Harold Urey

Hull-Oakes Sawmill

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David Bar Katz

I have part of one of the boards found in an old barn that was torn down several years ago. Nothing like the smell of fresh cut wood and the beauty of a finished object made of wood. What a great, great presentation, but just as interesting have been all the follow up comments, so many by people in my age bracket, i.

Incredible memories, and I saw most of the large mills in CA when I was a woods rat cruising timber. I am surprised to see that there is still at least one log pond around. Once the big handling equipment that LeTourneau, Cat and Euclid built came on the scene, most mills turned to log yards, sorting on land instead of water. Beyond the head rig the conveyor system could handle only small dimension stuff. If they were cutting an RR tie or a large square, once it was to dimension the sawyer would bring back the carriage at full speed, the dogs would be lifted, and when the carriage came to a stop the timber would shoot back out of the mill, fall some 20 feet, and land in the pond with a gigantic splash.

Could give you quite a start if you were driving by and not expecting it. I used to work in a lumber yard back in Ames, Iowa for several years.

I received your presentation from friends in Central Oregon this morning and how great it is. I have read every one of the comments and much to my suprise there are none from Anacortes, WA, where we had two huge sawmills, a pulp mill, a plywood mill, and a dozen shingle mills, plus numerous individual shake cutters. Wood and fish was our life blood on this island.

I grew up hanging out at our local shinglemill on Similk bay at Summit Park, and knew every hand there. IT was all steam, as all our mills were. My dad worked in the logging industry before me. Years later as an engineer and business owner, I converted two steam mills to Hydraulic.

The first at Johnsondale, CA a complete company owned town and mill and the second was a smaller mill at Davenport, CA. I did live in the Bloedel-Donovon Owners house in Bellingham, Washington in that over looked their mill.

Thanks for sharing this wonderful piece of history. I have driven by this mill you showcased many times. The lovely old log trucks were out though and made for great photographs. The sawmill is going to be open to the public for a tour on May 18, as a part of Historic Preservation Month.

I grew up in the Wauconda Area Graduated from Republic High schoo in , As a kid I used to help a friend of the family cut railroad ties I used to use a sort of knife like article and cut the bark off of the ties that he cut. Made a dollar a day then after a stint in the Army after being discharged in I worked in a steam powered saw mill in Tonasket, Washington for quite some time so I really enjoyed this article Thanks again for bringing back fond memories Bill Fischer.

I visited Hull Oakes a few years ago and found it fascinating. Now I am involved in a writing project involving specific elements of Oregon history and would like to use this story as a resource, with permission. When I got out of the Navy in 79 my new bride lived in Corvallis. We moved from Georgia to Philomath Oregon where there was I believe 5 sawmills within the city limits or very close to it. I went for a millwright position at Pedee lumber company, which had already been filled.

The owner did me a favor since we were both navy men from the black gang boiler rooms he put me on as the off bearer by the big bandmill. I soon began to wonder if he really did me a favor or not, when you work in one of these old mills where most all of the work was manually done, there was know slowing down and you generally had more than one job at a time. If you worked in one of these mills and lasted, you were a real man.

Thanks for the memories. I am in the process of setting up a small mill in the back of my place, not to really make money but to enjoy the sounds and smells of logs being milled.

Some guys want bass boats, I prefer a sawmill. Sawmill in Monroe, Oregon. There also has been one book written about the mill, its processes and history. Here is the citation:. A Case Study in Industrial Archaeology.

Keep up the good work. What an excellent documentary of the mill and the timber industry. It brings back a flood of memories as my entire family has been involved in the industry in one way or another for over years.

The company would later become Publishers Paper Co. Sadly, the mill was recently forced into bankruptcy when it was unable to compete with the Chinese for raw materials. My Grandfather started a career in the woods in Alsea maintaining a steam donkey for the logging operations. He later moved to the Hull-Oaks mill in maintenance to work on the steam engines there. To know the toughness of these folks, my Grandfather talked of the times that he would walk from Alsea to Corvallis for food provisions for the family.

That is an uphill walk back of some 22 miles carrying a load of groceries! During the depression, another group took the risks and constructed a plywood mill in Albany. This mill used steam power for the lathe while the balance of the machinery was electric. The electric power came from two steam turbine generators that had sufficient generation capacity to run the entire city of Albany in an emergency. The steam was also used in the dryers to dry the veneer. At times the peeler blocks were so large in diameter that they would be chucked off center and rocked back and forth to cut down one side and then re-chucked to clear the floor.

During World War II, these thick panels of plywood were used for the carrier decks on our aircraft carriers. I started my career in wood products at this mill; learning to run every machine station there was while going to college, studying in the field of accounting. Later, as a CPA working for a national accounting firm in Portland, I would return to this mill to audit the books as an independent accountant.

Sadly, this mill too is gone; lost to the Spotted Owl controversy that closed down logging operations for so many mills. One of my major clients turned out to be Publishers Paper Co. Later, I would leave public accounting and take various accounting positions with Publishers. I later moved on to other wood produicts companies finally retiring.

