# [Health Care Threads merged - please stop creating new threads]



## momeason

PLEASE do not make this political.

I read and researched and figured out if I closed all my windows and tabs, made sure that my browser was set to accept cookies and deleted all previous cookies, I was able to sign in and complete my application on healthcare.gov.

I now know my current exchange options and the options with my current insurer, but I am still waiting because BCBSNC has stated on their website that they will roll out some lower cost options in the coming week.

Most Tuggers spend lots of time making their timeshare work for them. I hope people will spend time exploring which insurance option works for them. Things are changing and just like we do not take the developer's word on what works best for us in timeshares, it benefits each individual to learn about their new coverage options and not take your insurance company's advice without researching on your own. My husband and I have to get our own individual coverage. We are no longer under group coverage. When we were under group coverage, I spent many hours each year deciding on a plan and how much to put in Flex,etc.

The website is improving, but it is still a work in progress. After you finish applying by phone or the website, you will learn your personal options.
We plan to help our 29 yr old son who is a grad student to apply soon. He has no insurance right now. That really scares me.


----------



## StevenTing

Shouldn't your 29yo be doing this himself?  Or by help out, do you mean help him pay?


----------



## Patri

Thankfully my employer is offering the same coverage next year, but part of the rate increase is because of ACA, the letter stated. I have no confidence next year's hours won't be cut etc. so they can get out of coverage for 2015 if it is too burdensome.
I got onto a preliminary healthcare.gov page a few weeks ago just to look at rates (without having to put in personal information). Rates were triple what mine are now, but I couldn't see if I would qualify for any tax credit. Aren't they giving a credit vs. just a better rate? I'd rather not spend the extra money up front.


----------



## SMHarman

Patri said:


> Aren't they giving a credit vs. just a better rate? I'd rather not spend the extra money up front.


the credit is computed as an immediate rate discount. 



Sent from my LT26i using Tapatalk


----------



## glypnirsgirl

I provide health insurance for 3 employees (others have better coverage through their spouses) --- two employees in their late 50s and one in his late 20s. The two fifty years olds cost me $3,200 per month NOW.

I asked each employee to go to the website to see what they can get. Without qualifying for any credit, the savings are huge. 

For the same insurance carrier with a lower deductible, the rate drops to $1100 for BOTH of the 50 year olds - a savings of $2100. I have not been able to give anyone raises for the last 3 years because any raise has been eaten up by health insurance costs. I provide 100% coverage. 

It goes up some for the 29 year old. So, I will be increasing everyone's wages by enough to cover the health insurance plus $500 per month as the first raise in a long time. 

For us, it has been a win-win-win-win. They get better insurance, it costs me less to subsidize the coverage, they get more money in their pocket, I get more money in my pocket. 

I do not understand the anomalies. I am just happy to see the results.

elaine


----------



## Patri

Wow Elaine, you are a NICE employer. Fully-paid insurance is almost unheard of these days. Employees should not have fussed about no raise, as the benefits more than compensated. It's been a tough couple of years for many people.


----------



## Ken555

*FYI-I did log onto healthcare.gov*



glypnirsgirl said:


> I provide health insurance for 3 employees (others have better coverage through their spouses) --- two employees in their late 50s and one in his late 20s. The two fifty years olds cost me $3,200 per month NOW.
> 
> I asked each employee to go to the website to see what they can get. Without qualifying for any credit, the savings are huge.
> 
> For the same insurance carrier with a lower deductible, the rate drops to $1100 for BOTH of the 50 year olds - a savings of $2100. I have not been able to give anyone raises for the last 3 years because any raise has been eaten up by health insurance costs. I provide 100% coverage.
> 
> It goes up some for the 29 year old. So, I will be increasing everyone's wages by enough to cover the health insurance plus $500 per month as the first raise in a long time.
> 
> For us, it has been a win-win-win-win. They get better insurance, it costs me less to subsidize the coverage, they get more money in their pocket, I get more money in my pocket.
> 
> I do not understand the anomalies. I am just happy to see the results.
> 
> elaine



Fantastic. I'm in a similar position, though not with such savings. I've decided also to cancel our group policy effective 1/1/14...it simply doesn't make any sense to keep it given the alternatives. The company will continue to contribute under Section 125 so it doesn't cost the staff more than needed, saving taxes, etc. (if you're not planning on this, you may want to inquire with your payroll company, as it will be a direct savings to your staff with a little more paperwork for you).


Sent from my iPad


----------



## momeason

StevenTing said:


> Shouldn't your 29yo be doing this himself?  Or by help out, do you mean help him pay?



I mean encourage him to get insurance and yes, help him pay. He is a Seminary student with very low income. I am concerned about him not having insurance. It is more of a priority for me than for him.


----------



## PStreet1

From what I've seen, the actual number of doctors/hospitals you can use on the plans offered is more important than the cost.  Lots of networks are narrowing hugely to achieve cost savings.  If there are fewer doctors/hospitals you can use, but the same number (or more) people using them, that will be a problem.


----------



## Passepartout

PStreet1 said:


> From what I've seen, the actual number of doctors/hospitals you can use on the plans offered is more important than the cost.



Around here virtually ALL healthcare is provided by one conglomerate hospital group. There are very few outlier docs who are not part of the umbrella organization, so one insurance plan is about the same as another- as far as docs-in-network is concerned.

Jim


----------



## geekette

PStreet1 said:


> From what I've seen, the actual number of doctors/hospitals you can use on the plans offered is more important than the cost.  Lots of networks are narrowing hugely to achieve cost savings.  If there are fewer doctors/hospitals you can use, but the same number (or more) people using them, that will be a problem.



Note that one is free to visit any doctor that will see them, it's just less expensive to use a doctor in-network.  If your preferred doc is not on the list for in-network, call them up to see if they would accept your ins anyway or if you can negotiate self-pay rates.  Over time my primary has or has not been "in my network" but I never quit seeing him.  most specialists he recommends are also not in-network but have always been willing to work with me.  

Official lists of providers are more of a guide than an absolute with the big asterisk in place to let you know it may cost more to go off-network.


----------



## bogey21

*Why Buy Insurance*

I bought one of the new policies for my 42 year old Son primarily so that if something "catastrophic" happened to him, our (self, ex-wife and our other 2 kids) exposure would be limited to his annual "out of pocket".  If all 4 of us chip in, we can easily handle that.

The question I have is did I make a mistake?  He has no income (please don't ask why) so I guess he wouldn't have a penalty to pay for not having insurance.  Couldn't I just wait until something happens to him to buy insurance as he can't be denied coverage for a pre-existing condition?

George


----------



## geekette

bogey21 said:


> I bought one of the new policies for my 42 year old Son primarily so that if something "catastrophic" happened to him, our (self, ex-wife and our other 2 kids) exposure would be limited to his annual "out of pocket".  If all 4 of us chip in, we can easily handle that.
> 
> The question I have is did I make a mistake?  He has no income (please don't ask why) so I guess he wouldn't have a penalty to pay for not having insurance.  Couldn't I just wait until something happens to him to buy insurance as he can't be denied coverage for a pre-existing condition?
> 
> George



I think the fly in the ointment is Open Enrollment.  If Something Happens beyond open enrollment, I don't think he can just sign up right there and then.

So far as I know, no one would be on the hook for his out of pocket but him, depending on family structure. I think a spouse is the only one legally liable as spouses are always responsible for each others' debts.  

I think your intention was that the rest of you help foot his bills until he reaches the annual limit and then bennies are in full force, and from that standpoint, it seems like a good way to go.

Good for you for looking after him.  I hope his health remains solid so no catastrophic care is ever necessary.


----------



## SMHarman

geekette said:


> So far as I know, no one would be on the hook for his out of pocket but him, depending on family structure. I think a spouse is the only one legally liable as spouses are always responsible for each others' debts.



Only if it is a joint debt or maybe in community property states. 

Sent from my LT26i using Tapatalk


----------



## Passepartout

bogey21 said:


> The question I have is did I make a mistake?  He has no income (please don't ask why) so I guess he wouldn't have a penalty to pay for not having insurance.  Couldn't I just wait until something happens to him to buy insurance as he can't be denied coverage for a pre-existing condition?
> 
> George



George, with no income, does your son qualify for Medicaid? That is what many people in very low income situations are finding.

Jim


----------



## bogey21

Passepartout said:


> George, with no income, does your son qualify for Medicaid?



I'm sure he does but our concern is not regular medical needs but rather something catastrophic and our thought is that we would rather have Blue Cross and Doctors and Hospitals accepting Blue Cross available.  Probably not rational thinking but that is where we are coming from.

George


----------



## pjrose

glypnirsgirl said:


> I provide health insurance for 3 employees . . .
> 
> For us, it has been a win-win-win-win. They get better insurance, it costs me less to subsidize the coverage, they get more money in their pocket, I get more money in my pocket.
> 
> . . .
> 
> elaine



Elaine, without the three employees, will your own insurance go up since you aren't a group?  Or maybe there weren't enough of you to be a group anyway?


----------



## momeason

bogey21 said:


> I'm sure he does but our concern is not regular medical needs but rather something catastrophic and our thought is that we would rather have Blue Cross and Doctors and Hospitals accepting Blue Cross available.  Probably not rational thinking but that is where we are coming from.
> 
> George



If you fill out an application with your son on healthcare.gov and use his income info, he can buy a BCBS plan and you can pay the low cost. You get to choose the plan and what doctors.


----------



## momeason

The majority of working adults are covered under a group health plan and do not need to buy individual health plans. Until 2011, my family had always been covered. When my husband retired early after Wachovia Bank was forced to sell out, we found ourselves shopping for individual plans. We turned down the retiree plan because it was $2000/month.
We had several pre-existing conditions but none are life threatening. We thought we would be able to get coverage. We thought wrong. Both of us were turned down. I was turned down for acid reflux, past physical therapy for a back issue and past use of anti-anxiety meds prescribed during a family crisis with our daughter. My husband was turned down for moderate sleep apnea.
For those of you who have always been under a group plan, you do not understand how difficult it can be to get individual coverage. We did not know either until it happened to us. We went under COBRA for 18 months. 
We were able to get individual coverage when COBRA ran out. ( I believe it was because the ACA was about to come into full effect) On June 1, 2013 we started a high deductible plan with BCBS and opened a Health Savings Account. We pay most of our costs because our deductible is $10,000 family. We use pre-tax dollars to pay our medical bills. We are also able to deduct our cost of insurance from our taxes since we pay 100% of the costs. Having insurance we pay at the BCBS negotiated rate. I see the original charges and they are outrageous. A normal income person would never be able to pay their medical bills if they had even a moderately serious illness or injury if they had to pay the un-negotiated rates. 

In September, we received a notice that our policy is being cancelled. Of course, the notice blames the ACA..Affordable Care Act, aka Obamacare.
Now I am shopping again for a plan. At least now, we will never be turned down for a pre-existing condition. Now, I do not have to decide whether or not to go to the doctor for a problem based on whether it is worth it to get another diagnosis on my record. For the past 2 years, I considered that when deciding whether to ask my doctor about a problem or potential problem. That is not a good way to manage potential problems, but under the current system I had to weigh that. I needed insurance but I was often afraid to use it. I was paying for the visits with our money, but I still had to decide if I wanted to risk another black mark on my medical history.
In our case, we have funds to cover day to day medical needs with negotiated insurance rates. We also have the funds to buy insurance. People with lesser incomes are not so fortunate. Many have to choose between food and medical care. 
 I believe many who have never faced shopping for individual plans do not know what it is like. Just wanted to share a little of my personal experience of the reality.


----------



## bogey21

momeason said:


> If you fill out an application with your son on healthcare.gov and use his income info, he can buy a BCBS plan and you can pay the low cost. You get to choose the plan and what doctors.



I spent about 45 minutes on healthcare.gov but to no avail.  Response times were fine but they want me to call Experian to verify something or other.  Couldn't get through to Experian so I went to the Blue Cross Illinois website and found that the Bronze 06 Plan would cost $157.84 per month. That took me 5 minutes.  One of these days when I can make contact with Experian I will verify the price of the Bronze 06 Plan using healthcare.gov.  I won't know until I get through but my gut tells me that the cost will be the same $157.84 which I am ok with.  This is almost as frustrating and time consuming as filing my income taxes!!

George


----------



## bogey21

momeason said:


> ......*Having insurance we pay at the BCBS negotiated rate.* I see the original charges and they are outrageous. A normal income person would never be able to pay their medical bills if they had even a moderately serious illness or injury if they had to pay the un-negotiated rates.....



Some may not realize it but one of the benefits of having a BCBS Plan (even one with a high deductible) is getting the benefit of the BCBS negotiated rates even for the charges you pay out of pocket.

George


----------



## SMHarman

bogey21 said:


> Some may not realize it but one of the benefits of having a BCBS Plan (even one with a high deductible) is getting the benefit of the BCBS negotiated rates even for the charges you pay out of pocket.
> 
> George



That should be the case for any medical plan. The negotiated rate is what you or the insurer will be paying the bill based on. 

Looking at the rack rate on my EOBs is another thing that makes me shake my head about the best medical system in the world.  Pretty easy to do an awesome job for $1000 when the procedure costs $10 

Sent from my LT26i using Tapatalk


----------



## momeason

My point exactly. If the visit, lab or procedure can be done for that price..then that should be the price. I am glad most people can get insurance now which will level the playing field. Using the insurance company to get there is convoluted but at least care will be more affordable. I am trying hard not to be political. I have run across many people in the last two years who told me that I must have done something wrong if I was being denied coverage. They said I must have let my policy lapse. I have been insured every day of my life but until Jun1,2013, it was through group coverage or COBRA group coverage. A lot of people with group coverage know nothing about the individual market for health insurance. The insurers business is to make money, not to worry about the health of their individual policyholders.


----------



## Ken555

*FYI-I did log onto healthcare.gov*



pjrose said:


> Elaine, without the three employees, will your own insurance go up since you aren't a group?  Or maybe there weren't enough of you to be a group anyway?



Speaking for myself and my business, our insurance costs with everyone as an individual via the new plans will be significantly less than what it was with a group. We've had group insurance for about six years (for the first bunch of years we were all on individual policies that the company helped pay for, but when I acquired a company about six years ago I convinced myself I needed a group policy for the new staff...I was wrong) and by my rough estimate my company has spend more than $30,000 in order to have group insurance rather than individual. For small businesses, group policies don't always make sense. The biggest advantage was the ability to provide insurance for anyone but now that everyone is able to get individual policies that advantage is no longer true. I wouldn't be surprised to find a major change in small group premiums in the next few years, assuming the insurance companies want to retain those accounts.

FWIW, a group needs two people to qualify.

Sent from my iPad


----------



## floridabob

momeason said:


> PLEASE do not make this political.
> 
> I read and researched and figured out if I closed all my windows and tabs, made sure that my browser was set to accept cookies and deleted all previous cookies, I was able to sign in and complete my application on healthcare.gov.
> 
> I now know my current exchange options and the options with my current insurer, but I am still waiting because BCBSNC has stated on their website that they will roll out some lower cost options in the coming week.
> 
> Most Tuggers spend lots of time making their timeshare work for them. I hope people will spend time exploring which insurance option works for them. Things are changing and just like we do not take the developer's word on what works best for us in timeshares, it benefits each individual to learn about their new coverage options and not take your insurance company's advice without researching on your own. My husband and I have to get our own individual coverage. We are no longer under group coverage. When we were under group coverage, I spent many hours each year deciding on a plan and how much to put in Flex,etc.
> 
> The website is improving, but it is still a work in progress. After you finish applying by phone or the website, you will learn your personal options.
> We plan to help our 29 yr old son who is a grad student to apply soon. He has no insurance right now. That really scares me.



I think posters that are recommending logging into healthcare .gov should add a disclaimer that their information may be hacked including SS numbers.

An expert testified before the Senate today and stated if your info hasn't been hacked it will be in the future. Please be aware. Below is a portion of the story. Please don't make this political.

Kennedy told FoxNews.com he based this on an analysis revealing a large number of SQL injection attacks against the healthcare.gov website, which are indicative of "a large amount" of hacking attempts.

'I would say the website is either hacked already or will be soon.'
- David Kennedy, CEO of information security firm TrustedSEC
"Based on the exposures that I identified, and many that I haven’t published due to the criticality of exposures – if a hacker wanted access to the site or sensitive information – they could get it," he told FoxNews.com.

A spokesman for the Department of Health and Human Services, which runs the nation's new healthcare website, did not immediately respond to a request to for more information.

One key problem facing Healthcare.gov is that security wasn’t built into the site from the very beginning, he said -- an opinion shared by both Kennedy and Fred Chang, the distinguished chair in cyber security at Southern Methodist University.

“There’s not a lot of security built into the site, at least that’s what we can see from a 10,000 foot view,” Kennedy told the committee. And although the site doesn’t house medical records, it integrates deeply with other sites, includes ecommerce information, and houses a vast array of data that presents a very salient target.

“It’s not only social security numbers … it’s one of the largest collections of personal data, social security and everything else, that we’ve ever seen,” Kennedy said.

Some members of the panel expressed surprise at the harsh words, noting that, among other things, people enter social security numbers all over the web.  Congresswoman Eddie Johnson, D.-Texas, a member of the committee, noted too the ready availability of medical records in the past.

“Why is there such an outcry in this court when medical records have been so available [in the past],” she asked. “Is the healthcare industry lagging in these security measures?”

That’s exactly the case, said Avi Rubin, technical director of Johns Hopkins University's Information Security Institute. The healthcare industry is indeed woefully behind.

“It’s actually the most far behind in terms of security … there are even things in the operating room that surprise me. I think the healthcare it industry needs to learn a lot from some of the other industries to bring its security up to par,” Rubin said.

Rubin called for a security review of the site, but stopped short of calling for a complete tear down and rebuild of the healthcare.gov site. Others were less cautious.

“You can bolt a metal door on to make a house better, but if the foundation is bad…” Kennedy said.

All four cyber security experts unanimously concurred that, given the security issues, Americans should not use the site at present.
  Print
   Email
   Share
 inShare9


----------



## Passepartout

floridabob said:


> I think posters that are recommending logging into healthcare .gov should add a disclaimer that their information may be hacked including SS numbers.
> 
> An expert testified before the Senate today and stated if your info hasn't been hacked it will be in the future. Please be aware. Below is a portion of the story. *Please don't make this political.*
> 
> Kennedy told *FoxNews.com *he based this on an analysis revealing a large number of SQL injection attacks against the healthcare.gov website, which are indicative of "a large amount" of hacking attempts.
> 
> 'I would say the website is either hacked already or will be soon.'
> - David Kennedy, CEO of information security firm TrustedSEC
> "Based on the exposures that I identified, and many that I haven’t published due to the criticality of exposures – if a hacker wanted access to the site or sensitive information – they could get it," he told FoxNews.com.
> 
> A spokesman for the Department of Health and Human Services, which runs the nation's new healthcare website, did not immediately respond to a request to for more information.
> 
> One key problem facing Healthcare.gov is that security wasn’t built into the site from the very beginning, he said -- an opinion shared by both Kennedy and Fred Chang, the distinguished chair in cyber security at Southern Methodist University.
> 
> “It’s not only social security numbers … it’s one of the largest collections of personal data, social security and everything else, that we’ve ever seen,” Kennedy said.
> 
> Some members of the panel expressed surprise at the harsh words, noting that, among other things, people enter social security numbers all over the web.  Congresswoman Eddie Johnson, D.-Texas, a member of the committee, noted too the ready availability of medical records in the past.
> 
> “Why is there such an outcry in this court when medical records have been so available [in the past],” she asked. “Is the healthcare industry lagging in these security measures?”



Emphasis is mine, Snipped for some brevity. 

Floridabob, you ask that this not be made political, then you lift verbatim from Fox News and without attribution. Not that they have a well known agenda. Just coincidence? I think not.

Read again the allegations above. Nowhere does the 'expert' find or quote examples. Just fear mongering. Sure we all are or should be careful with personal information. And SSA and credit card info, and bank, and mom's maiden name and all that. This is no different.

The public already knows that healthcare.gov is suffering a troubled rollout. It will be fixed. And referencing Medicare.gov and SSA.gov and IRS.gov, the gov't has experience with people's personal information, and keeping it secure. They will do the same with healthcare.gov. 

So in the interest in keeping this thread apolitical, find, and attribute REAL unbiased views.

Jim


----------



## SMHarman

floridabob said:


> I think posters that are recommending logging into healthcare .gov should add a disclaimer that their information may be hacked including SS numbers.
> 
> An expert testified before the Senate today and stated if your info hasn't been hacked it will be in the future. Please be aware. Below is a portion of the story. Please don't make this political.
> 
> Kennedy told FoxNews.com he based this on an analysis revealing a large number of SQL injection attacks against the healthcare.gov website, which are indicative of "a large amount" of hacking attempts.
> 
> 'I would say the website is either hacked already or will be soon.'
> - David Kennedy, CEO of information security firm TrustedSEC
> "Based on the exposures that I identified, and many that I haven’t published due to the criticality of exposures – if a hacker wanted access to the site or sensitive information – they could get it," he told FoxNews.com.
> 
> A spokesman for the Department of Health and Human Services, which runs the nation's new healthcare website, did not immediately respond to a request to for more information.
> 
> One key problem facing Healthcare.gov is that security wasn’t built into the site from the very beginning, he said -- an opinion shared by both Kennedy and Fred Chang, the distinguished chair in cyber security at Southern Methodist University.
> 
> “There’s not a lot of security built into the site, at least that’s what we can see from a 10,000 foot view,” Kennedy told the committee. And although the site doesn’t house medical records, it integrates deeply with other sites, includes ecommerce information, and houses a vast array of data that presents a very salient target.
> 
> “It’s not only social security numbers … it’s one of the largest collections of personal data, social security and everything else, that we’ve ever seen,” Kennedy said.
> 
> Some members of the panel expressed surprise at the harsh words, noting that, among other things, people enter social security numbers all over the web.  Congresswoman Eddie Johnson, D.-Texas, a member of the committee, noted too the ready availability of medical records in the past.
> 
> “Why is there such an outcry in this court when medical records have been so available [in the past],” she asked. “Is the healthcare industry lagging in these security measures?”
> 
> That’s exactly the case, said Avi Rubin, technical director of Johns Hopkins University's Information Security Institute. The healthcare industry is indeed woefully behind.
> 
> “It’s actually the most far behind in terms of security … there are even things in the operating room that surprise me. I think the healthcare it industry needs to learn a lot from some of the other industries to bring its security up to par,” Rubin said.
> 
> Rubin called for a security review of the site, but stopped short of calling for a complete tear down and rebuild of the healthcare.gov site. Others were less cautious.
> 
> “You can bolt a metal door on to make a house better, but if the foundation is bad…” Kennedy said.
> 
> All four cyber security experts unanimously concurred that, given the security issues, Americans should not use the site at present.
> Print
> Email
> Share
> inShare9



There are two types of large corporate type websites.
1) Those that have been hacked
2) Those that have been hacked but don't know it yet.

http://bits.blogs.nytimes.com/2013/04/22/the-year-in-hacking-by-the-numbers/?_r=0

The Verizon report also highlighted the lag between the time an organization has been breached and the time it discovers the breach. “The compromise-to-discovery timeline continues to be measured in months and even years, as opposed to hours and days,” the report said.


----------



## floridabob

Passepartout said:


> Emphasis is mine, Snipped for some brevity.
> 
> Floridabob, you ask that this not be made political, then you lift verbatim from Fox News and without attribution. Not that they have a well known agenda. Just coincidence? I think not.
> 
> Read again the allegations above. Nowhere does the 'expert' find or quote examples. Just fear mongering. Sure we all are or should be careful with personal information. And SSA and credit card info, and bank, and mom's maiden name and all that. This is no different.
> 
> The public already knows that healthcare.gov is suffering a troubled rollout. It will be fixed. And referencing Medicare.gov and SSA.gov and IRS.gov, the gov't has experience with people's personal information, and keeping it secure. They will do the same with healthcare.gov.
> 
> So in the interest in keeping this thread apolitical, find, and attribute REAL unbiased views.
> 
> Jim



http://abcnews.go.com/blogs/politic...warn-healthcare-gov-is-vulnerable-to-hacking/

A quote from ABC NEWS:Three of the four witnesses agreed that the Obama administration should take the site offline in order to address the security flaws.

Another quote:“We can actually enable their web cam, monitor their web cam, listen to their microphone, steal passwords,” he explained. “Anything that they do on their computer we now have full access to.”


----------



## Passepartout

floridabob said:


> http://abcnews.go.com/blogs/politic...warn-healthcare-gov-is-vulnerable-to-hacking/
> 
> A quote from ABC NEWS:Three of the four witnesses agreed that the Obama administration should take the site offline in order to address the security flaws.



Three of the four are the same ones quoted in the FoxNews article quoted. Kennedy, Rubin, and Congresswoman Johnson. Good searching.

I'm certainly not saying that anytime one puts personal information on the internet, there is no chance of someone intercepting it. We do it every day. When we buy something on eBay or Amazon, when we do a bill-pay at our bank, when we do taxes, when we apply for Social Security. Even when we stand in line at the pharmacy to pick up a 'script- or hand our credit card to a server in a restaurant. Our personal information is at risk. Not doing health care because of this is no excuse not to try.

That doesn't mean it makes any sense to take healthcare.gov down and try to reinvent the wheel. There STILL has been NO evidence of compromise of personal information. None. Only speculation and fear mongering.

In states where they have chosen to have their own marketplaces, they are on track- and even ahead of the projected numbers. That there have been many people actually finding out how good their insurance can be and how affordable it is is testament to the underlying need and pent-up desire to step up and have quality health care. 

Mods, If I stepped over the line, I apologize, and feel free to edit or delete my comments. I tried to make it about fairness, not division.

Jim


----------



## floridabob

Passepartout said:


> Mods, If I stepped over the line, I apologize, and feel free to edit or delete my comments. I tried to make it about fairness, not division.
> 
> Jim



Moderators I have bolded purely political spin. I have only given facts. People can make there own minds up whether to access the site.


----------



## ricoba

Just sayin', but seems to me there are some political overtones in this thread.  

I am shocked that a discussion on health care has turned political!


----------



## Passepartout

Passepartout said:


> Three of the four are the same ones quoted in the FoxNews article quoted. Kennedy, Rubin, and Congresswoman Johnson. Good searching.
> 
> I'm certainly not saying that anytime one puts personal information on the internet, there is no chance of someone intercepting it. We do it every day. When we buy something on eBay or Amazon, when we do a bill-pay at our bank, when we do taxes, when we apply for Social Security. Even when we stand in line at the pharmacy to pick up a 'script- or hand our credit card to a server in a restaurant. Our personal information is at risk. Not doing health care because of this is no excuse not to try.
> 
> That doesn't mean it makes any sense to take healthcare.gov down and try to reinvent the wheel. There STILL has been NO evidence of compromise of personal information. None. Only speculation and fear mongering.
> 
> In states where they have chosen to have their own marketplaces, they are on track- and even ahead of the projected numbers. That there have been many people actually finding out how good their insurance can be and how affordable it is is testament to the underlying need and pent-up desire to step up and have quality health care.
> 
> Mods, If I stepped over the line, I apologize, and feel free to edit or delete my comments. I tried to make it about fairness, not division.
> 
> Jim



I have deleted the offending sentences.


----------



## ace2000

Passepartout said:


> I tried to make it about fairness, not division.
> 
> Jim


 

:hysterical:


----------



## glypnirsgirl

pjrose said:


> Elaine, without the three employees, will your own insurance go up since you aren't a group?  Or maybe there weren't enough of you to be a group anyway?



Three is the minimum number to be a "group." 

I am covered by my husband's insurance through his employer. Our contribution to our own health insurance is increasing slightly. 

This afternoon, I got a call from an independent agent. Our current provider is United Health Care. The deductible is $3000 per person, $6000 per family. UHC will be going down to $1100 to get the individual coverage AND reduce the deductible to $2500/$5000. I was thrilled.

This afternoon, I got a call from an independent insurance agent that quoted the same policy at $464 through Humana --- WHAT??? Now thinking about it, I wonder if that is for each person rather than for both. 

Everyone has met their deductible for the year so we aren't changing until 1/1/2014. 

I still don't understand the anomalies --- why some people are seeing such increases and I am having such terrific savings.


----------



## Conan

glypnirsgirl said:


> I still don't understand the anomalies --- why some people are seeing such increases and I am having such terrific savings.



I think in most (all?) cases the people who are seeing premium increases had barebones plans that didn't meet ACA (Obamacare) minimum benefit standards.


----------



## ace2000

Conan said:


> I think in most (all?) cases the people who are seeing premium increases had barebones plans that didn't meet ACA (Obamacare) minimum benefit standards.


 
And the young are losers in the new plan.  Of course, they just need to be quiet since their new coverage is _better_.


----------



## MuranoJo

Passepartout said:


> Emphasis is mine, Snipped for some brevity.
> 
> Floridabob, you ask that this not be made political, then you lift verbatim from Fox News and without attribution. Not that they have a well known agenda. Just coincidence? I think not.
> 
> Read again the allegations above. Nowhere does the 'expert' find or quote examples. Just fear mongering. Sure we all are or should be careful with personal information. And SSA and credit card info, and bank, and mom's maiden name and all that. This is no different.
> 
> The public already knows that healthcare.gov is suffering a troubled rollout. It will be fixed. And referencing Medicare.gov and SSA.gov and IRS.gov, the gov't has experience with people's personal information, and keeping it secure. They will do the same with healthcare.gov.
> 
> So in the interest in keeping this thread apolitical, find, and attribute REAL unbiased views.
> 
> Jim



Absolutely.  And as momeason has posted before, those of us with group coverage would be shocked if we were forced out of that 'safe haven.'


----------



## Conan

> Quote:
> Originally Posted by *Conan*
> 
> 
> _I think in most (all?) cases the  people who are seeing premium increases had barebones plans that didn't  meet ACA (Obamacare) minimum benefit standards._





ace2000 said:


> And the young are losers in the new plan.  Of course, they just need to be quiet since their new coverage is _better_.



  When our children graduated college (pre-Obamacare so they lost coverage from our policy at age 22) we worried a lot that if they couldn't find work that included an employer-sponsored health plan they would be at risk of having no insurance.  We bought our son the only affordable plan we could find - - high deductible and nothing but catastrophic coverage.  Of course, also pre-Obamacare, had our son gotten any serious illness (or sports injury, or automobile accident) during that period, that would be a pre-existing condition that would have disqualified him from coverage for the rest of his life even if he eventually got into a proper employer-sponsored plan.

Under Obamacare, it's a non-issue for a family like ours until the child reaches age 26.  Maybe they'll be on an employer-sponsored plan by then but if they're not, and if they're earning say $25,000/year, their insurance cost for a Silver plan will be about $2,600/year before the tax credit which after the credit is less than $1,800/year out-of-pocket for quality insurance. 
http://kff.org/interactive/subsidy-calculator/

But they hate Obamacare and refuse to pay $150/month for quality health insurance.  What will the government do to them?
Here's how the Brookings Institute puts it:
"To be honest, not much, though you should at least browse the exchange and see what you’re turning down. In deeply Republican Oklahoma, for example, the cheapest policy is only $96 per month. Still, if you blow off Obamacare and don’t get insured by April next year, your grand total fine is only about $100 _[or 1% of family income if that's more]_ (though it will increase over the years _[to $325 or 2% if greater in 2015 and $695 or 2.5% if greater in 2016]_). And there’s another loophole: If the policy costs more than 10 percent of your annual income or you don’t pay any federal taxes, you won’t have to pay a penalty anyway. (In Massachusetts, less than 0.3 percent of people paid any penalty.) In short, if you don’t participate in Obamacare, the government won’t send black helicopters after you."
http://www.brookings.edu/research/o...-questions-about-obamacare-aca-patel-sanghavi


----------



## channimal

I think the real bias is when both views/opinions aren't given equal air time.  When one side is given carte blanche and any opposing view is labeled as "political" and censored then the entirety is pure rubbish.


----------



## ace2000

Conan said:


> Here's how the Brookings Institute puts it:
> "To be honest, not much, though you should at least browse the exchange and see what you’re turning down. In deeply Republican Oklahoma, for example, the cheapest policy is only $96 per month. *Still, if you blow off Obamacare and don’t get insured by April next year, your grand total fine is only about $100 (though it will increase over the years).*



The fine for 2014 is $95 per adult or 1% of family income (whichever is greater).   
The fine for 2015 is $325 per adult or 2% of family income (whichever is greater).  
The fine for 2016 is $695 per adult or 2.5% of family income (whichever is greater).  

Be careful what you are advising here.  Do the math on the 1% and you'll find that it may be substantially more than $100.


----------



## b2bailey

ace2000 -- to me, your Post is what FACTUAL looks like.


----------



## DeniseM

channimal said:


> I think the real bias is when both views/opinions aren't given equal air time.  When one side is given carte blanche and any opposing view is labeled as "political" and censored then the entirety is pure rubbish.



Please review the posting rules, before posting again:



> Honor changes entered by moderators
> You may not alter, edit, or delete any edits introduced into your message by a Moderator or Administrator. This is considered a serious offense and may result in loss of posting privileges.
> 
> *In addition, do not enter complaints about moderation into BBS messages. *Such posts will be considered off-topic and will be removed. Any such complaints or discussion should be communicated to the bbs staff directly via email or personal message.


----------



## geekette

ace2000 said:


> The fine for 2014 is $95 per adult or 1% of family income (whichever is greater).
> The fine for 2015 is $325 per adult or 2% of family income (whichever is greater).
> The fine for 2016 is $695 per adult or 2.5% of family income (whichever is greater).
> 
> Be careful what you are advising here.  Do the math on the 1% and you'll find that it may be substantially more than $100.



Thank you for this public service post.  People that think "it's only $100" had better be sure that For Them it is only $100.


----------



## geekette

Conan said:


> But they hate Obamacare and refuse to pay $150/month for quality health insurance.  What will the government do to them?
> Here's how the Brookings Institute puts it:
> "To be honest, not much, though you should at least browse the exchange and see what you’re turning down. In deeply Republican Oklahoma, for example, the cheapest policy is only $96 per month. Still, if you blow off Obamacare and don’t get insured by April next year, your grand total fine is only about $100 (though it will increase over the years). And there’s another loophole: If the policy costs more than 10 percent of your annual income or you don’t pay any federal taxes, you won’t have to pay a penalty anyway. (In Massachusetts, less than 0.3 percent of people paid any penalty.) In short, if you don’t participate in Obamacare, the government won’t send black helicopters after you."
> http://www.brookings.edu/research/o...-questions-about-obamacare-aca-patel-sanghavi



If they hate insurance, that's their deal, but if they go uninsured and Something Happens, it's not like they can suddenly enroll outside of the enrollment window.  They are free to roll the dice but should be aware that fees charged will be their responsibility, it's not going to be a minor copay.

I would fear less about 'what the govt will do to them' than what they will do to their own financial security.


----------



## Conan

ace2000 said:


> The fine for 2014 is $95 per adult or 1% of family income (whichever is greater).
> The fine for 2015 is $325 per adult or 2% of family income (whichever is greater).
> The fine for 2016 is $695 per adult or 2.5% of family income (whichever is greater).
> 
> Be careful what you are advising here.  Do the math on the 1% and you'll find that it may be substantially more than $100.



You're right.  In my example the 26-year old (if he's single I suppose) has the choice to pay $150/month for good health insurance or $21/month ($42/month in 2015; $58/month in 2016) for no health insurance.  I've made the correction to my earlier post.

Also the Silver Plan cited is more than the minimum ACA-qualified plan so he can probably get that $150/month premium down to well below $100/month rather than pay $21 / $42 / $58 per month for nothing. [Well actually, not nothing, since Obamacare did allow his parents to carry him on their plan from age 22 to age 26, and also thanks to Obama if he suffers a serious illness or accident while uninsured he may have some entry-date hurdles but he won't be uninsurable for the rest of his life as used to be the case.]


----------



## SMHarman

geekette said:


> Thank you for this public service post.  People that think "it's only $100" had better be sure that For Them it is only $100.


And for the Mathematically challenged
$9,500 *1% is $95.
So if individuals AGI is above $9,500 the fine will be higher.

