoving bunk. Nothing is free. Every single one of those things is paid for in your premium.

            Now, if any single one of those screening (most of which can be gotten free already) finds something, then the huge copays and deductibles kick in. But, in fact, to get these free benefits, you already have to be paying for your care. I stand by my claim that ObamaCare is great if you don’t need it.

            I’ll just pick one at random to show how useless these “freebies” are. Free urinary track testing for pregnant women. Well, how do you get this “free testing”. Why, you have to be pregnant and you have to have a doctor and he has to be seeing you for your pregnancy. That last three involve spending big bucks for copays and deductibles to get this tiny, but “free” benefit. No one is going to go somewhere and say “I am pregnant. I am here for my free urinary track screening”. It is nonsense, just as most all the other screenings are. In fact, it all these free screenings and coverage for conditions most people will never need that is jacking up the price for ObamaCare.

            Do not try to tell me anything is “free”. It is all being paid for out of premiums. The whole thing is a disaster and all these screenings are meaningless without a doctor treating you in the first place. Putting lipstick on this pig does not help sell it.

          • shaysite

            What an idiotic response.

            Of course you have to pay a premium with ACA plans to get services, even those that don’t require a co-pay.
            What planet are you from? All insurance, including that offered decades before ACA, requires a premium to be paid.

            But you weren’t criticizing all insurance for not being totally free. You were attacking ACA only, for supposedly costing more than pre-ACA plans. When in fact, many services (including all of those preventive ones I listed) are provided by ACA without additional co-pay beyond the premium WHEREAS most pre-ACA plans charged co-pays and deductibles for those same services-ON TOP OF THEIR PREMIUM CHARGES.

            In response to that, the best you can do is complain that ACA-like all other insurance-charges premiums and make up a story about how ACA’s preventive services supposedly can’t really be accessed without doing other things.

            What proof do you have of that?

            The truth is that you are just making stuff up to attack a law that you oppose solely on ideological grounds, regardless of what it does or doesn’t do.

          • Rick Caird

            I love it. All those people who have lost their insurance because the plans did not comply with ObamaCare regulation and have found the ObamaCare policies are unfordable are not to be believed for ideological reasons.

            Have you been reading all these anecdotes or are you blindly listening to Obama. Do not call me an ideologue when all the anecdotal evidence shows substantial increases in costs with significantly larger deductibles and copays along with more limited networks. I am attacking this stupid law because it is a catastrophe, sold on lies, will cost $2 trillion over the net 10 years, and will cost the middle class more than they can afford. Anyone who looks can plainly see that is true. You, on the other hand, …

            Finally, you can claim that these “free” services were paid for before, but to make that claim stick, you would need to compare, in total, what people pay for ObamaCare and the services versus what they paid before. You can’t do that. Hope is not a strategy.

            I, personally, have never paid for a mammogram. I doubt you (and I assume you are female) have ever paid for a prostrate exam. Under ObamaCare, though, the cost for both is rolled into your premium even if it seems to be free.

            I am afraid you are not worth any more of my time, even though my time is “free” and there is not a deductible or copay. There is an opportunity cost, though. I will use that time for the opportunity to read a John Milton sonnet on his blindness. Good luck.

          • shaysite

            I see…so you’re not even going to try find any proof of your claim that ACA preventive care services are unobtainable without paying large fees not stated in the law.

            You know what that makes the reader think? You know it isn’t true.

            And all you do is assert that preventive care was “free” before ACA? From whom? It wasn’t any of the employer based insurance I had from the 1990s until 2008. All of my insurance plans prior to ACA required co-pays for everything.

            All the anecdotal evidence? What about this anecdotal evidence?

            http://acasuccessstories.tumblr.com/
            https://www.facebook.com/acasuccessstories
            http://content.time.com/time/magazine/article/0,9171,2162940,00.html

          • shaysite

            I challenge you to provide a point by point argument with proof that each of the included preventive services offered under ACA plans cannot be ACCESSED without paying additional fees.

            There are a lot of services here. But I bet that you cannot provide proof that ANY of them require additional payment beyond the premium, much less show that a majority require additional payment.

            Go ahead, I dare you-show us proof that a single one of these services requires additional payment beyond the premium.

            No that doesn’t include costs for other care “if they find something.” Those costs would apply to other services and are not charged unless and until other care is needed.

          • Rick Caird

            Each and every one of them (except things like drug store BP machines) require you have a doctor and are seeing him. I defy you to walk into a clinic, whip out your ObamaCare card, and demand a mammogram without ever having been there before. Go ahead. I’ll wait. I would love to hear how it works out for you.