I still build from wood and will until I die. In my early years I would pass through the mill many times on my way to hunt for deer in the hills west of the mill and later on, to ride motorcycles all over those hills. If you knew the old dirt log roads well enough you could ride all the way to the Oregon Coast. The guys at the mill were always friendly and would wave as you went by or stop you on your way out from hunting to inquire of your luck. The sound of the screaming saws, the steam engine, debarker and the mill overall was a symphony of pure pleasure.

Finally, being politically incorrect, as most timber folks are, I will note that the favored term for the articulated arm on the carriage that turns the log is the Nigger. Thanks for a great story of real America. I was a personal friend to Ralph Hull. He wanted the mill to continue after his death and his genius was in acquiring timber ownership to leave as a continueing raw material supply.

The mill does not run exclusively on Ralph Hull timber but I sincerely doubt if it could still operate without the private timber holding. Ralph was a Good Samaritan. Not only are the folks at Hull-Oakes fine and respectful, they are intelligent as well. There are no computer-operated machines in the mill; every operator is working with the computer in his or her head.

Furthermore, every log cut is to meet a specific order, which can vary from one log to many, and from small to large as the photos showed. It is an unusual and remarkable place. Thanks for a great photographic record. I just read this online and I wanted to tell you that I grew up around Hull-Oaks. My grandpa worked there for years until he finally retired. Even today if you ask around the mill if they knew Barney, they would. Also my uncle still works up there has since he was 18 years old.

My father worked there off and on when I was growing up. I really enjoyed reading what you wrote. I hope you get a chance to go back out there and do another article. I throughly engoyed this entire article. I am an old fan of steam power in every application and am fortunate to live only one 1 mile from a steam traction engine museum here in Portland, Tn. The museum also contains over gasoline, diesel and kerosine powered tractors on steel and rubber tracks or wheels.

They belt up many different tractors and Traction Engines to it to cut the mostly popular and oak logs. It was donated to the Celebration and most effectively powered by the owner of several Keck-Gonnerman engines. They can bee seen, heard, and smelt working away every October on the first week-end. Right off of state rd. Come see us, and Remember,…….

Beautiful job on this site thanks Wayne. Gary Katz I would like to thank you for your work and photos on the Hull-Oakes mill. As a young man I had one of the best childhoods growing up there, I wish every kid could have had that growing up and this world would be a better place.

My father worked for Diamond Match Lumber Co. He past away at 47yrs. However the memories that your story stirred, when we would cut the pine and redwood boards, oh the fragrance, working late in the night to get the orders out for next day deliveries.

As you can see I have started a small lumber company just because I love it, certainly not for the money. Can you tell me if Hull-Oakes mill has someone there that I can contact to visit them?

Once again, thank you for preserving the past. Found your site thru the net. That is a cool machine and history too. My husband has managed to line up a Coutts 2 head rig. I have contacted All Blades Canada and they have gave a place in Ont to get the blade to be pounded and order the bits. My question is is there a place in western Canada that we can get the blade pounded and order bits.

The timber industry used to be huge there. I knew a young man who, while working in a mill, got hit by a piece of the band saw blade when it hit a spike. Yes, someone spiked logs in protest of certain logging practices.

In researching to write about that incident, I came across your site and found the info very helpful and fascinating as well. This is a great article. Video of those saws in operation would have been amazing. A great story of a successful American family-owned and operated business. I have been in the reclaimed lumber bus. Our source of material comming from buildings of the Industrial rev.

I noticed they had a hand sign to sawer to tell what size of cut. That was developed in the south found in the book The Fasinating Lumber business. Plywood in Eugene, Oregon. Does anyone have photographs, videos, or documentation of any kind on the lathe? But I am sad. I was there Friday and loaded some beautiful timbers from there on my truck. I should have asked for a tour: The guy who describes the screaming motors and overwhelming noise and vibration all around you as a symphony of pure pleasure obviously has NO clue of what it is really like to come out alive at the end of the day.

Pure Terror and broken backs. Smashed legs and feet. Bill Oakes gave first-aid, probably saving his life. Offbearing that band saw was a near death experience every day! As for those back teeth ,I once saw them cut several feet and 4 inches deep in a log because the setter hit the wrong lever while backing up.

Later, they did lose a band which almost decapitated Ralph K while cutting it out. I was laughed at for diving for safety. My brother was stuffed onto that band saw table by an unaware timber sawyer, almost breaking his legs and inches from those shark teeth.

As carrier driver which was one of the best jobs, I had a choice between one carrier with only a hand brake and one s vintage carrier that smoked so bad it would make me sick. Admittedly this was later remedied with some better machines. They are all still there lined up like a museum. I had never seen one of the pond boats out of the water until recently. It is being repaired for current use. Undoubtedly the ugliest boat ever built. So stare in wonder, I still do.