Of course as others have said, not buying a policy is like shorting a penny stock.  There is not much further for it to fall, but the exposure if it rallys is huge.

With the removal of coverage limits, the $1,800 of premium protects you from the upside of hundreds of thousands of medical bills.


----------



## momeason

*I can keep my health insurance plan, BUT*

Talked to a BCBSNC rep today. We can now keep our current high deductible HSA plan for 2014 if we want. If you have not chosen your plan for 2014, you may want to wait. If you did already choose a new plan because your current plan was cancelled, I think you may be able to go back to your current plan. Here is the big BUT. According to the agent, there will be the normal average rate increase..probably about 16%.
What other costs go up an average of 16% per year? The insurance companies have been making record profits since 2002 and it continues. We would all hit the ceiling if our MFs went up 16% per year.
So if your insurance rates are going up this year, keep in mind that 16% of the rate increase is from your insurer. It has nothing to do with the ACA.


----------



## floridabob

momeason said:


> Talked to a BCBSNC rep today. We can now keep our current high deductible HSA plan for 2014 if we want. If you have not chosen your plan for 2014, you may want to wait. If you did already choose a new plan because your current plan was cancelled, I think you may be able to go back to your current plan. Here is the big BUT. According to the agent, there will be the normal average rate increase..probably about 16%.
> What other costs go up an average of 16% per year? The insurance companies have been making record profits since 2002 and it continues. We would all hit the ceiling if our MFs went up 16% per year.
> So if your insurance rates are going up this year, keep in mind that 16% of the rate increase is from your insurer. It has nothing to do with the ACA.



I guess you missed it. "YOU can keep your insurance *AND* your rates will go down $2500". :hysterical: [Political comment deleted.]


----------



## ace2000

floridabob said:


> I guess you missed it. "YOU can keep your insurance *AND* your rates will go down $2500". :hysterical: [deleted].



I like the part where "it has nothing to do with ACA".


----------



## momeason

I did further research and now determined my existing plan does not cover maternity. that is why it was being cancelled. I now can stay in the plan another year due to recent events. The insurer, BCBS, is doing their normal average rate increase of ONLY 16%. I was told about this by a BCBSNC agent.
This is a normal yearly increase….his words. It has nothing to do with the new Healthcare Laws.
Insurance companies have been raking in record profits since 2002. 
My hubby has less than 3 years before Medicare. Unfortunately, I have almost 10 more years to deal with this gouging by the insurance industry.

If you have individual coverage and were forced to change plans, you may wish to contact your insurer for a "do over"


----------



## momeason

I said nothing political. Your posts need to be deleted.

I was telling you what my insurance agent relayed to me. I can keep my plan and my rates go up 16%.


----------



## ace2000

momeason said:


> I said nothing political. Your posts need to be deleted.
> 
> I was telling you what my insurance agent relayed to me. I can keep my plan and my rates go up 16%.



And then you chose to make the political comment that "it has nothing to do with ACA".  Everything in the health insurance industry today is about the ACA and the upcoming changes.


----------



## geekette

ace2000 said:


> And then you chose to make the political comment that "it has nothing to do with ACA".  Everything in the health insurance industry today is about the ACA and the upcoming changes.



No.  The business-as-usual rate hikes by health insurers was occurring long before ACA.


----------



## Conan

momeason said:


> Talked to a BCBSNC rep today. We can now keep our current high deductible HSA plan for 2014 if we want. If you have not chosen your plan for 2014, you may want to wait. If you did already choose a new plan because your current plan was cancelled, I think you may be able to go back to your current plan. Here is the big BUT. According to the agent, there will be the normal average rate increase..probably about 16%.
> What other costs go up an average of 16% per year? The insurance companies have been making record profits since 2002 and it continues. We would all hit the ceiling if our MFs went up 16% per year.
> So if your insurance rates are going up this year, keep in mind that 16% of the rate increase is from your insurer. It has nothing to do with the ACA.



Would you mind posting what the 2014 premium is for the high-deductible plan and roughly what it covers, and what the premium would be for an ACA bronze plan (if the high deductible plan covers more than one person I guess the comparison is the combined ACA premium for the same people).  Also since the tax rebate is different based on income, that would be the full-price ACA premium.

Thanks!


----------



## ace2000

geekette said:


> No.  The business-as-usual rate hikes by health insurers was occurring long before ACA.



Not sure what your point is, but you don't think making health insurance companies cover pre-existing conditions and covering dependents till age 26 will have no impact on current rates?


----------



## presley

California voted to go against Obama asking everyone to extend insurance for another year.


----------



## Passepartout

ace2000 said:


> Not sure what* your point is*, but you don't think making health insurance companies cover pre-existing conditions and covering dependents till age 26 will have no impact on current rates?



The point is, that insurance rates have been going up at far above the rate of inflation for years. Check your own costs. Yes, it will cost more to cover those with pre-existing conditions, and the young who live at home, but it is designed to be offset by mandating that the young (and presumably healthy) will sign up and be insured- and pay-outs will be less.

The Insurance Industry is frothing at the mouth to get these millions of new customers. Why do you think you are seeing all the commercials on the TV from BCBS or United or Kaiser or any/all of the other insurers to get people to choose them. Trust me, it isn't out of the kindness of their hearts.


----------



## ace2000

Passepartout said:


> The point is, that insurance rates have been going up at far above the rate of inflation for years. Check your own costs.



I agree. But, if you do the research, all medical costs have been increasing at a rapid rate.  It's kind of naive placing all the blame on the insurance companies.


----------



## geekette

ace2000 said:


> Not sure what your point is, but you don't think making health insurance companies cover pre-existing conditions and covering dependents till age 26 will have no impact on current rates?



Sure.  

What was the rationale for the skyrocketing for the past decade since anyone already sick wasn't accepted and people making big claims got dumped?


----------



## tschwa2

ace2000 said:


> Not sure what your point is, but you don't think making health insurance companies cover pre-existing conditions and covering dependents till age 26 will have no impact on current rates?



My company changed to covering children up to 26 several years ago.  According to the insurance rep, age 18-26 dependents are among the healthiest people they cover so on a per person basis it often lowers the cost per person.


----------



## geekette

ace2000 said:


> I agree. But, if you do the research, all medical costs have been increasing at a rapid rate.  It's kind of naive placing all the blame on the insurance companies.



Also naive to place all the blame on ACA.


----------



## ace2000

tschwa2 said:


> My company changed to covering children up to 26 several years ago.  According to the insurance rep, age 18-26 dependents are among the healthiest people they cover so on a per person basis it often lowers the cost per person.



Again, what's the point?  Are you saying that adding this age group will have no impact on the health insurance rates?  Not possible.  

The new changes are fine.  But you just can't say that those changes will have no impact on current rates.  That's a false statement.


----------



## Passepartout

ace2000 said:


> I agree. But, if you do the research, all medical costs have been increasing at a rapid rate.  It's kind of naive placing all the blame on the insurance companies.



I don't think I am placing blame on the insurance companies. They are raising rates so that they can pay the ever increasing costs levied by the medical industry. And the medical industry raises rates in order to cover the uninsured who come into emergency rooms and doctors who order whole batteries of tests so that when they get sued for malpractice, they can show that they left no stone unturned to treat the patient. It's a vicious circle.

Now, if the general populace has insurance, they won't go to emergency rooms with a runny nose. If insurers pay a flat rate to treat an illness, and negotiates drug prices and encourages use of generic medicines instead of brand names, the rate of price increases can be reduced.


----------



## ace2000

geekette said:


> Also naive to place all the blame on ACA.



I agree ...


----------



## momeason

I did not say that the new rates have nothing to do with the ACA. I said my insurance agent, [political comment deleted], said that there would be a 16% rate increase. He said it was the normal, average yearly rate increase.

So my supposition is that about 16% of any rate increase would have happened with or without the law. If your increase is higher than that, then the difference could be attributed to the law. I think that is a reasonable supposition after the statements made by my BCBS agent. Please let others decide this for themselves without going into attack mode.

Even if I have to pay more, I am happy about the law. My husband and I have minor pre-existing conditions that caused us to be turned down on the individual market in 2011. I am very glad that is behind us and all the others with pre-existing conditions who must buy on the individual market probably feel the same. 

I have been trying to show people my real experience to help those who may not have time to research. Many of these posts are the opposite of helpful knowledge.


----------



## Conan

In case you missed my note above, would you mind posting the 2014 premiums for the coverage you're being quoted versus what you would pay (before tax credits) for an ACA Bronze plan?

[These healthcare-related threads get so noisy!]


----------



## PigsDad

momeason said:


> The insurance companies have been making *record profits *since 2002 and it continues.


Along with most companies.  What's your point?



> So if your insurance rates are going up this year, keep in mind that 16% of the rate increase is from your insurer. It has nothing to do with the ACA.


Fact: the average profit margin at the large insurance companies is in the 3-4% range.

Their profit margins are not increasing 16% a year, so the price increase is due to *medical costs *going up, *not *the insurance companies.  Anyone halfway competent in math could figure this out for themselves, but unfortunately we are bombarded with flashy headlines.

Kurt


----------



## Passepartout

[Never mind.]


----------



## presley

My insurance rates have been going up regularly for the last 10 years.  We have never used enough of it to even come close to breaking even.  

While the rates have climbed, the last 2 years, our insurance vowed to not profit more than 2%.  So, when they do make more than 2%, we get a small refund check.  Clearly, we have been subsidizing the sick for as long as we have had insurance.


----------



## momeason

For Conan

I live in NC. I do not qualify for any subsidy. My state does not have its own exchange and BCBSNC is the only company offering individual coverage next year.

I am 55 and my husband is 62..age is a factor.

Our 2013 plan is called Blue Options HSA. It has a $10,000 deductible and a $10,000 max out of pocket. The $10,000 is per group. There is no split of $5,000 per person. This is an advantage plan with a large network. 

Currently, we pay $681.45 for the 2 of us. that is with the auto pay option discount.
Next year is estimated to be $785..rates are not posted yet.( Adding 16%)

The closest new Bronze plan is the Advantage 5500. The deductible is $5500 per person, $11,000 group. Out of pocket maximum is $11,000. Our current plan is in the Advantage series which gives you the largest network of providers. I do not want a value plan because the network would be limited.
The 2014 rate for this plan is $1033/mo for the 2 of us.

Neither one of these plans have a copay. We pay for all doctor visits unless we meet the deductible. At that point, we would pay 0 for the rest of the year. We pay negotiated rates and use pre-tax dollars for all medical expenses. 
Because we pay for our insurance,no employer, we also get to deduct the insurance costs from our taxes.

If you want more info, PM me and I will be glad to give you my phone number. I have done lots of research and I am able to see all the NC plans on healthcare.gov. I will be glad to answer any questions.


----------



## ace2000

momeason said:


> So if your insurance rates are going up this year, keep in mind that 16% of the rate increase is from your insurer.* It has nothing to do with the ACA*.





momeason said:


> *I did not say that the new rates have nothing to do with the ACA.*



Sorry, that is exactly what you said.  

And then you purposely chose to shift all the blame for the increase to the insurance companies.  What's the point of your post?  To divert blame somewhere else?


----------



## VacationForever

momeason said:


> For Conan
> 
> I live in NC. I do not qualify for any subsidy. My state does not have its own exchange and BCBSNC is the only company offering individual coverage next year.
> 
> I am 55 and my husband is 62..age is a factor.
> 
> Our 2013 plan is called Blue Options HSA. It has a $10,000 deductible and a $10,000 max out of pocket. The $10,000 is per group. There is no split of $5,000 per person. This is an advantage plan with a large network.
> 
> Currently, we pay $681.45 for the 2 of us. that is with the auto pay option discount.
> Next year is estimated to be $785..rates are not posted yet.( Adding 16%)
> 
> The closest new Bronze plan is the Advantage 5500. The deductible is $5500 per person, $11,000 group. Out of pocket maximum is $11,000. Our current plan is in the Advantage series which gives you the largest network of providers. I do not want a value plan because the network would be limited.
> The 2014 rate for this plan is $1033/mo for the 2 of us.
> 
> Neither one of these plans have a copay. We pay for all doctor visits unless we meet the deductible. At that point, we would pay 0 for the rest of the year. We pay negotiated rates and use pre-tax dollars for all medical expenses.
> Because we pay for our insurance,no employer, we also get to deduct the insurance costs from our taxes.
> 
> If you want more info, PM me and I will be glad to give you my phone number. I have done lots of research and I am able to see all the NC plans on healthcare.gov. I will be glad to answer any questions.



Thank you!  This is the kind of data we want to see.  My pet peeve, whether you call it political or not, is that this is not health care reform.  The primary goal of health care reform needs to be about driving costs down so that health care becomes more affordable for all.


----------



## Luanne

sptung said:


> Thank you!  This is the kind of data we want to see.  My pet peeve, whether you call it political or not, is that this is not health care reform.  The primary goal of health care reform needs to be about driving costs down so that health care becomes more affordable for all.



To me, the reform part is that those with pre-existing conditions can now get health insurance and also that birth control AND pregnancy are covered.


----------



## rickandcindy23

Insurance is for those times when you need it, so of course you are paying for all of the other people who are sick and needing it.  It's called insurance because that is what it is. That's the very definition.   

Just like life insurance.  You get a huge amount of money if your spouse dies, but you are paying very little, because your spouse is likely not going to die until well into old age.  Same thing. 

Some day, all of the money you paid for insurance will be justified.  In the last ten years I have had gallbladder problems and a hysterectomy.  Before that, I had three kids, but that was a long time ago.  I have done well with insurance, but in the beginning, not so much.  Now, I feel it's starting to pay off.  I went to the doctor just yesterday for tests. 

Nothing changes for us, except a slightly higher cost for us to pay each year, which happens every year.  But I guarantee that when we are off of the insurance the DFD provides (20 months from now), I will be looking at the Affordable Care website to look at options.  If I can get a better deal that way than by staying with our Kaiser, I will switch.  We have had Kaiser for 40 years and love it.  My doctor is amazing, and my OB/Gyn is great, too.   

I saw on CNN yesterday that some computer experts are concerned about the security of SS#'s and personal information on the website for the Affordable Care Act.  I hope they fix it soon.  But I think it's wise to freeze one's credit with all credit reporting agencies as an added peace of mind.


----------



## ace2000

momeason said:


> *So my supposition is that about 16% of any rate increase would have happened with or without the law. If your increase is higher than that, then the difference could be attributed to the law. * I think that is a reasonable supposition after the statements made by my BCBS agent. Please let others decide this for themselves without going into attack mode.



Not going into attack mode here, and not to beat a dead horse, but how can you keep repeating this statement that your entire 16% increase would have happened with or without the law?  And then you tell everyone that any increase up to that point is all on the insurance companies?

The insurance companies are now forced under ACA to cover pre-existing conditions as well as provide coverage to dependents less than age 26.  Those are major factors for insurance costs. 

Please provide some support to the claim you have chosen to repeat several times.


----------



## geekette

sptung said:


> Thank you!  This is the kind of data we want to see.  My pet peeve, whether you call it political or not, is that this is not health care reform.  The primary goal of health care reform needs to be about driving costs down so that health care becomes more affordable for all.



agree.  this is Insurance Reform.  Nothing with healthcare is changing.


----------



## ace2000

rickandcindy23 said:


> I saw on CNN yesterday that some computer experts are concerned about the security of SS#'s and personal information on the website for the Affordable Care Act.  I hope they fix it soon.  *But I think it's wise to freeze one's credit with all credit reporting agencies as an added peace of mind.*



Not a bad idea... or at the least be careful.


----------



## geekette

ace2000 said:


> Not going into attack mode here, and not to beat a dead horse, but how can you keep repeating this statement that your entire 16% increase would have happened with or without the law?  And then you tell everyone that any increase up to that point is all on the insurance companies?
> 
> The insurance companies are now forced under ACA to cover pre-existing conditions as well as provide coverage to dependents less than age 26.  Those are major factors for insurance costs.
> 
> Please provide some support to the claim you have chosen to repeat several times.



How about the fact that it has gone up 16% for her Every Year in the past?


----------



## ace2000

geekette said:


> How about the fact that it has gone up 16% for her Every Year in the past?



I have no idea what the background on her insurance policy is.  You don't either.


----------



## tschwa2

I'll try to look up our last couple of years.  I don't think we have had a 16% increase but it certainly has been in the 9-12% annual increase over the past several years.


----------



## geekette

ace2000 said:


> I have no idea what the background on her insurance policy is.  You don't either.



Try post #65


----------



## ace2000

geekette said:


> Try post #65



I've read it.  An insurance premium is based on a lot more factors than just those details.


----------



## geekette

ace2000 said:


> I've read it.  An insurance premium is based on a lot more factors than just those details.



Fine, try post 50 that says "normal increase".

What is it you actually want???  Would you like to contact her ins co to find out Exactly What these increases are based on, because I don't think anyone here, except maybe an insurance exec, can give you exactly what you want.  

if your rates haven't been skyrocketing for the past decade or so, Lucky You.  The rest of us have seen annual increases, some of them Very Large.  Do I know Exactly Why?  No, my insurer doesn't quite provide the sort of intimate detail you request.  

Why don't you tell us what the premiums are precisely based on so that we will have a formula to use next year?


----------



## ace2000

geekette said:


> Fine, try post 50 that says "normal increase".
> 
> What is it you actually want???  Would you like to contact her ins co to find out Exactly What these increases are based on, because I don't think anyone here, except maybe an insurance exec, can give you exactly what you want.
> 
> if your rates haven't been skyrocketing for the past decade or so, Lucky You.  The rest of us have seen annual increases, some of them Very Large.  Do I know Exactly Why?  No, my insurer doesn't quite provide the sort of intimate detail you request.
> 
> Why don't you tell us what the premiums are precisely based on so that we will have a formula to use next year?



You're asking me to comment on why her premiums are going up at 16%?  I don't know.  You don't know either. 

I'm only questioning the _blame the insurance company mentality_ path that the OP chose to go down.


----------



## ace2000

geekette said:


> Why don't you tell us what the premiums are precisely based on so that we will have a formula to use next year?



I don't have the answer for you.  Have you thought about trying a Google search?


----------



## momeason

The point is that premiums have been going up a lot every year. I had group coverage prior to June 1,2013 so I have very little history in the individual market. Our group plans usually increased at least 10%. The individual market has been based on many factors age, gender and most importantly health history. I do not know how much the rates have been increasing since I had group coverage. I am just believing my insurance agent. We cannot compare apples and oranges…let's just drop this attack.

I guess the insurance industry will get a little cost savings from not having to hire all those people who dug deep into our medical histories before granting or denying coverage. I was interviewed by multiple people from two insurance
companies in 2011 and 2013 when I was shopping for coverage. They asked about so many details from various diagnosis..(many of which had been changed for the better). If a doctor tested me for anything, it was assumed I would have problems. I had to try to get through that most of those test results were negative. We took COBRA group coverage after being turned down in 2011.
Started individual coverage on June 1.2013.


----------



## geekette

ace2000 said:


> I don't have the answer for you.  Have you thought about trying a Google search?



You're the one stating they are based on a lot more, that it couldn't possibly just be the insurance company raising it.  google it your own self.  It matters nothing for me, I'm covered by employer.


----------



## svwoude

momeason said:


> For Conan
> 
> 
> I am 55 and my husband is 62.



And from an earlier post - My previous plan did not have maternity coverage

This is part of the reason your new plan is going up 16%
You are being forced to pay for coverage ( I am making an assumption here)
that you don't need


----------



## momeason

svwoude said:


> And from an earlier post - My previous plan did not have maternity coverage
> 
> This is part of the reason your new plan is going up 16%
> You are being forced to pay for coverage ( I am making an assumption here)
> that you don't need




The 16% increase is if I keep my existing plan per the new option to keep my plan. I will still not have maternity coverage. I made that clear when I posted the 16% increase. The 16% increase is not related to any new plan changes. The plan remains the same. It is a rate increase from the insurer for the identical plan.
This plan does not meet the new standards but it is being grandfathered.


----------



## Passepartout

svwoude said:


> You are being forced to pay for coverage that you don't need



That's what insurance and taxation is about. It's a part of living in a civilized society, and not like animals in 'survival of the fittest'. I have never fathered a child. Yet I have paid property taxes for nearly 50 years. The vast majority of which has gone to support schools I have never set foot in- nor has any progeny of mine benefited. Another healthy chunk supports a fire department. Thank goodness, I've never needed them. The number of times I have directly interacted with the police- again very few. 

As to health insurance, I don't know if my old insurance covered pap smears, pregnancy, or birth control. I DO know it covered PSAs and digital prostate exams, though my wife couldn't care less. Medicare covers both.

So anyway, welcome to being a member of civilized society. 

Jim


----------



## momeason

Passepartout said:


> That's what insurance and taxation is about. It's a part of living in a civilized society, and not like animals in 'survival of the fittest'. I have never fathered a child. Yet I have paid property taxes for nearly 50 years. The vast majority of which has gone to support schools I have never set foot in- nor has any progeny of mine benefited. Another healthy chunk supports a fire department. Thank goodness, I've never needed them. The number of times I have directly interacted with the police- again very few.
> 
> As to health insurance, I don't know if my old insurance covered pap smears, pregnancy, or birth control. I DO know it covered PSAs and digital prostate exams, though my wife couldn't care less. Medicare covers both.
> 
> So anyway, welcome to being a member of civilized society.
> 
> Jim



Thank you Jim. I wanted to say some of this but I was trying not to be political. 
To some other posters, I would prefer that if you do not have the need to shop for individual coverage for yourself or someone you care about, then keep your opinions to yourself. My intent was to help people make informed decisions in the individual marketplace. I started the first post in the first thread with that. If you are not here to help, then you are just noise.


----------



## Miss Marty

*An estimated 800,000 Maryland residents currently are uninsured.*

_
Affordable Care Act Health Coverage_

Signed into law in March 2010, the Patient Protection and Affordable Care Act (ACA) requires legal residents ages 18 to 64 to have health insurance coverage beginning in 2014 or pay a fine.


----------



## Conan

momeason said:


> I was interviewed by multiple people from two insurance companies in 2011 and 2013 when I was shopping for coverage. They asked about so many details from various diagnosis..(many of which had been changed for the better). If a doctor tested me for anything, it was assumed I would have problems. I had to try to get through that most of those test results were negative. We took COBRA group coverage after being turned down in 2011. Started individual coverage on June 1.2013.



Thanks for posting the information about your insurance premiums and history.  We've been in an employer's group plan so we haven't had to look into private coverage.  The way our deal with the employer was structured though, we've had to pay the full cost of coverage by salary reduction, $17,000/year for a pretty good family plan.  We're about to cross the finish line and get into Medicare. Part B and D premiums are looking good to us!

The prices you're seeing  for people who haven't made it to 65 are consistent with the calculator at http://kff.org/interactive/subsidy-calculator/ The truth is, people who don't have the benefit of a subsidized employer plan, if they also earn too much to qualify for the tax rebate, aren't going to find any bargains.  So as you note what's new under ACA is that insurance companies will no longer be able to cherry pick who they want to cover in the individual market. (And people with an employer plan who leave or lose their job can expect to find health insurance that's cheaper than COBRA and that doesn't expire.)

On the other hand, Obamacare may help put an end to what was the strategy for healthcare, by default or by design, for many of the 47 million Americans who didn't have an employer plan, weren't poor enough for Medicaid or old enough for Medicare, and couldn't or wouldn't pay the price of private coverage.  http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Their strategy almost always was to do without preventive medicine, tough it out or go to the emergency room if something happened, and in the worst case hope to get treated on credit and then just go bankrupt.

But they had Freedom!


----------



## dioxide45

The only way for the system to work is if everyone pretty much has the same coverage (just pays different premiums, deductible and coinsurance/copays). To only cover maternity for those that need it is pointless. Their premiums would be through the roof. The idea of insurance is and has always been that the people that don't make claims pay for those that do make claims. If people didn't add maternity coverage to their plan, people that needed it would not be able to afford it since they would be the only people wanting it. People usually plan to get pregant or have a child (I know, not always). It isn't like getting ill or injured where it is unplanned.

One issue with medical insurance today is that insurance companies have to insure basic maintenance. When you have to get your oil changed in your car you don't file an insurance claim. But you do when you go for an annual checkup at the doctor. Now if you had an extended warranty and needed an engine replaced, you would file a claim but you still wouldn't for the oil change. Insurance should really just cover catastrophic loss, not day to day maintenance.

Another problem is equal access to helthcare. Countries with a single payer system usually don't have this issue like the USA does. In the USA, the wealthy have easier access to healthcare than the poor. In single payer systems, everyone is usually equal. Now I am not saying single payer systems are the answer as they have their own problems. The issue for many people though is equal access to healthcare.


----------



## dioxide45

We have been on a HDHP for the past year. My only issue with these are that they are pure profit to the insurance companies. If one doesn't ever go over their deductible or use any of the preventative care, those premiums are pure profit. Of course that will help off set those that do go over their deductibles. The problem is that it seems that HDHPs are priced high for what you actually get. Several hundred dollars a month on the individual market is high IMO for what amounts to no coverage if you don't have a catastrophic event where you hit your deductible. I think they are using these plans to subsidize all the other plans they offer, even the more traditional plans.


----------



## momeason

Surveys have consistently shown that the large majority of respondents believe that insurance companies should be required to cover people with pre-existing conditions. Respondents also do not believe that insurance companies should be allowed to drop customers who get serious illnesses. Insurance companies have been doing both of these things for many years.
If there was regulation that required the insurance company to accept and keep these higher risk patients and there was no regulation requiring young healthy people to have insurance, insurance rates really would go through the roof.

I agree that rates are high, but only 10% or less of currently insured people need to buy on the individual market. For most employed Americans or those over 65 or retired from government, the law does not change much. Most do not really have a dog in the fight and most of them do not understand the reality of trying to buy an individual health plan.


----------



## momeason

dioxide45 said:


> We have been on a HDHP for the past year. My only issue with these are that they are pure profit to the insurance companies. If one doesn't ever go over their deductible or use any of the preventative care, those premiums are pure profit. Of course that will help off set those that do go over their deductibles. The problem is that it seems that HDHPs are priced high for what you actually get. Several hundred dollars a month on the individual market is high IMO for what amounts to no coverage if you don't have a catastrophic event where you hit your deductible. I think they are using these plans to subsidize all the other plans they offer, even the more traditional plans.



I also think the rates are high, but we all insure our homes. Most of the time, we do not use that insurance either. It is there to cover a catastrophic loss.
My husband had expensive golf clubs stolen and in the same year we had a leak in our AC unit that caused damage in our home. We had two claims that year and we received a cancellation notice. We had never had a claim in the 15 years before. ( This was 16 years ago.) It seems it doesn't take much to get cancelled in any insurance market.
We have a health insurance plan to cover what we cannot afford to cover and to get us negotiated rates on the outrageous healthcare costs. The US system is not ideal, but it is what we have. At least, we all have healthcare. I do not want to take the risk that nothing bad is going to happen. Very regularly, someone I know is diagnosed with a serious health problem. Let's be thankful that we all have access to healthcare..it is almost Thanksgiving!


----------



## floridabob

[POST DELETED:  *floridabob* - Did you get my private message?  I asked you to stop posting political messages - further violations may result in suspension of your posting privileges. - DeniseM]

[***As it turns out "floridabob" is actually a registered TUG member,  posting under a different guest name, to promote his political agenda.  "floridabob" will no longer be posting.]


----------



## Passepartout

floridabob said:


> "Even if the law were fully implemented, there would have been 26 million uninsured people," co-author Steffie Woolhandler said in an interview Thursday. "This isn't just about the Medicaid expansion. This is the system as originally designed."
> 
> *Thirty million is a lot smaller than the 48.6 million Americans who lack insurance coverage right now*.
> 
> As you can see, there's not much of a difference.



Actually 48.6 million, minus 30 million is nearly 20 million people who don't have insurance now who will under ACA. You got a better plan to insure more? Please, speak now. We're on pins and needles!

We will see when the law gets fully implemented- which is expected to take 2-3 years. The first year of implementation, 2014, we know there will be some people who will keep their old insurance. In '15, and '16, those older grandfathered plans will have expired, the rebates will be operating as expected, AND the tax consequences will be much higher than they will be in the first covered year.

Sure, a sizable number will choose to stick with HDHP plans that still leave them exposed to significant costs and swallow the miniscule 'fines' for not signing up. Those fines increase in subsequent years and the HDHP plans sunset.

There is your incentive to sign up. Will EVERY person sign up. Nope. But most will when they weigh the benefits vs. the cost.

Jim


----------



## dioxide45

Passepartout said:


> Sure, a sizable number will choose to stick with HDHP plans that still leave them exposed to significant costs and swallow the miniscule 'fines' for not signing up. Those fines increase in subsequent years and the HDHP plans sunset.



Did you mean to use OR in this sentence? I believe some of the plans offered on the ACA exchanges are in fact HDHPs. So they are not going away. The plans that are going away are the ones that don't meet the minimum requirements of ACA. These are not necessarily HDHPs. So you can sign up for a HDHP and avoid the tax penalties.


----------



## geekette

dioxide45 said:


> We have been on a HDHP for the past year. My only issue with these are that they are pure profit to the insurance companies. If one doesn't ever go over their deductible or use any of the preventative care, those premiums are pure profit. Of course that will help off set those that do go over their deductibles. The problem is that it seems that HDHPs are priced high for what you actually get. Several hundred dollars a month on the individual market is high IMO for what amounts to no coverage if you don't have a catastrophic event where you hit your deductible. I think they are using these plans to subsidize all the other plans they offer, even the more traditional plans.


I'm not so sure about the HDHP being big profit makers as I think preventive @ 100% is mostly used by the insureds.  Why not?  It's everything else that you pay pay pay for until deductible.  But if you hit deductible, then they cover most everything.  Some years you come out ahead, some years they come out ahead, but at least you get your screenings and can contribute to an HSA.

It would be wonderful if everyone could have an HSA but they are only available w/ HDHP.  

Mine is partially subsized so true cost masked.  Still, cheapest monthly pay I have had in over a decade (not counting what I voluntarily have deducted from my paycheck to go to HSA).  Prescriptions @ $4 shocked me.

If the monthly rate is good, and one can afford to divert cash to HSA, it could be a good way to go, at least short term, if one is generally healthy.  Having a build up in the HSA is a valuable tool to have.  Now that I have an HSA, I don't ever want to not be able to contribute to one.  ymmv


----------



## Passepartout

dioxide45 said:


> The plans that are going away are the ones that don't meet the minimum requirements of ACA.
> 
> So you can sign up for a HDHP and avoid the tax penalties.



I have not examined all the policies available, so it makes some sense to have some of them be high deductible policies as long as they provide the minimum benefits of ACA.

I guess I could have been clearer about the policies that would sunset. Sorry for the confusion (maybe mine).


----------



## geekette

dioxide45 said:


> Did you mean to use OR in this sentence? I believe some of the plans offered on the ACA exchanges are in fact HDHPs. So they are not going away. The plans that are going away are the ones that don't meet the minimum requirements of ACA. These are not necessarily HDHPs. So you can sign up for a HDHP and avoid the tax penalties.



That is correct.  Part of the confusion might be that many high deduct plans are indeed catastrophic only.  That is not, however, the only flavor they come in.


----------



## dioxide45

geekette said:


> I'm not so sure about the HDHP being big profit makers as I think preventive @ 100% is mostly used by the insureds.  Why not?  It's everything else that you pay pay pay for until deductible.  But if you hit deductible, then they cover most everything.  Some years you come out ahead, some years they come out ahead, but at least you get your screenings and can contribute to an HSA.
> 
> It would be wonderful if everyone could have an HSA but they are only available w/ HDHP.
> 
> Mine is partially subsized so true cost masked.  Still, cheapest monthly pay I have had in over a decade (not counting what I voluntarily have deducted from my paycheck to go to HSA).  Prescriptions @ $4 shocked me.
> 
> If the monthly rate is good, and one can afford to divert cash to HSA, it could be a good way to go, at least short term, if one is generally healthy.  Having a build up in the HSA is a valuable tool to have.  Now that I have an HSA, I don't ever want to not be able to contribute to one.  ymmv



We signed up for a HDHP with HSA in 2013. I wish I had run the numbers much sooner. As this year alone it has saved us about $1500 over a traditional plan. That money now sits in an HSA. Now we have employer sponsored health coverage, so I am sure we would be paying a much higher premium on the individual market. If that were the case, we wouldn't have as much in an HSA.

An HSA is good if you can afford to stash cash in there. It is a truly great vehicle. You put money in tax free and take it out tax free. It also grows tax free if you invest it. You don't have to meet the minimum health spending that you have to have in order to take healthcare costs as a deduction when itemizing on your return.


----------



## SMHarman

dioxide45 said:


> We signed up for a HDHP with HSA in 2013. I wish I had run the numbers much sooner. As this year alone it has saved us about $1500 over a traditional plan. That money now sits in an HSA. Now we have employer sponsored health coverage, so I am sure we would be paying a much higher premium on the individual market. If that were the case, we wouldn't have as much in an HSA.
> 
> An HSA is good if you can afford to stash cash in there. It is a truly great vehicle. You put money in tax free and take it out tax free. It also grows tax free if you invest it. You don't have to meet the minimum health spending that you have to have in order to take healthcare costs as a deduction when itemizing on your return.



I'd love to hear more on this. 
My employer does not contribute to the HSA anymore. 
The HSA plan costs 2.75% of gross. The Traditional plan 3.4% and the HMO about 3%  
With that saving in monthly premium diverted to HSA. I could never work out how to come out even let alone ahead. 
It seems to only work well for young single highly compensated people who can use it as a 401k style top up. 

Sent from my LT26i using Tapatalk


----------



## Rose Pink

I haven't read all the responses in this thread but did want to let people know that the dreaded price increases in medical insurance did not happen to us.  Our plans went up only about $2.  They've gone up much more than that over the past years.  

I haven't tried to get on the exchange to see if there are other plans out there that are better than DH's employer's plan.

I looked into the High Deductible plan offered a few years ago but figured we would end up paying more because the deductible was so high.  We'd end up paying more in deductibles than we would save in premiums. I can see where it would be a good gamble for young people with no illnesses.  Just this year DH has had knee and shoulder surgeries and told both times he will need replacement surgery sooner than later.  Let that be a lesson to you folks who think it is macho to power lift.  You shatter your cartilage.


----------



## dioxide45

SMHarman said:


> I'd love to hear more on this.
> My employer does not contribute to the HSA anymore.
> The HSA plan costs 2.75% of gross. The Traditional plan 3.4% and the HMO about 3%
> With that saving in monthly premium diverted to HSA. I could never work out how to come out even let alone ahead.
> It seems to only work well for young single highly compensated people who can use it as a 401k style top up.
> 
> Sent from my LT26i using Tapatalk



I currently don't have a lot of healthcare usage. In the past it is possible that perhaps we wouldn't have been able to plow as much in to the HSA. I recently lost a lot of weight and have been taken off a lot of meds that under the HDHP probably would have eaten up some of that money.

Though I will agree. An HSA is best for the young and healthy. If you only have one or two office visits a year, and only take a couple of prescriptions, you can save quite a bit of money in the HSA.

In our plan the HSA was about $20 cheaper per pay period than the traditional plan. This was about 45% less. By putting that difference in to the HSA, it was $560 right there. Our employer does contribute to the HSA throughout the year. So between that and putting in the difference between the traditional plan premium and the HDHP premium I already had $1000 in there. We always contributed to a HCRA in the past. I always found myself at the end of the year finding stuff to buy in order to avoid the use it or lose it provision on a HCRA. This year, I just put the difference in the HSA I have had some healthcare usage this year with a couple doctors visits and some trips to the dermatologist. So it has used up some HSA contributions but I won't lose any contributions to the HSA that go unused.

However, the best thing about the HDHP is the negotiated rates. A doctor visit isn't over $100 and visits to the dermatologist are between $40 and $65. So the impact on the HSA hasn't been bad.

Another thing, if you do take regular maintenance medications, our plan pays for those at 80% with no deductible. Prescriptions for things like high blood pressure or cholesterol control do not impact you as much as you would think allowing you to keep that money in the HSA.