          • shaysite

            You have to visit a network provider to get covered preventive services under ACA AND other private insurance before ACA-including the employer insurance I had before ACA(and still have BTW).

            There is no single “Obamacare Card.” ACA is a law governing many different PRIVATE insurance plans, each of which issue their own cards.

            You wouldn’t have been able to go into an office and get covered preventive care from providers outside of network for pre-ACA insurance: your erecting straw men and other red herrings because you can’t back up what you are saying about ACA.

          • dwmcqueen

            I defy you to whip out an “ObamaCare” card. If you have one of these things – of course it will fail, since it doesn’t exist.

          • Rick Caird

            That’s silly, Queenie. You have a card showing you are insured. What? Is that a new concept to you?

          • dwmcqueen

            Real mature. But to address your other asinine comment which will be the last reply I do to you because clearly you want to resort to name-calling and juvenile hollow attacks – If I walk in to a medical office and show an “ObamaCare” card as my private insurance card, I will get laughed right out. If, on the other hand, I show a Blue Cross Blue Shield, United Healthcare or one of the any other numerous insurance company plans that offer insurance under the reformed insurance system, then I will likely not be laughed out.

          • shaysite

            If you really believe that improving access to preventive care makes healthcare MORE expensive nationwide you’re truly in the lala land of flat earth conservatism.

            Never mind all of the statistics from WHO, NEH, Bloomberg and others which you show that the European and Japanese use of preventive care allows them to pay 50% less as a percentage of GDP than we do for healthcare while getting better outcomes.
            Just use common sense: What costs more to treat-removing a mole or stage four melanoma?

          • Rick Caird

            If you truly believe that all these little screening are going to improve health and health care, you need to look at the Oregon Medicaid study.

            You are also completely delusional if you think preventive care is the reason for less spending. Less sending is due to rationing by wait times. Unless it is the NIH, where rationing is done by not feeding or giving water to elderly patients.

            Your questions on moles is interesting. What does cost more? Removing moles on every person in the US or treating those who get melanoma? People like you seem to think screening is free, but they neglect the cost of screening large numbers of people.

          • shaysite

            Japan spent 8.5% on healthcare as a percentage of GDP in 2008. The US Spent 17%. Life expectancy in Japan has been 4 years longer than that of the US and they are also healthier by many other measures. Prior to ACA, access preventive care was also received much more emphasis and was much easier to obtain than in the US.

          • shaysite

            Removing every mole on every person??

            No doctor or public health official would advise doing such a thing. Most moles don’t need to be removed. If all of them did-as you suggest there’d be no point in screening now would there?

            Your problem isn’t ACA…I’m afraid you’re simply lacking in common sense.

          • shaysite

            BTW: trust me on this, it is simply not possible for dinosaurs to have walked on the earth alongside Adam and Eve or any other people.

          • dwmcqueen

            It is not paid in the premium, but you bet the insurance industry (a for profit industry, btw) is using its actuary tables to figure out the risk of the individual in using those services and what premium they need to charge in return. They also factor in any decrease in future costs these preventative measures may cause. This is, after all, a 90s-era conservative insurance reform alternative to big government single payer. Insurance reform would naturally require some work to figure out what “insurance” is, as compared to the poor excuses for insurance that existed before.

    • RicksAsylum

      No. We are not.
      .
      “the use of narrow networks, also known as high-performance health plans, allows insurance companies to increase competition among doctors and hospitals by being more selective about with which companies they include in their coverage.”
      .
      What this means is that the ACA policies will have fewer doctors and fewer hospitals available in any given plan. That means less choice for the patient and longer waits for service. It also means we must trust our insurance company to select our doctor for us since they will be limiting the number of doctors available to choose from.
      .
      Most of the ‘savings’ I have seen demonstrated as examples are actually just the result of the federal subsidies making the bottom line lower. The real cost of the policy tends to be signifigantly higher that before. Not to mention some outrageous deductibles and out of pocket maximums.

  • Rick Caird

    This whole post by Goddard is nonsense. ObamaCare mandates people pay for coverage they don’t need. It has limited provider networks and, no, it is not cheaper than most employee based polices, at least to the buyer.

    This is another wild attempt to lie us into believing ObamaCare is a good deal for the average person. It is not and never will be.

    • dwmcqueen

      Actually, “it mandates coverage that people who are eternally optimistic don’t think they need, but under the prior system may statistically need; and the absence of coverage would force that person into bankruptcy and the rest of us would eventually pay their costs due to increased medical fees charged by the hospitals to make up for that bankrutpcy”…*breath*

  • sanderdog

    Narrow networks mean limited access to care. You cannot keep your doctor or your hospital and you will be lucky to see a competent doctor for more than a minute.

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