Thanks for the extensive article about the Hull-Oaks Sawmill. I was re-reading an article about the mill in one of my old issues of Invention and Technology, Spring, I Googled the mill and came upon your article. I teach engineering and art in two middle schools in Oregon and hope to someday show your photos to my students.

It was hard and dirty work, but I loved the smells of the fresh cut woods and their resins aroma. Thank you for this wonderful web site. This should be on the history channel as it is so vital to what we are and how we started out.

Washington was our first steam mill developed by Pope and Talbot after President Lincoln gave them 15, acres of timber in Washington State. The thing that impressed me the most was the work ethic of the personnel. The story is great. From an old logger lady who worked in a logging camp starting in Then transferred to Weyerhaeuser in My husband worked in a small sawmill in North Bend, WA.

Am looking for any more info about the mill. If you could e-mail me please. I am an HO railroad builder and would love to model this mill and adjacent buildings and town if there is one nearby. He was married to my mother, Pauline Kyle, from Alpine. They are no longer living. Oh how I wish I could show him this photo essay and ask him what roll he played. I know he worked in the office but maybe started out in the mill? Are there records of those that worked at the Mill in years past?

Thank you, Paula Eubanks Smith. I was 9 years. The mill had burned down and dad rebuilt it. The planer was there and the 2 boilers survived. They bought used equipment from a mill in central Oregon by Interstate 5.

Our carriage gun was shot. We could cut 30 ft logs. The gang saw was powered by its own steam engine as was the whole planer mill. I have an aerial picture from era.

These mills used to be all up and down the Pacific northwest. Shotgun was the old term for a long cylinder that connected directly to the carriage. They called it a shotgun because the steam pressure could be built up by the sawyer, and he could literally shoot the carriage back.

Some of the old timers tell stories of getting a green setter on the carriage and knocking him off his seat with a quick blast to the back end. Lived in Coos Bay Or. Did everything but run the Headrig. Unfortunaly, the mill site is now a casino now. But still think I could walk around and show people where every bit of equipment was. Hate to see the lumber industry go to hell.

When I was a kid my dad showed me your mill. More carriage then I have ever seen. Interesting to say the least. I would love to hear the operation. This is the mix of industry and nature. Thanks for sharing the photographs. My grandfather was a sawyer.

There are three saw mills — pole mills in the town where I live. I love the finished products moving out on trucks And I enjoy watching the process. There are four foresters in the congregation I pastor that also help to re-forest the land. Through some methods of management, these foresters have perfected, there is timber plenty to supply the demand and stay ahead of the curve.

This was a very interesting article. I am a wood turner and it is very interesting to see the processing of log to lumber.

Thank you for such a rich and historical article. I grew up there for the first 6 years of my life and learned to swim in the mill pond. When the mill closed, 2 years after the death of my grandfather, It became deserted and falling down. They thought it would be a great place to live and raise their children. They moved in and rebuilt the homes, grocery store, school house and church.

It is now a wonderful place to visit and stir up allot of old memories. Whenever I go home to New Orleans I always make a point of stopping at the mill. It remains the MILL in my heart. I looked at your mill from the air a few years back while doing some mapping in the area, and have wanted to get a closeup look on the ground.

I retired in My last in a computer operated mill in Ca. Also worked in steam powered mills,great in the winter. I worked in the mill before going into aviation in I enjoyed many things about working in the mill and did almost every job there from pond monkey to car loader. One thing I did not like was when an ambulance came up the road because it meant a friend or relative had a serious accident.

My cousin, Bill Oakes, is shown running the boilers. He is now retired but does guided tours of the mill a couple days each week. What a great Tour on the net. Thanks for this tour. I worked in a small mill in Trout Creek, MT as a Filler, given a general instruction on filling for a day or two. I had watched for some time. I am very mechanical minded.

I did it all, leveled, benched, tensioned, fitted, welded ETC. They were 19 gauge band, Box saw blades. I loved the job. Our Journeyman Filler was impressed. I was 47 at the time, Never seen a mill let along worked in one. I was from Eastern MT. I did finally after a few days and sleeping on it. I did the chipper blades amoung other millwright things. Are there still that size logs in OR?

Thanks for all the great pics. I see my Uncle Sid posted above. I grew up within a mile of the Hull-Oakes sawmill. The steam whistle calling end-of-shift was one of my favorite sounds growing up. I live in another state now, but just seeing your beautiful pictures and the familiar faces in them has brought back so many memories. When I was small, a city kid, our father loved to take quick trips exploring our new state, New Mexico.

Once I was going crazy wanting to just get out and run when he spyed a funny looking, open ended bldg with lots of soft looking dust piled around it. It looked like some wind storm was blowing it all around in the valley but there was no wind strong enough to do that.

We took off running and found ourselves in a small family owned sawmill; and, they were running the machines making an awful, echoing racket. Not such a big mill, but it was an experience I never forgot. So often we are in such a big city hurry we forget to notice and appreciate the basic lifestyles and businesses that have made our country so proud and powerful. I still love that scent of life!