----------



## momeason

We are at the other end of the spectrum..last year our agent said we might want to consider the HDHP. Young people do not generally need this type of plan because a good coverage plan can be reasonable. We chose this type of plan because the premiums are much lower. To get a plan that would actually pay for doctor visits would cost over $6450 more per year. Our plan will pay 100% on everything after the $10,000 deductible. Out of pocket maximum is also $10,000. There are $30-$60 copays in the "better plan" and still relatively high copays on prescriptions and an out of pocket maximum of $12,700.

We do not need to budget our care on a monthly basis. The funds are in the HSA. We think the odds are that we will will not spend that $6450 on medical costs. If we do, it would probably mean we had something serious, in which case, the lower out of pocket maximum will come in handy. We can afford to gamble with a few thousand.

A lot of young people do not have the funds or the discipline to contribute to HSAs. They think they are invincible. That is why many have no insurance. They are taking a huge risk. Who will pay the bills if they get testicular cancer  or fall while rock climbing. A HDHP at least keeps them from running up a huge bill if they get really sick and gets them those negotiated rates. (If we all have insurance..maybe the rates will not have to be negotiated?)


----------



## dioxide45

I think a HDHP is great for the young. Starting to save early is the best way to let your money grow. They should be saving while they do not need the funds, so their HSA goes up. While traditional plans are fairly cheap for the young, the HDHP are usually always cheaper. Even if one just puts in the difference of what they would bay between the two types of plans, they would have significant savings after only a few years.


----------



## klpca

We switched to a high deductible plan a few years ago and managed to hit the maximum deductible both years, negating any savings. My husband had to have gallbladder surgery one year and my daughter had a broken Talus the next. Both required so many tests and procedures that the costs escalated quickly. Then throw in some garden variety issues (allergies, asthma, RA) and we were out of pocket to the tune of $10k each year, in addition to our premiums.  (Not sure why the company didn't have an HSA). Anyway we switched to Kaiser (HMO) and that has worked out great for us. Our premiums are comparable to our old PPO but our out of pocket is much less. When I read your stories I wonder what we did wrong, but in the end we feel good about where we are now.


----------



## VacationForever

I tried a high deductible plan for one year for my generally young and healthy son.  Guess what, I called 911 for an emergency.  The paramedics said he was alright but asked if we wanted him transported to the hospital.  Silly newbie me said, sure, when I could have driven him then.  Bill for the ambulance service? $2000, because high deductible plans do not pay for ambulance transportation.  Hospital emergency room bill was a separate amount.  I have shied away from high deductible plans thereafter.


----------



## Tia

ace2000 said:


> ...making health insurance companies cover pre-existing conditions and covering dependents till age 26 will have no impact on current rates?




What has been going on now with those 26 and below who where were not in school or covered by employer plans is lots of them have gone without.  They were still able to get treatment even for big stuff that is written off  when they can prove little income so then passed along... as nothing is free I think we can agree.  Either your covering them with insurance or not but they do get treated one way or the other.  Maybe it's like being on a teeter-totter


----------



## dioxide45

klpca said:


> We switched to a high deductible plan a few years ago and managed to hit the maximum deductible both years, negating any savings. My husband had to have gallbladder surgery one year and my daughter had a broken Talus the next. Both required so many tests and procedures that the costs escalated quickly. Then throw in some garden variety issues (allergies, asthma, RA) and we were out of pocket to the tune of $10k each year, in addition to our premiums.  (Not sure why the company didn't have an HSA). Anyway we switched to Kaiser (HMO) and that has worked out great for us. Our premiums are comparable to our old PPO but our out of pocket is much less. When I read your stories I wonder what we did wrong, but in the end we feel good about where we are now.



I guess we are lucky with our employer sponsored HDHP in that our deductible is only $1250 with a $2000 annual out of pocket max. Next year it goes up to $2,500 with a $4,500 out of pocket max. So we would never have a huge bill in the $10,000 range. I think that is why even if we hit the max, we would still be close to break even vs a traditional plan.

With our old traditional plan, we had copays of $20 for the doctor and $40 for a specialist. An office visit in most of our cases is a negotiated rate of about $80-$100 and going to the dermatologist was between $35 and $65. So we really didn't have to pay much more above our old copays with our new HDHP.

They obviously don't work well if you have an emergency that requires surgery of a hospital stay. But that is the nature of insurance, you are taking a gamble either way.


----------



## dioxide45

sptung said:


> I tried a high deductible plan for one year for my generally young and healthy son.  Guess what, I called 911 for an emergency.  The paramedics said he was alright but asked if we wanted him transported to the hospital.  Silly newbie me said, sure, when I could have driven him then.  *Bill for the ambulance service? $2000, because high deductible plans do not pay for ambulance transportation.  *Hospital emergency room bill was a separate amount.  I have shied away from high deductible plans thereafter.



I am not sure this is always the case. It is more that HDHP doesn't cover any medical services (except preventative care) until you reach the deductible.


----------



## momeason

We are shopping on the individual market. We can get a HDHP which would let us use our HSA with a much lower deductible. The plan with a $2800 deductible costs $6450 per year more. We are only risking $3650 by choosing the $10,000 deductible plan. Since we are older, 55 and 62, our rates are high. We will pay $785 per month for the $10,000 deductible plan. That is a savings of $540 per month in premium costs.

If our actual medical costs exceed $6450, then we lose on our gamble. Our best guess is that they will not. For 7 months this year with me having to go to Urgent care multiple times we are still likely to be under $3000 in actual medical costs for 7 months of coverage. When the worst case is only an extra $3650 in cost of premiums plus care for a year, that is a risk I can afford to take.
We all need to run the numbers and figure out what we are comfortable with. We are not comfortable paying for more insurance than we think we need.
I would rather put the money aside and get to keep it if my health stays good.


----------



## bogey21

rickandcindy23 said:


> But I think it's wise to freeze one's credit with all credit reporting agencies as an added peace of mind.



A good idea.  I did it and am happy I did, but it can be a hassle.  For example if you want to change your auto insurance to a new provider, they will want to check your credit.  To allow them to do so you have to call the Credit Agency the new company uses; ask them to allow access to your credit account for 24 hours; and give them your 6 or 8 digit security code.  Still I'm glad I did it.

George


----------



## VacationForever

dioxide45 said:


> I am not sure this is always the case. It is more that HDHP doesn't cover any medical services (except preventative care) until you reach the deductible.



When I bought the high deductible plan I was calculating out of pocket for medical expenses only.  The ambulance billed showed that my high deductible plan only paid them about $200, and I had to foot the rest of it.  It was a sticker shock for me.


----------



## maggiesmom

*Signing up for Health Care *

I just went into the government health care to sign up my family, everything with ok (copied off every page, before it was summited).

 Got my email to review plans  and low a behold - They have my Frist name misspelled . So I called gave the person all my info and after 15 mins waiting she comes back on the line and tells me : I'm sorry sir, but when can't do anything at this time. You'll just have to wait.: mad:

Thanks for letting me vent..

HAPPY THANKSGIVING EVERYONE


----------



## SMHarman

So is the misspelling a typo on your part or data that got corrupted in transmission?


----------



## zinger1457

The best thing to do when you run into a problem on ACA is just create a new account (need a different email address).  It's usually much faster then trying to get someone from ACA to fix it.


----------



## maggiesmom

zinger1457 ,Thanks, I'll try using a different email address. 

maggiesmom


----------



## maggiesmom

SMHarman- No typo on my part. Going to try  it with different email.


----------



## momeason

*Yeah..figured out a way to lower costs and get better coverage*

I have been researching insurance so much, I have been invited to become an agent. I am taking the course now. Have not been on TUG much because of this. Will be taking my licensing exam in a week or two. January through March, I will be working in a program to educate and enroll individuals called NC ENROLL. 

In my personal search for the best individual coverage option, since we had the option to keep our grandfathered plan, we started looking at the breakdown of rates within the family plan of our grandfathered plan and our new options. Boy were we surprised!

I wanted to lower my deductible from $10,000 to $5000. My husband did not care about doing that for himself. He wanted the lowest rates. We thought we wanted to move me to a lower deductible policy and let him keep the 2013 plan, but when we learned the rate breakdown, that made no sense. Because the rate breakdown made no sense.

My husband is 62 and I am 55. Our new rate for the grandfathered 10k deductible plan was going to be $873/month. When I obtained the rate breakdown it was $558/mo for my husband and $315/mo for me..huge difference due to the slight age difference of 7 years. I loved the $315/mo for me but we needed to reconsider what to do.

So... I kept our grandfathered plan which will become an individual plan with a $5000 deductible and $5000 max out of pocket. (Our current plan had a $10,000 individual/$10,000 family deductible..definitely favored the insurer)
My husband moved to a new plan with a $5500 deductible and $5500 max out of pocket. The difference in his rates between the old $10k plan and his new $5.5k plan is only $25/mo. His new plan is $583/mo. and lowers his deductible and out of pocket by $4500.
I stay with the grandfathered plan at only $315/month and lowered my deductible and out of pocket by half to 5k. Both plans are HSA plans which continue to have large tax savings for us.

We were not sure BCBS would let us do this particularly since my hubby was the primary subscriber on the 2013 acct. My agent called BCBSNC and was told it can be done and how to submit it. Change forms are in. ( I hope it isn't like II and they come back and say no later. )

I also purchased insurance for my son for his Christmas present. I did this on healthcare.gov..Yes, it works. It has been for weeks.

My daughter and her husband are shopping the Maryland exchange. She said the prices are much better than COBRA. (They are young..27 and 30)

I applied the same bargain hunting and research efforts to this as many of us do to buy and use timeshares for the least possible dollar outlay. I am pleased with the outcome if we actually get what I signed us up for today. Keep your fingers crossed for me. Our combined rates are higher than last year but I am pleased with our new deductibles.

Sometimes you just have to think and execute way outside of the box!


----------



## simpsontruckdriver

As a side note, Insurance is a good career move. DO NOT stick with only Health Insurance, also get Life Insurance/Annuties. That way, once the Exchange Enrollment Period is up (March 31st), you can go on to sell Life Insurance to anyone. The biggest advantage is, if you sell for a year and make $36000 in commissions, you will make a minimum $36k per year in renewals (assuming you stay with the agency and your customers stay with you). Living in Florida - "Heaven's Waiting Room" - Medicare recipients are a BIG business.

The downside to Insurance Sales is it is 100% commission. If the agency gives you a salary, your commissions are lower, since they need to make money somehow.

TS


----------



## Conan

momeason said:


> I have been researching insurance so much, I have been invited to become an agent. I am taking the course now.
> ....
> I also purchased insurance for my son for his Christmas present. I did this on healthcare.gov..Yes, it works. It has been for weeks.
> 
> My daughter and her husband are shopping the Maryland exchange. She said the prices are much better than COBRA. (They are young..27 and 30)
> 
> I applied the same bargain hunting and research efforts to this as many of us do to buy and use timeshares for the least possible dollar outlay. I am pleased with the outcome if we actually get what I signed us up for today. Keep your fingers crossed for me. Our combined rates are higher than last year but I am pleased with our new deductibles.



Well done!


----------



## momeason

simpsontruckdriver said:


> As a side note, Insurance is a good career move. DO NOT stick with only Health Insurance, also get Life Insurance/Annuties. That way, once the Exchange Enrollment Period is up (March 31st), you can go on to sell Life Insurance to anyone. The biggest advantage is, if you sell for a year and make $36000 in commissions, you will make a minimum $36k per year in renewals (assuming you stay with the agency and your customers stay with you). Living in Florida - "Heaven's Waiting Room" - Medicare recipients are a BIG business.
> 
> The downside to Insurance Sales is it is 100% commission. If the agency gives you a salary, your commissions are lower, since they need to make money somehow.
> 
> TS



Thanks for the suggestion, but I am probably not interested in full time work. Hubby is retired and we love to travel. We have travelled at least 12 weeks each of the last two years. We also live on the coast and have a lot of company in summer and I do not want to work in summer. We travel in the spring most years and sometimes in the fall. Working winter would be fine but I do not want to do tax returns.

I decided to do this so I can help people navigate through this new process. I think I will have the opportunity to work only enrollment periods in the future and that will work just fine for me if I want to. This would be late fall. My agent thinks I could work for her company if I want. I am working for an initiative starting in January, 2014. I really want to help right now and we will see what comes.

Other TUG members who want a job might heed your suggestion. Insurance can be a good second career for those seeking new employment. I just do not think I want to work enough of the year to make the minimum..lol. I am in early retirement mode and loving it most of the time. I stay so busy, I wonder how people have time to work!


----------



## hvacrsteve

Its been challenging to say the least!
Unfortunately as of January 1st our plan is gone!
We haven't been able to find anything even close that compares to what we had, either in coverage or price.
So for the first time in over 30 years we will be without insurance!

This was not something we were planning on!  Hopefully we can stay healthy and not get into any accidents.  
When I give our circumstances to any of them, heathcare.gov, ehealthcare etc. I never get a call back!  They all want to help until.....they hear the rest of the story!  As Paul Harvey always confirmed!

I even wrote the President and got a response, but it was of no help!
We may be able to go catastrophic, but I don't know yet, I am not sure what good that is either.  If I have to pay a lot for nothing what good is it really.

Maybe a stop lose policy, any one have any ideas?


----------



## presley

hvacrsteve said:


> Maybe a stop lose policy, any one have any ideas?



States have different rules.  Most states have to allow you one more year on your current policy.  Where I live, California, it was voted to not permit the extra year.    If you are in a state that uses the national health care (healthcare.gov) you should be able to continue with current policy for a year.  It's a grace period for those who have policies that are being cancelled.


----------



## hvacrsteve

Presley,
Thanks, I have already been down that road, its up to the insurance company, ours said they have already cancelled those plans and there is nothing they can do for us.  I can't make them do it.  I think the big issue is that we had some very high claims from an accident my wife had a few years back, close to .5 million I would say.  
As soon as they look us up, I never get a call back!
I call again and get the same run around.
I probably have over 60 hours in this since we received our notice to no avail.
I know more than I ever wanted to know about all the changes, I could probably write a book!
I had one of our Senators office call back yesterday, they have no answers other than to say I am so sorry.  That is not the intent of the new law!  They give me the same 800 to call that keeps telling me they can't help us.
Go figure, I just need to find something.  Maybe Lloyds of London?


----------



## vacationhopeful

hvacrsteve said:


> ..... any one have any ideas?



Divorice the wife, ... can't be any different that when one spouse has to be poor for LTC (nursing home care due to illness) ... on paper only.


----------



## Ridewithme38

vacationhopeful said:


> Divorice the wife, ... can't be any different that when one spouse has to be poor for LTC (nursing home care due to illness) ... on paper only.



Be careful with this, when you have been the primary provider, you can be ordered to continue to pay for the ex's insurance after the divorce...(This is why i'm not around much anymore, i've been spending a lot of time on custody/divorce forums learning everything i can)


----------



## Tia

Soon as someone goes without insurance count on something going wrong.... happened to a fairly young relative lately. Rather then pay for Cobra chose to take a chance  and just spend 3 days inpatient with tests to look for problem causing symptoms.


----------



## hvacrsteve

vacationhopeful said:


> Divorice the wife, ... can't be any different that when one spouse has to be poor for LTC (nursing home care due to illness) ... on paper only.



I don't think its a realistic option, although it would help solve the problem!


----------



## hvacrsteve

Ridewithme38 said:


> Be careful with this, when you have been the primary provider, you can be ordered to continue to pay for the ex's insurance after the divorce...(This is why i'm not around much anymore, i've been spending a lot of time on custody/divorce forums learning everything i can)



Sorry to hear you are going though this, I once did many years ago!
I really never want to again!


----------



## hvacrsteve

Tia said:


> Soon as someone goes without insurance count on something going wrong.... happened to a fairly young relative lately. Rather then pay for Cobra chose to take a chance  and just spend 3 days inpatient with tests to look for problem causing symptoms.



Honestly, it scares the heck out of me, we are no longer kids anymore and we have both had health issues, expensive ones.

The sad part is I supported the intent of the law, now it has put us a position of financial peril should anything bad actually happen!

So much for patient protection!


----------



## Passepartout

Steve, I'm terribly sorry for your situation. Not to get too nosy, but can you describe in general terms your (now ending) insurance? Deductible? co-pays? limits? And how about ACA questions re: pre-existing conditions? I was of the impression that age-only were taken into consideration, not pre-existing conditions. Was that not correct?

Many(most) of those cancelled policies were cancelled because they either had limits, didn't cover pre-existing conditions or diagnostics. Turns out they were insurance in name only and when a policy holder put in a claim, they would be denied under a variety of reasons or clauses. They simply didn't qualify as 'insurance' under the minimum definition under ACA.

Was what you had, pre 1-1-14 one of those?

Jim


----------



## bogey21

Passepartout said:


> .
> Many(most) of those cancelled policies were cancelled because they either had limits, didn't cover pre-existing conditions or diagnostics. Turns out they were insurance in name only and when a policy holder put in a claim, they would be denied under a variety of reasons or clauses. They simply didn't qualify as 'insurance' under the minimum definition under ACA.


FWIW I had a policy on my 43 yo Son that was cancelled.  It was exactly what I wanted, coverage in case something big happened and access to bc/bs negotiated rates, a $5,000 deductible, a $3,000 annual out of pocket, and prescription discounts.  *So the Government decided I was stupid and what I had wasn't 'insurance'*.  

So I get pushed to the Exchange and now have just about the same thing except it is now a $6,000 deductible and a $6,000 annual out of pocket.  The only thing better about the new policy is no Life Time limits.   Oh yes, and I now pay more!!

George


----------



## Loggie

I have to say that I am fortunate enough that my policy will not cancel until November 1, 2014.  My new policy will double in price and my deductible will double also.  Friends of ours policy went from $600 to $1200.  Some deal?  My brothers buddy just finished saying goodbye to everyone .. his policy was cancelled denied a subsidy cannot afford the new policy ........ run around through the .gov.   He will die the first of the year as he will not be able to have dialysis.  How many more like this?


----------



## Patri

Passepartout said:


> Many(most) of those cancelled policies were cancelled because they either had limits, didn't cover pre-existing conditions or diagnostics. Turns out they were insurance in name only and when a policy holder put in a claim, they would be denied under a variety of reasons or clauses. They simply didn't qualify as 'insurance' under the minimum definition under ACA.



It just occurred to me, this whole thing should have been reversed. Let people cancel their policies if they did not like current coverage, knowing if they signed up with ACA plans, it would have those benefits. Don't order insurance companies to drop their customers, many of whom were perfectly happy and could afford what they had.


----------



## Passepartout

Loggie said:


> My brothers buddy just finished saying goodbye to everyone .. his policy was cancelled denied a subsidy cannot afford the new policy ........ run around through the .gov.   He will die the first of the year as he will not be able to have dialysis.



Does he qualify for Medicaid? People without- or very low income do. Or is his income higher than the 400% of poverty level so he doesn't qualify for subsidy? No hospital or dialysis center will deny care to anyone regardless of ability to pay. It may bankrupt him, but he will get care.

Obviously I can't know the details of your brother's friend's situation, but I don't think what you have related is the whole story.

Jim


----------



## Passepartout

bogey21 said:


> FWIW I had a policy on my 43 yo Son that was cancelled.  It was exactly what I wanted, coverage in case something big happened and access to bc/bs negotiated rates, a $5,000 deductible, a $3,000 annual out of pocket, and prescription discounts.  *So the Government decided I was stupid and what I had wasn't 'insurance'*.
> 
> So I get pushed to the Exchange and now have just about the same thing except it is now a $6,000 deductible and a $6,000 annual out of pocket.  The only thing better about the new policy is no Life Time limits.   Oh yes, and I now pay more!!
> 
> George



You have said that he had no income. (back in post 12) Does he qualify for Medicaid?


----------



## bogey21

Passepartout said:


> You have said that he had no income. (back in post 12) Does he qualify for Medicaid?



He does qualify for Medicaid.  My problem is that I look at Medicaid as welfare and I don't feel right asking the taxpayer to cover me or my kids when I have the ability to pay.  Old fashioned?  Stupid?  Maybe, but that is the way I feel.

George


----------



## Passepartout

That's twice in back-to-back posts that you've either perceived or self described yourself as 'stupid'. I don't think so, but possibly you might re-examine your perception. There is no shame in taking advantage of programs designed to help people who are unable to pay on their own. Your son didn't have a part in making the law nor would he choose to be in a position to accept it. That's just the reality of the situation. It's laudable for you to pay for him to have private insurance, but not necessary. 

Not to wander into forbidden territory here, but the governor of Texas must feel much like you do. He refused to allow expanding Medicaid for Texas residents, at no cost to the people of the state, creating the largest pool of low income uninsured people in the USA. For the life of me, I can't see how that benefits the residents of the state.

I wish you, and him, well.


----------



## bogey21

Just an observation in the FWIW Department.  I had to have an ultra sound the other day.  My Doctor scheduled it at a testing clinic right down the street from a major hospital in Fort Worth.  I had never been there before.  When I arrived I found a parking lot for about 75 cars with but one empty spot.  When I went inside to check in there were easily over 100 people in the waiting room (Not all were there for a test.  Some of course were there to support others).  As I looked around the room I remember thinking that 90% of those waiting were either on Medicare (including me) or Medicaid.  My appointment was for 11 am.  I finally got to take my test at about 1 pm.  I also remember wondering how long I would have had to wait if everyone in the State had health care coverage.

George


----------



## Passepartout

I was referred to the ER by my PCP on a weekend over concern for a possible DVT (leg blood clot). I had to wait 5+ hours to even see a resident, and the guy running the ultrasound never could find a clot. Fortunately, I had insurance that covered all but about $65 of a $3000 bill. People without insurance get all their health care at the ER because they can't be turned away regardless of ability to pay. We ALL get the bill.


----------



## simpsontruckdriver

As a Medicare health insurance agent, I have talked with people who did not want to take Medicaid/Social Security Extra Help, because they don't want "welfare". The truth is, Medicaid and SS EH are there to help pay medical bills for those who can't afford it. For instance, some Medicare recipients have medicines that push their drug costs into the "Catastrophic Phase" (over $4500 in a year), yet they struggle to pay for other needs. Why? If they apply to Social Security, and if they are approved for Extra Help, ALL their medications drop to less than $10 each, all but eliminating the Catastrophic Phase. In addition, any Late Enrollment Penalties are waived, as well as any Part-B and Part-D premiums.

If a person can't afford medical care, Medicare or younger, the government can help. No one should go without food AND needed medical care.

TS


----------



## hvacrsteve

Passepartout said:


> Steve, I'm terribly sorry for your situation. Not to get too nosy, but can you describe in general terms your (now ending) insurance? Deductible? co-pays? limits? And how about ACA questions re: pre-existing conditions? I was of the impression that age-only were taken into consideration, not pre-existing conditions. Was that not correct?
> 
> Many(most) of those cancelled policies were cancelled because they either had limits, didn't cover pre-existing conditions or diagnostics. Turns out they were insurance in name only and when a policy holder put in a claim, they would be denied under a variety of reasons or clauses. They simply didn't qualify as 'insurance' under the minimum definition under ACA.
> 
> Was what you had, pre 1-1-14 one of those?
> 
> Jim



My wife and I are on the same policy and it is a great policy.  No co insurance, hospital visit is $50.00, all visits to regular doc are covered, $10.00 prescriptions.
For both of us, $1,200 a month.
They have paid out over $5ook over the last 5 years, major accident, 7 surgeries total.

Canceled because of the ACA, not sure the exact clause, I think no drug rehab if I remember correctly!  Has no life time limit already, great policy!  Never have been denied anything!

I can't get any ACA policies that will cover both of us together, no exceptions.
New options, for her, I can't find any.  I have spent over 40 hours on the phone with .gov, over 32 hours on the phone with the other people that supposedly can help!  Five other insurance companies.  Once they find out her history they will never call me back!  I go into the black hole!

Me, I can get one to cover just me, its $800.00 a month, $6000.00 deductible and 1000% more for my prescriptions!

I think I can  maybe get her a catastrophic plan now after Fridays announcement, not sure though, I am sure it will cover less and cost more than twice what we were paying with what my new is already. The one before was $350.00 a month for me and the balance was her premium.

Point is, I was perfectly happy with what I had, I may be able to get insurance for both of us but it has been and still is a nightmare and the out of pocket potential is many times what it was!
I know the value of a good policy and the ones on the ,GOV suck compared to what we had if you can get one and then can afford it!  
This will be, if I can get us covered a huge expense I did not plan on!

So I know we will not have insurance on January 1, what happens after that, who knows!


----------



## hvacrsteve

Patri said:


> It just occurred to me, this whole thing should have been reversed. Let people cancel their policies if they did not like current coverage, knowing if they signed up with ACA plans, it would have those benefits. Don't order insurance companies to drop their customers, many of whom were perfectly happy and could afford what they had.



Duh, why would they do such a stupid thing as that?  It made too much sense!, In the mean time a whole lot of people got waivers to the law!  That is the part that makes me the maddest!  I am losing a great policy and some one else got a waiver!  
I usually see my congressman around, I haven't seen him in months!
I will setting down at his table the next time I do see him and give him a piece of my mind!


----------



## Loggie

No he does not qualify for Medicaid.  He is trying to get on the catastrophic plan, but so far nothing.  

God bless all of you in the New Year to come.  I know more people that will now NOT have insurance than what do.  I have friends that are getting their hours cut and losing their employer based health care in November ... I am afraid for this country.


----------



## Passepartout

hvacrsteve said:


> My wife and I are on the same policy and it is a great policy.  No co insurance, hospital visit is $50.00, all visits to regular doc are covered, $10.00 prescriptions.
> For both of us, $1,200 a month.
> They have paid out over $5ook over the last 5 years, major accident, 7 surgeries total.
> 
> Canceled because of the ACA
> The one before was $350.00 a month for me and the balance was her premium.
> 
> Point is, I was perfectly happy with what I had



Easy to see why you were perfectly happy!

This is HANDS DOWN, the most generous health insurance plan I've EVER heard of! Regardless of the reason they say they are cancelling it because of, the bottom line is that it simply isn't profitable.

Insurance companies are businesses. They exist to make a profit. On the policy you outlined above there is no way under the sun that there are enough of the 'Immortal 20somethings' to sign up to offset the people like yourselves that submit half-million dollar claims.

The only thing that will make ACA work is if enough of the young, healthy people enroll so that the insurance companies continue to be profitable- while providing necessary care for all their enrollees who submit the majority of claims.

Thanks for outlining the reason you can't find comparable coverage. You have had a supremely generous plan for as long as you have. Consider yourselves fortunate. I think it will be very difficult to replicate going forward.

Good Luck

Jim


----------



## Ken555

Just like other issues (and online reviews of anything) we hear more about the negatives than the positives about this issue. Bad news spreads quickly. 

Here's my bad news in this issue. My insurance agent, who had committed to providing excellent service and communication, completely dropped the ball on assisting myself and my staff get new policies and answer questions. I only found out while I was in Hawaii last week that they didn't do their job. I applied and completed my own application online at coveredca.com in less than 10 minutes (it was about as simple as could be and worked great). Then I fired my agent. If they don't won't follow up and do their job then what's the point of having them? Unfortunately, they were a liability that almost cost me more money for less benefits starting on Jan 1st. 

The good news, as stated above, is that the website worked great and was fast. I even checked yesterday to verify my account online and got in quickly and it's all there.

I'm looking forward to my new plan, even though it doesn't do everything I want (yet). Still, it has more benefits for less cost than the plan I've had for the last few years.


Sent from my iPad


----------



## ThreeLittleBirds

Spouse and I were deemed uninsurable. This was after paying $12k in premiums, only to be dropped with our first claim. The insurance company then considered a noted pre-existing condition as too high risk (but the claim had nothing to do with the pre-existing conditions).

We were 39 and 40 years old when this happened. Been uninsured since.

Finally able to get insurance again, and what we consider to be a great plan at a great price. The folks at the Connect for Health Colorado have been great to work with, and I find it a real shame that all states didn't have designated exchanges. Sure, the phone lines were pretty jammed toward the end, but it's not like we didn't have fair warning.


----------



## simpsontruckdriver

My wife and I will have to decline health care, at least for another month or so. Our governor declined (as did others) Medicaid expansion, so anyone who makes less than $15000 gets NO help. With me sitting on Unemployment, my income in 2013 is less than $15000, so we have to pay FULL PRICE ($568 per month). She needs surgeries, I need rehab on my arm, and deductible-first plans are not financially possible. FYI, my area (Central Florida) does not have any Catastrophic Plans, only Bronze - Platinum.

TS


----------



## presley

simpsontruckdriver said:


> My wife and I will have to decline health care, at least for another month or so. Our governor declined (as did others) Medicaid expansion, so anyone who makes less than $15000 gets NO help.



I recently got a formal letter in the mail saying I can't buy on the exchange. Reason is we are considered to be too poor.  I disagree, but oh well, sucks to be us.  Our choices are either keep our old policy which goes up to $1200./month for a $6K deductible per person or see if the state will cover any emergencies.  We don't have any current health issues, other than I take allergy medicine.  It's much less expensive pay cash than to pay $1200/month for a $6K deductible.  I wanted to buy Silver plan for$400-$500/month, but we don't qualify because we are too poor.  Whatever.


----------



## bogey21

Too poor to buy health care!  I don't understand.  I bought a Bronze Plan directly from Blue Cross for my 45 yo Son who has zero income.  Note that I went directly to Blue Cross, not through the Exchange.

George


----------



## momeason

simpsontruckdriver said:


> My wife and I will have to decline health care, at least for another month or so. Our governor declined (as did others) Medicaid expansion, so anyone who makes less than $15000 gets NO help. With me sitting on Unemployment, my income in 2013 is less than $15000, so we have to pay FULL PRICE ($568 per month). She needs surgeries, I need rehab on my arm, and deductible-first plans are not financially possible. FYI, my area (Central Florida) does not have any Catastrophic Plans, only Bronze - Platinum.
> 
> TS



The catastrophic plans are officially offered only to those under 30. If you are below the poverty level as you are right now, you absolutely CAN get an exception and buy catastrophic health insurance plan. Try doing a fake rate quote while not signed in. You will not be able to see the plans when signed in since you are over 30. Put in a fake age under 30. You could also consider just buying insurance for your wife and let her get her needs covered. It will not start until Feb 1 now, but it can be done. PM me if you need more info.
Most catastrophic plans do have high deductibles, but the out of pocket max is only $6350 for the entire year for an individual. You may be able to find a compassionate doctor who will let you pay your part on a payment plan.

Check out the cost and if you think you can swing it, then contact the reps at healthcare.gov and find out how to buy the catastrophic plan. Maybe you can 
get licensed to sell health insurance. There is a high demand right now.


----------



## momeason

presley said:


> I recently got a formal letter in the mail saying I can't buy on the exchange. Reason is we are considered to be too poor.  I disagree, but oh well, sucks to be us.  Our choices are either keep our old policy which goes up to $1200./month for a $6K deductible per person or see if the state will cover any emergencies.  We don't have any current health issues, other than I take allergy medicine.  It's much less expensive pay cash than to pay $1200/month for a $6K deductible.  I wanted to buy Silver plan for$400-$500/month, but we don't qualify because we are too poor.  Whatever.



Just curious, how do you pay the MFs on all your resorts at that income?

You can get an exception and buy a catastrophic plan designed for those under 30. That is much cheaper and will get you preventative care and 3 visits with a low copay and a low out of pocket maximum. 
You are exempt from the requirement to buy insurance, but you should be allowed to buy catastrophic or any other plan. That is the law. Call a rep and talk to them for the exception. Enrollment goes until 3-31-2013. My son has an extremely low income as he went back to school. He was exempted from the requirement to buy insurance because he has a very low income. He was, however, allowed to buy insurance but there is no subsidy available. We are paying for his insurance. NC rejected Medicaid expansion. People who do not make at least 110% of the federal poverty level were supposed to get Medicaid. In many states this expansion was rejected and there are many people who are still not getting access to Medicaid or insurance.


----------



## bogey21

I still don't understand.  My Son is 45 and has zero income.  That means he is poor and over 30.  The Bronze Plan I bought for him directly off Blue Cross'  website costs $157.84 a month.  It has a $6,000 deductible; a $6,000 out of pocket limit; and no lifetime limit.  To me it is a catastrophic plan in disguise.  Other advantages are that Doctors charge at the Blue Cross negotiated rate and there is some prescription coverage that I have not bothered to check out.

George


----------



## presley

momeason said:


> Just curious, how do you pay the MFs on all your resorts at that income?



That's why I mean.  I don't think I am too poor to buy insurance.  I've been paying $755./month for the whole family.  California has chosen to have their own healthcare exchange.  I cannot buy off of Healthcare.gov.  I have to buy off of Coveredcalifornia and that is what their response to me was.  They will let me continue my current plan which is raising up to $1200./month if I want to buy directly through Blue Shield,the company I've been with for many years.  Not worth it to me as I've been paying all these years and have not come close to breaking even on the amount I've paid out to BlueShield.


----------



## simpsontruckdriver

FYI, I have a Florida 2-40 Health Insurance license. I can sell any health insurance, I just need to find a company to work with. The same company that got me certified in Medicare could get me certified in Exchanges, but it's money out of pocket that I don't have. And, since Florida does not have an exchange, there's not really a demand for them here in the state. Companies who offer private health exchange insurance in Florida - BCBS, Coventry, and CIGNA - already hired agents (Navigators).

Since Florida is "Heaven's Waiting Room", Turning-65 (aka T65) is a cash cow. If an agent has several plans to offer to Seniors, as well as Term Life Insurance, there's plenty of money to be made - as long as the company hands out tons of leads.

TS


----------



## momeason

simpsontruckdriver said:


> FYI, I have a Florida 2-40 Health Insurance license. I can sell any health insurance, I just need to find a company to work with. The same company that got me certified in Medicare could get me certified in Exchanges, but it's money out of pocket that I don't have. And, since Florida does not have an exchange, there's not really a demand for them here in the state. Companies who offer private health exchange insurance in Florida - BCBS, Coventry, and CIGNA - already hired agents (Navigators).
> 
> Since Florida is "Heaven's Waiting Room", Turning-65 (aka T65) is a cash cow. If an agent has several plans to offer to Seniors, as well as Term Life Insurance, there's plenty of money to be made - as long as the company hands out tons of leads.
> 
> TS



My training is being paid for by an agency selling BCBS through the federal marketplace. It was less than $300 anyway. I have a job waiting for me. I am just doing health insurance on the exchange for the next 3 months. have a lead for a closer agency for next fall. I do not want to work year round.


----------



## momeason

presley said:


> That's why I mean.  I don't think I am too poor to buy insurance.  I've been paying $755./month for the whole family.  California has chosen to have their own healthcare exchange.  I cannot buy off of Healthcare.gov.  I have to buy off of Coveredcalifornia and that is what their response to me was.  They will let me continue my current plan which is raising up to $1200./month if I want to buy directly through Blue Shield,the company I've been with for many years.  Not worth it to me as I've been paying all these years and have not come close to breaking even on the amount I've paid out to BlueShield.



I would beg for an exemption to buy a catastrophic plan. If they tell you you are too poor, it should be offered to you and should be reasonable. The plans are actually pretty good. Also if they think you are poor, are you being offered Medicaid? California expanded Medicaid.


----------



## presley

momeason said:


> Also if they think you are poor, are you being offered Medicaid? California expanded Medicaid.



The letter said we would hear from Medical - the california plan.  It's been 3 weeks and we haven't heard.  I've tried looking it up online and everything redirects me back to coveredcalifornia.  It honestly doesn't matter.  I'm putting $500./month into a savings and that will go to any doctor visits/medicine that we need.  That's still much less than what I've been paying and it doesn't require a handout for me to go to the doctor.  If we have a big emergency, I really don't care if we have to sell everything we own to pay for it.  

I'm just resentful that we have been paying so much money for so long to subsidize other people and now we have been priced out of our plan.  As it was, for $755./month, I was out over $9K last year in premiums.  Then, we each had a $5200. deductible.  So, we would need to spend over $14K in a year just to get to ground zero.  Now, that number is up to $20K if I keep my insurance.  I thought the health exchange would give us a break and I guess in a way it has since I will be self-insuring for much less per month and I won't have a deductible now.


