Posted in Affordable Care Act (ObamaCare), Economic Issues, Medical Costs, News From Washington, DC & Related Shenanigans, Patient Choice, Quality, Uncategorized

ObamaCare by the numbers: A real life example by Bill Klapwyk

Extracted from posted comments by Bill Klapwyk on a Linkedin discussion:

Here is an example of how ACA is helping me which is what the Republicans have decided needs amended and the democrats refuse to even talk about.

Household income in 2014:
436% of poverty level
Unsubsidized annual health insurance premium in 2014:
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
Amount you pay for the premium:
$4,145 per year
(which equals 6.13% of your household income and covers 100% of the overall premium)
You could receive a government tax credit subsidy of up to:
(which covers 0% of the overall premium)

Bronze Plan

The premium amounts above are based on a Silver plan. You could purchase other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

For example, you could enroll in a Bronze plan for about $3,435 per year (which is 5.08% of your household income). For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.
Out of Pocket Costs

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

A Silver plan has an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher. Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.
Other Coverage Options

Children and young adults under age 30 are eligible to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($12,700 in 2014). However, preventive services are covered with no cost sharing required.

My current insurance costs me $115 a month and is a $5000 max out of pocket. It covers at 80/20. The exchange cost for me is $345.42 per month and we wont talk about the 70/30 or the additional $7700 per month out of pocket. It might be worthy to note here that I am lower middle class which is the people this law is supposed to help right? If I’m lower middle class how does this help anyone in the middle class?

You wanted facts there are your facts. That helps those that can’t afford insurance how? By forcing them to buy insurance at premiums higher than the ones they currently can’t afford. Did the math, did the investigating, did the find out what it will cost me. Are the Republicans in the wrong for trying to delay this for a year to try and make some good amendments to the law my opinion is no. The fact that the Democrats completely refuse to even have a discussion about the ACA and anytime it is brought up in any interview they skirt around the issue should be evidence enough that it isn’t a good thing as it sits and needs to be amended.

Bill Klapwyk


A primary care physician by training, my passion is researching and writing about the importance restoring patient centered care, supporting independent private physicians, promoting free-market solutions and seeking sustainable fiscal policy in healthcare.

3 thoughts on “ObamaCare by the numbers: A real life example by Bill Klapwyk

  1. Your question really gets the basics of a lot of Government initiatives that provide some form of benefits. What has made these programs always go up and up in cost with no end in sight, is that most are structured as a defined-benefit rather than a defined-contribution. This creates a situation that promotes virtually unlimited utilization of a finite resource. Focusing on the benefit side, and hoping costs can be contained on the upper end of that sliding scale (no limit to upper end prices by the way) also does not give the supply side any motivation to compete on price. The only care about Reimbursement levels based on contracts. This is the main cause of the Cost-Push inflation that we experience in health care in the U.S.
    Moving towards a Defined-Contribution model for “safety net” government resources would solve a myriad of budget issue and cost over-runs and help get us back to fiscal sanity.

    The other main factor that is related economically to your point is that the Government does not stay neutral in how it treats individuals is similar socio-economic situations. The tax policy allows vastly different treatment of individuals in similar financial situations depending their employment status (self, contractor, employed, size of employer and benefits offered), which acts as a perverse economic incentive (disincentive) to purchase insurance, in the case of health care.

    When it comes to health care, the most comprehensive, cogent, practical and potentially politically viable approach to fixing this issue that I have ever came across can be found at this link. It is well worth 50 minutes of your time to view. I think just about anyone should be able to find a lot of common ground in this approach outlined by John C. Goodman.

    Here are the links to articles that speak the best to all your concerns.



Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s