Thanks for the article! Got this from a good friend, Steve Lovell we worked together over the years but in different environments……heavy manufacturing. Company name Hearne Hardwoods. Hawaiian guitars to name a few. All of these people are gifted…. Reading this story and thinking about these people I mentioned here, helps me strengthen my belief in the good and greatness of America. As a relatively young amateur woodworker, I really enjoyed the article. I really liked the article on the mill!

We did about 20, bft a day finished product — white cedar has much rot in it with about 10 people in the mill. I would sort all of the wood that came off of the edger and either send it to the resaw or throw it down to the chipper. Sawmills are some of the most dangerous places to work. High gear, all the time. Cold and really dusty. I once had a slab suddenly shoot out of the edger, in a blurr, and graze my neck…. I thanked the Lord for protecting me that day!!

I went back to carpentry. But I am thankful that I had a job and I learned much. A Love Story" Emmy Nomination. This project originated when Katz received an Alfred P. At Fox Searchlight Bar Katz is penning a script based on the true story of Clark Rockefeller, a man who took on false identifies for decades, one of which was a Rockefeller.

This project is reportedly far into development. It also on The Blacklist, a list honoring the best screenplays that have not yet been filmed. At Universal Pictures Bar Katz is penning a script based on the true story of two FBI agents who throw a fake wedding to arrest world class criminals. He has had six plays selected for their annual Barn Series Festival between Always full of surprises. Bar Katz was one of the featured artists of Labyrinth theatre company's series of artist salons, exploring the process artist go through to produce a finished product The other salons featured muMs and Daphne Rubin Vega.

Katz creates a fantastic biography of Jerry Siegel, the co-creator of Superman, to explore the roots of art and its relationship to the world. The History of Invulnerability speaks to the troubled yearnings of the human soul. The spectacular production is well worth seeing.

The script by David Bar Katz is a powerful piece of writing The ACA does not impose asset limits for the Medicaid expansion population. Stringent asset limits remain, however, for individuals who qualify for Medicaid because of qualifying disabilities. States and the federal government should raise or eliminate these asset limits, which harm individuals with disabilities and their families. The ACA made that system even more complicated, by adding the new health insurance marketplaces, Medicaid expansion, and other innovations.

Employer-sponsored group coverage remains the foundation of our health financing system. Federal and state governments heavily subsidize this form of coverage through exclusions from federal income and payroll taxes and from state income tax of employer and often employee contributions for coverage. Americans have also traditionally obtained coverage through many other channels.

The elderly and many people with disabilities, for example, qualify for Medicare, while certain categories of the poor have long qualified for Medicaid and then CHIP. These various forms of health care and coverage are financed through multiple funding streams that are often poorly coordinated.

Care and coverage are also regulated by different federal entities and by fifty state governments, whose priorities, political perspectives, administrative structures, and regulatory requirements are often quite different. Although the ACA included reforms aimed at virtually all of the various pieces of our patchwork of coverage, it left most pre-existing programs largely intact.

Most Americans continue to get health coverage as they always have, largely unaffected by the ACA. The most dramatic effect of the ACA has been to help people who were not previously covered.

Before , most working-age adults under age 65 who were not offered health insurance through employment were not eligible for any government assistance or tax subsidies to help them purchase health coverage.

Many people were unable to afford health insurance unassisted. The ACA took two approaches to extending coverage. First, it expanded Medicaid eligibility to cover individuals and families with incomes below percent of the federal poverty level FPL who were not otherwise covered. Second, it offered tax credits on a sliding scale to individuals and families with incomes between and percent of the FPL—who were not otherwise offered coverage in government programs or affordable and adequate employer-based coverage—to help them purchase health insurance through state health insurance marketplaces.

The Medicaid expansion has not reached all Americans. Currently more than three million adults in twenty states are uncovered because of that decision. Furthermore, while the tax subsidy approach can claim many successes, it remains cumbersome and it has not been wholly effective.

More than half of the 9 million moderate-income Americans currently enrolled through the ACA marketplaces were uninsured before they obtained such coverage. Over 5 million of the uninsured remain uncovered because Congress deliberately excluded individuals not lawfully present in the United States from federal assistance. We shall describe strategies for improving Medicaid coverage later in this report.

The rest of this section will focus on gaps in and limitations of the tax subsidy approach to making coverage affordable for moderate-income Americans. At the time the ACA was enacted, political realities dictated that assistance for moderate-income Americans must be provided through tax credits rather than through a new entitlement program.

Those with incomes below percent of the federal poverty level FPL are eligible for at least some subsidies on the state marketplaces. Yet the actual tax credits are based on retrospectively reported income as determined at tax-filing time. Predicting household finances is especially challenging for individuals with fluctuating incomes. It is also difficult because household income includes not only the income of the applicant, but also the incomes of other household members.