----------



## geekette

presley said:


> That's why I mean.  I don't think I am too poor to buy insurance.  I've been paying $755./month for the whole family.  California has chosen to have their own healthcare exchange.  I cannot buy off of Healthcare.gov.  I have to buy off of Coveredcalifornia and that is what their response to me was.  They will let me continue my current plan which is raising up to $1200./month if I want to buy directly through Blue Shield,the company I've been with for many years.  Not worth it to me as I've been paying all these years and have not come close to breaking even on the amount I've paid out to BlueShield.



Wait, you HAVE to buy off the state exchange?  Why?  You can get insurance from anyone, so long as it meets new law minimums.  You may not be eligible for a subsidy off-exchange, but you can buy whatever you want.

Check with different ins cos that are not on the exchange.


----------



## geekette

presley said:


> The letter said we would hear from Medical - the california plan.  It's been 3 weeks and we haven't heard.  I've tried looking it up online and everything redirects me back to coveredcalifornia.  It honestly doesn't matter.  I'm putting $500./month into a savings and that will go to any doctor visits/medicine that we need.  That's still much less than what I've been paying and it doesn't require a handout for me to go to the doctor.  If we have a big emergency, I really don't care if we have to sell everything we own to pay for it.
> 
> I'm just resentful that we have been paying so much money for so long to subsidize other people and now we have been priced out of our plan.  As it was, for $755./month, I was out over $9K last year in premiums.  Then, we each had a $5200. deductible.  So, we would need to spend over $14K in a year just to get to ground zero.  Now, that number is up to $20K if I keep my insurance.  I thought the health exchange would give us a break and I guess in a way it has since I will be self-insuring for much less per month and I won't have a deductible now.



But you will pay a penalty per uninsured person.


----------



## geekette

Loggie said:


> I have to say that I am fortunate enough that my policy will not cancel until November 1, 2014.  My new policy will double in price and my deductible will double also.  Friends of ours policy went from $600 to $1200.  Some deal?  My brothers buddy just finished saying goodbye to everyone .. his policy was cancelled denied a subsidy cannot afford the new policy ........ run around through the .gov.   He will die the first of the year as he will not be able to have dialysis.  How many more like this?



I'm not sure why he would choose death over finding a place to get dialysis?  There are plenty of poor people that receive life saving treatments every day.  Is his doctor refusing to treat him?  Are there no hospitals near him?  Clinics?  University med schools?


----------



## Passepartout

presley said:


> I'm just resentful that we have been paying so much money for so long to subsidize other people and now we have been priced out of our plan.  As it was, for $755./month, I was out over $9K last year in premiums.  Then, we each had a $5200. deductible. * So, we would need to spend over $14K in a year just to get to ground zero*.  Now, that number is up to $20K if I keep my insurance.



That's how insurance works. Those who are relatively healthy pay for those who aren't. Same way with fire insurance. Those who don't have a fire wipe them out pay so that those who suffer loss are covered.

Y'know what's worse than not getting your money's worth out of insurance premiums? Getting your money's worth.

Your premiums are buying you peace of mind. It isn't an investment.

Jim


----------



## isisdave

I live in California and wanted to know if we could buy a "metal" plan for our 21-year-old son, who is not a dependent for tax purposes and makes less than $15000. He would be eligible for Medi-cal, but we don't want that because there are few family-practice and almost NO specialists who take Medi-cal (Medicaid). We were looking at Silver plans.

This doesn't apply yet, since he IS eligible to be covered under my employer's plan and therefore can't be covered through the exchange, but if I were to be suddenly "retired" then:

The answer I got was (1) Yes, you can buy a metal plan for someone eligible for Medicaid, but there will be no subsidy; and (2) you can't do it on the website, you have to phone.

I don't know if this is accurate, but it seemed to address part of the problem of presley being "too poor."


----------



## bogey21

geekette said:


> Wait, you HAVE to buy off the state exchange?  Why?  You can get insurance from anyone, so long as it meets new law minimums.  You may not be eligible for a subsidy off-exchange, but you can buy whatever you want.



This is what I was talking about earlier.  When I wanted a policy for my 45 year old unemployed Son (and didn't want Medicaid and subsidy wouldn't mean anything because he has no income) I ignored the Exchange and just went to company websites where I easily found a policy.   Sure it is $6,000 deductible, $6,000 maximum out of pocket, but it has Affordable Care Act bells and whistles.

George


----------



## simpsontruckdriver

FYI, the business of Insurance is to spread out loss. Companies are out to make a small profit. The ONLY people who were against the PPACA ("ObamaCare") were the insurers. The insurers denied those with pre-existing conditions, since they are the greatest loss for a company. Now that they are required to cover them, they're probably going to take a loss for a little while, which cuts into their profit margins (but will not put them "in the red"). If an insurer goes "in the red", it is not the fault of the law, but the company.

TS


----------



## bogey21

simpsontruckdriver said:


> FYI, the business of Insurance is to spread out loss. Companies are out to make a small profit. The ONLY people who were against the PPACA ("ObamaCare") were the insurers. The insurers denied those with pre-existing conditions, since they are the greatest loss for a company. Now that they are required to cover them, *they're probably going to take a loss for a little while*, which cuts into their profit margins (but will not put them "in the red"). If an insurer goes "in the red", it is not the fault of the law, but the company.



A normal response to reduced profits is higher rates.  

George


----------



## Passepartout

One of the things built into the ACA is a provision that insurers HAVE to spend at least 80% of their income on claims. If they don't, the additional MUST be divided up and distributed to policy holders.

The Act and it's sign-up is just barely getting underway. The first people to get coverage will be covered tomorrow (Jan. 1, 2014) with sign-ups continuing into the year. It remains to be seen how many will sign up, and what the demographics will be. IF (and now it's a big IF) lots of young- healthy people enroll and premiums exceed claims, rates will be adjusted down. If the majority of people signing on are older, sicker, with more claims, rates will increase. Hence, to make the program more attractive and make the objective of near universal healthcare work, younger people should be encouraged to enroll.

Jim


----------



## Tia

Read somewhere yesterday online that to be covered as of 1/1/14 you have to of also paid the premium to the policy, not paid = not covered. Makes sense to me but guess there are those who it might come as a surprise...


----------



## geekette

Tia said:


> Read somewhere yesterday online that to be covered as of 1/1/14 you have to of also paid the premium to the policy, not paid = not covered. Makes sense to me but guess there are those who it might come as a surprise...



I believe it's more like if you have not paid, you have the coverage but must pay the bills and submit claims for reimbursement.

Best to pay the premium, imo, since I always hated the claim forms and was excited when providers starting doing the claim process for us.


----------



## momeason

Presley will not have a penalty since she her income was deemed too low to purchase. She does need to enroll in Medi-cal to avoid the shared responsibility payment..ie penalty. Shared responsibility makes sense since all taxpayers pay to cover emergency room care for the uninsured. The ACA is attempting to reduce the numbers of uninsured so emergency rooms will not be used for primary care. This benefits everyone, the newly insured who can get better, consistent care and the taxpayers who won't have to pay these huge hospital bills.


----------



## hvacrsteve

For the first time in over 30 years I woke up with no insurance!
It is sad when things and promised and then not followed through on to put it lightly!

My question is if we have to go to the hospital, because I haven't read it myself, are they still required to accept us, especially considering our plan was cancelled due to the new law?


----------



## Passepartout

They will accept you. Then they will bill you. This is exactly the reason buying health insurance has been mandated. To keep people from going bankrupt because they need- and have to have- health care they can't afford. Having read your synopsis of your insurance, it would have been cancelled anyway, new law or not.

Good luck to you and best wishes for your continued good health.

In the end though, it's a lot like playing Russian Roulette. Eventually you land on the loaded chamber.

Jim


----------



## ace2000

Passepartout said:


> They will accept you. Then they will bill you. This is exactly the reason buying health insurance has been mandated. To keep people from going bankrupt because they need- and have to have- health care they can't afford.



How is this any different than the past???  I don't get the point you're making.


----------



## Passepartout

ace2000 said:


> How is this any different than the past???  I don't get the point you're making.



It isn't different than the uninsured encountered in the past (yesterday). The OP asked if he would be turned away without insurance. This is a situation he had not encountered before. My answer is that he will not be turned away. Then billed. The point was, that the intention of the ACA was to mandate that everyone buy insurance so that they could not be bankrupted by the 'healthcare industrial complex'. I'm sorry to say, that in his family's situation, no affordable solution was found.

Get it now?


----------



## Tia

ace2000 said:


> How is this any different than the past???  I don't get the point you're making.



It's not different but it is what will happen. ER's do not have to treat non emergencies I don't believe. Cheaper to go see your own doctor and pay cash talking to them ahead of time for a possible cash discount?


----------



## vacationhopeful

Tia said:


> It's not different but it is what will happen. ER's do not have to treat non emergencies I don't believe. Cheaper to go see your own doctor and pay cash talking to them ahead of time for a possible cash discount?



That is TRUE - ERs have to stop the life threating bleeding but not kill or remove the cancer. And if you can sit up, you can be put into a car to also leave the hospital with very limited supply of meds. And you might be very surprised with WHAT is considered to NOT be life-threaten illness, like they don't have to remove the stitches or cast later -- that is NOT a life threatening issue. 

The accountants could decide if you get surgery to repair the leg or if the leg cut off. What you and the family might want is not the issue - it is WHAT you can pay for on your VISA card, right then and now.


----------



## am1

The goal is not to break even on insurance year to year.  The reason you have it is for the expensive times.


----------



## hvacrsteve

Passepartout said:


> They will accept you. Then they will bill you. This is exactly the reason buying health insurance has been mandated. To keep people from going bankrupt because they need- and have to have- health care they can't afford. Having read your synopsis of your insurance, it would have been cancelled anyway, new law or not.
> 
> Good luck to you and best wishes for your continued good health.
> 
> In the end though, it's a lot like playing Russian Roulette. Eventually you land on the loaded chamber.
> 
> Jim



This wasn't in my plan of course.  We have remedies, just not in the US!
Thankfully there is a World economy!  I just want to know before we have a major problem.  It is just sad when a Government uses it power to take from some to benefit others with no accountability.  We have had the same policy for many years and it reality we had still paid in premiums more than our expenses were when you take into account the many years we had almost zero in claims.

I should not have to sell assets to have to pay for health insurance and I refuse to do so.  This extra expense was not in our budget or our long term plan.


----------



## vacationhopeful

Steve, when you work hard and the powers to be CHANGE the rules on the Game of Life, it truly stinks.

It would be wonderful if the politicians had to work for 40 years at 40 hours a week before they got a penny of government retirement monies ....


----------



## hvacrsteve

vacationhopeful said:


> Steve, when you work hard and the powers to be CHANGE the rules on the Game of Life, it truly stinks.
> 
> It would be wonderful if the politicians had to work for 40 years at 40 hours a week before they got a penny of government retirement monies ....



I have a feeling that things will change, I know many people besides myself in the same boat.
I also know there are another 50-100 million that will also lose their insurance in the coming year.
I can't imagine a scenario where something better will not come out of this.
The stakes are just far too high for it not to.  My congressman is in hiding right now, I don't blame him either.  Just like a dog that stole meat!


----------



## Passepartout

hvacrsteve said:


> It is just sad when a Government uses it power to take from some to benefit others with no accountability.



As I pointed out waaaay upthread, I am childless. Never had a loved one set foot inside a school nor ever called a fire department or police for an emergency. Yet every year I get billed for and pay my property taxes, the vast majority of which goes to support schools and emergency services. Is that taxation without accountability? No, it's called living in a civilized society.

It's the same thing you are grousing about. In a civilized society, there are things that those who can pay provide for those less fortunate. It's the way it is.

I am saddened that your carrier chose to cancel your policy. I hope that something is offered that you can afford. The risk of both physical and financial ruin is just too great. At an absolute minimum, open a Healthcare Savings account with before tax money to help out with day-to-day medical expenses. If you have to go offshore for the big stuff, that is your choice.

Again, Best wishes. Your old coverage is gone and your state chose not to allow it to be renewed for another year. I hope you can find a replacement.

Healthcare should be a right, not a privilege.

Jim


----------



## amycurl

As of today, I will now be paying $100 less/per month for my daughter's individual policy; the coverage will also be better (yay dental insurance!) She will still be with the same company, same doctors, etc.

We purchased through the exchange *without* subsidies. 

The news, as always, is filled with bad news. Good news rarely makes headlines.


----------



## momeason

hvacrsteve said:


> This wasn't in my plan of course.  We have remedies, just not in the US!
> Thankfully there is a World economy!  I just want to know before we have a major problem.  It is just sad when a Government uses it power to take from some to benefit others with no accountability.  We have had the same policy for many years and it reality we had still paid in premiums more than our expenses were when you take into account the many years we had almost zero in claims.
> 
> I should not have to sell assets to have to pay for health insurance and I refuse to do so.  This extra expense was not in our budget or our long term plan.



If your plan was cancelled, you can buy a catastrophic plan through the exchange. The cost is very reasonable and it will give you preventative care, 3 doctor visits at $35 copay and a maximum out of pocket for the year of $6350. Any medical expenses you incur will be at an insurance negotiated rate.
The cost is probably lower than any plan you had before. 
There are solutions. From your statements, it appears that you wish to complain and do not wish to find the solutions. There are not nor will there be 50-100 million losing their insurance in the coming year. Where do you get your news..Rush Limbaugh.
I am a licensed insurance agent and I have been trained on the exchange.
Your situation has remedies. You may have preferred your own plan and cost, but you do not need to go without any coverage.
Here is a news article to get you started.
http://health.usnews.com/health-insurance/virginia


----------



## hvacrsteve

momeason said:


> If your plan was cancelled, you can buy a catastrophic plan through the exchange. The cost is very reasonable and it will give you preventative care, 3 doctor visits at $35 copay and a maximum out of pocket for the year of $6350. Any medical expenses you incur will be at an insurance negotiated rate.
> The cost is probably lower than any plan you had before.
> There are solutions. From your statements, it appears that you wish to complain and do not wish to find the solutions. There are not nor will there be 50-100 million losing their insurance in the coming year. Where do you get your news..Rush Limbaugh.
> I am a licensed insurance agent and I have been trained on the exchange.
> Your situation has remedies. You may have preferred your own plan and cost, but you do not need to go without any coverage.
> Here is a news article to get you started.
> http://health.usnews.com/health-insurance/virginia



That is great!  Not what I had nor what I want!
I just want what was promised!
I have spent over 60 hours working on a solution.
Until last week when they raised the age on the catastrophic plans I had no options.  I am not sure that I do now!
My news comes from the reality of the insurer's I have been talking with telling me I haven't seen nothing yet, wait until 2014 when small businesses start dropping policies like hot cakes because the cost are double!


----------



## hvacrsteve

amycurl said:


> As of today, I will now be paying $100 less/per month for my daughter's individual policy; the coverage will also be better (yay dental insurance!) She will still be with the same company, same doctors, etc.
> 
> We purchased through the exchange *without* subsidies.
> 
> The news, as always, is filled with bad news. Good news rarely makes headlines.



I am glad someone is getting a break!


----------



## hvacrsteve

Passepartout said:


> As I pointed out waaaay upthread, I am childless. Never had a loved one set foot inside a school nor ever called a fire department or police for an emergency. Yet every year I get billed for and pay my property taxes, the vast majority of which goes to support schools and emergency services. Is that taxation without accountability? No, it's called living in a civilized society.
> 
> It's the same thing you are grousing about. In a civilized society, there are things that those who can pay provide for those less fortunate. It's the way it is.
> 
> I am saddened that your carrier chose to cancel your policy. I hope that something is offered that you can afford. The risk of both physical and financial ruin is just too great. At an absolute minimum, open a Healthcare Savings account with before tax money to help out with day-to-day medical expenses. If you have to go offshore for the big stuff, that is your choice.
> 
> Again, Best wishes. Your old coverage is gone and your state chose not to allow it to be renewed for another year. I hope you can find a replacement.
> 
> Healthcare should be a right, not a privilege.
> 
> Jim



I agree about the financial ruin!  Believe I also know about paying for everyone else tax wise! I paid 16k in property taxes this year and many times that in other taxes!


----------



## bogey21

Passepartout said:


> Healthcare should be a right, not a privilege.



Who determined this?  When?

George


----------



## momeason

hvacrsteve said:


> That is great!  Not what I had nor what I want!
> I just want what was promised!
> I have spent over 60 hours working on a solution.
> Until last week when they raised the age on the catastrophic plans I had no options.  I am not sure that I do now!
> My news comes from the reality of the insurer's I have been talking with telling me I haven't seen nothing yet, wait until 2014 when small businesses start dropping policies like hot cakes because the cost are double!



Many insurers are like you, resistant to change. 
There are many more millions being helped by the law. It is for the greater good and is a great first step in providing better healthcare for all. At least the catastrophic plan will protect you and your assets. I certainly would not go without any protection just because you feel screwed.

I am sorry YOU lost your plan. BTW, I did too. I am paying significantly more.
I feel blessed to have all that we have and I want to help others who are not so fortunate. I became licensed so I could help others without spreading  negativity. The insurance companies were fighting this law until the end. My agent was nice about it, but she was overwhelmed with learning the ins and out at the last minute and appalled about the big hole created for those making less than 138% of the Federal Poverty level in our state and many others because of a lack of medicaid expansion. Medicaid expansion was an integral part of the law. Except for the Medicaid hole, everyone making up to 400% of the federal poverty level can receive assistance paying for coverage. Depending on which agent you used, you may or may not have access to subsidies. Most agents are not qualified to help you get a subsidy. They had to choose to do the training and get security qualified. Going through healthcare.gov will give you access to advance tax credits if you fall into that income bracket. If you make more than 400% of the federal poverty level, count yourself blessed. I know I do. I work towards creating opportunities for others to succeed. Taking care of basic needs such as food, shelter, safety, education and health come first. It is difficult to succeed in school or the workplace if basic needs are not met.
I am so glad that so many people who have never had access to healthcare and so many who lost their ability to buy on the individual market because of pre-existing conditions now have access to good healthcare, You also still have access. You are just resentful because it may cost you more. Most good things come at a price.
Roads, schools, police and yes, our hospital systems. Access to healthcare is better in every other developed country. We are playing catch-up. 
This law is far from perfect, but it is a beginning.

There are many examples of things not working out as we were told. 
Social security, The Medicare Prescription Drug program and many wars, like IRAQ and Vietnam. 
BTW, the donut hole in the Medicare Prescription Drug programs is quickly closing under the ACA. There is lots of good in the law and it will be improved. It is a work in progress. It is a major change and a compromise at that. Let's keep working to improve it.


----------



## Passepartout

bogey21 said:


> Who determined this?  When?
> 
> George



Every other civilized nation on earth considers health care to be a right. The US is behind the curve, but we are trying to catch up.


----------



## bogey21

Passepartout said:


> Every other civilized nation on earth considers health care to be a right. The US is behind the curve, but we are trying to catch up.



You didn't answer my question.  Who determined that that health care is a right?  Where is it articulated?  The Constitution?  The Bill of Rights?  Holy books?  Don't get me wrong.  I want everyone to have access to quality health care.  I just want to know who determined that it is a right.

George


----------



## Passepartout

bogey21 said:


> I want everyone to have access to quality health care.



Apparently, people who think like you do. No particular single name can be put to it, just the nebulous 'people' in general.


----------



## simpsontruckdriver

The biggest reason for giving all Americans health care: Emergency Rooms. As of last year, go to an ER, and lots of the patients are there for "primary" care. Colds, flu, sore body parts, non-emergency issues. Then, the hospital must write off their bills, because the patient winds up filing bankruptcy. With the law, those who need primary (non-emergency) care will go to their PCP (Primary Care Physician), leaving the ER for those with genuine emergencies. Those who can't go to their PCP can go to an Urgent Care and have that covered.

On the Medicare PDP (Prescription Drug Plan) side, the PPACA requires the drug maker AND the insurer cover 50% of the Rx costs in the Coverage Gap ("Donut Hole") by 2020. That will save Seniors hundreds, if not thousands, of dollars in a year. If the PPACA is removed, insurers will NOT be required to pay for prescriptions in the Coverage Gap.

TS


----------



## ace2000

simpsontruckdriver said:


> The biggest reason for giving all Americans health care: Emergency Rooms. As of last year, go to an ER, and lots of the patients are there for "primary" care. Colds, flu, sore body parts, non-emergency issues. Then, the hospital must write off their bills, because the patient winds up filing bankruptcy. With the law, those who need primary (non-emergency) care will go to their PCP (Primary Care Physician), leaving the ER for those with genuine emergencies. Those who can't go to their PCP can go to an Urgent Care and have that covered.



In a perfect world I'd believe you.  However...

Study: Expanding Medicaid doesn’t reduce ER trips. It increases them.

http://www.washingtonpost.com/blogs...aid-doesnt-reduce-er-trips-it-increases-them/


----------



## geekette

hvacrsteve said:


> That is great!  Not what I had nor what I want!
> I just want what was promised!
> I have spent over 60 hours working on a solution.
> Until last week when they raised the age on the catastrophic plans I had no options.  I am not sure that I do now!
> My news comes from the reality of the insurer's I have been talking with telling me I haven't seen nothing yet, wait until 2014 when small businesses start dropping policies like hot cakes because the cost are double!



Please elaborate on what you believe you were promised ?


----------



## ace2000

geekette said:


> Please elaborate on what you believe you were promised ?



You know there's no way to answer that without getting very political.  But, if you're really curious do a google search on the false promises of the Affordable Healthcare Act.


----------



## wilma

hvacrsteve said:


> We have remedies, just not in the US!
> Thankfully there is a World economy!  I just want to know before we have a major problem.



What does this mean? You plan on living in another country?


----------



## hvacrsteve

geekette said:


> Please elaborate on what you believe you were promised ?



Like 
If you Like your Plan, you can keep it! Period!

Nothing more, nothing less!


----------



## hvacrsteve

wilma said:


> What does this mean? You plan on living in another country?



I want be their unless I need a major operation and am able to make the trip.


----------



## wilma

hvacrsteve said:


> I want be *their *unless I need a major operation and am able to make the trip.



Where do you want to be?


----------



## momeason

ace2000 said:


> In a perfect world I'd believe you.  However...
> 
> Study: Expanding Medicaid doesn’t reduce ER trips. It increases them.
> 
> http://www.washingtonpost.com/blogs...aid-doesnt-reduce-er-trips-it-increases-them/



We have never had widespread health insurance reform before. Expanding Medicaid without all the other provisions of the ACA may have been a problem in the past. With all the other changes of the law and widespread insurance coverage, we may see a different result. This is a work in progress. With everything changing as it is with the ACA, in time we hope things will improve. We know that our past healthcare delivery system did not work well. We need to work towards a system that does work better. This is finally a starting point. If the entire law had been embraced and improved and not fought tooth and nail by politicians and corporations, things may have been better. What we need to do now is make constructive improvements based on the early results. 
Bitching and moaning without offering constructive reform does not help most of us.


----------



## hvacrsteve

[As you have been reminded may times, political posts are not permitted on TUG.  This kind of post is the way to get the thread closed - DeniseM Moderator]


----------



## amycurl

To answer the question of "who decided health care is a right?," I would like to point you to Article 25 of The UN International Declaration of Human Rights:

"(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

Eleanor Roosevelt was one of the drafters of the Declaration, and chaired the committee. 

So there's one answer to that question.


----------



## momeason

amycurl said:


> To answer the question of "who decided health care is a right?," I would like to point you to Article 25 of The UN International Declaration of Human Rights:
> 
> "(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."
> 
> Eleanor Roosevelt was one of the drafters of the Declaration, and chaired the committee.
> 
> So there's one answer to that question.



Thank you for that quote!


----------



## Passepartout

hvacrsteve said:


> Like
> If you Like your Plan, you can keep it! Period!
> 
> Nothing more, nothing less!



No person, regardless of their office can make promises for another person or business. What was said could have been said more accurately- like, "If the plan you have meets the minimum standards, AND is still offered by your carrier on Jan. 1, you can keep it." But truly accurate, nuanced phrases seldom make good sound bites.

Get over it. Your plan was cancelled. Move on and get your family covered. Going without coverage is just too big a risk. Steve, sometimes it seems like you are so wrapped up in griping about political realities you can't do anything about, that you've lost track of the objective.

It isn't worth moving to Timbuktu, or Thailand, or Germany or Mexico to get affordable healthcare- but maybe in your circumstances and location, Maryland might be a consideration.

More Best Wishes.


----------



## hvacrsteve

Passepartout said:


> No person, regardless of their office can make promises for another person or business. What was said could have been said more accurately- like, "If the plan you have meets the minimum standards, AND is still offered by your carrier on Jan. 1, you can keep it." But truly accurate, nuanced phrases seldom make good sound bites.
> 
> Get over it. Your plan was cancelled. Move on and get your family covered. Going without coverage is just too big a risk. Steve, sometimes it seems like you are so wrapped up in griping about political realities you can't do anything about, that you've lost track of the objective.
> 
> It isn't worth moving to Timbuktu, or Thailand, or Germany or Mexico to get affordable healthcare- but maybe in your circumstances and location, Maryland might be a consideration.
> 
> More Best Wishes.



If they know they can't keep them, they shouldn't make them.
Pretty simple, that is all I have to say about this entire subject.
Some people keep their word, others don't even know what it means.
It is difference in beliefs, I am old school. I do what I say I will do.
I don't really need health insurance, but I have maintained it, I have principles and I live by them.  I guess I just expect too much from people.  I have to stop doing that.  Maybe I will drop by In another 6 months or so if I am still alive. LOL!


----------



## bogey21

I had an interesting experience today.  My Primary Care Physician of the last 30 years is retiring on January 15th.  I figured I should get set up with another Doctor, preferably closer to home.  There are a lot of primary care practices in Fort Worth so I picked an area near a major hospital and cold called to see if I could get set up.  The first two places I went told me they weren't taking any new Medicare patients.  It was the same deal at my third stop with the Doctors currently on staff.  Fortunately for me they are bringing in a new Partner on February 1st who will accept me, Medicare and all, in order to start building a book of business.

George


----------



## simpsontruckdriver

If you're on Medicare and a Medicare Advantage plan, you can call your MAPD's customer service number (or go online) to find a covered doctor. You could also do it online. If you have a PPACA Exchange plan, or even if you have an Employer (Group) plan, you can go online to the plan's site to get providers.

TS


----------



## sue1947

hvacrsteve said:


> If they know they can't keep them, they shouldn't make them.
> Pretty simple, that is all I have to say about this entire subject.
> Some people keep their word, others don't even know what it means.
> It is difference in beliefs, I am old school. I do what I say I will do.
> I don't really need health insurance, but I have maintained it, I have principles and I live by them.  I guess I just expect too much from people.  I have to stop doing that.  Maybe I will drop by In another 6 months or so if I am still alive. LOL!



My health care provider cancelled my plan each of the last 5 years. Each time, I was rolled into another plan that was the closest to the previous one. In addition, each time, my premiums went up to a total of 300% in 6 years.  Now that is the old school method.  
  Change happens.  If your health care provider wanted to cancel your plan, they can.   With the new exchanges, I got a comparable plan that has more coverage for half the price.


----------



## hvacrsteve

[Steve - this is your 2nd warning in this thread - one more, and I'm sending you to Band Camp - again. - DeniseM Moderator]


----------



## mspeggysue911

We have been fortunate. My dh's employer provided plan changed and the new plan has a slightly higher deductible and a slightly higher out of pocket (still very reasonable) and the premium is doubling. But the employer pays for 80% of the premium. So what we use to pay $150 a month for we will now be paying $300 a month for. The company is giving all the pilots a raise to help offset the increased cost in the insurance.

However my unemployed son qualifies for expanded medicaid, but since our state didn't expand medicaid he does not qualify for any subsidies in insurance plans. The only thing is, since he doesn't get insurance or medicaid he will not have to pay the fine. But he still will not have any kind of insurance.

And I know Obama kicked the can down the road by saying insurance companies can keep these non-ACA complaint plans for one more year. At the end of 2014 millions of employees will be losing the employer provided plans they now have and either be paying higher premiums or be forced onto the exchange by the employers who find it cheaper to pay the fines than paying for the insurance.


----------



## momeason

mspeggysue911 said:


> We have been fortunate. My dh's employer provided plan changed and the new plan has a slightly higher deductible and a slightly higher out of pocket (still very reasonable) and the premium is doubling. But the employer pays for 80% of the premium. So what we use to pay $150 a month for we will now be paying $300 a month for. The company is giving all the pilots a raise to help offset the increased cost in the insurance.
> 
> However my unemployed son qualifies for expanded medicaid, but since our state didn't expand medicaid he does not qualify for any subsidies in insurance plans. The only thing is, since he doesn't get insurance or medicaid he will not have to pay the fine. But he still will not have any kind of insurance.
> 
> And I know Obama kicked the can down the road by saying insurance companies can keep these non-ACA complaint plans for one more year. At the end of 2014 millions of employees will be losing the employer provided plans they now have and either be paying higher premiums or be forced onto the exchange by the employers who find it cheaper to pay the fines than paying for the insurance.



In some of these cases insurance with subsidies will be cheaper on the exchange for the employees and may save the employer money. Many of these employees do not make high salaries. At least there will be options. No one knows how many employers are going to drop coverage. You cannot make the statement that it will be millions. Whatever the number, most will now have options, even if they have pre-existing conditions.


----------



## pgnewarkboy

The elephant in the room is the outrageous charges by medical care providers - particularly hospitals and big pharmaceuticals.  It s well documented that this well heeled lobby keeps Americans paying too much for the exact same care provided at less than one half the cost  in other countries.


----------



## Timeshare Von

Anyone interested in the healthcare mess from an economic perspective, check out Michael C. Porter's "Redefining Health Care." 

While working for an ag economics association several years ago, Porter was a keynote speaker.  What he has to say holds a lot of truth.


----------



## Tia

There was something also this last summer that listed huge differences for care right here in this country . This is one article I found when I searched http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?_r=0



pgnewarkboy said:


> The elephant in the room is the outrageous charges by medical care providers - particularly hospitals and big pharmaceuticals.  It s well documented that this well heeled lobby keeps Americans paying too much for the exact same care provided at less than one half the cost  in other countries.


----------



## momeason

pgnewarkboy said:


> The elephant in the room is the outrageous charges by medical care providers - particularly hospitals and big pharmaceuticals.  It s well documented that this well heeled lobby keeps Americans paying too much for the exact same care provided at less than one half the cost  in other countries.



So true, but you left out the health insurance industry as another contributor to the problem. This industry has spent billions lobbying against the ACA which is basically insurance reform and regulation.
Big Pharm wrote and lobbied for and bought the votes to pass the Medicare Prescription Drug Plan in 2007. Big Pharm representatives wrote that 2007 bill which includes a provision that Medicare cannot negotiate prescription drug prices. The result is that among the Top 20 drugs used by seniors, Medicare pays 20% more than the VA benefit system. The VA is still allowed to negotiate the prices of the prescription drugs.
The other party passed the Medicare Prescription Drug Plan in 2007 and its cost is astronomical but it benefits big corporate sponsors unlike the ACA which regulates the insurance industry. 6 weeks after this Medicare bill passed in 2007, the head of Medicare landed a great job as a corporate lobbyist for Big Pharm. The congressional sponsor of the bill also went to work as the same type of lobbyist within a few months.
There is so much fight against the ACA because it regulates industry rather than subsidizing industry. Follow the money.


----------



## Ironwood

At the risk of resurrecting an old thread that many will suggest we've seen enough of....here's Ralph Nader's take on the comparison of Canadian Health Care vs US Health Care.

http://www.thestar.com/opinion/commentary/2014/01/12/canadian_health_care_better_than_obamacare.html


----------



## momeason

Ironwood said:


> At the risk of resurrecting an old thread that many will suggest we've seen enough of....here's Ralph Nader's take on the comparison of Canadian Health Care vs US Health Care.
> 
> http://www.thestar.com/opinion/commentary/2014/01/12/canadian_health_care_better_than_obamacare.html



The original proposals in 2009 were for a single payer system. It took 50 years to get Insurance Reform aka the ACA or Obamacare. I do not think American politicians will ever pass a single payer system. Too much money flowing in from the Insurance lobby.


----------



## momeason

Two tips:

1.If you still have not received your Insurance Plan Documents, you have 10 days to examine your documents and return the plan. Within this 10 days, you can get a full refund. This applies whether you purchased your individual plan from a private insurer or the exchange. This law is little known. It is basically a right of rescission. (Of course, if you go to the doctor and then cancel your plan, the claim will not be paid.)
For BCBSNC, the "free look period" begins when you receive your welcome kit.
BCBSNC has not sent out the welcome kits to any of its individual subscribers.
We purchased through our Farm Bureau agent, not the exchange. We purchased on the exchange for our son. In both cases, BCBSNC phone reps have told us, no one has their documents yet. They are supposed to be mailed this week. I am guessing the same situation exists in other states.

2. Be very wary of HMOs and other plans that limit your network. Because of the "Free Look Period, you may be able to switch. Even if your doctor is in the limited network, you may need a specialist and find very few choices or you may be traveling and find no good alternatives.
With BCBS, if you choose an Advantage plan the network includes 91% of the doctors and medical facilities across the US. There are Advantage plans available at every metallic level..ie Bronze, Silver, Gold and Platinum. You will pay a little more for the larger network, but the difference is slight. The other networks give much more control to the insurer.

3. If you qualify ( by income level) for subsidies and cost sharing, you must select a silver level plan to get the cost sharing. Cost sharing can lower your deductibles and your copayments or coinsurance.

If you have specific questions, I will try to help you. PM me. I have been certified in the Federal Marketplace so I may be able to answer some of your questions.


----------



## Conan

momeason said:


> If you qualify ( by income level) for subsidies and cost sharing, you must select a silver level plan to get the cost sharing. Cost sharing can lower your deductibles and your copayments or coinsurance.



Interesting, and a distinction I didn't know about until now.

It turns out that the tax credits, which reduce premium costs, are available to all levels of plan, for individuals and families earning up to 400% of the federal poverty level (FPL). People receiving subsidies can apply their subsidy toward  the purchase of more or less expensive plans, but must pay the  difference between the premium in the selected plan and the subsidy.
http://kff.org/interactive/subsidy-calculator/

The 400% of FPL (2013) figure by family size in the 48 mainland states is
1 $45,960
2 $62,040
3 $78,120
4 $94,200
5 $110,280
6 $126,360
7 $142,440
8 $158,520

 On the other hand, cost sharing reductions are not available in bronze plans. They are available to individuals and families with incomes below 250% of the FPL who enroll in silver plans (only?). These cost sharing reductions reduce consumer costs (such as out-of-pocket maximums, copays, and coinsurance) at the point of service, whereas tax credits reduce only premiums. 

The 250% of FPL (2013) figure by family size in the 48 mainland states is
1  $28,725
2  $38,775
3  $48,825
4  $58,875
5  $68,925
6  $78,975
7  $89,025
8  $99,075


----------



## momeason

Conan said:


> Interesting, and a distinction I didn't know about until now.
> 
> It turns out that the tax credits, which reduce premium costs, are available to all levels of plan, for individuals and families earning up to 400% of the federal poverty level (FPL). People receiving subsidies can apply their subsidy toward  the purchase of more or less expensive plans, but must pay the  difference between the premium in the selected plan and the subsidy.
> http://kff.org/interactive/subsidy-calculator/
> 
> The 400% of FPL (2013) figure by family size in the 48 mainland states is
> 1 $45,960
> 2 $62,040
> 3 $78,120
> 4 $94,200
> 5 $110,280
> 6 $126,360
> 7 $142,440
> 8 $158,520
> 
> On the other hand, cost sharing reductions are not available in bronze plans. They are available to individuals and families with incomes below 250% of the FPL who enroll in silver plans (only?). These cost sharing reductions reduce consumer costs (such as out-of-pocket maximums, copays, and coinsurance) at the point of service, whereas tax credits reduce only premiums.
> 
> The 250% of FPL (2013) figure by family size in the 48 mainland states is
> 1  $28,725
> 2  $38,775
> 3  $48,825
> 4  $58,875
> 5  $68,925
> 6  $78,975
> 7  $89,025
> 8  $99,075



Your numbers are correct. Many qualifying consumers will miss the detail that they must buy a SILVER level plan to get the cost sharing. Eligible people may get the benefits of a gold or platinum plan when choosing a silver plan. Those under the 250% of the FPL also get lower premiums buying the Silver plan. This is why I would recommend using a navigator or a licensed agent who has been certified in the Federal Marketplace. There are a lot of details to absorb. BCBSNC has 4 videos that certified agents use to introduce health insurance terms and the options at the beginning of presentations. We are doing presentations to church and community groups..anyone who wants the information. Then we answer questions and help eligible people enroll. We only get small flat rate commissions. We do not get paid based on which plan is chosen and we get no hourly pay or salary. You have to do it for other reasons other than money..lol. I truly do want to help people enroll in the best plan at the lowest costs
My daughter and her husband originally applied for no subsidy. I encouraged her to apply and they did get a subsidy, not cost sharing.
She is not in my state.


