I have spent the last week, with my neighbor, researching this thing. We have had coffee and cocktails over this thing. We have called each other with each new nugget of info we have learned. Which doesn't mean we know even close to what we should know, but we have discovered some things.
Our situations are very different, no need to bore y'all w/that, but for our own reasons, we each have a stake in the ACA. So let me say from the get go here, that what's the most important to both of us is the ban on pre-existing conditions AND the lack of a cap on your coverage. I don't think Americans who have been lucky or have good plans through their employer, can get their hands around this, even though they may think they understand it intellectually.
The first thing many employed people (not self employed) can't get their hands around, is that they might be unemployed tomorrow. And boy howdy, wait till they see what COBRA will cost them. The second thing many Americans can't get their hands around, imo, is that employer provided insurance has become more expensive with worse coverage, and has been doing so for years. Not without exception but slowly and surely. I think employer provided coverage will only get worse, and will eventually become extinct due to rising costs. As it should. As much of the rest of the civilized world knows, it is a model that has outlived its time.
Now on to the nitty gritty of those of you who ARE self employed. If you are self employed and have been paying to insure your family for years as my husband and I have, then you know it has become like a second mortgage. We could have a lovely cabin for what we have paid a month to insure ourselves and our son. To be specific, $1500 a month.
Now, this is mitigated by the fact that it is 100% deductible and gets to the heart of what I want to say here. If self employed, to adequately consider your options, you have to look at the price you pay for insurance AFTER your tax deduction. For the sake of conversation, let's just assume a third of what you pay in health care is tax deductible. For us this brings the cost of our current insurance down to $1,000 a month. This will of course, depend on your gross income, and overshoots some and undershoots others, and isn't even accurate for us, but again, for the sake of conversation.
So when I first looked at the exchanges in my state, I was looking at the bronze options, thinking wow, we could save up to $700 a month on premiums. Which we could. However, that was before I looked at the effect of our deduction, which brings those savings down considerably.
Then there is the fact that our son needs a very expensive prescription drug each month. And here is another place the ACA is not what we would like it to be. I did not know how much this drug "really" costs because we have been paying a fortune for insurance that covers it, except for a very reasonable co-pay.
Thought I better research it, and found that even the generic of his medication is around $350 a month, the brand name is over $500 a month. I was shocked. And this is where Obamacare doesn't do the trick, UNLESS, you go for the gold, which will save us much less in the end, but it will still save us some money.
The gold ACA option in my state on the plan I'm looking at is a $1,000 deductible, which means that I will pay for my son's prescription outright till after two and a half months, for the generic, when my son's deductible on this plan will be filled. Then we still pay a 20% copay till our out of pocket costs exceed around $4,300. 20% of even the generic form of his medication adds up, but not fast enough to exceed this number in a year.
So here's the bottom line. I realize I am just one anecdotal story, with it's own twists and turns that don't apply to others. BUT, here's the takeaway. If you are self employed, you must consider the fact that your out of pocket expenses must equal a certain percentage of your income to qualify as a deduction. In my state I believe it is 17%.
Therefore, for some folks, you are better off paying a higher premium from the get go, i.e., the gold, as it is 100% tax deductible, whereas your out of pocket expenses on the bronze or silver, may add up, but will NOT be deductible.
I know, I know, it makes your head spin. Mine too. And I questioned whether I should even write this diary, but did so anyway because I wanted to share what I've been parsing out, and in the hopes that it will help someone out there, and of course, that someone out there will help me with more information.
My husband and I are both self employed in different businesses, so that makes us a small minority. And of course, all this will vary from state to state. Still, the principles and possibilities I suggest, are good things for everyone who is self employed to consider.
AND, IMO, one of the places Obamacare really falls down on is expensive prescription drugs. I don't blame this entirely on Obama, or the Democrats. The issue of big pharma is probably even bigger than other medical issues, so big it could not be taken on at the inception of the ACA, or we wouldn't have an ACA.
I did not write this diary to criticize the ACA. As I said at the beginning, the ban on pre-existing condition rape and coverage caps is very important to my family, and a vast improvement from what we had. We have not been able to even consider other coverage for years, because of my husband's pre-existing condition, and have lived under the threat that our premiums could go up at any minute because of it.
For us, in the end, we won't save that much on our monthly premiums under Obamacare, although we will save some. But We WILL get much better "catastrophic" insurance than we had, and we will NOT be punished rate wise for my husband's condition. This is HUGE for us. And of course, we can keep our 21 year old son on our policy. He needs this desperately, is so struggling to make his way. And he's not alone amongst the younger generation, as we all know.
All this just to say, no matter your situation as a self employed person, the ACA is probably going to be better for you---anywhere from a lot better to a little better. It is NOT single payer. But at least it leaves the door open to that, state by state, something very little discussed by anyone.
And in a better country, we'd be well into tweaking the ACA to be better by now, instead of defending it against a government shut down to defund it. But we are NOT yet in a better country. It is what it is.
I look forward to any feed back here, and hope this diary is not so confusing it does no
one any good. I took that risk, because I so want to share and share alike in this community, and do everything I can to help in the less brave new world of Obamacare than we would like, but a brave new world nevertheless.