Even predicting household composition for an entire year may be challenging, as enrollees marry, divorce, have children, or die. In relying on tax credits to expand coverage, the ACA follows a familiar strategy. Although America has maintained large health care entitlement programs for the elderly and poor, it has long relied—with bipartisan support—on the tax system to subsidize health coverage for the majority of Americans, who receive employer-sponsored coverage.

The IRS has demonstrated impressive administrative capacity to manage many aspects of this process, and has long operated programs such as the Earned Income Tax Credit EITC , which rank among the most successful and popular efforts to assist low-income Americans.

The formulas used for calculating premium tax credits under the ACA also adjust payments to take account of premium variations in different insurance markets, household size, and the age of household members. Tax credits available under the ACA are often insufficiently generous to provide affordable coverage. Gaps in the current law also leave coverage unaffordable for many households. Were it politically possible, we would abandon the tax system as the mechanism of covering low-income Americans and extend Medicaid or Medicare or create a new program to do so.

Given the daunting political obstacles to such approaches, we offer instead recommendations for improving the current system. Under the ACA, workers are ineligible for marketplace tax credits if their employer offers them health insurance coverage that is deemed to be adequate and affordable.

The family glitch arises because of the way in which affordability is actually defined. These percentages will be higher for and subsequent years. This rule is fair for single workers, but not for many workers with families. Workers who need family coverage may be cut off from access to marketplace tax credits, even when the much higher cost of family coverage greatly exceeds 9. CHIP offers other advantages over marketplace plans, particularly for children experiencing significant health needs.

However, half the states set the CHIP eligibility level at percent of poverty or less, leaving many families excluded from marketplace coverage by the family glitch also unable to get CHIP coverage for their children. Although the family glitch is often described as a legislative drafting error, it results from questionable statutory interpretation by the IRS see Box 2.

Whether this problem is addressed by Congress or administratively, and whether relief is extended to all individuals in affected families or just to dependents, it is important to provide working families the financial help they need to gain practical access to affordable health insurance. RAND Corporation researchers recently examined two alternatives for fixing the family glitch. The first approach would allow all family members, including employed family members with access to affordable individual coverage, to be eligible for the APTC if employer family coverage were unaffordable; the second approach would give only dependents access to APTC subsidies.

Blumberg and John Holahan of the Urban Institute performed similar analyses , and obtained consistent estimates. The RAND team estimates that granting eligibility to all family members would allow 4. The second approach would allow 2. The proportion of affected working families spending more than 10 percent of their income on health care in would decrease from 87 percent under current rules to 47 percent under the first option or 58 percent under the second.

Fixing the family glitch would come at some cost, but also would bring significant benefits for those who lack access to coverage because of it. It should be the place to start for expanding ACA coverage for families with incomes above the Medicaid eligibility level.

Taxpayers earning less than percent of FPL often experience variable work hours. Their incomes may depend upon the generosity of tip income, demand for a product or service, even, in many jobs, on the weather. A taxpayer or household member may gain or lose a job over the year, move from part-time to full-time status, or visa-versa.

Moreover, tax credits are based on household size and composition. But household composition and size change, as babies are born, couples marry or divorce, people die, or older children become independent. Tax year statistics on the functioning of the tax credit program reflected these uncertainties. In , for only 10 percent of taxpayers eligible for the APTC did the credits paid out in advance equal the credits for which taxpayers were in fact determined to be eligible when they filed their taxes.

Forty percent received additional tax credit amounts when they filed their taxes because they received too little APTC given their final income. Most about 65 percent of those who received excess APTC did not have to make a specific additional payment to the IRS because the excess amount was recovered from a tax refund to which they otherwise have been entitled.

See Figures 4 and 5. As of June , only 3. One simple step to smooth the functioning of the APTC and avoid burdensome reconciliations would be to improve the accuracy of the credits by providing coverage applicants with a clearer and more comprehensive explanation of how their APTC was calculated. Currently, applicants receive a statement when they become eligible that tells them the amount of their APTC and the amount of income on which APTC were based.

Eligibility may be calculated based on the income reported by the applicant or on income drawn from prior tax records or other sources.

A more transparent explanation could explain how the income was computed, including what income was considered in calculating the amount. The current notice informs the taxpayer that changes in income, available coverage alternatives, or household composition must be reported and that failure to do so may result in the taxpayer having to pay back overpayments, but the notice could include examples of how changes in household income or size might affect the amount the taxpayer would have to pay back.

Taxpayers could also be sent quarterly notices including the income projections on which their tax credits are calculated and advised to report any changes in income to avoid over- or under-payment of their APTC. Monthly premium statements from insurers could also remind enrollees of their obligation to keep enrollment information current. The issuance of the A form that enrollees are sent to assist with tax reconciliation could be moved up to mid-January to ensure that taxpayers received early notice of their need to file taxes and the amount of APTC on which their taxes would be calculated.