----------



## ScoopKona

I'd like to chime in and say that my plan didn't change. I like it. And I can keep it. I seriously wish every man, woman and child could have the same healthcare plan that I do. I have the same level of healthcare that is offered to members of Congress. There are next to no out of pocket expenses. Nothing is deducted from my paycheck. I simply do not worry about healthcare. Routine visits (like quarterly dentist visits/cleanings, semi-annual checkups and all the usual "gotta go to the doctor" stuff is free.) Above and beyond procedures (with exceptions like cosmetic surgery) is so inexpensive that it might as well be free. For instance, when I finally decide to get my knee scraped, that's all covered and I'll get all the time off that I'll need.

I think it's criminal that we are the only developed country that has not sorted out universal healthcare. Everyone should have the same level of confidence in their health options that I enjoy.

My only problem with this new system is that it didn't go far enough. It seems to me like most people are getting a big headache and the runaround. They could have taken a proven system like my plan, or Senator Bigwig's plan, and implemented it nationwide.


----------



## Conan

ScoopLV said:


> I think it's criminal that we are the only developed country that has not sorted out universal healthcare. Everyone should have the same level of confidence in their health options that I enjoy.



And the only country where medical bills are the #1 cause--1,700,000 cases per year--of personal bankruptcy.
http://www.nerdwallet.com/blog/heal...ion-americans-65-struggle-medical-bills-2013/http://www.cnbc.com/id/100840148


----------



## geekette

mspeggysue911 said:


> ...And I know Obama kicked the can down the road by saying insurance companies can keep these non-ACA complaint plans for one more year. At the end of 2014 millions of employees will be losing the employer provided plans they now have and either be paying higher premiums or be forced onto the exchange by the employers who find it cheaper to pay the fines than paying for the insurance.



Employer plan premiums have been skyrocketing for years.  What difference are you trying to point out?  Employers change plans all the time, so "losing" a plan is a very common event for an employee.  Like, annually.

And for the record, no one is "forced onto the exchange", all are free to shop wherever they would like.  Further, it is the unwise employer that pays a fine vs look after their employees (you must not know that companies receive breaks by offering benefits?).  

I simply do not believe it will come to pass that "most" employers dump the benefits pkgs.  I think it will be more likely that some employers will pass along a greater share of the premium to the employee but mine has never been free, so again, what is it you say I, and millions of other employees, will lose at end of 2014?


----------



## bogey21

geekette said:


> I simply do not believe it will come to pass that "most" employers dump the benefits pkgs.  I think it will be more likely that some employers will pass along a greater share of the premium to the employee but mine has never been free, so again, what is it you say I, and millions of other employees, will lose at end of 2014?



Back when I was working I was President of a large financial institution.  Part of my job was to oversee Employee Benefits.  If I were still working, I would seriously consider paying the Government whatever they required for me to stop providing Health Care for my employees.  I would cushion the blow to my employees by providing each a "stipend" to help them pay for their own Health Care.  After 2 or 3 years I would announce that the "stipend" was being discontinued and that we were increasing base salaries by the amount of the "stipend".  After that we would start adjusting our salaries to the "market".  Bottom line is that  in 4 or 5 years our only expense for Health Care would be what we had to pay the Government for not offering it and our salaries would be in line with the Market saving my company a bunch of money.  Watch for variations of this over the next few years.

George


----------



## Ken555

bogey21 said:


> Back when I was working I was President of a large financial institution.  Part of my job was to oversee Employee Benefits.  If I were still working, I would seriously consider paying the Government whatever they required for me to stop providing Health Care for my employees.  I would cushion the blow to my employees by providing each a "stipend" to help them pay for their own Health Care.  After 2 or 3 years I would announce that the "stipend" was being discontinued and that we were increasing base salaries by the amount of the "stipend".  After that we would start adjusting our salaries to the "market".  Bottom line is that  in 4 or 5 years our only expense for Health Care would be what we had to pay the Government for not offering it and our salaries would be in line with the Market saving my company a bunch of money.  Watch for variations of this over the next few years.
> 
> George



I agree completely. Well summarized. And yet another reason why a single payer system would be more cost effective for the government (and all of us) over the long term. As I posted earlier, my small company canceled our group plan as of this month, yet we are paying the same amount per employee for their health insurance - it's just less expensive overall since our group plan didn't save us anything compared to individual plans. "Benefits" from larger companies may continue to shrink over the next few years and I would be surprised if we don't hear stories from others about how they have to pay more for their own plans since their company stopped, or lessened, their contribution toward health care.

In the end, why would a company pay more than it has to for health care? If the government won't require it, they will always look out for their bottom line first, second and always.


----------



## geekette

bogey21 said:


> Back when I was working I was President of a large financial institution.  Part of my job was to oversee Employee Benefits.  If I were still working, I would seriously consider paying the Government whatever they required for me to stop providing Health Care for my employees.  I would cushion the blow to my employees by providing each a "stipend" to help them pay for their own Health Care.  After 2 or 3 years I would announce that the "stipend" was being discontinued and that we were increasing base salaries by the amount of the "stipend".  After that we would start adjusting our salaries to the "market".  Bottom line is that  in 4 or 5 years our only expense for Health Care would be what we had to pay the Government for not offering it and our salaries would be in line with the Market saving my company a bunch of money.  Watch for variations of this over the next few years.
> 
> George


They could do that, sure, but they would then find a lot of lost productivity while we all try to arrange our own insurance during worktime.  Every Fall at open enrollment time.  We would also lose the section 125 or whatever that allows my premiums to be taken pre-tax.

Probably I would avoid those employers that make it my job to hunt down insurance since it has been a normal benefit for my entire work life.  Far easier for me to decide who I don't want to work for.

I don't have to secure my own insurance and I'm glad of that.  It is a very large task and I do not envy those needing to do it.  It's not easy, it takes a lot of time and is likely quite confusing.

It got bundled up with jobs a long time ago maybe because it is such a pain and not having to do it myself is absolutely A Benefit.


----------



## geekette

Ken555 said:


> I agree completely. Well summarized. And yet another reason why a single payer system would be more cost effective for the government (and all of us) over the long term. As I posted earlier, my small company canceled our group plan as of this month, yet we are paying the same amount per employee for their health insurance - it's just less expensive overall since our group plan didn't save us anything compared to individual plans. "Benefits" from larger companies may continue to shrink over the next few years and I would be surprised if we don't hear stories from others about how they have to pay more for their own plans since their company stopped, or lessened, their contribution toward health care.
> 
> In the end, why would a company pay more than it has to for health care? If the government won't require it, they will always look out for their bottom line first, second and always.



I was also thinking single payer at Geo's post but so many are so very against it that I don't expect it in my lifetime.

Definitely we will continue to hear of worker contributions to health care going up because that has been the case for a decade or so now.  ACA did not bring that, it was already here.  

If there is someone on the board that has been an employee for the same company for 10 years, and you contribute towards your premiums, please tell us what direction that contribution has been going - up, down, about the same.

I have 2 employers in those 10 years so can't do apples to apples because the industries/employee groups are much different.  The employer I was with for 7 years absolutely passed on the increases to us (I left in mid 2010).  Current job ate the increases so I am lucky to have a benevolent ceo.  I am paying more, however, because they expanded our options and I upsized on dental and major med.


----------



## Passepartout

Businesses have used the provision of 'fringe benefits' to attract- and keep good employees. If company 'A' provides health insurance, which costs the employee little or nothing (and gets a healthy tax reduction), while company 'B' in the same industry drops insurance, first for dependents, then provides a 'stipend' with which the employee 'can' buy coverage, which is taxable income to them, guss which company will attract- and retain quality employees.

Yes, the new law will need to be tweaked to make it attractive for businesses to continue to provide insurance, and not set their employees adrift in the sea of insurers, but I have faith that this scenario will be more prevalent than George's.

Of course the whole thing becomes moot with single payer, but since the ACA was engineered to shepherd millions of healthy young subscribers into the greedy hands of the insurance industry, they would scream like a gut-shot panther if single payer were suggested again.

Time will tell.

Jim


----------



## Ken555

geekette said:


> They could do that, sure, but they would then find a lot of lost productivity while we all try to arrange our own insurance during worktime.  Every Fall at open enrollment time.  We would also lose the section 125 or whatever that allows my premiums to be taken pre-tax.



We continue to offer section 125 with employee individual plans. I'm not sure we should, but we are. We simply pay the entire amount of the employee health premium and deduct the amount above the contribution the company provides from salary under section 125. This is no different than it was with a group plan, except we have the health insurance paid direct from the company (most are via auto payment by a corporate Amex...more SPG points! ).


----------



## bogey21

Just more food for thought as to how many companies think. When I retired in 2001 I retired with a Defined Benefit Pension which has worked out very well for me.  Shortly after I retired my ex-employer started tinkering with the terms of the Defined Benefit Plan making it less desirable.  New hires were all given 401ks rather than being covered by the Defined Benefit Plan.  The next shoe to fall was to freeze the Defined Benefit Plan for existing employees and set up 401ks for them.

George


----------



## isisdave

The whole employer-employee relationship has changed in the last 20 years or so. Now my employer tells us quite frankly "we consider quarterly whether each employee should be kept on or let go. Don't take it personally." Only three layoff waves in 2013, however; guess that's good by 21st century standards.

Employers who consider employees to be interchangeable parts (and I'm talking engineers and scientists, who you'd think might be considered a LITTLE more like individuals) will propel them toward the exchanges, and this will be good for the exchanges as it will fill them with more young, healthy people than they might otherwise get. I think the policies will have to get tweaked, at least as far as deductibles, because far too many people who can't afford the Bronze deductible will sign up for that plan, and many will still be unable to afford care.

As a Boomer who grew up in an age where people really did worry about nuclear annihilation, it surprises me that Live-For-Today is a more prevalent attitude today than it was then.


----------



## bogey21

isisdave said:


> I think the policies will have to get tweaked, at least as far as deductibles, because far too many people who can't afford the Bronze deductible will sign up for that plan, and many will still be unable to afford care.



Good point.  I think the large deductibles they signed up for will be a shock to many who bought without a lot of thought.  I can see some who bought Bronze Plans going one of two ways.  Either they will drop them after a few months figuring the premiums are money down the drain or they will upgrade to a plan with a smaller deductible next time around.

George


----------



## Tia

isisdave said:


> The whole employer-employee relationship has changed in the last 20 years or so...........



Yes when my Grandfather retired in the 60's he had a pension and health insurance coverage from his company, that my Grandmother continued to receive after he was gone.  Seems companies are more profitable now as they have cut costs and shifted them to the employees.


----------



## Loggie

I just wish that I was able to choose health insurance that is available in other parts of Michigan.  Wayne country/Detroit has some great policies.  My stress level is so high just knowing that in November my policy will be gone.  I just wish that I knew how much Aetna was going to jack my policy up to.  No one should have had to have gone through this to please a small group of uninsured.  The policies that I have to choose from are not but catastrophic if you ask me.


----------



## Ken555

Loggie said:


> No one should have had to have gone through this to please a small group of uninsured.



Along with providing insurance to those who don't have it, the change will directly impact how many people consider the ER their sole source of medical treatment. This change will lower the overall cost of medical care for the country. While I sympathize with your particular challenges in obtaining affordable healthcare, the country must think about realistic solutions which lower our overall healthcare expense. Any change which impacts such a large number of people was not going to please everyone. Hopefully it will get better over the next few years.


----------



## Loggie

The worse thing is that on my side of the state many are already on Medicaid and still intend to use the ER as their primary care doctor.  Also I know MANY that did not have health care and do not intend to have health care.  As they said their main concern is to heat their houses and to put food on their tables.


----------



## geekette

Loggie said:


> The worse thing is that on my side of the state many are already on Medicaid and still intend to use the ER as their primary care doctor.  Also I know MANY that did not have health care and do not intend to have health care.  As they said their main concern is to heat their houses and to put food on their tables.



From that standpoint, the timing is terrible as many remain unemployed/underemployed.

I would be interested in how it is known how many (on Medicaid or not) 'still intend to use the ER as their primary care doctor.'


----------



## Passepartout

Loggie said:


> The worse thing is that on my side of the state many are already on Medicaid and still intend to use the ER as their primary care doctor.



I suspect that when they are turned away as long as they are medically stable, and not in a life-threatening circumstance, they will reconsider. If they are treated, and the state gets a bill for several thousand dollars for something a doc-in-the-box can treat for a hundred, who do you suppose will get billed? This is exactly the thing the ACA is trying to address.

(Boy, you should have seen the tangent I took off on, but after re-reading it, the ol' delete key was the best way)

Jim


----------



## Patri

For those still searching via the govt. website: an IRS employee told a friend it is not secure at all. She has no health insurance now and doesn't dare enter her personal information. She also can't afford to buy a policy herself. She is waiting it out, hoping to find a different job with some kind of insurance benefits.


----------



## momeason

Loggie said:


> I just wish that I was able to choose health insurance that is available in other parts of Michigan.  Wayne country/Detroit has some great policies.  My stress level is so high just knowing that in November my policy will be gone.  I just wish that I knew how much Aetna was going to jack my policy up to.  No one should have had to have gone through this to please a small group of uninsured.  The policies that I have to choose from are not but catastrophic if you ask me.



The law does not just please a small number of uninsured. There have been many millions who have been being denied individual coverage every year and many millions afraid to leave their job, both due to pre-existing conditions. Those who stick with a job just to keep group coverage do not show up in any statistics. 
The total estimated number of uninsured Americans in 2013 was over 48 million which is 15.4% of Americans. How in the world do you consider that a small number?
If you do not qualify for an advance tax credit, aka a subsidy, this means you make at least 400% of the Federal Poverty level and you should consider yourself very blessed. My husband and I are also paying more but we know we can afford it. Maybe we take one less trip. We are not wealthy but we know we have much more than 90% or more of the people that are getting new insurance coverage. Count your blessings instead of your complaints. Have some compassion for those who can now purchase Affordable Health Coverage or who have been denied coverage for years because they have pre-existing conditions.


----------



## momeason

Patri said:


> For those still searching via the govt. website: an IRS employee told a friend it is not secure at all. She has no health insurance now and doesn't dare enter her personal information. She also can't afford to buy a policy herself. She is waiting it out, hoping to find a different job with some kind of insurance benefits.



The security is very high. I work with it every day. You get locked out of it very easily if you cannot answer the security questions exactly right. It takes a phone call and lots of verification to get back in. It is more secure than your tax return.

Fear mongers are spreading that rumor. Just because somebody works for the IRS does not mean they are knowledgeable about the site. 

I certainly would not worry more about my security on the site than my health coverage.


----------



## momeason

The Speaker of the house today spoke about about the limited provider networks of Obamacare. Another mis-representation. When you choose your plan, you choose an insurance carrier. You can choose within each Metallic level, value plans with a limited network or large network plans. Identical plans and networks are offered on the exchange and directly from your private insurer carrier. There are no "Obamacare Networks" 

More fear mongering


----------



## b2bailey

I started to write a very positive note about our success with obtaining insurance through the website, but I got sidetracked by the most recent posting from momeason. I want to clarify through my personal experience. On the Exchange, for residents of Georgia -- there is ONLY ONE choice for a provider. There are the different levels of coverage -- but the ONLY PROVIDER choice is Humana.


----------



## momeason

bogey21 said:


> Good point.  I think the large deductibles they signed up for will be a shock to many who bought without a lot of thought.  I can see some who bought Bronze Plans going one of two ways.  Either they will drop them after a few months figuring the premiums are money down the drain or they will upgrade to a plan with a smaller deductible next time around.
> 
> George



I purchased a Bronze plan last year and this year. We are insuring against big losses. We would rather take our chances knowing that $5,000 each is our total out of pocket risk. We do not want to pay the insurer several thousand extra for low deductibles and copays. The out of pocket maximums are low IMO...$5500 per year for each of us. We do not qualify for subsides and the premiums for "good coverage plans" are thousands higher. I recommend using a navigator, a certified marketplace counselor or an agent who has been trained in the Federal Marketplace. I am #3 and trained for 100 hours. Using assistance costs the applicant nothing and can really help one make the best choices.

When advising those I am assisting, I do not recommend the Bronze plans for several reasons. 
1. Most applicants do not have savings and the ability to absorb a $5000 hit.
2. Most qualify for subsidies which make better plans very affordable.
3. Many qualify for cost-sharing which drastically lower deductibles and 
out of pocket limits. To qualify for the cost sharing, applicants must choose a Silver plan. Many miss out on this cost sharing.
4. With subsidies, these plans are really Affordable

There is a learning curve for everything new.


----------



## Blues

momeason said:


> There have been many millions who have been being denied individual coverage every year and many millions afraid to leave their job, both due to pre-existing conditions.



This fact really strikes a chord with me.  Now, I can talk about how I had to stop being an independent consultant and go back to my former employer, 8 years ago, due to this issue.

But I'd rather talk about my dad, who died in 1980 at age 60.  He was diagnosed as being terminal, with a rare blood disorder, 10 years before his death.  Despite declining health and total lack of energy, he literally worked until the day he died.  Why?  To keep his health plan, so he wouldn't bankrupt his family during his terminal illness.  I've always considered this a cruel, cruel policy.

-Bob


----------



## momeason

b2bailey said:


> I started to write a very positive note about our success with obtaining insurance through the website, but I got sidetracked by the most recent posting from momeason. I want to clarify through my personal experience. On the Exchange, for residents of Georgia -- there is ONLY ONE choice for a provider. There are the different levels of coverage -- but the ONLY PROVIDER choice is Humana.



In eastern NC, where I live the only insurance provider is BCBSNC. Fortunately, there are many plan and network options. I do feel the lack of competition led to a little higher rates.
The point remains, the networks are the same networks Humana or BCBS and other carriers offer off the exchange. Doctors are providers within the various insurance networks. Doctors do not decide whether or not to be an " Obamacare network doctor" As an aside, for the past several years, I have seen many doctors drop Medicare and Medicaid patients. This saddens me. I feel in some many parts of our society, money is just too important. People are not important enough.

Insurance companies made the decision to participate or not in the Federal exchange. In states where the Marketplace is not supported, often we see fewer 
insurance companies participating. After we can make it through the transition year, I believe we will see many more insurers on the Exchanges. Just my opinion.

If you do not need a subsidy, you can buy your coverage from whoever you wish. You still get all the protections of the ACA.


----------



## Patri

momeason said:


> Fear mongers are spreading that rumor. Just because somebody works for the IRS does not mean they are knowledgeable about the site.



It's funny that anyone who has an opinion other than yours is fearmongering. Yet you are getting paid for your opinion. You have a vested interest. 
You have no clue who that IRS person is. You don't want to acknowledge there are problems yet. Just because you can get into the site does not mean you know the experience of everyone else, or know the evidence that personal information can get hacked. Your employer probably is not going to tell you that.


----------



## ScoopKona

Blues said:


> This fact really strikes a chord with me.  Now, I can talk about how I had to stop being an independent consultant and go back to my former employer, 8 years ago, due to this issue.
> 
> But I'd rather talk about my dad, who died in 1980 at age 60.  He was diagnosed as being terminal, with a rare blood disorder, 10 years before his death.  Despite declining health and total lack of energy, he literally worked until the day he died.  Why?  To keep his health plan, so he wouldn't bankrupt his family during his terminal illness.  I've always considered this a cruel, cruel policy.
> 
> -Bob



But consider the alternative! (No, really, everyone please stop and consider the alternative.)


----------



## ace2000

Patri said:


> It's funny that anyone who has an opinion other than yours is fearmongering. Yet you are getting paid for your opinion. You have a vested interest.
> You have no clue who that IRS person is. You don't want to acknowledge there are problems yet. Just because you can get into the site does not mean you know the experience of everyone else, or know the evidence that personal information can get hacked. Your employer probably is not going to tell you that.



+1

This thread would be a lot better if everyone would leave their opinions behind and stick to the facts.  And the fact is that this current plan has a LOT of problems.


----------



## vacationhopeful

Among my friends (many who are self-employed), many have not had the time or collected info to "play" with the website. Working 60-80+ hour weeks for the last 4+ years and just trying to pay bills, many do NOT have their financial information in the best shape to sit down for this website. Some have health insurance and some don't. 

Those with an insurance agent get told to go "run the numbers yourself". 

momeason - I read your experiences in helping others to enroll and wonder are these people like my friends with complexed income sources and deductions by the pound *OR* households with a monthly/weekly income checks taking the standard deductions?


----------



## pgnewarkboy

*An interesting, informing, important Documentary*

Escape Fire - The Fight To Rescue American Health Care.

 A powerful and thought-provoking documentary that exposes the U.S. "healthcare system as one designed to profit on disease rather than health. The film interweaves personal stories with the efforts of leaders battling to transform it. "

I watched this last night on Amazon Prime instant video. It is not political and doesn't engage in good vs. evil attacks.

The documentary makes a strong case based upon scientific evidence that our health care SYSTEM is focused on managing chronic disease instead of preventing and relieving chronic disease through life style changes.  This focus on managing disease through expensive pharmaceuticals, testing, and invasive procedures is  expensive and not as effective as making lifestyle changes that are known to work.   Of course, there is the appropriate use of pharmaceuticals, testing, procedures, etc. but it is should not always be the first option.  Many many people can benefit from lifestyle changes.  

The financial incentives are wrong.  A doctor and hospital get paid $1500 for a 10 minute consultation on a heart stent and something like 20 dollars for a 45 minute consultation on how to change your lifestyle to prevent artery clogging and REDUCE the clogging you have in your artery.


----------



## laurac260

momeason said:


> The Speaker of the house today spoke about about the limited provider networks of Obamacare. Another mis-representation. When you choose your plan, you choose an insurance carrier. You can choose within each Metallic level, value plans with a limited network or large network plans. Identical plans and networks are offered on the exchange and directly from your private insurer carrier. There are no "Obamacare Networks"
> 
> More fear mongering



There's "blatant misrepresentation of facts" (where I come from they call it lying), then there's fear mongering.

Which of these camps do you ultimately prefer?   And, do you believe that fear mongering only exists in one camp???  

I've stayed out of this thread for the most part, but I have to chime in, once again, to say how frustrating that one side is allowed to have carte blanche to say whatever they want on TUG, and "the other side" gets stifled at every turn.  

I'll let the masses decide what I am talking about on this one.


----------



## laurac260

*Single payer system?  It's coming...*

Atleast if THIS guy has anything to say about it.  

http://www.youtube.com/watch?v=fpAyan1fXCE


----------



## momeason

vacationhopeful said:


> Among my friends (many who are self-employed), many have not had the time or collected info to "play" with the website. Working 60-80+ hour weeks for the last 4+ years and just trying to pay bills, many do NOT have their financial information in the best shape to sit down for this website. Some have health insurance and some don't.
> 
> Those with an insurance agent get told to go "run the numbers yourself".
> 
> momeason - I read your experiences in helping others to enroll and wonder are these people like my friends with complexed income sources and deductions by the pound *OR* households with a monthly/weekly income checks taking the standard deductions?



I spent 4 weeks researching for myself which plan was best for us. For most of the life of this thread, I was not an agent. I was a consumer trying to understand and apply the law.
I became an agent, with many reservations about the insurance industry, in order to help people make their way through the confusion. I get paid $35 to sign someone up. So far, it usually takes me 10 hours or more to locate this person because we live in an area where many are employed by the military. Because I do a thorough job helping people, it takes me hours to help each person. Yes, I do help the self-employed. Just did one yesterday. Home daycare provider. One of her friends will enroll today who also is also self employed. 
Actually, I just received a call while writing this post. The day care provider I helped yesterday gave my name to another day care provider. Now I will doing a presentation to 5 or more on January 25. Yes, a Saturday, I schedule presentations on Sundays, nights and weekends. Whenever people can make time. I help them on my schedule. There are many agents who are doing this trying to make a living. Some are less helpful than others. I am doing this as a ministry. There are others who are doing this as totally unpaid volunteers with legal aid and other organizations. I do recommend getting assistance from a trained volunteer or a compassionate agent.

I am a flat commission, contract worker for an initiative which provides education and enrollment assistance. I became an agent in order to help people get through the "confusion" I do not tell them to go " run the numbers" and get back to me.
I assist as much as possible. If one does not file tax returns, I CANNOT help you qualify for advance tax credits. Self employed can still buy on the exchange without tax numbers, but they cannot get subsidies without taxable income info. Individual insurance is available through any individual insurance seller if the applicant does not want to apply for a subsidy. Income information is optional. I provide all my clients with a quick check chart at the beginning so they will have an idea if the subsidy process is worth it. The chart has been posted recently in this thread. Go back a page. 

The law does have problems. The Prescription Drug plan in 2007 had big problems also. I want to help resolve the problems of this plan. The intent of the law is access to preventative and ongoing management of health. It is insurance reform and consumer protection and assistance.

I did not drink any kool-aid. Those who have not experienced purchasing health insurance on the individual market do not have direct experience with the problems we had before the law. Now we have different problems in transition. I have directly experienced being turned down. So has my husband and several others I know and are working with. The agents I work with are not "Fans" of the insurance industry. We are proponents of good access to healthcare. There is a lot of difference. I did not go into it with blinders on, nor do I get my news from TV or radio media on the subject. I have lived it, trained in it and now I work with it daily.

This is not a money making project for me. I am trying to share my knowledge.
I do get tired of being attacked by those who believe what they hear when they have not lived it.

IMO, I would rather be on a road to fix the problems we have. When a better system is proposed, I will be all for it. Right now I am trying to help the uninsured get coverage.


----------



## momeason

pgnewarkboy said:


> Escape Fire - The Fight To Rescue American Health Care.
> 
> A powerful and thought-provoking documentary that exposes the U.S. "healthcare system as one designed to profit on disease rather than health. The film interweaves personal stories with the efforts of leaders battling to transform it. "
> 
> I watched this last night on Amazon Prime instant video. It is not political and doesn't engage in good vs. evil attacks.
> 
> The documentary makes a strong case based upon scientific evidence that our health care SYSTEM is focused on managing chronic disease instead of preventing and relieving chronic disease through life style changes.  This focus on managing disease through expensive pharmaceuticals, testing, and invasive procedures is  expensive and not as effective as making lifestyle changes that are known to work.   Of course, there is the appropriate use of pharmaceuticals, testing, procedures, etc. but it is should not always be the first option.  Many many people can benefit from lifestyle changes.
> 
> The financial incentives are wrong.  A doctor and hospital get paid $1500 for a 10 minute consultation on a heart stent and something like 20 dollars for a 45 minute consultation on how to change your lifestyle to prevent artery clogging and REDUCE the clogging you have in your artery.



I agree with you completely. The pharmaceutical industry does not want to cure you, they want to keep you as a customer in many cases. The pharmaceutical industry sponsors the large majority of research and the medical schools.

The insurance industry only wanted to insure the well and if you did have coverage, they wanted to prevent illness for profit reasons. Money drives it all.
The insurance industry spent billions fighting the law, now they are trying to work it to their benefit now that it is here. I am a consumer advocate trying to do the best I can with the system we have.
It has not been nor will it be probably in my lifetime an efficient system. That is because of the money in politics....both sides.  A different issue, but definitely related.


----------



## momeason

Patri said:


> It's funny that anyone who has an opinion other than yours is fearmongering. Yet you are getting paid for your opinion. You have a vested interest.
> You have no clue who that IRS person is. You don't want to acknowledge there are problems yet. Just because you can get into the site does not mean you know the experience of everyone else, or know the evidence that personal information can get hacked. Your employer probably is not going to tell you that.



What I get paid is laughable. I do this to help others get access to healthcare.
I have been working towards getting everyone access to healthcare since 2008.
I just completed my formal Federal Marketplace insurance training a few weeks ago because I realized at this point, it was my best avenue to help. I am a volunteer community organizer for many groups. Yes, I have an agenda. Helping others get healthcare is my current project. Many have another agenda, keeping people away from the Marketplace.


----------



## PStreet1

I've been only a reader of this thread until now, but it does seem to this observer that those who see more problems with Obamacare than they see benefits are castigated as knowing nothing or trying to keep people away from the marketplace--and neither charge appears to have merit.

Being more concerned with the problems they see than with the benefits you see doesn't make them unfeeling/unhelpful/badly mistaken people; it does make them people who do not see this issue the same way the proponents of Obamacare see it, and at least for the time being, people are still allowed to see things differently in the U.S.


----------



## Conan

I'm sure this is too much to hope for, but could we have *two* healthcare threads:  One for facts and one for arguments?


> It turns out that the tax credits, which reduce premium costs, are  available to all levels of plan, for individuals and families earning up  to 400% of the federal poverty level (FPL). People receiving subsidies  can apply their subsidy toward  the purchase of more or less expensive  plans, but must pay the  difference between the premium in the selected  plan and the subsidy.
> http://kff.org/interactive/subsidy-calculator/
> 
> The 400% of FPL (2013) figure by family size in the 48 mainland states is
> 1 $45,960
> 2 $62,040
> 3 $78,120
> 4 $94,200
> 5 $110,280
> 6 $126,360
> 7 $142,440
> 8 $158,520
> 
> On the other hand, cost sharing reductions are not available in bronze  plans. They are available to individuals and families with incomes below  250% of the FPL who enroll in silver plans (only?). These cost sharing  reductions reduce consumer costs (such as out-of-pocket maximums,  copays, and coinsurance) at the point of service, whereas tax credits  reduce only premiums.
> 
> The 250% of FPL (2013) figure by family size in the 48 mainland states is
> 1  $28,725
> 2  $38,775
> 3  $48,825
> 4  $58,875
> 5  $68,925
> 6  $78,975
> 7  $89,025
> 8  $99,075


----------



## Ken555

Fact. I had individual health insurance for a long time. 
Fact. My "expert" health agent convinced me that I would receive better rates by offering a group plan for my small business, and I agreed to switch to a group plan as I thought it was essential for the business (I was 100% wrong, though it can be essential for other businesses). 
Fact. When I tried switching back to an individual policy I was denied because of a one line entry my doctor made during a checkup a year or two prior. I then unsuccessfully spent many hours, over many months, trying to get that document updated and the insurance company to correspond with the doctor to update the records, as the doctor's note should not have caused a denial and she wanted to update it, etc.
Fact. My business has paid at least $35,000 MORE over the last 4-5 years for a group policy as opposed to the premiums we would have paid for similar plans as individuals. This is all lost money, as far as I am concerned, and directly contributed to our inability to provide adequate bonuses and raises to the staff. 
Fact. Like many other businesses not in the financial services industry, we saw a reduction in overall revenue year after year due to the economy.
Fact. After defending my health insurance agent to my staff and others as someone who would advocate our needs and assist with the transition to new plans for 2014, they completely dropped the ball and neglected us. I fired the agency last month after they admitted that they can't do what they promised months ago in terms of providing exemplary service since they don't receive enough revenue as a commission (the irony is that I would have been happy paying a small premium for assistance, but I don't see anyone offering that option). For the first time since college, I do not have a health insurance agent and don't believe I require one. 
Fact. It took me less than 10 minutes to register at CoveredCA.com and select a plan. The website worked flawlessly at the time I registered.
Fact. If not for the new health insurance, 2014 would be yet another year of being forced to pay inflated rates for health insurance.

Obviously, not everyone is seeing the same benefits as I am. However, this does not mean that the entire program is flawed. Like others, I think it should be improved. I am continually dismayed at the constant negativity on this issue over my entire lifetime rather than proactive changes with the actual goal of improvement. Of course, I have been convinced that such positive activity will not occur until and unless the money is removed from the decision making process itself, and that's not likely to happen anytime soon, if ever.


Sent from my iPad


----------



## DavidnRobin

Ken - very well laid out. It seems that many people seem to have forgotten that the constitution strives for "a more perfect union" and not 'a perfect union' - those are well-chosen and intentional words.   Some people use the argument that the ACA needs to be perfect to be implemented. That will never happen, and they are happy with the status quo as long as it is not them (millions w/o health coverage - millions forced into bankruptcy due to medical bills - millions not covered due to pre-existing conditions...)  People continue to astound me...


----------



## MuranoJo

momeason, I applaud you for all you're doing.  Thanks for helping those who need it.

Just found out an acquaintance's wife doesn't have health insurance (he is on Medicare).  When I mentioned ACA to him, he didn't know what that was!!  After describing it as Obamacare, he said he should sign her up but didn't know how.  Holy Toledo, where do these people come from?


----------



## Blues

Oops, just noticed the message was about the wife.  Nevermind!


----------



## geekette

Patri said:


> It's funny that anyone who has an opinion other than yours is fearmongering. Yet you are getting paid for your opinion. You have a vested interest.
> You have no clue who that IRS person is. You don't want to acknowledge there are problems yet. Just because you can get into the site does not mean you know the experience of everyone else, or know the evidence that personal information can get hacked. Your employer probably is not going to tell you that.


People make assumptions about technical things all the time just because they work there.  

I consider your contribution hearsay, it really doesn't matter to me what that employee does at the IRS.  They absolutely were not the code monkey on the job so what would they know about the actual security protocols in the code?  

"The experience of everyone else" does not change the fact that the code is a process that your IRS friend is unlikely to have any access to except maybe as a compiled component (file that you can't just view).  They may be able to game the front end but that doesn't mean it is "not very secure".

I am with Mom, saying something like "I know someone who said it's not very secure" is indeed fear-mongering in my opinion.  I have no vested interest.


----------



## momeason

geekette said:


> People make assumptions about technical things all the time just because they work there.
> 
> I consider your contribution hearsay, it really doesn't matter to me what that employee does at the IRS.  They absolutely were not the code monkey on the job so what would they know about the actual security protocols in the code?
> 
> "The experience of everyone else" does not change the fact that the code is a process that your IRS friend is unlikely to have any access to except maybe as a compiled component (file that you can't just view).  They may be able to game the front end but that doesn't mean it is "not very secure".
> 
> I am with Mom, saying something like "I know someone who said it's not very secure" is indeed fear-mongering in my opinion.  I have no vested interest.



Thank you geekeete.

More facts:
I helped two people this week who ended up with monthly payments for great coverage. Chris now will pay a $24.95 monthly payment. She could have chosen $10.11 for a lesser plan. Barbara will be paying $41 per month. She had a value option at $0/month. Each of these women is single, 58 yrs old and have income in the 15k range.
This law really does make health insurance affordable. I was thrilled to be able to give them such great news.

Unfortunately, I face an uphill battle since there is so much negative noise.
So many do not want to apply because they do not believe that can afford the monthly payments. In the cases of people living below 250% of the Federal Poverty level, there are options which are very close to free.
Filling out an application does not obligate anyone.

Also, even though I work in NC, I am more than willing to answer questions on the Federal marketplace..healthcare.gov for anyone in any state on the Federal exchange. Send me a PM and I will give you my phone number.  You are welcome to give it to anyone who needs and wants help. Obviously, I will not earn a commission from out of state. that is not why I do this.

I just ask that no one calls to argue the merits of the law.

Thank you to those who understand my desire to help.


----------



## ace2000

geekette said:


> People make assumptions about technical things all the time just because they work there.




Here are the real facts... 

