Question about Obamacare

[muon2]

When we talk about health insurance, we are actually conflating two different aspects of health care management. One aspect involves the risk management, the traditional role of insurance. This part of a plan involves the unlikely but costly need for medical procedures like surgeries and serious illnesses. The other aspect involves budget management where one might anticipate a certain number of medical expenses for wellness care and minor illnesses over the course of a year.

The different plans allow the user to balance these two aspects. A person who is willing and able to handle their own budget management can opt for bronze and just cover their risk. Another person who has more budget constraints or has a more uncertain budget might choose a higher level plan.

An analogy with car insurance would be a bronze level plan with liability coverage only meeting the state minimum mandate for coverage. The silver plan might add collision coverage to the liability, but still have a significant deductible. The gold plan then adds a maintenance contract on top of the regular insurance for collision and liability. The analogy is not exact, since all levels of the exchange health insurance include some "maintenance", but it gives the idea. A better analogy would involve setting coverage and deductibles for all three parts of car insurance then prepackaging them into only four choices.

[muon2]

There is really no difference on which doctors you have access to between the bronze, silver, gold or platinum plans for a given health insurer.  The only difference is the cost sharing when using health care services.  But as pointed out before there is a cap on that cost as well even if one were to go with a bronze plan.

But lets be clear, the plans offered on Obamacare exchange will pay doctors differently from a Medicad, Medicare and company sponsored health insurance.  
On the whole, company sponsored health insurance plans will pay doctors the most so the access to doctors will be the best under these plans.  After that would be Medicare which starting with Obamacare will pay less to doctors so the number of doctors what will take Medicare will start to shrink.  Right behind that would be the Obamacare health exchange plans.  And the worst payment to doctors would be Medicad.  Doctors would often refuse patients on Medicad because they would be treating them for a loss.  The same would also take place but to lesser extent for the Obamacare exchange plans as well as.

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

I'm talking about our health carriers, not US ones:

http://www.statistik.at/web_en/statistics/Public_finance_taxes/maastricht_edp_indicators/government_deficit/052873.html

They are running surpluses for years now. They are funded by the social security contributions by each worker/retiree. Social security contributions are automatically deducted from the gross wage you earn and the more you earn, the higher the social security contributions. Social security contributions in Austria means A) health insurance B) pension insurance C) work-related accident and recovery insurance and D) unemployment insurance.

Part of the differences are due to whether the deductions are state or federal, and who is assessed the tax.

A) Medicare is a federal deduction paid by both employer and employee. It's also federal for the ACA, but only for individuals and businesses that don't provide employee health insurance. Proposals to go to a straight deduction for insurance were rejected by Obama in early 2009 primarily due to union objections.

B) Social Security is a federal deduction paid by both employer and employee.

C) Workers compensation is generally a state mandate for employers to buy private insurance with the type of coverage (and associated cost) set by state law.

D) Unemployment insurance is a combination of state and federal taxes paid by the employer.

As you can see the tradition in the US is to shield the worker from most of these taxes and place them on the employer. For A and B the employer pays half the tax and for C and D the employer generally pays all of the tax.