> what amount was being subsidized by your company

Around $200 per month. The risk pool aspect would be true if the risk were the dominant factor in the price, which I think it isn't.

> The idea is self-insuring $15-20k is absurd for most people

People who can afford $1400/month even if no healthcare is used? I'd much rather save the money and if someone in my household has a catastrophic scenario put it on a credit card or spend the next <12 months on a payment plan of $1000/month.

> subsidize more of the cost of this care

The key word in that sentence is this. What care are we talking about? The ACA plans cost a minimum of $900/month even if I use no care at all (and that's for the plan with very high co-pays, etc.).

I've been on an ACA plan for the past two benefit years, and the plans keep getting much more expensive and offering worse coverage. The question is, why is this happening? And why is it that on the so-called "marketplace" there is not a high deductible plan that had been available via non-ACA plans via employers?

I think the answer is that it is far from an actual marketplace. There must be some incentive for providers not to offer high deductible plans or actual risk-based plans.

A risk pool is a way of packaging a lot of people into one financial model, but the larger and more heterogeneous the group, the more the prices should reflect actuarial reality. The exact opposite is the case.

Considering that so much money and research has gone into building the healthcare.gov website, why can't I simply adjust sliders to optimize the plan the same way I book a flight? I'd like to slide the monthly premium slider to the bottom, slide the maximum out-of-pocket to about 15x the mid-high premium price, adjust the "worst case event" slider to about $20K and (hopefully) find a plan for a few hundred dollars a month, which I know exists in the actual market because I had it a few years ago! If anything, a larger risk pool should have allowed insurers to offer plans that strongly discourage adverse selection (such as high deductible plans) and reflect the actual risk of cost incurred to the insurer.

The plans on healthcare.gov not only fail to offer this, but the wording, the pricing examples, and fine print is all out of some sort of bureaucratic nightmare scenario. I actually had a physician and a lawyer sit with me to try to understand the fine print and the likely cost of a few scenarios other than pregnancy and diabetes (which are shown), and we sat there confused for several hours.

I'd like to see our president sit before the nation sharing his desktop screen and watch him navigate through the site and explain the answers to the very simple things we were wondering about, as well as explain some of the more confusing terminology, as well as things like "why are there two separate plans that are so similar being offered by this company?" or "which of the priced items on this list are excluded from the individual deductible?" I'm quite sure that he'd need to do quite a bit of research and rehearsal before he'd be able to give such a demo with confidence.

When we put trust in our officials to handle things for us, there is a tremendous amount of responsibility that they take on in that capacity. Here we were, one highly computer-literate person, one doc, and one lawyer, utterly flummoxed for several hours. Imagine the average person after a long day trying to make this very important choice for his/her family. It's just wrong.

Maybe the idea is to make all the plans more and more similar until there is really just one choice that is priced based on income and nobody feels it's worth the time searching or reading any of the coverage descriptions because we all realize that the plans are all nearly the same by design, and that we're just meant to pay our "share" based on income and be grateful that such great care has been provided for us.

One thing is for certain. It's not a marketplace. There are simply not competitive plans. There is no way to sort the plans according to any differentiating factors. The "wizard" that the site offers tries to partition people into three groups based on expected usage, but does not offer any consideration to low users or users who are comfortable with the idea of getting a large bill and either taking on debt to pay it off or going on a payment plan with the provider.

And, far worse, all any of the plans I reviewed do to create an incentive for low use is subsidize non-emergent primary care visits. There is zero incentive beyond that to reduce one's use of care. Since the spread between the cheapest and most expensive plan is so small, anyone who expects to need any healthcare at all is better off choosing a silver or gold plan. If this incentive is different for people whose coverage is subsidized, I'd consider it discriminatory fwiw.