_Hackers: HealthCare.gov still riddled with potential security issues_

http://www.nbcnews.com/technology/h...-riddled-potential-security-issues-2D11940198

Cybersecurity researchers slammed HealthCare.gov's security during a House hearing on Thursday, saying the site is still riddled with problems that could put consumers' sensitive health details at risk.

“The reason we’re concluding that this is so shockingly bad is that the issues across the site are so varied,” David Kennedy, founder of the information security firm TrustedSec, told NBC News before the hearing. “You don’t even have to hack into the system to see big issues – which means there are [major problems] underneath.”


----------



## Passepartout

No one *HAS* to use the website. You can check it out to see what plans and insurance carriers are available where you live, then simply call them on the phone and order your insurance. Or do it in person with a 'navigator'.


----------



## ace2000

Where do you think the 'navigator' is going to type in your information???


----------



## Passepartout

Ace, I can't understand your continual arguments. Instead of just throwing stones, how about pointing out work-arounds and helping folks who have been shut out of affordable health care get it?

Here- from today's testimony: “*To date, there have been no successful security attacks on Healthcare.gov and no person or group has maliciously accessed personally identifiable information from the site*,” CMS said in the statement, adding that it continually conducts security testing on the site.

The whole article here: http://www.nbcnews.com/technology/h...-riddled-potential-security-issues-2D11940198

Sure, anytime one places information on the Internet, or swipes a card at Target, or Neiman Marcus or Macy's or your neighborhood restaurant or gas station, there is risk of someone with bad intentions getting it. As mentioned in a thread in the Mexico forum this morning when asked where someone would get their timeshare ownership info and home phone number. A longtime TUGger answered that it was likely lifted by a person at their resort and sold on the black market.

The only way your information can be totally safe would be to live in a cave and never interact with another human.

Welcome to the 21st century.

Jim


----------



## geekette

You mean the fact that an article that details opinions is out there.



> “*To date, there have been no successful security attacks on Healthcare.gov and no person or group has maliciously accessed personally identifiable information from the site*,” CMS said in the statement, adding that it continually conducts security testing on the site.
> ...
> The third of the three cybersecurity researchers on the panel disagreed. *Waylon Krush, CEO of the security firm Lunarline, stressed that he would put his information on the site.*
> 
> Krush explained that Lunarline has worked with federal clients, and he used his written testimony to lay out the six-step process that federal information systems use to mitigate risk.
> 
> *He also criticized Kennedy and Gregg for engaging in what he called speculation, pointing out that “no one at this table” was involved in the setup and management of HealthCare.gov.* What’s more, he added, because hacking into the system would be a crime, no one has – at least not legally -- looked deep into the site to fully understand its setup.
> 
> *“Just as security critics lack the hands on knowledge necessary to make dramatic claims about the site's weaknesses, I cannot claim to understand all of Healthcare.gov's security intricacies,”* Krush said in his written testimony.





ace2000 said:


> Here are the real facts...
> 
> _Hackers: HealthCare.gov still riddled with potential security issues_
> 
> http://www.nbcnews.com/technology/h...-riddled-potential-security-issues-2D11940198
> 
> Cybersecurity researchers slammed HealthCare.gov's security during a House hearing on Thursday, saying the site is still riddled with problems that could put consumers' sensitive health details at risk.
> 
> “The reason we’re concluding that this is so shockingly bad is that the issues across the site are so varied,” David Kennedy, founder of the information security firm TrustedSec, told NBC News before the hearing. “You don’t even have to hack into the system to see big issues – which means there are [major problems] underneath.”


----------



## ace2000

Passepartout said:


> Ace, I can't understand your continual arguments. Instead of just throwing stones, how about pointing out work-arounds and helping folks who have been shut out of affordable health care get it?



How about just presenting real facts and sticking to those instead of misinformation and personal opinions?  I'm helping by providing the 'facts'.


----------



## Passepartout

ace2000 said:


> How about just presenting real facts and sticking to those instead of misinformation and personal opinions?  I'm helping by providing the 'facts'.



OK. Fact: *“To date, there have been no successful security attacks on Healthcare.gov and no person or group has maliciously accessed personally identifiable information from the site,”* CMS said in the statement, adding that it continually conducts security testing on the site.

*Millions* of people have put their information on Healthcare.gov.

Now your turn. Name someone who's personal info has been hacked on the site.


----------



## ace2000

Passepartout said:


> OK. Fact: *“To date, there have been no successful security attacks on Healthcare.gov and no person or group has maliciously accessed personally identifiable information from the site,”* CMS said in the statement, adding that it continually conducts security testing on the site.



Target could've said something very similar three months ago.  The Healthcare.gov site has only been available for a few months.  To think that the web site is safe today because of your statement above is just more of the misinformation and false opinions that you've been spreading around the entire thread.


----------



## Passepartout

ace2000 said:


> Target could've said something very similar three months ago.  The Healthcare.gov site has only been available for a few months.  To think that the web site is safe today because of your statement above is just more of the misinformation and false opinions that you've been spreading around the entire thread.



You can't have it both ways. You cite the very same testimony to say that healthcare.gov is riddled with security flaws, when the very testimony states that no breaches have occurred.

These are not examples of my 'misrepresentation and false opinions', they're yours.

Jim


----------



## ace2000

Passepartout said:


> You can't have it both ways. You cite the very same testimony to say that healthcare.gov is riddled with security flaws, when the very testimony states that no breaches have occurred.
> 
> These are not examples of my 'misrepresentation and false opinions', they're yours.
> 
> Jim



Exactly how did I try to have it both ways?  Unlike you, all I did was present the article which is based on today's news.  I posted that article in direct response to the the previous posts stating there is nothing to worry about in regards to the web site security.  

Now, you've got the facts - which is the sworn testimony of experts testifying before Congress.  You and geekette can cherry-pick anything you want to out of the article.  I'm sure everyone else here can make up their own minds.


----------



## geekette

I don't know why anyone would think Any website is Completely Secure.  Any security protocol I can make up means that anyone else in the world can have the same idea.  Do you know exactly where the server housing your personal email is and if that building has monitored security?  me neither.

once you click Enter, you have no control over the routes your info takes.  What I'm typing now, email to mom later, anything.  The more hops your info takes, the more risks.  

 some sites are more at risk than others, some take in more sensitive data than others.  In the cyber world, you take your chances.  If that is not good enough, make a phone call, write a letter, do a personal visit.  But don't ever assume that you are 100% safe on any website.


----------



## ace2000

geekette said:


> *some sites are more at risk than others*, some take in more sensitive data than others.  In the cyber world, you take your chances.  If that is not good enough, make a phone call, write a letter, do a personal visit.  But don't ever assume that you are 100% safe on any website.




Exactly, and healthcare.gov has been determined to be at major risk.  This is not fearmongering, it is fact.  Two of the three experts testifying before Congress today said they would not trust putting their own information on the site.


----------



## ace2000

geekette said:


> In the cyber world, you take your chances.  If that is not good enough, make a phone call, write a letter, do a personal visit.



If you make a phone call, letter, or visit, your information still goes into the same database.  That same data is very easily susceptible and at risk to hackers too.   It doesn't matter how the data got in.  So, I'm not sure what your point is here.  

To be clear, I am not suggesting that everyone avoid signing up for the insurance.  That's for each individual to decide.  But, please let's put good information out there and refrain from the personal biases and opinions that seem to keep showing up in this thread.


----------



## momeason

Ace, I do not believe there has been a determination of major risk. It is the OPINION of 2 of the 3 security experts that it is a major risk. Darrell Issa hired those outside security experts. He has been in outspoken opposition to the entire ACA and healthcare.gov. I only know that there have been no reports of any security breeches. Opposition and obstructionism of this implementation has been rampant. If somebody wanted to get in and create more problems, they probably would have done it by now. I hear a lot of noise, but no real evidence that there is a security issue.
Let everyone decide for themselves. I know we file our taxes online. There can be the same problems there.

The risk to the health and life of millions is a greater risk to millions than your concern for website security. Having health care provides security and comfort, better long term health outcomes. 

We have noted your concerns. When there is a breech like Target's breech you can come back and say I told you so. Until then, please give it a rest.


----------



## laurac260

momeason said:


> Ace, I do not believe there has been a determination of major risk. It is the OPINION of 2 of the 3 security experts that it is a major risk. Darrell Issa hired those outside security experts. He has been in outspoken opposition to the entire ACA and healthcare.gov. I only know that there have been no reports of any security breeches. Opposition and obstructionism of this implementation has been rampant. If somebody wanted to get in and create more problems, they probably would have done it by now. I hear a lot of noise, but no real evidence that there is a security issue.
> Let everyone decide for themselves. I know we file our taxes online. There can be the same problems there.
> 
> The risk to the health and life of millions is a greater risk to millions than your concern for website security. Having health care provides security and comfort, better long term health outcomes.
> 
> We have noted your concerns. When there is a breech like Target's breech you can come back and say I told you so. Until then, please give it a rest.



Because once again, only folks who WANTED Obamacare are allowed to have their opinions….  the rest of us need to quietly stand in the corner.  You'll get your turn to say "I told you so".  But by then, it will be too late (oops, did I say that out loud?)


----------



## PStreet1

The security issue is real, and it certainly has nothing to do with whether you are closed out of the site if you can't answer security questions.

The real concern is that if this system is breached, since it is connected to the IRS site......well, need I say more?  Today the testimony on Capital Hill revealed nothing new,  except that nothing has been fixed, and in fact, new code has introduced new problem areas.

As to Issa having gotten the outside security experts.....it seems to me there is a problem in believing that any expert who is called in by the "other side" must be lying.  As a user/consumer, you would have absolutely no way to know what the problems are; security experts would have a way to know, and they are testifying before Congress that there is a severe problem.

Making a phone call or doing it by paper is, obviously, no answer:  the data will all be in the same base and once there, it's vulnerable.

Whether one takes the chance on it is, obviously, a different issue, but your not having seen or heard about breaches yet means absolutely nothing.


----------



## Patri

PStreet1 said:


> The security issue is real, and it certainly has nothing to do with whether you are closed out of the site if you can't answer security questions.
> 
> The real concern is that if this system is breached, since it is connected to the IRS site......well, need I say more?  Today the testimony on Capital Hill revealed nothing new,  except that nothing has been fixed, and in fact, new code has introduced new problem areas.
> 
> As to Issa having gotten the outside security experts.....it seems to me there is a problem in believing that any expert who is called in by the "other side" must be lying.  As a user/consumer, you would have absolutely no way to know what the problems are; security experts would have a way to know, and they are testifying before Congress that there is a severe problem.
> 
> Making a phone call or doing it by paper is, obviously, no answer:  the data will all be in the same base and once there, it's vulnerable.
> 
> Whether one takes the chance on it is, obviously, a different issue, but your not having seen or heard about breaches yet means absolutely nothing.



Oh Pat, you are so wrong. Don't you understand there is only one person we can trust on this entire issue? We have been so misled, I am grateful that person has come forward to save us from our misconceptions.


----------



## PStreet1

momeason said:


> I only know that there have been no reports of any security breeches....  If somebody wanted to get in and create more problems, they probably would have done it by now. I hear a lot of noise, but no real evidence that there is a security issue.
> Let everyone decide for themselves. I know we file our taxes online. There can be the same problems there.
> 
> The risk to the health and life of millions is a greater risk to millions than your concern for website security.
> 
> We have noted your concerns. When there is a breech like Target's breech you can come back and say I told you so. Until then, please give it a rest.



1.  No reports of breeches:  I assume you know that Health and Human Services has publically said that if your data is stolen/compromised, they will not tell you.  The House passed a bill saying they would be required to tell you--that's all--but the Senate said no, that's not necessary.

2.  taxes on line:  yes, that's part of the risk.  Obamacare's site is tied to the IRS site, which presumably was secure.  If Obamacare's site is not secure, it could lead to accessing the IRS site.

3.  Risk from data being stollen:  do you know anyone who has spent months getting a case of identify theft straightened out and lost considerable money in the process?  I do.  I grant that it isn't life threatening as a serious disease is, but it can cause significant financial loss.

4.  Come back after something happens on a scale like Target's mess:  by then, it will be too late--and remember, Health and Human Services doesn't have to let you know if it does happen.

You are right that health insurance is very, very important, and it is totally clear that your motives are good and that you are helping many people.  Those two facts, however, do not mean that there are no problems people need to be very concerned about.


----------



## Brett

article in the NY Times today 

http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?hp

not good news if you have a high deductible health care policy !


----------



## momeason

Brett said:


> article in the NY Times today
> 
> http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?hp
> 
> not good news if you have a high deductible health care policy !



The ACA limits the high deductibles and out of pocket maximums. For individuals, the out of pocket maximum is $6,350, the deductible on the new HDHP is $5500.
These plans are recommended with pre-tax dollar Health Savings accounts.

This lady was treated outrageously and these types of costs make all of us pay higher health insurance premiums.


----------



## MuranoJo

As a patient who has gone through Moh's surgery, I can say it was absolutely ridiculous what they put her through and what it cost.  IMO, she was way over-treated & over-charged.

My Moh's surgery was handled by a top specialist, it was all done in her office, I wasn't knocked out, and the results were great.  Total cost was under $3000, and I think my OOP was about $150. or so.


----------



## pjrose

*Different Subject - Medicare Questions*

Maybe this is up there somewhere, but it's a l-o-n-g thread.

This year first DH and then I will move over to Medicare.  We've been deluged with stuff from insurance companies about supplemental coverage.  

We are presently covered by a costly but very comprehensive family plan through his employer - large network of state universities.  With DD's neuro-cardio issues over the years (which she seems to have outgrown knock on wood) and her extremely expensive pregnancy complications and coverage for the DGs's first 30 days in the NICU, it's more than paid for itself.

DH plans to continue working until both DS and DD reach 26, unless by that time they are gainfully employed and have comparable coverage available.   

Meanwhile, he and then I will be off the plan, so presumably he will continue with just family or dependent coverage through employer. 

ok, on to the Medicare questions.....

Since he'll be paying for the employer plan anyway, why do Medicare?  Is it necessary?  Can we jump on later?  

I keep waffling about knee replacement.  I know it's got to be done, I know if I drop 20-30 lbs my knee will feel a  lot better but that won't stop the fact that I've been bone-on-bone for 40 years (meniscus removed after skiing accident).    I heard somewhere (here?) that it's better to get it done while still on private insurance than Medicare.  True? Why?  

Other questions I should be asking?  Suggestions?  Advice?


----------



## MuranoJo

PJ,  I'm no expert at all since I'm not on Medicare, but I've always heard you are penalized in increased Medicare premiums if you do not sign up once you are eligible.    

Re. the knee, DH is on Medicare and has had two recent knee replacements and they covered a great % of the cost.  I can check w/him to see if he remembers our OOP cost, though I don't recall it being too bad.

I'm sure others who are more experienced will be along with good info.


----------



## Conan

pjrose said:


> DH plans to continue working .....
> 
> Since he'll be paying for the employer plan anyway, why do Medicare?  Is it necessary?  Can we jump on later?



Medicare Part A is free, and you each should sign up for it at age 65. If you have hospitalization-type expenses that Medicare covers then Medicare will be primary and your employer insurance (if you have it) will be secondary, but as far as I know there's no disadvantage in having it, and there may be penalties or coverage limits under the employer plan if you don't sign up for Medicare A at age 65.

Medicare Part B (and D for drugs) is not free. The penalty for not signing up at 65 is waived if you're in an employer plan, so the choice is yours. I don't think there's any alternative to comparing costs and benefits in making that decision. Likewise if you're going to drop out of the employer coverage it would be prudent to take on one of those Medicare supplement plans so you need to add those costs and benefits to the puzzle.


----------



## momeason

I believe everything that has been said is true. Also, i am almost positive that simpsontruckdriver sells the supplemental. He would be qualified to a answer questions. Sounds like you have no need for a supplemental plan, but he should know a lot about Medicare. You have to train and pass an exam all about Medicare rules to sell the supplemental plans.

From what I know, you need to sign up for the free part now. IT may be a big problem with your employer group coverage if you don't. They expect Medicare to be your primary after age 65. ..may be required. 

You could also talk to your HR benefits people if you have more questions.


----------



## Passepartout

There is a good FAQ at www.medicare.gov where you should be able to find the answer to this.


----------



## laurac260

*And then there's this*

http://www.foxnews.com/politics/201...s-6-weeks-trying-to-disenroll-from-obamacare/


----------



## Blues

pjrose said:


> Since he'll be paying for the employer plan anyway, why do Medicare?  Is it necessary?  Can we jump on later?



PJ, you and your DH are in the same position as me and my DW.  She's of Medicare age, I'm not.  I'm still working, with excellent health coverage that includes her (for which we pay 25% of the cost).  I've consulted our HR department, the Social Security office, and the director of a Senior's advocacy group.  They all say the same thing.  There's an exception to the penalties for not signing up for part B at age 65.  That exception is: if you're covered by equivalent or better insurance, the penalty won't apply.  I did all the asking around, because I wanted to make sure, and to also make sure we wouldn't have to file something now to establish that exception.  The answer is, we don't need to do anything now.  When I retire, we'll apply for DW's part B then.  That's when we'll need to get a form signed by my employer, stating that DW had coverage during the intervening years.  Once that form is filed, she can get part B at the then prevailing rates, without any penalties.  Same for me, as I'll also be 65 then.

As far as filing now for part A, which is free -- we've gotten conflicting advice.  The SS office told me "don't bother".  The Seniors advocate told us that we should go ahead and file, since it's free and could potentially cover something that my insurance doesn't.  So that's what we've done - she has filed for part A, but not part B.  We'll both file for part B when I retire.

And yes, she's been deluged with offers for supplemental coverage too.  It's amusing.

HTH,
Bob


----------



## dixie

*How do you get through the red tape with Obamacare? Help*

Son signed up for Obamacare, they have his money, but seem to have no record of his policy. Went to the Doctor and they wouldn't see him because they couldn't prove he had insurance. such a mess and we do not know how to reach anyone to help us. He has spent hour on the phone. They said someone didn't check a "box" when signing him up and his policy is all screwed up.

what can we do????


----------



## Timeshare Von

dixie said:


> Son signed up for Obamacare, they have his money, but seem to have no record of his policy. Went to the Doctor and they wouldn't see him because they couldn't prove he had insurance. such a mess and we do not know how to reach anyone to help us. He has spent hour on the phone. They said someone didn't check a "box" when signing him up and his policy is all screwed up.
> 
> what can we do????



This is one of the many implementation issues that folks have been worried about.  It's unfortunate that your son (and you) are going through this.

I would suggest contacting Fox News (Greta Van Susteren perhaps since she's been covering these types of issues for weeks now).  Maybe they can help through providing media attention to your son's case.


----------



## geekette

dixie said:


> Son signed up for Obamacare, they have his money, but seem to have no record of his policy. Went to the Doctor and they wouldn't see him because they couldn't prove he had insurance. such a mess and we do not know how to reach anyone to help us. He has spent hour on the phone. They said someone didn't check a "box" when signing him up and his policy is all screwed up.
> 
> what can we do????



Get a copy of the cancelled check from his bank or credit card statement and call the insurance company to relay to them When They Took His Money and by what method.  Escalate within the insurance company and potentially refer the matter to the state insurance board (I think that's what it's called?)


----------



## easyrider

My wife and I have always been self employed and as such we have always purchased individual medical insurance policies or paid as an employer with a group policy. The individual policies had yearly increases in everything except benefits to the point where there was no limit on the 20% deductible making it very costly to use for anything catastrophic. 

For many of the same reasons I have read here I was very reluctant to try the ACA exchange but when I did I found that the caped deductible and subsidy was very attractive. We did sign up and even though there were a couple of glitches in the process we managed to obtain a pretty good policy for less cost than our previous policy that provides way better coverage.

The first problem for us when signing up was my wifes names. She has used her middle name as her first name since birth and then when we married her name changed again. It took about 20 minutes on the phone with the exchange to get this right.

There was an issue of our primary care doctor not on the list of providers but this was resolved and we will still be using our regular doctors.

My first prescriptions this year went flawlessly.

Our doctors appointments are still on with problem.

Every one is in charge of there own protection. Things we normally feel worth protecting our are life, health and property. Many overlook identity. In todays world a person needs identity protection. You need this if you have anything including a good credit rating worth protecting. There are many places that sell this type of protection and there are free sites like credit karma where you can personally monitor you credit. 

The truth is this is a cover you behind world we live in and always has been.

Bill


----------



## pjrose

*Dixie: This is likely an issue with the ins company not the ACA*

This is not necessarily an issue with the ACA (Affordable Care Act).  When you say "they have his money," who do you mean by "they"?  Did he sign up for insurance via the exchange, choosing a particular company and plan?  Did he pay via check, or use a credit card online?  

My guess is that the issue is with the insurance company from which he bought a policy.  With a copy of the cancelled check or payment on his credit card or bank account, and calls to the insurance company's toll-free number, he should be able to get this solved. He should ask to be transferred to a supervisor or manager, document name/extension/time/etc, and ask for a case number.

If "They said someone didn't check a "box" when signing him up and his policy is all screwed up." then there apparently is a policy.  Get its number.   

Unfortunately, calls to straighten out issues with any large company - telephone, computer, insurance, hospital, retailer - can take forever and be nightmares.  I believe the phone support people are trained with the basics - logging in, ordering something - but can't help with anything beyond that - hence escalating or advancing up a level or two.


----------



## pjrose

*Medicare, employer coverage, and dependents*



pjrose said:


> Maybe this is up there somewhere, but it's a l-o-n-g thread.
> 
> This year first DH and then I will move over to Medicare.  We've been deluged with stuff from insurance companies about supplemental coverage.
> 
> We are presently covered by a costly but very comprehensive family plan through his employer - large network of state universities.  With DD's neuro-cardio issues over the years (which she seems to have outgrown knock on wood) and her extremely expensive pregnancy complications and coverage for the DGs's first 30 days in the NICU, it's more than paid for itself.
> 
> DH plans to continue working until both DS and DD reach 26, unless by that time they are gainfully employed and have comparable coverage available.
> 
> Meanwhile, he and then I will be off the plan, so presumably he will continue with just family or dependent coverage through employer.
> 
> ok, on to the Medicare questions.....
> 
> Since he'll be paying for the employer plan anyway, why do Medicare?  Is it necessary?  Can we jump on later?
> 
> I keep waffling about knee replacement.  I know it's got to be done, I know if I drop 20-30 lbs my knee will feel a  lot better but that won't stop the fact that I've been bone-on-bone for 40 years (meniscus removed after skiing accident).    I heard somewhere (here?) that it's better to get it done while still on private insurance than Medicare.  True? Why?
> 
> Other questions I should be asking?  Suggestions?  Advice?



It turns out that our present employee-sponsored insurance will remain as first payer, with Medicare as second payer.  If DH opts out of the present insurance, he forgoes all benefits....I haven't double-checked that statement, but I infer it includes forgoing family benefits.

We'll need to check the dollars and cents of sticking with what we have till DD turns 26 vs supplemental policies for ourselves and policies via the ACA pool for DD and DS.


----------



## momeason

dixie said:


> Son signed up for Obamacare, they have his money, but seem to have no record of his policy. Went to the Doctor and they wouldn't see him because they couldn't prove he had insurance. such a mess and we do not know how to reach anyone to help us. He has spent hour on the phone. They said someone didn't check a "box" when signing him up and his policy is all screwed up.
> 
> what can we do????



Obamacare does not have anyone's money. When you click the pay now button
you are directed to the insurer's website. If payment was made, the payment went to the insurer. He needs to contact the insurance company and work with them to resolve the issue. Healthcare.gov will never have specific policy numbers.
Healthcare.gov is a marketplace to shop and compare plans after determining eligibility and subsidies. Once a plan is chosen it goes to the insurer. I know in my state, BCBSNC is overwhelmed. The problem is most likely with the insurance company.
We do not qualify for subsidies so we purchased directly through my normal BCBS agent. We did not enroll through healthcare.gov. We still do not have our plans and payments correct. We have been double charged and have had 3 different sets of cards arrive. 
The insurance companies are changing many plans,many unnecessarily and they were not prepared.
There are many reasons which would probably be considered political.

So many people like to put all the blame in one spot. Figuring out who to blame does not fix the screw ups though. 

I would call whatever insurance company took your son's payment. The government does not accept any payments. Only the insurance companies take payments. Subsidies are paid directly to the insurance companies and the consumer pays the rest of the premium.

I am so sorry your son is having difficulty. I wish you all the best. If the insurance company cannot find policy, do not make any more payments. The insurance company will be required to send last chances to pay before cancellation. These notices will have his policy # on them. 
I do not know if he has received any notices. When he signed up he would have chosen whether to receive email or paper notices. The first payment may not have a subscriber or policy#, but the second payment must have a policy #.
If he still does not have it resolved before 2-15, I would use an agent certified in the marketplace and re-enroll. It would require a new username password and email.
If he does not qualify for subsidies to reduce his payment costs, just go sign up 
with any good broker. To get subsidies you must apply through healthcare.gov.
If he ends up with 2 policies, he can just cancel one.
The earliest he can get a new policy would be March 1 though. Must re-enroll by Feb 15.

I would keep calling the insurance provider. They are the ones with his money if the payment was processed. I assume he checked his bank account or credit card. It would obviously be much better to find the original policy so he can have coverage sooner rather than later.


----------



## am1

Seems complicated.  Good luck to everyone.


----------



## Rose Pink

nevermind--got confused with the different threads


----------



## Ken555

Timeshare Von said:


> This is one of the many implementation issues that folks have been worried about.  It's unfortunate that your son (and you) are going through this.
> 
> I would suggest contacting Fox News (Greta Van Susteren perhaps since she's been covering these types of issues for weeks now).  Maybe they can help through providing media attention to your son's case.




Why would anyone resort to the media - that upstanding source of objectivity - to resolve a problem regarding a simple accounting mess? I just don't get how anyone would confuse this particular issue of simple accounting confusion to anything more serious.

I think we all need another shot of common sense.


Sent from my iPad


----------



## pjrose

momeason said:


> . . . If payment was made, the payment went to the insurer. He needs to contact the insurance company and work with them to resolve the issue. Healthcare.gov will never have specific policy numbers.. . . We did not enroll through healthcare.gov. We still do not have our plans and payments correct. We have been double charged and have had 3 different sets of cards arrive.
> The insurance companies are changing many plans,many unnecessarily and they were not prepared.. . .
> 
> I would call whatever insurance company took your son's payment. The government does not accept any payments. Only the insurance companies take payments. . . .
> 
> I am so sorry your son is having difficulty. I wish you all the best. If the insurance company cannot find policy, do not make any more payments. The insurance company will be required to send last chances to pay before cancellation. These notices will have his policy # on them. . . .
> with any good broker. To get subsidies you must apply through healthcare.gov.
> . . .
> 
> I would keep calling the insurance provider. They are the ones with his money if the payment was processed. I assume he checked his bank account or credit card. It would obviously be much better to find the original policy so he can have coverage sooner rather than later.



+1 



Ken555 said:


> Why would anyone resort to the media - that upstanding source of objectivity - to resolve a problem regarding a simple accounting mess? I just don't get how anyone would confuse this particular issue of simple accounting confusion to anything more serious.



+1 to this.  If I called the media every time I had a customer service issue with ATT or Comcast or Highmark Blue Shield or Microsoft.......


----------



## Timeshare Von

My comment about going to the media was in the context that this is a national issue; one that the media (particularly Fox News Channel) is trying to help people through the problems while also holding those responsible accountable.

That said, I agree it is very complex . . . and I wish only the best to anyone having to struggle through the process created by the ACA and HHS.


----------



## Passepartout

Timeshare Von said:


> My comment about going to the media was in the context that this is a national issue; one that the media (particularly Fox News Channel) is trying to help people through the problems while also holding those responsible accountable.
> 
> That said, I agree it is very complex . . . and I wish only the best to anyone having to struggle through the process created by the ACA and HHS.



Ahhh, now THERE is a good place to report the difficulty, and punish those responsible!!

If I am mistaken, and surely some kind person will point it out if I am, what do Mr. Murdock, Mr. Ayles, Ms. Sustenen, (sp) and others get out of dissuading people from acquiring health insurance? I suspect they have the best coverage money can buy, and are far above the 400% of poverty income, so don't qualify for any help.

I don't choose to watch any-well, except some sports- on their channels because they seem bent, not on helping people, but on erecting obstacles and barriers to make folks fear getting insurance coverage.

Why is this, and what do you suppose they get out of it?

Jim


----------



## ace2000

Passepartout said:


> Ahhh, now THERE is a good place to report the difficulty, and punish those responsible!!
> 
> If I am mistaken, and surely some kind person will point it out if I am, what do Mr. Murdock, Mr. Ayles, Ms. Sustenen, (sp) and others get out of dissuading people from acquiring health insurance? I suspect they have the best coverage money can buy, and are far above the 400% of poverty income, so don't qualify for any help.
> 
> I don't choose to watch any-well, except some sports- on their channels because they seem bent, not on helping people, but on erecting obstacles and barriers to make folks fear getting insurance coverage.
> 
> Why is this, and what do you suppose they get out of it?
> 
> Jim



Jim, I completely understand.  It's a real shame we don't live in a country that has complete control of the media and never reports on it's failures.  

Have you been back to any of your timeshares in Russia lately?


----------



## Passepartout

ace2000 said:


> Jim, I completely understand.  It's a real shame we don't live in a country that has complete control of the media and never reports on it's failures.
> 
> Have you been back to any of your timeshares in Russia lately?



Forgive me for being obtuse. I missed your point. If it's in support of a free press,  I wholeheartedly support it, but when just one outlet seems to simply push one view, that seems to go against the well being of the viewer, one wonders what they have to gain.

And what's up with the 'timeshare in Russia' quip? And why is it in a healthcare discussion? Maybe you were just drawing the similarity that Russians have healthcare. Noted. Thanks.


----------



## ace2000

Passepartout said:


> Forgive me for being obtuse.



No problem.




Passepartout said:


> And what's up with the 'timeshare in Russia' quip?



Could be wrong, but from reading your posts, I just figured that would be a place you'd enjoy visiting.


----------



## Passepartout

ace2000 said:


> Could be wrong, but from reading your posts, I just figured that would be a place you'd enjoy visiting.



You're right. We do enjoy visiting other cultures and will be there in May. But that belongs in another thread, not this one.

Jim


----------



## heathpack

ace2000 said:


> No problem.
> 
> 
> 
> 
> Could be wrong, but from reading your posts, I just figured that would be a place you'd enjoy visiting.



Lol, I thought you were implying Jim was a communist trying to squash free speech!  I got that totally wrong!

Its funny, a friend at work was just telling me about his upcoming trip to Russia. It does sound great. 

But I digress, back to healthcare....


H


----------



## ace2000

Passepartout said:


> You're right. We do enjoy visiting other cultures and will be there in May. But that belongs in another thread, not this one.
> 
> Jim



:hysterical:  Thanks, I needed that this morning.  Happy Friday to all!


----------



## bogey21

Passepartout said:


> If I am mistaken, and surely some kind person will point it out if I am, what do Mr. Murdock, Mr. Ayles, Ms. Sustenen, (sp) and others get out of dissuading people from acquiring health insurance?



Fox provides information and a point of view.  So do CNN, MSNBC and others.  I watch them all, get various points of view, and try to sort it out for myself.  My personal point of view is that they all provide value.

George


----------



## Passepartout

bogey21 said:


> Fox provides information and a point of view.  So do CNN, MSNBC and others.  I watch them all, get various points of view, and try to sort it out for myself.  My personal point of view is that they all provide value.
> 
> George



Oh, I certainly understand varying one's sources of information and drawing from them your own informed decisions. This week, at the resort we are in, the US TV choices are Fox, CNN, and a NYC NBC feed.

But George, you quoted my post on not seeing what the big Kahunas at Fox get from trying to keep their viewers from getting what they themselves have. Health insurance. That they offer another editorial view is fine, but it does not provide service to their viewers. 

Deflecting the subject seems to be the tactic here.


----------



## Ken555

Passepartout said:


> Deflecting the subject seems to be the tactic here.




Let's not let facts get in the way of a good story. I don't care which news outlet any of you watch - in my opinion all major media in the US are biased and no longer objective. And, every story seems to be so dramatic that it is designed to enrage the viewers regardless of topic. In my opinion every news director at all major news outlets should quit, since they either can't control the story the way they want (ie undue influence by unnamed others) or they aren't objective and have a goal other than providing news. Personally, I like the BBC (tho it also has its problems) and a few German stations (which are now available in the States) - the European perspective on global stories is markedly different than our own.

I suggest we keep this thread focused on healthcare and not on the media or else we're obviously going to talk more about Russia (and not about the Olympics or how wonderful St Petersburg is, but more about long lines for toilet paper). 




Sent from my iPad


----------



## pjrose

*Dixie? Update?*



Ken555 said:


> I suggest we keep this thread focused on healthcare



+ one here.  And I'm interested in the results of the lost insurance info from above; did Dixie's  son call the ins co? Did he make any progress?


----------



## momeason

Another story that we never hear the end of?

OTOH, I am loving my temporary job, best I ever had. It is so fulfilling helping people who had lost their insurance ( or in some cases never had it ) get new health insurance coverage. I have never had a job I enjoyed so much. I am serious. People can talk about the problems all day and there are many that need to be fixed, but the reality is that the ACA is helping millions and there are millions more to be helped. There are some people paying higher costs, my hubby and I included, but I love opening up healthcare to many more. My services come with extras. I explain how to use the new insurance, recommend doctors and leave everyone free to call me. I give tips on where to get $5 dental care at the dental school. Not part of my job, just what I like to do.
It is the best project I ever did. The new law and me, in a small way, are making a difference.
We had a sleet/freezing rain day today and I completed lots of apps over the phone since we were all having a forced day off. My snow day was very productive. Love it!!


----------



## bogey21

Ken555 said:


> Personally, I like the BBC (tho it also has its problems) and a few German stations (which are now available in the States) - the European perspective on global stories is markedly different than our own.



I was in the Library the other day and picked up a copy of Macleans, a Canadian weekly.  Their perspective on a couple of issues (one was Canadian Health Care) was interesting to say the least.  Later I discussed the articles with a friend of mine who is married to a woman from Thailand who often talks to her relatives at home.  He tells me that their perspective on some of our politicians and issues is also most  interesting.

George


----------



## pjrose

Interesting discussion over the last few months with a woman from Canada whose child has the same skull malformation as my DGS (who is doing great).  DGS was diagnosed at birth, Neurosurgeon at the hospital where he was in the NICU was monitoring him for months, we switched to a children's hospital where we got an appointment the day after calling, surgery done a few weeks after that.  

The woman in Canada's son was diagnosed last November - 3 months ago.  It took another month, I believe, for her to get a CT scan, another month for an appt to go over the results with her.  The dr. put in referrals for her child to see a neurosurgeon and other specialists; the appointments are coming up in a few months.  Something like six months just to even SEE the neurosurgeon, and who knows how long it'll take to schedule surgery if it's determined to be appropriate.  Meanwhile, this condition can cause inter cranial pressure and brain damage......

Two examples don't make a pattern, but from what I've heard and read I do believe our system is generally much faster.  

Mods - please feel free to delete if you feel I crossed a line here.


----------



## Brett

*health care*

http://www.nytimes.com/2014/02/13/us/over-1-million-added-to-rolls-of-health-plan.html?ref=us&_r=0

"More than 1.1 million people signed up for health insurance through federal and state marketplaces in January, 
 Most promising, according to the Department of Health and Human Services, is that 25 percent of those signing up for insurance from October through January were ages 18 to 34 the young and presumably healthy people whom insurance companies need as customers in order to keep premiums reasonable for everyone."


----------



## ottawasquaw

*Who really knows the facts?*

I am sympathetic to those asking us to stick the facts and avoid politics. The truth is we all come from a place which is a combination of our personal experiences and values.

Over the years, I've come to TUG for information and that's why I've taken the time to read this thread. Much of it is antidotal "evidence" especially the posts from the OP. Madame, you appear to be a good-hearted woman, but as you have stated yourself, your job, while rewarding is not self-supporting.

Using the exchange probably works better if one has some idea of one's projected income. That works for most folks but not everyone. 