The reconciliation process could also be adjusted to ease the burden of reconciliation. Allowing some variance from projected to actual income at the time of reconciliation could reduce administrative complexity and taxpayer burden. Taxpayers could be excused from having to pay back tax credits if their final household income were within a certain percentage perhaps 10 percent of their projected income, as long as the taxpayer did not intentionally underreport income.

Taxpayers who were determined to have received less in APTC than they were entitled by the same percentage of variation would not receive an additional payment unless they had intentionally foregone advance payment of the full tax credit. Taxpayers should also have the option of the IRS reconciling their APTC and actual premium tax credits rather than having to do it themselves.

If they fail to do so, however, the IRS could simply perform the reconciliation calculation for them, assuming the information on form A to be correct. Taxpayers could be notified on the form A that the IRS will perform the reconciliation calculation for them if they fail to file a form No one should lose access to premium tax credits simply because they fail to file this form.

Although Medicaid, tax credits, and cost-sharing reduction payments help make insurance affordable, health insurance is still so costly for many moderate- and middle-income Americans that they refuse coverage. Current tax credits require individuals and families with incomes below percent of FPL to pay too much before tax credits take over. One consequence is that many low-income workers are declining subsidized employer-based and marketplace-based coverage. Reducing or eliminating premiums for Medicaid-ineligible families below percent of the FPL would greatly improve take-up among those in greatest need.

Affordability is also a problem among those with higher incomes. More than 15 million uninsured Americans have incomes in excess of percent of FPL, while 5.

Households with incomes above percent of FPL are not entitled to financial assistance, and few have sought coverage through the marketplaces. The full schedule of ACA subsidies could potentially particularly in combination with income limits of other federal and state anti-poverty programs create adverse work incentives.

They also impose significant burdens on middle-income Americans who lack access to employer-sponsored coverage. Blumberg and Holahan also propose allowing individuals with incomes above percent of FPL to gain access to tax credits, as long as the premiums they would have to pay for the second-lowest-cost gold plan cost more than 8.

Thus assistance would not be linked only to the amount of income but also to the cost of coverage. Adoption of this proposal would improve access to affordable health insurance for moderate- to middle-income households.

Yet its cost would not be open ended, as the number of households that would be eligible for coverage would rapidly diminish as income increased. Middle-income taxpayers without access to employer coverage would at least be entitled to a fixed-dollar tax credits even if their incomes were too high to qualify for income-based credits. From both a substantive and a political perspective, such proposals merit consideration.

Fixed-dollar tax credits have long been proposed as an alternative to the current employer-sponsored insurance tax exclusion. These proposals have come primarily from conservative or libertarian advocacy groups, but have also been put forward by many economists across the political spectrum. Under one proposed alternative, taxpayers who do not have employer-sponsored coverage could choose between income-based tax credits, which could continue to phase out at percent of FPL based on the cost of coverage, as described above, and fixed-dollar tax credits, which could be more generous than income-based tax credits at the percent of poverty level.

The amount of the credits should be set high enough to have a significant effect on affordability, but would still leave most of the responsibility for the cost of insurance with enrollees at higher income levels. Credits should be age-adjusted to ensure that they reflect age-related premium differences. Such credits should be limited to individuals who are not covered through their work, since employer-sponsored coverage is already tax subsidized.

However, individuals offered coverage through their work should be able to decline that coverage and purchase coverage through the marketplace and claim tax credits if this alternative is more affordable. This program structure may lead some employers to stop offering coverage, as firms and workers compare the value of the fixed credit to the value of the tax exclusion.

As long as marketplaces offer good coverage, we regard this as an acceptable policy tradeoff. Fixed-dollar tax credits for higher-income individuals would not require reconciliation based on actual income or to repayment to the Treasury, as long as total household income remained below the maximum eligibility level.

Fixed dollar tax credits would thus be more predictable and simpler than income-based tax credits. It may not even be necessary to pay them in advance, as taxpayers could reduce withholding or estimated tax payments in anticipation of the credits and use the savings to help pay for health insurance. A fixed-dollar tax credit such as that proposed here would come at some cost.

Since it would only be available to individuals who do not enroll in employer coverage and who did not qualify for income-based credits, it would be much less costly than a universal tax credit. One attractive pathway to finance this system would be to cap the employer-sponsored coverage tax exclusion, a proposal that has wide support in the policy research community.

Further research is needed to determine the amount of tax credits, their total cost, and how they would be financed. The ACA has reduced the financial burdens associated with injury and illness, and has made health care more affordable for millions of Americans. Although ACA provides valuable limits on total out-of-pocket spending, it has not restrained the long-term trend toward higher deductibles and copayments in employer-sponsored coverage. Higher cost-sharing indisputably reduces the volume of care received by consumers, and thus overall expenditures.

Yet there is considerable and growing evidence that such cost-sharing does so indiscriminately, reducing consumption of high-value as well as low-value care. Covered individuals increasingly seek care from narrow provider networks and find medications listed on limited or tiered formularies.

