In the 90's, it didn't seem so bad for employer-provided insurance - well, unless Dental insurance was a concern.
Six years prior to the ACA - pretty much the time Medicare part D came into the picture, (though I think that's more coincidence than causation) employers with good insurance were experiencing significant premium and patient responsibility/deductible rate increases, along with loss of basic service coverage for what was previously taken for granted. My employer at the time started having to pass on 18% - 25% premium rate increases every year for basically the same coverage - and they were a "preferred employer" using a major health insurance company, with over 50K higher paid employees spread out in only four states. Of course, most of the employees were engineers and scientists, who tended to be older, but still.
My employer's premium for employee, spouse and family went from ~ $270 a month in 2004 to ~ $825 a month in 2008, with the same insurance company.
The deductible went from $1Ksingle/$3K family to $3500 single/$6K family.
Services were cut - Mental Health went from 24 therapy/doctor visits a year/2 weeks inpatient to pooling and limiting all types of therapy (mental health, physical, and occupational) to 24 visits a year and only 72 hrs. inpatient.
Doctor's visits: $10 primary/$20 specialty and Urgent Care/$75 ER with $100 hospitalization went to $50 primary/$75 specialty and Urgent Care/$250 ER with $500 hospitalization in 4 years.
The prescriptions went from a three tiered monthly <$10 generic/$20 preferred/$45 name brand or specialty to 75% generic/60% preferred, name brand or specialty.
So, maybe the doctor could provide you a referral to a MFGR's "coupon/affordable care" program if your couldn't afford the monthly *after-insurance* costs of $1500 for three prescriptions along with the $2600 2-pack injectable for your spouse's disability that kept him functional and at least able to drive on occasion. Well, until your spouse got kicked off your insurance because he would cap out for any reasonable health insurance by 2014, and you'd be stuck with coming up with $2K a month for the premiums on a $20K deductible high risk plan just for him, unless the two of you got divorced and he'd have to move out to just to get Medicare coverage through his SSI.
That's what we were looking at just in 2008, when he had gone over 1/2 his lifetime cap.
A normal healthy family, pre Medicare eligibility, might just be stuck with having to elect the "Basic" health plan on the employer's benfits menu, and grumble about the $600 - $800 a month they have to pay to keep family coverage they might never use for anything but check-ups if they're lucky.
But under the pre-ACA plans available to the worker types - especially after 2006, if there was *anything* chronic in your family, or if anyone had a serious injury or illness, you could easily be on the hook for over half your annual pay just to cover the medical expenses.
Or, you would have to figure out if it would be better to go untreated, and the patient eventually die after being a burden on the family years/decades earlier than they would have if they had gotten treatment in the first place. Just as they do in third-world countries.
Haele
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