For the time being, healthcare remains a market-driven product. There is more competition in large metropolitan areas. This is a problem which ACA has exposed. Many folks were aware of the inequities of insurance where folks could be cancelled or never underwritten due to pre-existing conditions. I dare say, fewer understood the limitations of less populated areas which actually explain the anomalies that many posters are seeing.

I'd like to address a few disconcerting remarks. "I feel in some many parts of our society, money is just too important. People are not important enough." Well, actually, if you were an MD who spent a quarter of a million dollars to get the education you needed to earn your paycheck, then you might value the time you spend with your family over taking on more patients for less pay. Surely that makes sense? The quote is seeing the situation from only one side. 

"A doctor and hospital get paid $1500 for a 10 minute consultation on a heart stent and something like 20 dollars for a 45 minute consultation on how to change your lifestyle to prevent artery clogging and REDUCE the clogging you have in your artery." I have the same problem with this statement. An MD spent 12 additional years in school to do complex surgery to fix people and not necessarily dispense information which is readily available. An interesting side note, I recently learned that my medical insurance (individual policy, HDHP) includes a health coach! I now have a nutritionist who phones me regularly to keep me on track!

"After we can make it through the transition year, I believe we will see many more insurers on the Exchanges. Just my opinion." Hardly! Insurance companies based 2014 premiums on less information than ever! No one knows what 2015 will look like. Goodness, 12 months ago, few of us anticipated this mess! Stay tuned!


----------



## pgnewarkboy

ottawasquaw said:


> I am sympathetic to those asking us to stick the facts and avoid politics. The truth is we all come from a place which is a combination of our personal experiences and values.
> 
> Over the years, I've come to TUG for information and that's why I've taken the time to read this thread. Much of it is antidotal "evidence" especially the posts from the OP. Madame, you appear to be a good-hearted woman, but as you have stated yourself, your job, while rewarding is not self-supporting.
> 
> Using the exchange probably works better if one has some idea of one's projected income. That works for most folks but not everyone.
> 
> For the time being, healthcare remains a market-driven product. There is more competition in large metropolitan areas. This is a problem which ACA has exposed. Many folks were aware of the inequities of insurance where folks could be cancelled or never underwritten due to pre-existing conditions. I dare say, fewer understood the limitations of less populated areas which actually explain the anomalies that many posters are seeing.
> 
> I'd like to address a few disconcerting remarks. "I feel in some many parts of our society, money is just too important. People are not important enough." Well, actually, if you were an MD who spent a quarter of a million dollars to get the education you needed to earn your paycheck, then you might value the time you spend with your family over taking on more patients for less pay. Surely that makes sense? The quote is seeing the situation from only one side.
> 
> "A doctor and hospital get paid $1500 for a 10 minute consultation on a heart stent and something like 20 dollars for a 45 minute consultation on how to change your lifestyle to prevent artery clogging and REDUCE the clogging you have in your artery." I have the same problem with this statement. An MD spent 12 additional years in school to do complex surgery to fix people and not necessarily dispense information which is readily available. An interesting side note, I recently learned that my medical insurance (individual policy, HDHP) includes a health coach! I now have a nutritionist who phones me regularly to keep me on track!
> 
> "After we can make it through the transition year, I believe we will see many more insurers on the Exchanges. Just my opinion." Hardly! Insurance companies based 2014 premiums on less information than ever! No one knows what 2015 will look like. Goodness, 12 months ago, few of us anticipated this mess! Stay tuned!



Many people spend a fortune going to school and getting advanced degrees who earn far less than doctors and far less than their education and skill set should warrant.


----------



## Patri

pgnewarkboy said:


> Many people spend a fortune going to school and getting advanced degrees who earn far less than doctors and far less than their education and skill set should warrant.



Your point? Do you want those people diagnosing or operating on you? If you wait long enough, the government will set the price points for those professions too.


----------



## ace2000

Brett said:


> http://www.nytimes.com/2014/02/13/us/over-1-million-added-to-rolls-of-health-plan.html?ref=us&_r=0
> 
> "More than 1.1 million people signed up for health insurance through federal and state marketplaces in January,
> Most promising, according to the Department of Health and Human Services, is that 25 percent of those signing up for insurance from October through January were ages 18 to 34 the young and presumably healthy people whom insurance companies need as customers in order to keep premiums reasonable for everyone."



Another misrepresentation of the facts.  Unfortunately the benchmark has always been 40 percent, so I'm not sure why the administration seems happy with the 25 percent figure.  You tell me.

Here's a recent source from Time which provides another angle on the 25 percent figure:

http://swampland.time.com/2014/02/12/obamacare-enrollment-young-invincibles-sebelius/

*But only 25 percent of those enrolled were between the ages of 18-34, well below the 40 percent benchmark the administration set for the age group. *Younger, healthier enrollees are necessary to subsidize coverage for older enrollees.


----------



## Ron98GT

Timeshare Von said:


> My comment about going to the media was in the context that this is a national issue; one that the media (particularly Fox News Channel) is trying to help people through the problems while also holding those responsible accountable.
> 
> That said, I agree it is very complex . . . and I wish only the best to anyone having to struggle through the process created by the ACA and HHS.



No it isn't, your wrong.  This particular issue involves one individual, selecting one insurance company, in one particular state.  It's a local consumer issue.  Their son needs to work with that insurance company.  If he can't resolve the issue, some "local" TV stations have a consumer affairs department. But he probably should start with getting all his ducks in-order:  get copies of all paperwork, canceled checks, and any contacts that he has made to that insurance company and his states Department of Insurance.


----------



## bogey21

ace2000 said:


> *But only 25 percent of those enrolled were between the ages of 18-34, well below the 40 percent benchmark the administration set for the age group. *Younger, healthier enrollees are necessary to subsidize coverage for older enrollees.



It will be interesting to see how many of the 18-34s who have signed up stick with their policies.  Will they continue to fork out $150 - $200 every month for something they don't use when/if things get tight for them financially?

George


----------



## Passepartout

Patri said:


> If you wait long enough, the government will set the price points for those professions too.



You mean, like they do for Medicare and Veterans Healthcare recipients? ACA doesn't set rates that providers charge. The individual insurance carriers can choose which providers are 'in network' or not, directing policyholders towards lower cost providers, or paying the difference between in- and out- of network. That's the way it has been for as long as I have had health insurance, whether it was employer provided or privately acquired. I bet it works that way with yours too.


----------



## ace2000

bogey21 said:


> It will be interesting to see how many of the 18-34s who have signed up stick with their policies.  Will they continue to fork out $150 - $200 every month for something they don't use when/if things get tight for them financially?
> 
> George



They might bail, but the fines will keep going higher over the next few years.  The reality of the mandate has not set in yet because nobody is paying the fines - yet.


----------



## SueDonJ

ottawasquaw said:


> … "A doctor and hospital get paid $1500 for a 10 minute consultation on a heart stent and something like 20 dollars for a 45 minute consultation on how to change your lifestyle to prevent artery clogging and REDUCE the clogging you have in your artery." I have the same problem with this statement. An MD spent 12 additional years in school to do complex surgery to fix people and not necessarily dispense information which is readily available. An interesting side note, I recently learned that my medical insurance (individual policy, HDHP) includes a health coach! I now have a nutritionist who phones me regularly to keep me on track! ...



I'm not sure I understand this.  Sure, based on his/her schooling and expertise, it might be a waste of resources to expect _a surgeon_ to counsel patients on the best ways to prohibit and/or treat the conditions that might ultimately require surgery.  But an MD is exactly the person I want to "dispense that information," because an MD's expertise usually goes far beyond that of someone employed by a health insurance company as a "health coach."

Don't get me wrong, it's great that health insurers are providing information that helps to keep us informed about good health practices; it speaks to the premise of an ounce of prevention ...  But if my body suffers a physical ailment despite the glut of available information, at that point I want counsel from an MD who is technically qualified to gauge whether a visit to a surgeon is in order.


----------



## ace2000

Ron98GT said:


> No it isn't, your wrong.  This particular issue involves one individual, selecting one insurance company, in one particular state.  It's a local consumer issue.  Their son needs to work with that insurance company.  If he can't resolve the issue, some "local" TV stations have a consumer affairs department. But he probably should start with getting all his ducks in-order:  get copies of all paperwork, canceled checks, and any contacts that he has made to that insurance company and his states Department of Insurance.



I don't get your point.  Your quibbling over whether it's "individual" or "national"?  ACA is the federal law of the land and will be enforced by the "national" government, not at the state level.  Any federal law could be interpreted as "individual" using your logic above.  

If I had a problem like this that needed resolved, I'd take any support I could get.


----------



## SueDonJ

ace2000 said:


> I don't get your point.  Your quibbling over whether it's "individual" or "national"?  ACA is the federal law of the land and will be enforced by the "national" government, not at the state level.  Any federal law could be interpreted as "individual" using your logic above.
> 
> If I had a problem like this that needed resolved, I'd take any support I could get.



But going to a media outlet to fix what appears to be one person's specific problem with a specific insurance company's bookkeeping efforts is a bit of overkill, isn't it?  That would be like you purchasing a bag of onions at Stop&Shop that go moldy the next day, then you call CNN in order to expose the Dept of Agriculture as being deficient!

People have had bookkeeping problems with insurance companies ever since the first insurance company was established, yet except in the most egregious of situations we managed prior to the ACA inception to get those problems fixed without calling out the cavalry.  Going to a national media outlet with these types of problems now might get them fixed quicker, but there's no doubt that the suggestion furthers an agenda.


----------



## ace2000

SueDonJ said:


> But going to a media outlet to fix what appears to be one person's specific problem with a specific insurance company's bookkeeping efforts is a bit of overkill, isn't it?  That would be like you purchasing a bag of onions at Stop&Shop that go moldy the next day, then you call CNN in order to expose the Dept of Agriculture as being deficient!



Perhaps overkill, but obviously if it works then it could be helpful advice.  

I'm not sure why her suggestion has turned into a lightning rod in this thread...  Oh, wait a minute, perhaps because it was Fox News, and the Fox haters are now up in arms!


----------



## geekette

pgnewarkboy said:


> Many people spend a fortune going to school and getting advanced degrees who earn far less than doctors and far less than their education and skill set should warrant.



and get asked to consult for free in their off hours.


----------



## geekette

Patri said:


> Your point? Do you want those people diagnosing or operating on you? If you wait long enough, the government will set the price points for those professions too.



I would like to see the trend lines that cause you to believe this.


----------



## Passepartout

ace2000 said:


> Oh, wait a minute, perhaps because it was Fox News, and the Fox haters are now up in arms!



That's just silly. It would make no difference if the suggestion had been to go the BBC (or any other nation- or worldwide outlet) with what is essentially a local bookkeeping problem.


----------



## SueDonJ

ace2000 said:


> Perhaps overkill, but obviously if it works then it could be helpful advice.
> 
> I'm not sure why her suggestion has turned into a lightning rod in this thread...  Oh, wait a minute, perhaps because it was Fox News, and the Fox haters are now up in arms!



No.  FOX has its place, I don't "hate" them or any other news outlets.  And I'm not "up in arms" - I just think it's overkill to take a bookkeeping error to a major media outlet when providing the right documentation to the right insurance company employee is the better solution.


----------



## ottawasquaw

SueDonJ said:


> Don't get me wrong, it's great that health insurers are providing information that helps to keep us informed about good health practices; it speaks to the premise of an ounce of prevention ...  But if my body suffers a physical ailment despite the glut of available information, at that point I want counsel from an MD who is technically qualified to gauge whether a visit to a surgeon is in order.



Good point, Susan, and I hope I'm not getting too OT, but I like to think the point of the thread is to have a thoughtful discussion of what our healthcare system is and where it is going. 

I'm starting to see where my appts are now with a new PA and no longer my MD. I've rec'd lots of unnecessary tests and prescriptions - all based on multiple misdiagnoses. I wonder if an MD would have made the same mistakes? So, yes, I am agreeing with you!


----------



## ace2000

SueDonJ said:


> And I'm not "up in arms" - I just think it's *overkill *to take a bookkeeping error to a major media outlet when providing the right documentation to the right insurance company employee is the better solution.



The overkill is that we're still dissing a post that was made over three weeks ago, where the person was just trying to be helpful.  

But, I'm in favor of staying on the original topic - which seems to be helping people get accurate information about their health care.  I was only responding to the earlier post today.


----------



## PStreet1

Brett said:


> http://www.nytimes.com/2014/02/13/us/over-1-million-added-to-rolls-of-health-plan.html?ref=us&_r=0
> 
> "More than 1.1 million people signed up for health insurance through federal and state marketplaces in January,
> Most promising, according to the Department of Health and Human Services, is that 25 percent of those signing up for insurance from October through January were ages 18 to 34 the young and presumably healthy people whom insurance companies need as customers in order to keep premiums reasonable for everyone."



Officially, now we know. The total signed up figure is 3.3 million. .

WALL STREET JOURNAL NEWS ALERT:

Health Exchanges Hit 3.3 Million Enrollees by January

Some 3.3 million people signed up for health coverage via insurance exchanges through January, but enrollment from young Americans remained tepid, new Obama administration figures show. 

The latest figures signal an uptick in insurance enrollment as 2014 began. Roughly 2.2 million people had signed up for private plans nationwide by Dec. 28. The Affordable Care Act’s exchanges first opened in October. Enrollment among young Americans–a closely watched demographic *because their participation *keeps premiums lower–*barely ticked up in January*. 

http://online.wsj.com/news/articles/...=djemalertNEWS

And, according to the article, *signups have fallen off dramatically and returned to the lethargic November rates*. 

HOWEVER, Only about half of those who signed up have paid http://news.investors.com/politics-o...?ref=SeeAlso--  so do they count as "signed up"? For anyone but the government, they certainly wouldn't be included in "those who have signed up." When I shop at Amazon and leave stuff in my basket that I didn't pay for, Amazon doesn't include me in the count of "those who bought ________________." 

In Washington state, 170,000 have filled out the forms (goal is 340,000 by the end of next month)--but of the 170,000, only 88,071 have, as of Feb. 1st, paid their premium. That looks like about 25% of the desired total can actually be counted. 

Wisconsin's Deputy Insurance Commissioner said their figures were about the same: only about half of those who signed up paid their premiums--ABC TV. http://www.wkow.com/story/24655076/2...-paid-premiums

HOWEVER, even the White House acknowledges that *30% of those who have signed up had insurance before.* If they say 30%, you can bet the % is much higher. This thing simply isn't getting uninsured people to sign up--let alone young people to support it. It's getting Medicaid people and old people, and most of them were already on Medicaid and Medicare.


----------



## geekette

PStreet1 said:


> This thing simply isn't getting uninsured people to sign up--let alone young people to support it. It's getting Medicaid people and old people, and most of them were already on Medicaid and Medicare.



Medicare is its own animal and people will age into it.  And die out of it.  That number should be relatively steady, but climbing as boomers hit 65.

Medicaid, however, will have added many people previously not eligible in the states that chose to expand the program.  We are also adding previously uninsured young people.  I don't think any of us expected 100% compliance but I think that number will tick up in the next few years when people are penalized or gouged with med expenses that could have been smaller had they been insured.

We are also getting the young adults on the parent policies.  It's not true that young people are not signing up, and plenty will have insurance thru their jobs and not shop exchanges.


----------



## Ron98GT

ace2000 said:


> The overkill is that we're still dissing a post that was made over three weeks ago, where the person was just trying to be helpful.
> 
> But, I'm in favor of staying on the original topic - which seems to be helping people get accurate information about their health care.  I was only responding to the earlier post today.


It's beyond overkill.  The specific problem has nothing do Fox, CNN, MSNBC, or anybody else.  This doesn't even have anything to do with the ACA (AKA Obama Care).  It's all about 1 individuals problems, with 1 insurance company, in one state. It's a local issue.  Within each state, the insurance company and all agents that actively sell insurance products, must be licensed with that state and are governed by that states statutes.  As previously stated, that persons son must make every attempt to work with the insurance company that they selected and document everything.  If they have a specific problem, they can contact their state Department of Insurance.

No newscaster, especially national, is going to make the effort to contact the posters son, collect all of the details, and resolve the issue with that one insurance company.  Their only Talking Heads.


----------



## pjrose

*FYI re son's problem with insurance company*

Dixie, the TUG member who posted about her son's insurance issue, has only posted in this thread once, on Jan 23, and has not been on TUG for two weeks, since Jan 28.  

So if anyone has any helpful info for Dixie, I suggest contacting her outside of the thread.


----------



## momeason

bogey21 said:


> It will be interesting to see how many of the 18-34s who have signed up stick with their policies.  Will they continue to fork out $150 - $200 every month for something they don't use when/if things get tight for them financially?
> 
> George



Know your facts, at least 80% of the young are paying much less than $100/mo.
More than 60% of the all the previously uninsured who choose plans on the Marketplace pay less than $100. Among young people, most pay far less than $100.
The prices of $100-$200/month are prices before the advance tax credits for those below 30 years old.


----------



## bogey21

momeason said:


> Know your facts, at least 80% of the young are paying much less than $100/mo.
> More than 60% of the all the previously uninsured who choose plans on the Marketplace pay less than $100. Among young people, most pay far less than $100.



I don't profess to know the economics of all this but if all these people are paying less than $100 per month, it will sure take a lot of them to cover the expenses incurred by those with serious medical problems.

George


----------



## ace2000

momeason said:


> Know your facts, at least 80% of the young are paying much less than $100/mo.
> More than 60% of the all the previously uninsured who choose plans on the Marketplace pay less than $100. Among young people, most pay far less than $100.
> The prices of $100-$200/month are prices before the advance tax credits for those below 30 years old.



Wrong.  


Americans will pay an average $328 per month for health coverage under President Obama's Affordable Care Act, recent data show.
...
The national average cited by HHS refers to the second-cheapest among silver plans on the market - which many healthcare economists expect to be the most popular for their balance of coverage and out-of-pocket costs. On average, the least expensive plans in this group were reported in Minnesota, where it costs $192 per month, and Tennessee, $245.

http://news.msn.com/us/obamacares-average-monthly-cost-across-us-dollar328?stay=1


----------



## ace2000

More facts for those that are curious about the potential costs for them...

A calculator produced by the Kaiser Family Foundation in collaboration with NPR allows shoppers to find out if they qualify for subsidized insurance coverage or Medicaid.

http://www.npr.org/blogs/health/201...tmctr=(not provided)&__utmv=-&__utmk=49412132


----------



## sue1947

ace2000 said:


> Wrong.
> 
> 
> Americans will pay an average $328 per month for health coverage under President Obama's Affordable Care Act, recent data show.
> ...
> The national average cited by HHS refers to the second-cheapest among silver plans on the market - which many healthcare economists expect to be the most popular for their balance of coverage and out-of-pocket costs. On average, the least expensive plans in this group were reported in Minnesota, where it costs $192 per month, and Tennessee, $245.
> 
> http://news.msn.com/us/obamacares-average-monthly-cost-across-us-dollar328?stay=1



Statistics; perhaps the most misunderstood of the branches of mathematics and/or economics.  

The average cost across all ages is an entirely different number than the average of the costs to young people.  
Is the average cited with or without the tax credit?  I would bet without based on my personal experience.   With statistics and polls, always check the fineprint.  
Will most young people pick the silver or the bronze?  I would bet on bronze.  
In other words, there are multiple factors that go into these decisions and drilling down into the statistics for different ages/geographical areas etc will produce different results.  

As a side note, I'm surprised that anybody expects the young and healthy to sign up before the deadline.  

Another sidenote:  I'm also somewhat bemused at how hard some are fighting to keep the old system. We pay more for health care and get the worst results of any developed country.  Paying more for less would seem to be the opposite of what the 'fiscal conservatives' want, but they seem to be the ones fighting the hardest to keep it.  

Sue


----------



## momeason

ace2000 said:


> Wrong.
> 
> 
> Americans will pay an average $328 per month for health coverage under President Obama's Affordable Care Act, recent data show.
> ...
> The national average cited by HHS refers to the second-cheapest among silver plans on the market - which many healthcare economists expect to be the most popular for their balance of coverage and out-of-pocket costs. On average, the least expensive plans in this group were reported in Minnesota, where it costs $192 per month, and Tennessee, $245.
> 
> http://news.msn.com/us/obamacares-average-monthly-cost-across-us-dollar328?stay=1



This does not take into account the advance tax credits. The are the prices of the plans. The insurance company gets the entire price. I am talking about the amount the customer pays after the subsidies which are advance tax credits. I work with this every day.
I also have not found a subsidy calculator which is very accurate because we need to ask all the questions, not just a few. 
I will admit that it is complicated, but I love helping people get access to Healthcare. I think there is a better way to accomplish this, but this is a lot better than having so many with no access to preventative care. Those without insurance go without care in our current healthcare model. Unacceptable.
NC does not have Medicaid Expansion. All of my clients are hard working Americans.
Most reporting has a very political bias. I am just trying to report what I encounter and how to help people make the most of the law.
I would rather answer questions about how to navigate the process than all the news links and statements by talking heads.


----------



## ace2000

sue1947 said:


> Statistics; perhaps the most misunderstood of the branches of mathematics and/or economics.
> 
> The average cost across all ages is an entirely different number than the average of the costs to young people.
> Is the average cited with or without the tax credit?  I would bet without based on my personal experience.   With statistics and polls, always check the fineprint.
> Will most young people pick the silver or the bronze?  I would bet on bronze.



Did you read the link?  It is without the subsidy.  The link also stated that the silver plan is the most popular.  My post also stated that even the least expensive plans (i.e. Bronze) were still $192 at the lowest.  

You want to refute my post with is backed up by real data and say nothing about a post that seems to post a bunch of random facts pulled from who knows where?  :hysterical:


----------



## ace2000

momeason said:


> Know your facts, at least 80% of the young are paying much less than $100/mo.
> More than 60% of the all the previously uninsured who choose plans on the Marketplace pay less than $100. Among young people, most pay far less than $100.



The real data shows that less than half of Americans qualify for subsidies at all.  Even if the young do get the subsidies there is absolutely no way that "at least 80%" get enough subsidies to pay "far less than $100" as you and Sue are wanting to claim.


----------



## Conan

Here are the latest figures on ACA projected coverage and subsidies: 
*Twenty-five million formerly uninsured will get coverage.
*The average subsidy for those earning little enough to qualify is about $6,000 per year.
http://www.cbo.gov/sites/default/fi...ffordableCareActHealthInsuranceCoverage_2.pdf


----------



## Patri

sue1947 said:


> Another sidenote:  I'm also somewhat bemused at how hard some are fighting to keep the old system. We pay more for health care and get the worst results of any developed country.



Subjective, and not true. Scandinavia pays huge taxes for their socialized medicine, but my relatives travel to Germany for what they see as faster and better care.


----------



## Passepartout

Patri said:


> Subjective, and not true. Scandinavia pays huge taxes for their socialized medicine, but my relatives travel to Germany for what they see as faster and better care.



This has nothing to do with either ACA or the previous 'pay for service' freedom-_from_-insurance requirement 'system' in the USA. In the rest of the world, Europe, Scandinavia, Germany, Great Britain, Canada, Japan, Korea, Russia etc, etc, etc, there is 'single payer' tax supported, 'socialized medicine'. 

The ACA is simply a subsidized (for lower income people) requirement that citizens purchase private health insurance from private companies. Nothing more. It is NOT socialized medicine.

Jim


----------



## Patri

Passepartout said:


> This has nothing to do with either ACA or the previous 'pay for service' freedom-_from_-insurance requirement 'system' in the USA. In the rest of the world, Europe, Scandinavia, Germany, Great Britain, Canada, Japan, Korea, Russia etc, etc, etc, there is 'single payer' tax supported, 'socialized medicine'.
> 
> The ACA is simply a subsidized (for lower income people) requirement that citizens purchase private health insurance from private companies. Nothing more. It is NOT socialized medicine.
> 
> Jim



I didn't say it was socialized. Sue said our system is the most expensive and has the worst outcome. That is a subjective statement. You have to factor in how (and by whom) premiums are paid for. Nothing is free. Subsidies are not free. Other countries pay for it in different ways, so it may be more expensive for them, and they don't think their medical care is necessarily better than in the U.S.
One blanket statement can't cover the whole world.


----------



## Passepartout

Patri said:


> Other countries pay for it in different ways, so it may be more expensive for them, and they don't think their medical care is necessarily better than in the U.S.



By measurement. We pay more dollars per person per year for our healthcare than any other nation on earth. Yet we place about 10 years shorter life expectancy behind all W. European countries in, and have higher child mortality than 80 other countries. 

How did you want to measure it?


----------



## bogey21

Passepartout said:


> Yet we place about 10 years shorter life expectancy behind *all* W. European countries.....



Really?  According to Wikipedia the life expectancy in most Western European countries is around 81 years.  Italy at 83.1 and Sweden at 83 are the outliers.  US is 79.8.  Subtract 79.8 from 81 and (at least I) get 1.2.  Maybe Wikipedia and/or my math are wrong but 1.2 years is not 10 years.  Are out costs too high?  Yes.  Is our life expectancy 10 years less than Western Europe?  I don't think so.

George


----------



## Patri

Passepartout said:


> How did you want to measure it?



With the truth.


----------



## Passepartout

bogey21 said:


> Really?  According to Wikipedia the life expectancy in most European countries is around 81 years.  Italy at 83.1 and Sweden at 83 are the outliers.  US is 79.8.  Subtract 79.8 from 81 and (at least I) get 1.2.  Maybe Wikipedia and/or my math are wrong but 1.2 years is not 10 years.
> 
> George



They still outlive us and more of their infants live to adulthood. Forgive my numerical exaggeration. Or don't.


----------



## ace2000

Patri said:


> With the truth.



Unfortunately the truth has been a constant casualty of this thread.  Never seen anything like it.


----------



## Passepartout

Patri said:


> With the truth.



I still don't know any other way to measure the efficiency of a healthcare system than to compare the cost compared to the outcome. If one system costs more, yet the recipients don't live as long, wouldn't you determine that a system that costs less, yet results in longer lifespans is better?

This is the whole premise behind the ACA. Nothing more, nothing less. Better care, longer lives, lower overall cost.


----------



## ace2000

Passepartout said:


> I still don't know any other way to measure the efficiency of a healthcare system than to compare the cost compared to the outcome. If one system costs more, yet the recipients don't live as long, wouldn't you determine that a system that costs less, yet results in longer lifespans is better?



I wonder if obesity rate, drug usage, r&d, or other environmental factors would possibly be factors in your equation???   Yes.

If you want a good gauge of how good a health care system is, why not look at where the other countries end up going for quality health care?  Or look at which country leads in the development of new medical advances.  You think those may be an indicator?


----------



## Passepartout

Ace, if your premise that the largest expenditure of drug R&D is correct, shouldn't we have the most favorable outcome? We don't. Other countries have lousy environmental rules and correspondingly low life expectancy (China comes to mind). Same for high percentage of smokers. Russia has a serious alcoholism problem- and high death rates to show for it. Yes, part of the reason for shorter lifespans of Americans is a high rate of obesity. Shouldn't we as a society be doing something about it? If you are overweight, expect a discussion about it next time you see your doc.

There is no one answer, but one thing we know for sure. People who have health insurance that covers diagnostic tests and preventative medicine go to the doc before their conditions become chronic and more expensive to treat. 

If you are well-off enough to afford good insurance coverage, good for you. You deserve it. Now help those less fortunate to be able to share in the good fortune with you. That's what this is about.


----------



## ace2000

Passepartout said:


> Ace, if your premise that the largest expenditure of drug R&D is correct, shouldn't we have the most favorable outcome? We don't.



Did you read my previous post?  Because of our wealth, we are the most obese country in the world.  Is it possible that obesity rate might be a factor?  How about drug usage?  Don't let the facts get in the way of your points though.


----------



## Ken555

Regardless of the nuances of health care currently being discussed, wouldn't we all agree that having more people with health insurance is a good thing? I think that's the goal of the ACA, and I think it's working, but none of us have the real facts on the numbers yet. 


Sent from my iPad


----------



## simpsontruckdriver

Insurance is based on the LAW OF NUMBERS. The more people are insured, the easier it is to spread out Loss. Basically, a few disasters are spread out over millions of subscribers. Car insurance is the same, and so is Health Insurance. That is why Pre-Existing Conditions were either EXPENSIVE or simply not covered before the PPACA. But, if 100 million Americans could be covered (in theory), those with high medical bills would be spread out among the healthy.

That is the foundation of insurance, and has been in effect for decades.

TS


----------



## Conan

*Only in America*
It's the Onion of course but still, only in America:


> *Delighted Health Insurance Executives Gather In Outdoor Coliseum To Watch Patient Battle Cancer
> *                      HARTFORD, CT—Creating an electric and intimidating atmosphere with their cheers and vocal cries for blood, throngs of health insurance executives reportedly crowded into a massive outdoor coliseum on Aetna’s corporate campus Monday to watch one of their policyholders engage in a life-or-death fight against cancer.
> 
> Sources confirmed that the stone arena was filled to capacity for the highly anticipated spectacle, with over 90,000 officials attending from providers as far away as WellPoint, Kaiser Permanente, and HCSC to see if the patient could survive an intense, brutal struggle with the advanced stage III illness.
> 
> “Today we bring you one of our most thrilling challengers to date: a 57-year-old caucasian male with preexisting high blood pressure and a family history of heart disease,” said Blue Cross Blue Shield CEO Scott Serota from an extravagantly decorated box seat, his booming voice immediately silencing the raucous masses of middle-aged executives. “He holds a privately purchased Aetna PPO with a $400 monthly premium and $1,500 annual deductible....”
> 
> “Bring out Aetna member #ABP80424!” ….


http://www.theonion.com/articles/de...lMarketing&utm_campaign=LinkPreview:2:Default


----------



## Passepartout

Ace, I'm confused. What exactly is your motive in this thread? Are you trying to keep people from buying affordable health insurance? What can you possibly gain from this? Do you want to return to the former status quo of people not being able to get insurance if they have a pre-existing condition? Do you somehow enjoy seeing people going bankrupt because they needed medical care they couldn't afford? Why?


----------



## ace2000

Ken555 said:


> Regardless of the nuances of health care currently being discussed, wouldn't we all agree that having more people with health insurance is a good thing? I think that's the goal of the ACA, and I think it's working, but none of us have the real facts on the numbers yet.



Yes, we would all agree that universal coverage would be great, fantastic, wonderful, and outstanding... in a perfect world.  However, at what cost?  And on the backs of our young population?  Nobody knows the answers right now.  And with the current administration puffing the numbers every chance they get, it may be a long time before we actually do know. 

It's way too early to make any judgement on the ACA, especially with all the postponements, and the fact that there is so much more left to be implemented.  Has it made you even the least bit curious why they keep delaying the unpopular phases of this deal?


----------



## Ken555

ace2000 said:


> Yes, we would all agree that universal coverage would be great, fantastic, wonderful, and outstanding... in a perfect world.  However, at what cost?  And on the backs of our young population?  Nobody knows the answers right now.  And with the current administration puffing the numbers every chance they get, it may be a long time before we actually do know.
> 
> It's way too early to make any judgement on the ACA, especially with all the postponements, and the fact that there is so much more left to be implemented.  Has it made you even the least bit curious why they keep delaying the unpopular phases of this deal?




Gosh I wonder. Perhaps because they're politicians? Every administration does this with even slightly controversial programs, and the ACA is definitely controversial. "On the backs of our young population" is exactly the correct way to do this, as it is with social security and other programs. Why act surprised? 


Sent from my iPad


----------



## ace2000

Passepartout said:


> Ace, I'm confused. What exactly is your motive in this thread?



Motive?  Just trying to correct the record.  I'm finding it unreal all the misinformation that's being posted here.  I'd rather just make this thread about the facts and delete all the worthless opinions - even including my own.  Seriously, go back and read the nonsense that's being posted in this thread.


----------



## Passepartout

ace2000 said:


> Motive?  Just trying to correct the record.  I'm finding it unreal all the misinformation that's being posted here.  I'd rather just make this thread about the facts and delete all the worthless opinions - even including my own.  Seriously, go back and read the nonsense that's being posted in this thread.



So what exactly is your hoped-for outcome? This is like poker. I'm calling your hand.


----------



## ace2000

Passepartout said:


> So what exactly is your hoped-for outcome? This is like poker. I'm calling your hand.



I hope the current plan works, but I see a tremendous amount of warning flags.  Things that really concern me.  I'd actually be more in favor of a single payer system than this mess.


----------



## Passepartout

ace2000 said:


> I'd actually be more in favor of a single payer system than this mess.



So would I. Single payer was my choice going in, but there is simply no way to get it past the bazillions of dollars going to lawmakers from the insurance industry lobby. I don't know that I'd call ACA a 'mess'. It's had it's difficulties rolling out, some self-inflicted, some cast upon it by those hoping against hope that it would just go away if they just fought hard enough and erected enough barriers (like voting for it's repeal 40some times). The rollout problems are pretty well smoothed out. People find they can just call their favorite insurance carrier or agent. No need to go online. 

But it is what it is, LAW. Signed. Challenged all the way to the Supreme Court, and upheld there. So rather than stand on the sidelines throwing obstacles up, why not work to get the largest group of uninsured people covered. The young. Those working in low paying, largely unregulated food, retail, and surprisingly, healthcare industries.

I want it to work. When I was helping my DW by doing data entry on bankruptcy forms, entering debts- most of them medical- for people whose financial lives were ruined and forced into bankruptcy over things they couldn't foresee. A mechanic who broke an arm. A home care provider who came down with pneumonia. A retail clerk who had a child with a degenerative disease that kept her family from getting any kind of care even after she healed. Not that any one of these things were all that expensive, but in each case the loss of a paycheck or insurance took down the families' finances.

There are facts and figures all over the map, but attached to all of them are people. The people are what ACA is designed to help- and to protect.

The law can be tweaked, amended, to make it more rsponsive, but first, it needs to be finally, and completely implemented. It's going to be a work in progress for some time. Probably years. All big, new programs are. But it is NOT going away.


----------



## bogey21

Ken555 said:


> Regardless of the nuances of health care currently being discussed, wouldn't we all agree that having more people with health insurance is a good thing?



Like everything else here the answer is yes, but.....

The but is will we have enough doctors and other professionals to service the increased number of insured (including Medicare and Medicaid) in a timely manner?

George


----------



## Ken555

bogey21 said:


> Like everything else here the answer is yes, but.....
> 
> 
> 
> The but is will we have enough doctors and other professionals to service the increased number of insured (including Medicare and Medicaid) in a timely manner?
> 
> 
> 
> George




Really? That's your most important concern? I've heard this being cited as a reason not to expand the number of insured, and I think that's quite absurd. Of course, those who say that have insurance. 

The medical providers will adapt, as they always have when change occurs. There may be a few rough years, but that's a small price to pay for our society to know that everyone will have health insurance. I suggest you keep your eye on the end game, which is lower costs for all and better healthcare for all...and it will take time to get there and won't be easy, but it's past time we got there. It's amazing how long we've kicked this particular can down the road, and lots of people would be just fine kicking it down another generation...


Sent from my iPad


----------



## simpsontruckdriver

America already has a SINGLE PAYER system... Medicare. An American citizen who works for 10 years (40 quarters) has paid for a Part-A (Hospitalization) from 65 years to death. Part-B pays for medical costs, and as of now, is $104.90 per month. Refusing either will get a person a Late Enrollment Penalty, unless they had compliant medical insurance.

TS


----------



## pgnewarkboy

The affordable care act establishes a marketplace of insurance providers. insurers will  determine when and if they will join the marketplace based upon profitability.  It is a business decision not a political decision. 

Pundits are paid to entertain and speak and write about things that agree with their audiences predilections. If you take all the political pundits and stacked them as high in the sky as you could you would have the worlds largest human tower of lies and nonsense- a modern day tower of Babel.

The marketplace is in its infancy. Time will tell how the exchanges under the affordable care act work out.


----------



## pgnewarkboy

Patri said:


> Your point? Do you want those people diagnosing or operating on you? If you wait long enough, the government will set the price points for those professions too.



Here is my point - most doctors are like most people. They want more money. Another point is there is no proven causality between higher doctor pay and better care and results. Some of the best doctors all over the world work for relatively little pay.  It should be clear to anyone  that the skill, ability, and dedication of any doctor or other health care professional has nothing to with how much they are paid.