While narrower networks can provide high-quality, cost-effective care, too-narrow networks or formularies can pose significant barriers to consumers getting the care they need. In-network providers are not always easily identified, and out-of-network providers are not easily avoided. People served by out-of-network providers may therefore face large and unexpected bills. In sum, the ACA has expanded coverage, but too many Americans lack access to affordable and transparently priced health care.

This section addresses problems raised by excessive cost-sharing and networks and formularies that are too restrictive. Although the ACA implements stop-loss provisions that reduce the risk of catastrophic financial loss, out-of-pocket medical costs continue to be a major concern for many Americans. The ACA is sometimes wrongly blamed for increasing consumer out-of-pocket spending, so far the new law appears to have neither aggravated nor slowed the long-term trend toward higher deductibles and copayments in private coverage see Figure 8.

High cost-sharing is having a real impact on American families. A recent Commonwealth Fund study finds that half of underinsured adults report being contacted by collection agencies or having to change their way of life because of medical bills.

Being underinsured also has medical consequences—a quarter of those responding to the Commonwealth survey reported not going to the doctor for a medical problem, not filling a prescription, or skipping medical tests or treatments recommended by a physician for financial reasons. The ACA has a confusing array of rules governing the adequacy of coverage that can, in some circumstances, leave care essentially unaffordable. Large employers with more than fifty full-time equivalent employees are required to provide minimum essential coverage to their full-time employees or to pay a penalty for each full-time employee if any employee receives premium tax credits for non-group coverage through the marketplace.

As applied to employer coverage, the minimum essential coverage definition requires vanishingly little. Minimum value employer coverage is somewhat more comprehensive than minimum essential coverage.

Minimum value employer plans must have an actuarial value of at least 60 percent that is, they must cover at least 60 percent of the costs of a standard self-insured-plan population and they must cover substantial hospitalization and physician services—but minimum value plans can still impose substantial cost-sharing on employees. Individual and small group insurance must meet higher standards although it often in fact imposes higher cost-sharing than most large-employer plans.

It must cover ten essential health benefits and provide coverage after cost-sharing set at one of four actuarial value levels—bronze 60 percent , silver 70 percent , gold 80 percent , and platinum 90 percent. Premium tax credits are keyed to the premium of the second lowest-cost silver plan in a market. Most marketplace enrollees who depend on premium tax credits choose to purchase bronze or silver plans.

Bronze, silver, and catastrophic plans bring high cost-sharing. But high cost-sharing can impose significant burdens, particularly those with modest incomes or costly health challenges. Lower-income families may face a choice between affordable coverage and affordable care. Other serious cost-sharing burdens remain. Insurers and group health plans can cover services from out-of-network providers but are not required to do so except for emergency services and often impose higher caps on out-of-network out-of-pocket expenditures.

Out-of-pocket caps also do not apply to services that do not qualify as essential health benefits. Although a standard silver plan is one that covers 70 percent of the actuarial value of covered services, the ACA also provides cost-sharing subsidies that boost the total value of a silver plan for marketplace enrollees with incomes below percent of the FPL. Households with incomes above this threshold, particularly those who receive out-of-network care, are often responsible for far higher out-of-pocket payments, even if their household incomes are below percent of FPL and they therefore remain eligible for financial assistance with their monthly premiums.

The ACA requires the federal government to reimburse health plans for the amounts they provide modest-income consumers in reducing cost-sharing. Litigation is now pending challenging the legality of this reimbursement in the absence of explicit congressional appropriation. The ACA should be amended to make health care more affordable.

Urban Institute researchers Linda Blumberg and John Holahan propose that the premium tax credits be set to cover the cost of 80 percent actuarial value gold plans rather than the 70 percent silver plans. Health care could also be made more affordable by reducing out-of-pocket limits. As noted above, the ACA imposes an out-of-pocket limit on all forms of health coverage. The ACA provided, however, that these reductions in out-of-pocket limits should not increase the actuarial value of plans above the limits set for cost-sharing reduction payments.

Thus, while out-of-pocket limits are reduced by two-thirds for enrollees with incomes below percent of FPL, out-of-pocket limits are reduced by less than a third for individuals with incomes between and percent of FPL, and not at all for those with higher incomes.

Significant cost-sharing relief could be afforded individuals with moderate incomes by effectuating the out-of-pocket limits imposed by the ACA without regard to actuarial value.

If the actuarial value of ACA benchmark plans were increased from 70 to 80 percent, as Blumberg and Holahan suggest, the out-of-pocket limit could be decreased across the board to the levels found in the original ACA, since insures could pay a larger share of total covered costs. Finally, the ACA employer responsibility regulations should be amended to improve coverage.

Minimum value coverage should include substantial coverage for pharmacy and diagnostic tests as well as hospitalization and physician services. Minimum essential coverage should require coverage of hospital, physician services, pharmacy, and diagnostic tests as well. Employers who fail to provide these services should be subject to the employer mandate penalties.

Employees who are not offered minimum value coverage as redefined should have access to marketplace coverage with premium tax credit support. As noted below, principles of value-based insurance design may prove helpful in defining the scope of coverage in these areas. Cost-sharing reduction payments are only available to individuals who purchase individual qualified health plans through the marketplaces and who are otherwise eligible for APTC assistance.

This leaves millions of individuals with coverage through their employment or through the individual market with incomes above percent of FPL exposed to levels of cost-sharing that may still make health care a significant economic burden.

One way of increasing affordability for middle-income populations is through account-based programs such as health savings accounts HSAs , health reimbursement accounts, flexible spending plans, and Archer medical savings accounts. These accounts permit tax subsidies for amounts set aside to cover medical costs, including cost-sharing imposed by health plans.

HSAs are sometimes touted as an all-purpose solution to health policy problems. In fact, HSAs provide one of the most heavily subsidized investment vehicles available and are used disproportionately by affluent taxpayers, who use them to maximize retirement savings rather than simply paying for health care, as money can be withdrawn from HSAs after age 65 for non-health care expenses without a penalty. HSAs can, however, be of value to marketplace enrollees.

While it would be preferable to increase APTC and cost-sharing reduction eligibility levels and generosity, if this is not politically possible, HSA investments can provide some relief for individuals with moderate incomes or individuals who underestimate their income and are faced with high APTC repayments at tax filing time.

Some legislative changes could make HSAs even more helpful for those who actually use them to cover health care costs. First, the out-of-pocket limits under the ACA could be amended to align them with out-of-pocket maximums for HSA-linked high-deductible health plans.

Although the limits were initially aligned, they increase under different inflation adjustment rules, making it possible that ACA compliant plans would not be HSA eligible. These rules could be easily aligned. Modest direct federal contributions to HSAs for moderate-income Americans could also be considered. These could be paid as a refundable tax credit at the time of tax filing based on actual taxable income, avoiding the need for reconciliation.

As with retirement accounts, modest subsidies could be implemented with a well-designed choice architecture that could overcome behavioral inertia to encourage greater savings. Government or private plans could also assist consumers with the logistical practicalities of establishing such accounts.

Consideration should also be given to allowing small employers to fund health reimbursement accounts HRAs that could be drawn upon by employees to purchase health insurance in the individual market.

This is currently illegal under administration interpretations of the ACA and preexisting tax law. Provision would also have to be made to ensure that the offer of an HRA did not disqualify employees from receiving marketplace premium subsidies unless the HRA contribution made coverage genuinely affordable. But with these protections, found in current legislative proposals HR , a program that allowed small employer contributions for coverage through HRAs could encourage some employers who would not otherwise offer traditional small group coverage to make coverage more affordable for their employees.

Even if the ACA is not amended to increase cost-sharing support, health insurers could make health care more affordable. Some marketplace plans currently offer some services—coverage of generic drugs for example—that are not subject to the deductible. In fact, in , 80 percent of marketplace silver plan enrollees selected a plan with a primary care visit covered before the deductible while 82 percent selected a plan with generic drugs covered below the deductible.

Such plan designs carry some danger of risk selection. If these plans impose lower cost-sharing on individuals with minimum medical demands, they must make up for it by imposing higher cost-sharing elsewhere, presumably on higher-cost individuals. On the other hand, if offering some covered services to individuals with low medical needs attracts those individuals into the marketplace, this might have the effect of lowering the cost of coverage for all marketplace participants.

As noted above, accumulating evidence confirms that greater patient cost-sharing leads to reduced utilization. But there is little evidence that consumers respond to cost-sharing by effectively comparing prices for costly services, or by focusing on the highest-value care. Annual medical spending quickly dropped, with total firm-wide medical spending declining by more than 10 percent.

Brot-Goldberg and colleagues found little evidence that workers effectively distinguished wasteful from valuable care. Given a financially generous high-deductible health plan with an accompanying HSA, even this group of relatively high-income, highly educated workers markedly reduced its receipt of clinical preventive services and other valuable care.

There was also little evidence that this relatively advantaged consumer group used available tools to identify cheaper services and providers, or even that consumers strategically responded to the actual economic incentives created by their insurance plan.

Researchers found especially concerning utilization declines among people with health problems, who may have foregone important forms of care. Almost half of the spending reduction also occurred among predictably sick individuals likely to exceed their annual deductibles, for whom the true marginal cost of specific services was often quite low. This overall pattern of findings casts doubt on the power of calibrated consumer incentives to safely and effectively improve the cost-effectiveness of medical care.

Value-based insurance design VBID attempts to balance the competing goals of greater economy and cost-effectiveness with greater financial protection and improved health. Consumers require the most generous coverage and most minimal cost-sharing for high-value services likely to improve health, with less generous cost-sharing for lower-value services such as name-brand drugs for which cheaper generic substitutes are readily available. Preventive Services Task Force based on rigorous clinical trials.

Expanding Access to Health Coverage for Moderate-Income Americans