----------



## Conan

Speaking of Medicare, here's how it was greeted by the Conservative wing:


> Ronald Reagan: “_f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” [1961]_


_



			George H.W. Bush: Described Medicare in 1964 as “socialized medicine.” [1964]
		
Click to expand...





			Barry Goldwater: “Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.” [1964]
		
Click to expand...





			Bob Dole: In 1996, while running for the Presidency, Dole openly bragged that he was one of 12 House members who voted against creating Medicare in 1965. “I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn’t work in 1965.” [1965]
		
Click to expand...

 http://thinkprogress.org/health/2009/07/29/170887/medicare-44/_


----------



## bogey21

Ken555 said:


> Really? That's your most important concern? .
> 
> The medical providers will adapt, as they always have when change occurs. There may be a few rough years.....



The number of Doctors is definitely a big concern for me.  My SIL just completed 5 years undergrad; 4 years Medical School; and 4 years internship.  That is 13 years total.  He is now signed up with a Medical Practice and will start in about 2 months.  Let me put it this way.  I think it is easier to add insureds than Doctors.

George


----------



## PStreet1

And there is currently, and has been for some time, a shortage of doctors who will accept new Medicare patients-- or in some cases, any Medicare patients.  Ask someone on Medicare who has moved and had to get new doctors.  Medicare pays on a low scale; doctors can't afford to have their practices overloaded with patients whose Medicare insurance won't pay to keep the doors open.

Even supplemental insurance isn't much help.  Doctors and hospitals aren't allowed to charge a Medicare patient more than 20% over the Medicare allowance, period; that 20% is what supplemental insurance pays.  Small wonder, doctors and hospitals aren't waiting with open arms to have their patient list heavily dominated by Medicare patients.  When you add that to the expected doctor shortage coming, there will probably be more than "a few rough years."


----------



## Ken555

PStreet1 said:


> When you add that to the expected doctor shortage coming, there will probably be more than "a few rough years."



So it's more than a few rough years. In the long run, nothing will change unless we force it to, since the healthcare industry ("industry") is comprised of insurance companies that have only one mandate - profit. No doubt pricing will change with availability, and there will be lots of good (and bad) individual experiences with the system (as there are now), yet I'm still positive about these changes. 

As demand increases, so will the number of doctors and medical staff trained...as with any industry. I'm sure some providers will use this as an excuse to raise rates. 

Sure, some doctors will not accept medicare and others will switch to a concierge program, but change will occur. It will be slow, and it will be difficult, but if not now when?


----------



## Conan

Sick. "Some Plans Refuse to Cover Medical Costs Related To Suicide Despite Federal Rules"
http://www.kaiserhealthnews.org/Sto...o-Cover-Medical-Costs-Related-To-Suicide.aspx


----------



## ace2000

Ken555 said:


> As demand increases, so will the number of doctors and medical staff trained...as with any industry.



Just what this thread needs, more opinions based on zero facts.  

If you knew anything about the "number" of doctors in our current health care system, you'd not be making such a ridiculous statement.  And it is definitely not like "any industry".


----------



## ace2000

Ken555 said:


> So it's more than a few rough years. In the long run, nothing will change unless we force it to, since the healthcare industry ("industry") is comprised of insurance companies that have only one mandate - profit.



The healthcare industry is made up of far more than the insurance companies.  They are not the only problem that needs to be solved.


----------



## Kal

ace2000 said:


> The healthcare industry is made up of far more than the insurance companies. They are not the only problem that needs to be solved.


 
 A 2-hour visit to the ER will run about $2500-$3000.  Look at all the folks using the ER as a "doc-in-the-box" when there is no payment by anyone.  Guess who ultimately pays!  (hint - it's not the insurance companies)


----------



## MuranoJo

Kal said:


> A 2-hour visit to the ER will run about $2500-$3000.  Look at all the folks using the ER as a "doc-in-the-box" when there is no payment by anyone.  *Guess who ultimately pays*!  (hint - it's not the insurance companies)



Exactly.  Not an efficient use of the medical system and taxpayers end up footing the bill.


----------



## Ken555

ace2000 said:


> Just what this thread needs, more opinions based on zero facts.
> 
> If you knew anything about the "number" of doctors in our current health care system, you'd not be making such a ridiculous statement.  And it is definitely not like "any industry".




Don't hold back, tell us what you really think. My main point has been that trying to connect healthcare for all vs ability for the industry to supply is simply absurd. There are a number of challenges, as has been said repeatedly, yet none justify reversing the clock on this program. Go ahead and show your anger at my statements but it won't change that the industry must change over time, as it's done in the past.


Sent from my iPad


----------



## Ken555

ace2000 said:


> The healthcare industry is made up of far more than the insurance companies.  They are not the only problem that needs to be solved.




Obviously. 


Sent from my iPad


----------



## Ken555

ace2000 said:


> Just what this thread needs, more opinions based on zero facts.
> 
> If you knew anything about the "number" of doctors in our current health care system, you'd not be making such a ridiculous statement.  And it is definitely not like "any industry".




One minute googling and...

http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf



> Delivery of Care: Increased Access to Health Services
> Today, approximately 1,200 health centers operate nearly 9,000 service delivery sites that provide care to more than 21 million patients in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.
> Overall, since the beginning of 2009, health centers have increased the total number of patients served on an annual basis by 4 million people, increasing the number of patients served from 17.1 million to 21.1 million annually. During this time, health centers have also added more than 35,000 new full‐time positions, increasing their employment from 113,000 to more than 148,000 staff nationwide




Sent from my iPad


----------



## ace2000

Ken555 said:


> As demand increases, so will the number of doctors and medical staff trained...as with any industry.





Ken555 said:


> One minute googling and...
> 
> http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf



You need to spend a few more minutes on your research then.  

Doctors control the number of doctors, and that is not "as with any industry" as you've stated above.  It's probably best that you state facts rather than just randomly talking about something you know nothing about.


----------



## Ron98GT

ace2000 said:


> You need to spend a few more minutes on your research then.
> 
> Doctors control the number of doctors, and that is not "as with any industry" as you've stated above.  It's probably best that you state facts rather than just randomly talking about something you know nothing about.


Sounds like someone else needs to state facts and not randomly talk.  Where is the research to back-up that statement and how it applies to a growing industry.

Medical schools are packed with people waiting to get in.  You want more doctors, build more medical schools (addressed in Ken's reference). In the mean time, PA's and RN's help to pick-up the slack where possible.

With the ACA, more people will have access to health care, which will make it an increasingly growing industry.

I liked Ken's reference:

http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf

Thanks for posting it.


----------



## bogey21

PStreet1 said:


> And there is currently, and has been for some time, a shortage of doctors who will accept new Medicare patients-- or in some cases, any Medicare patients.  Ask someone on Medicare who has moved and had to get new doctors.



I recently ran into this.  My Primary Care Physician retired and I needed a new one.  I went into the area around a large hospital in Fort Worth and started knocking on doors, practices with multiple Doctors.  I struck out at the first 3 or 4 then found one who would take a new Medicare patient.  In truth it wasn't all that hard but the writing is on the wall.

George


----------



## Ron98GT

bogey21 said:


> I recently ran into this.  My Primary Care Physician retired and I needed a new one.  I went into the area around a large hospital in Fort Worth and started knocking on doors, practices with multiple Doctors.  I struck out at the first 3 or 4 then found one who would take a new Medicare patient.  In truth it wasn't all that hard but the writing is on the wall.
> 
> George


We live in Las Vegas, NV.  We brought my mother (age 82) out here from Chicago a few years back.  We've never had any problems finding doctors that will accept Medicare, and a number stated that they prefer working with Medicare instead of fighting with insurance companies.  But then it seems like we have more hospitals and doctors offices here than 7-11's and gas stations.


----------



## Passepartout

bogey21 said:


> I recently ran into this.  My Primary Care Physician retired and I needed a new one.  I went into the area around a large hospital in Fort Worth and started knocking on doors, practices with multiple Doctors.  I struck out at the first 3 or 4 then found one who would take a new Medicare patient.  In truth it wasn't all that hard but the writing is on the wall.
> 
> George



Going door-to-door? That seems kind of 19th century to me. I'm assuming you have a Medicare supplement- why not just check the providers listed with them and make a few calls? Or asking your now retired-former PCP whom s/he suggests to take over your care? I'd think that person would have a good idea what health challenges you have and what area physicians best qualified to give you care.

Glad you found a new PCP anyway. One feels a little vulnerable to not have your regular doc listed in your phone's directory.


----------



## Ken555

ace2000 said:


> You need to spend a few more minutes on your research then.
> 
> Doctors control the number of doctors, and that is not "as with any industry" as you've stated above.  It's probably best that you state facts rather than just randomly talking about something you know nothing about.




Ace, I may be wrong, but the limited amount of time I care to spend on this makes me encouraged that the future will be significantly more appealing in regards to healthcare in our nation, especially in terms of availability and lowering of cost of healthcare as a percentage of GDP, as compared to the last several decades. Rather than simply state that I'm wrong without any facts or references, claim that I "know nothing", and infer that the government document I posted has no bearing on this topic (which directly refutes your position that medical personnel cannot grow to meet demand while it seems over the last five years there has been a huge increase as a percentage of total staff) how about you post some relevant links instead?


Sent from my iPad


----------



## ace2000

Ron98GT said:


> I liked Ken's reference:
> 
> http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf



I'm sure you did like it - not sure what it proves though.  All it states is that the number of doctors has increased over time, which is logical.

If you'd like to know how the AMA and other state groups are controlling and containing the number of doctors in the marketplace, read this.

http://reason.com/archives/2009/08/27/the-evil-mongering-of-the-amer

_But the entities that will be most injurious to the nation's health are not so much in the evil-mongers' group but the first group, including the American Medical Association—a doctors' cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century._

_But that's not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors. The AMA convinced lawmakers to shut down "deficient" medical schools, drastically paring back the supply of doctors almost 30 percent over 30 years. Few new medical schools have been allowed to open since the 1980s.

Still, the AMA along with other industry organizations until recently had issued dire warnings of an impending physician "glut" (whatever that means beyond depressing member wages), even convincing Congress to limit the number of residencies it funds to about 100,000 a year. This imposes a de facto cap on new doctors every year given that without completing their residencies from accredited medical schools, physicians cannot obtain a license to legally practice medicine in the U.S. Even foreign doctors with years of experience in their home countries have to redo their residencies—along with taking a slew of exams—before they are allowed to practice here._


----------



## geekette

so the answer is substandard doctors or letting overseas docs set up shop here without the credentialing the US docs had to go thru?  I don't think so.  I'd rather have fewer good docs than a glut of bad ones.  But, George Carlin had it right - by process of elimination, someone has The Worst Doctor.

fwiw I don't believe there will be (or is) a doctor shortage.  This is not the same as docs in practice that won't accept Medicare.  That is a different issue.


----------



## vacationhopeful

geekette said:


> so the answer is substandard doctors or letting overseas docs set up shop here without the credentialing the US docs had to go thru?  I don't think so.  I'd rather have fewer good docs than a glut of bad ones.  But, George Carlin had it right - by process of elimination, someone has The Worst Doctor.
> 
> fwiw I don't believe there will be (or is) a doctor shortage.  This is not the same as docs in practice that won't accept Medicare.  That is a different issue.



Actually, most of us will be seeing NP or PA and other subsets of the medical establishment verses a DO or MD. I know my family practice has a 1 to 1 ratio -- and most of the time, 5-10 day wait to see a medical doctor; a day or less for the NP.


----------



## Ron98GT

ace2000 said:


> If you'd like to know how the AMA and other state groups are controlling and containing the number of doctors in the marketplace, read this.
> 
> http://reason.com/archives/2009/08/27/the-evil-mongering-of-the-amer



Nothing like an unbiased (political) article/rant to acquire the facts regarding healthcare. :hysterical:

The author works for a right-wing think-tank and writes for Forbes, give me a break.


----------



## ace2000

Ron98GT said:


> Nothing like an unbiased (political) article/rant to acquire the facts regarding healthcare.
> 
> The author works for a right-wing think-tank and writes for Forbes, give me a break.



Sure.  Tell us all what you disagree with, or what is not factual then...  we'll be anxiously waiting for your expert reply.  :hysterical:


----------



## bogey21

Passepartout said:


> Going door-to-door? That seems kind of 19th century to me.



I'm getting old, don't know how much longer I will be driving, and wanted a Doctor near where I live which happens to be near a major hospital.  I stuck with my now retired Doctor even though he was over 30 miles away.  Now when I give up driving, getting to the Doctor (or Hospital) will be a 5 minute cab ride.

George


----------



## geekette

vacationhopeful said:


> Actually, most of us will be seeing NP and other subsets of the medical establishment verses a DO or MD. I know my family practice has a 1 to 1 ratio -- and most of the time, 5-10 day wait to see a medical doctor; a day or less for the NP.



My doctor brought in a PA about a decade ago.  Depends on your issue as to which you see (I think, based on my experience).  PA will pass a patient to doc as needed (or requested by doctor, a situation I have had, PA told me she was to screen me and send me on, regardless of findings).  While I have seen the PA here and there, I usually see the doctor. Not sure if it's because I've been with him 20 years and rarely there so they take my complaints of ailment more seriously???  

Nothing has changed in all these years - they maintain some "urgent" appts each day, there is no "days of waiting".  Which would make you think everyone stacks up in the waiting room, but they don't.  Still no more than 15 minutes wait except the time or 2 I was advised there was an emergency.  

Every practice is different.  I am lucky to have found a good fit for me that remains so 20 years later.


----------



## vacationhopeful

geekette said:


> My doctor brought in a PA about a decade ago.  Depends on your issue as to which you see (I think, based on my experience).  PA will pass a patient to doc as needed (or requested by doctor, a situation I have had, PA told me she was to screen me and send me on, regardless of findings).  While I have seen the PA here and there, I usually see the doctor. Not sure if it's because I've been with him 20 years and rarely there so they take my complaints of ailment more seriously???
> 
> Nothing has changed in all these years - they maintain some "urgent" appts each day, there is no "days of waiting".  Which would make you think everyone stacks up in the waiting room, but they don't.  Still no more than 15 minutes wait except the time or 2 I was advised there was an emergency.
> 
> Every practice is different.  I am lucky to have found a good fit for me that remains so 20 years later.



I agree with the are some "urgent" appointments at my Family Practice. But the schedule had changed GREATLY in the last 18-24 months. There is NEVER more than 1 MD in the office now - 2 or 3 NP/PA. My doctor who worked 40-50 hours per week was forced into retirement (he was 84, but I credit him with 3 years of every 90 day appointments and detail record keeping got me my Longterm Care policy) --- weight loss, 2X yearly lab work, blood pressure readings --- every visit they were recorded. I have not, in the last 18 months, seen the same WHOEVER twice.


----------



## Ken555

ace2000 said:


> I'm sure you did like it - not sure what it proves though.  All it states is that the number of doctors has increased over time, which is logical.




Yet isn't increasing the number of medical staff the main objection you raised earlier when I postulated that the healthcare industry would grow to meet demand? 


Sent from my iPad


----------



## Conan

Arkansas State Rep. Nate Bell (R)


> *Arkansas Lawmaker Admits He Just Wants Fewer Uninsured People to Sign Up For Health Care
> *"We’re trying to create a barrier to enrollment,” Bell explained, noting that lower enrollment ultimately translates to lower costs. “In general, as a conservative, if I have the opportunity to reduce government spending in a program from what’s projected… I’m probably going to take that deal.”
> http://thinkprogress.org/health/2014/02/18/3303871/arkansas-lawmaker-medicaid/#


----------



## Passepartout

Trying to reason with or get straight answers from [some TUGgers] is like playing Whack-a-Mole. You make a comment, answer an argument and another one pops up from a different angle. When asked what their motive is, the reply was "I want single payer"- which simply would not pass under current leadership. Then the argument is that there are not enough doctors. When presented with evidence that medical schools are ramping up medical training to qualify more clinicians, the argument is there are too many doc's.

There is no winning, and even when more people are getting insurance every day, some folks cannot be convinced that it's a good thing. Sheesh!

On an aside, the headline of our local fish-wrapper today was that Idaho is #2 in the nation (per capita) for 'Obamacare' sign-ups. They are on track to make the goal set before the start of sign-ups. Some 33,000 enrolled with a goal of 35,000. An additional 26,000 have completed applications but have not sent in the premium and officially enrolled. If they finish the enrollment by March 15, coverage will start April, 1.


----------



## ace2000

Passepartout said:


> Trying to reason with or get straight answers from [some TUGgers] is like playing Whack-a-Mole.



It's even harder when you have some that play loosely with the facts or post untruths.  But, hey it's all for a good cause, right?  All I've done is called you out on several of your misstatements on this thread.  I must have a motive, right?  I'm sure you don't like it, but try to back up your opinions with facts.  Because in the end, it really doesn't matter what you or I think.


----------



## ace2000

Ken555 said:


> Yet isn't increasing the number of medical staff the main objection you raised earlier when I postulated that the healthcare industry would grow to meet demand?



Where did I ever say that medical staff has not increased?  Please share with us.  

You stated that the numbers would grow with "supply and demand, just like any other industry".  And I informed you with the AMA and the government controlling the seats at the schools, it is not just like all the other industries. 

By maintaining a shortage of doctors, the medical profession protects job stability, job availability, and salaries.  Please inform us of "all the other industries" that can get away with that?


----------



## bogey21

Passepartout said:


> On an aside, the headline of our local fish-wrapper today was that Idaho is #2 in the nation (per capita) for 'Obamacare' sign-ups. They are on track to make the goal set before the start of sign-ups. Some 33,000 enrolled with a goal of 35,000. An additional 26,000 have completed applications but have not sent in the premium and officially enrolled. If they finish the enrollment by March 15, coverage will start April, 1.



Shows it can be done.  Then there is Oregon.  Last I saw, zero sign-ups.  I guess it depends on the competency of State elected officials.

George


----------



## Kal

ace2000 said:


> .... And I informed you with the AMA and the government controlling the seats at the schools, it is not just like all the other industries.
> 
> By maintaining a shortage of doctors, the medical profession protects job stability, job availability, and salaries....



Ahhhh, now we have another *conspiracy*. Haven't had a good one for almost 24 hours.


----------



## ace2000

Kal said:


> Ahhhh, now we have another *conspiracy*. Haven't had a good one for almost 24 hours.



What's the conspiracy?  The medical profession and the government (through financial aid) controls the amount of doctors that get accepted into medical school.  Do you have a hard time dealing with reality?  There's probably doctors that can help you.


----------



## simpsontruckdriver

One thing about most MEDICARE plans is, they offer "routine transportation". What that means is, if you can't drive to your doctor, they will provide a ride (usually a certain number per year). If your Plan does not offer it, plan on finding one that does when you qualify to change.

TS


----------



## Ken555

ace2000 said:


> You stated that the numbers would grow with "supply and demand, just like any other industry".  And I informed you with the AMA and the government controlling the seats at the schools, it is not just like all the other industries.
> 
> By maintaining a shortage of doctors, the medical profession protects job stability, job availability, and salaries.



I think you have focused on an issue with some validity, yet haven't backed your claim appropriately. Unfortunately, a quick search results in differing opinions about this issue. However, I'll take the point of your post seriously as a concern that the medical community is unable to grow to meet the anticipated demand the ACA will create when many more people have health insurance.

References for consideration:

US Bureau of Labor Statistics
http://www.bls.gov/web/empsit/ceshighlights.pdf
updated February 7, 2014 for January 2014

This government report of "Current Employment Statistics Highlights" states:



> Within health care, ambulatory health care services was the major driver of employment growth in 2013, adding an average of 15,000 jobs per month, in line with the prior year’s trend. Employment growth in hospitals and nursing and residential care facilities has slowed. Hospitals showed little net change in 2013, compared to 4,000 jobs added per month in 2012. Nursing and residential care facilities added an average of 2,000 jobs per month in 2013, compared to 4,000 per month in 2012.



The Harvard Business Review, in September 2013, wrote an article titled "The Downside of Health Care Job Growth" and which contains these comments:



> [...]the individual mandate, subsidized coverage, and Medicaid expansion in the Affordable Care Act (ACA), along with an aging population, will drive up the demand for health care.





> Using data from the Bureau of Labor Statistics (BLS) and the American Medical Association, my colleagues and I found that from 1990 to 2012, the number of workers in the U.S. health system grew by nearly 75%. Nearly 95% of this growth was in non-doctor workers, and the ratio of doctors to non-doctor workers shifted from 1:14 to 1:16.





> Demand and supply are not growing in tandem: from 2002 to 2012, inpatient days per capita decreased by 12% while the workforce in hospitals grew by 11%. This misalignment underlies some of the productivity decline we have observed in health care. Fortunately, we anticipate demand for health care to grow in 2014, so to the extent that jobs are not added, productivity gains are possible. Unfortunately, health care as an industry continues hiring far faster than demand is growing, adding 119,000 new workers in the first half of 2013, for example, with little increase in patient volume.





> [...]workers in the health system will need to worry about their wages as more jobs are added — unless care and costs are substantially reengineered in the systems in which they work. Health care practitioners should take pride in delivering consistent and excellent clinical outcomes with fewer labor hours and lower total costs, just as leaders have in other industries.



According to this article, which I encourage everyone to read in full (it's not long), there are efficiency issues to address and related items which directly affect overall quality of care. But, there's no concern about a lack of medical staff - in fact, the opposite, since the demand and supply are not "growing in tandem", though that is expected to adjust in 2014.

Once again, I ask that you post supporting documents to your belief that the AMA is artificially constraining the growth of the medical field so that the healthcare industry will be unable to adequately meet the demand. The Harvard Business Review seems not to mention this as an area of concern.

Convince me with facts. I'm willing to change my view on this topic if presented with a compelling argument, but you haven't even begun to do so. You're simply said "_ know nothing", yet you haven't proved that you know more - please do so.

http://blogs.hbr.org/2013/09/the-downside-of-health-care-job-growth/_


----------



## ace2000

Ken555 said:


> Convince me with facts. I'm willing to change my view on this topic if presented with a compelling argument, but you haven't even begun to do so.



Deal.  

Here's a link to a Forbes article and I pull out a couple of quotes (I quoted some of this earlier also):

http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html

But the entities that will be most injurious to the nation’s health are not so much in the evil-mongers’ group but the first group, *including the American Medical Association–a doctors’ cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. Instead of “palling up” with it, President Obama should do everything in his power to break its choke-hold and bring physician salaries–among the biggest drivers of health care costs–back down to Earth.*

But that’s not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors. The AMA convinced lawmakers to shut down “deficient” medical schools, drastically paring back the supply of doctors almost 30% over 30 years. No new medical schools have been allowed to open since the 1980s.

Doctors–and many Republicans–constantly carp about the costs of “defensive medicine” because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits. But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does. “While the U.S. malpractice system is extraordinary,” the study notes, “it is only a small contributor to the higher cost of health care in the United States.” Meanwhile, other studies have found that doctors’ salaries contribute more to soaring medical costs than the $40 billion or so that the uninsured cost in uncompensated care–the president’s bete noir.


----------



## Passepartout

Far be it for me to cast dispersions on so august a body as Forbes Magazine and it's writer/blogger,
*Shikha Dalmia*.

Her qualifications follow, as well as a request to be 'followed'

_Shikha Dalmia is a senior analyst at Reason Foundation and winner of the inaugural Bastiat Prize for Online Journalism. She served on the editorial board of the Detroit News for nearly a decade. She is a frequent contributor to Reason magazine and The Wall Street Journal as well as many other publications such as the Los Angeles Times, Chicago Tribune, Weekly Standard and LiveMint, India. She lives near Detroit and writes about a host of issues ranging from the auto industry and the economy to environmentalism and health care.
_
I'm sure that when I want an 'expert' opinion about the auto industry or the economy or for that matter, health care, she's just who I will NOT choose over the Bureau of Labor Statistics and The Harvard Business Review.

Good try, Ace, but this one lacks cred.


----------



## ace2000

Passepartout said:


> Good try, Ace, but this one lacks cred.



Just so we all understand, which part are you saying is not true?


----------



## Conan

*A hard-hitting anti-Obamacare ad makes a claim that doesn’t add up
*http://www.washingtonpost.com/blogs...bamacare-ad-makes-a-claim-that-doesnt-add-up/


----------



## Passepartout

ace2000 said:


> Just so we all understand, which part are you saying is not true?



Let's just say I disagree with this blogger. She is entitled to her opinion, but frankly,  her credentials don't stand up when compared to those of The Harvard Business Business Review and the Bureau of Labor Statistics.

That you chose to quote her opinion shows that you are grasping for unqualified sources to support your tenuous points shows how desperate you are. Here's one example of her unrealistic diatribe:  "Instead of “palling up” with it, President Obama should do everything in his power to break its choke-hold and bring physician salaries–among the biggest drivers of health care costs–back down to Earth." The President of The United States may do lots of things, but setting wages of ANY segment of the country's labor isn't among 'em. Get REAL!

Hell, I can find bloggers who will provide any number of 'proofs' that the earth is flat. And I see you've found some to support your 'flat earth' theory, too.


----------



## Passepartout

*I can see that I've been lured off the track....*

and I took the  bait and become embroiled in stuff that has little to nothing to do with implementation of ACA and supporting those who previously didn't have health insurance. 

Unless there is something that I feel I can add to the discussion rather than just rebutting silly, side issues tangential to the law itself, I am removing myself from this discussion.

The law works. It isn't perfect, but as it is it's thousands of percent better than what existed before it. The law can be modified to be more attractive to younger people, that's the key to it's long term success.

Carry on.

Jim


----------



## ace2000

Passepartout said:


> Here's one example of her unrealistic diatribe: "Instead of “palling up” with it, President Obama should do everything in his power to break its choke-hold and bring physician salaries–among the biggest drivers of health care costs–back down to Earth." The President of The United States may do lots of things, but setting wages of ANY segment of the country's labor isn't among 'em. Get REAL!


 
You've provided zero references to any of the points you've made in this thread and you've been proven wrong several times with the facts.    

Since this is the only real point you've made, I'll address it.  The government controls the cards on the number of doctors.  If they allow for more doctors then the salaries go down.

Here's a link for more reading.   Not the Harvard Business Review or the Bureau of Labor Statistics, sorry.

http://www.slate.com/articles/news_and_politics/explainer/2011/06/we_need_more_doctors_stat.html


----------



## ace2000

Passepartout said:


> The law works. It isn't perfect, but as it is it's thousands of percent better than what existed before it. The law can be modified to be more attractive to younger people, that's the key to it's long term success.
> 
> Carry on.
> 
> Jim


 
You've repeatedly told us over and over again that you are in favor of the new law. I'm sure you'll be back again to tell us the same thing, I have no doubt about it.


----------



## Passepartout

ace2000 said:


> *I hope the current plan works,* but I see a tremendous amount of warning flags.  Things that really concern me.  I'd actually be more in favor of a single payer system than this mess.



By your own admission, you are in favor of it too. But a single payer system (Medicare for all) is not gonna happen.


----------



## momeason

A few real stories from the real people I am helping.

1. A musician who plays often at our church and works as a hotel desk clerk.

She told me she had been feeling rather down on herself...thinking she is one of them..you know the 47%. She works hard, pays her bills but she is barely getting by and has not had insurance or been to a doctor in a couple of years.
She still felt like she might be looked down upon. I told her that her subscriber card would be just like everyone else's. No doctor or billing clerk will know whether she pays full price or $20 for her plan. The clients I am helping
are sales clerks, hair stylists, barbers, farmers, tax preparers, day care providers, restaurant employees,etc. These are hard working people, contributing members of society and now they will have full access to the healthcare system and they all have my number to help them.

2. A mother I helped today has a heartbreaking story. I am so pleased I could help her and her husband and 2 kids get covered. She was very recently diagnosed with polycystic kidney decease and a liver problem. She will probably need a transplant in the long term. She also has a liver problem. She is going
to Duke soon. She had a junk policy with Assurance Health and has $80,000 in medical bills from her recent testing. On April 1, she will have great coverage to see almost any doctor she wants...96% of doctors across the country are in her new plan. If she had this plan before the recent testing she would not have spent but $700 for this entire year. Her family qualifies for cost sharing, aka enhanced benefits, so her out of pocket maximum is only $700. With the new law, no individual, will ever be out more than $6350 out of pocket in any year. Also, there are no lifetime limits anymore and no pre-existing condition waiting periods or denials. My client will need ALL of these new protections. She was referred to me by another one of my clients.

My job is so rewarding. I just wish I could help more.


----------



## pjrose

momeason said:


> A few real stories from the real people I am helping.
> 
> 1. A musician who plays often at our church and works as a hotel desk clerk.
> 
> She told me she had been feeling rather down on herself...thinking she is one of them..you know the 47%. She works hard, pays her bills but she is barely getting by and has not had insurance or been to a doctor in a couple of years.
> She still felt like she might be looked down upon. I told her that her subscriber card would be just like everyone else's. No doctor or billing clerk will know whether she pays full price or $20 for her plan. The clients I am helping
> are sales clerks, hair stylists, barbers, farmers, tax preparers, day care providers, restaurant employees,etc. These are hard working people, contributing members of society and now they will have full access to the healthcare system and they all have my number to help them.
> 
> 2. A mother I helped today has a heartbreaking story. I am so pleased I could help her and her husband and 2 kids get covered. She was very recently diagnosed with polycystic kidney decease and a liver problem. She will probably need a transplant in the long term. She also has a liver problem. She is going
> to Duke soon. She had a junk policy with Assurance Health and has $80,000 in medical bills from her recent testing. On April 1, she will have great coverage to see almost any doctor she wants...96% of doctors across the country are in her new plan. If she had this plan before the recent testing she would not have spent but $700 for this entire year. Her family qualifies for cost sharing, aka enhanced benefits, so her out of pocket maximum is only $700. With the new law, no individual, will ever be out more than $6350 out of pocket in any year. Also, there are no lifetime limits anymore and no pre-existing condition waiting periods or denials. My client will need ALL of these new protections. She was referred to me by another one of my clients.
> 
> My job is so rewarding. I just wish I could help more.



Plus many thumbs up.

I'm sure you said earlier in this long thread, but I missed it....what is your job?  Do you work under the ACA in an advisor/counselor sort of position?


----------



## momeason

pjrose said:


> Plus many thumbs up.
> 
> I'm sure you said earlier in this long thread, but I missed it....what is your job?  Do you work under the ACA in an advisor/counselor sort of position?



I became a licensed insurance agent in December so I could work for an initiative that seeks out and helps individuals navigate throughout the ACA. i also did extensive training and was certified by the Federal government to advise and sell on the Federal Marketplace. I was volunteering to encourage individuals to sign up but I found people needed more help than I was qualified to give. This initiative asked me if I wanted to join them. I had to think for a week when I found out how much training was involved and the low pay, but I realized I was being led to do this. The team members do group education and enrollment sessions. We follow through the entire process, making sure additional documentation is sent in when necessary....we collect it and send it in. 
I go further than any of my other team members. I go out in to the surrounding community and talk to individuals and explain what the ACA can do for them personally. I make multiple trips and calls to individuals and to Barber Shops, salons, stores, etc. I explain how to use the plan and give everyone my home and cell numbers. I recommend good doctors and urgent care centers and tell them they can call me when they need assistance figuring out their new insurance.
I became an agent so I could do all of it, collect the payments and answer all questions. Many will not use their plans without someone to explain it to them.
I am not trying to get a commission and be done with it. I seek to improve their situation as much as I can. The little pay I receive goes for gas for my car so I can keep taking my knowledge to the people who need it.


----------



## heathpack

momeason said:


> I became a licensed insurance agent in December so I could work for an initiative that seeks out and helps individuals navigate throughout the ACA. i also did extensive training and was certified by the Federal government to advise and sell on the Federal Marketplace. I was volunteering to encourage individuals to sign up but I found people needed more help than I was qualified to give. This initiative asked me if I wanted to join them. I had to think for a week when I found out how much training was involved and the low pay, but I realized I was being led to do this. The team members do group education and enrollment sessions. We follow through the entire process, making sure additional documentation is sent in when necessary....we collect it and send it in.
> I go further than any of my other team members. I go out in to the surrounding community and talk to individuals and explain what the ACA can do for them personally. I make multiple trips and calls to individuals and to Barber Shops, salons, stores, etc. I explain how to use the plan and give everyone my home and cell numbers. I recommend good doctors and urgent care centers and tell them they can call me when they need assistance figuring out their new insurance.
> I became an agent so I could do all of it, collect the payments and answer all questions. Many will not use their plans without someone to explain it to them.
> I am not trying to get a commission and be done with it. I seek to improve their situation as much as I can. The little pay I receive goes for gas for my car so I can keep taking my knowledge to the people who need it.



Momeason, you are my hero today!  It's so nice to hear about someone doing good for society, helping people out.  I am very impressed & glad to "know" you.



H


----------



## Kal

heathpack said:


> Momeason, you are my hero today! It's so nice to hear about someone doing good for society, helping people out. I am very impressed & glad to "know" you.
> 
> 
> 
> H


 
 Just think how terrible it would be WITHOUT the ACA! And then there are the knuckle draggers who want to kill it.


----------



## geekette

Kal said:


> Just think how terrible it would be WITHOUT the ACA! And then there are the knuckle draggers who want to kill it.



anyone with a chronic illness or previous expensive problem hitting lifetime max at a young age already knows how terrible it was.


----------



## bogey21

momeason said:


> She had a junk policy with Assurance Health and has $80,000 in medical bills from her recent testing. On April 1, she will have great coverage to see almost any doctor she wants...96% of doctors across the country are in her new plan. If she had this plan before the recent testing she would not have spent but $700 for this entire year. Her family qualifies for cost sharing, aka enhanced benefits, so her out of pocket maximum is only $700. With the new law, no individual, will ever be out more than $6350 out of pocket in any year. Also, there are no lifetime limits anymore and no pre-existing condition waiting periods or denials. My client will need ALL of these new protections. She was referred to me by another one of my clients.



Don't get me wrong.  I think this is great for this individual.  What I wonder is will there be enough other individuals buying insurance (and not using it) to cover this individuals expenses?  If not, who pays?  The Government?

George


----------



## geekette

bogey21 said:


> Don't get me wrong.  I think this is great for this individual.  What I wonder is will there be enough other individuals buying insurance (and not using it) to cover this individuals expenses?  If not, who pays?  The Government?
> 
> George


There have always been a bunch of us that are insured that only go to the doctor when we are sick.  Even with preventive care onboard, I go when I am sick and otherwise don't always make time for 'checkups' as I'm not even clear on what that means.


----------



## geekette

bogey21 said:


> Don't get me wrong.  I think this is great for this individual.  What I wonder is will there be enough other individuals buying insurance (and not using it) to cover this individuals expenses?  If not, who pays?  The Government?
> 
> George



Also, I could be way wrong on this, but the insurance company is supposed to deploy our premiums to handle this care and now have to use more of our premium towards our actual care than they had to previously.  Once someone hits the annual max, the insurer pays it, not the govt, not the patient.  

I have never hit my annual max so insurer has never had to 'float me' and as the guarantor, there is no one but me to extract extra monies from.  If I become a dry well, then I file bankruptcy and insurer and providers are stuck.  So far as I know, they don't get to go to the govt to be made whole, they are in the business of taking premiums in exchange for covering eventualities.  Quite like auto or home insurance, they take the risk so we don't have to.  

I do not know if health insurers generally go the reinsurance route and my guess is no because they always had the lifetime cap, no one person could make such a run on the bank to send the insurer to financial ruin.  That could only ever happen to the patient.  And then once hitting lifetime max, patient is unable to get any care at all or pay exorbitant rates to be insured.  that's ruined 2 ways for those counting.


----------



## pjrose

heathpack said:


> Momeason, you are my hero today!  It's so nice to hear about someone doing good for society, helping people out.  I am very impressed & glad to "know" you.
> 
> 
> 
> H





Kal said:


> Just think how terrible it would be WITHOUT the ACA! And then there are the knuckle draggers who want to kill it.





geekette said:


> anyone with a chronic illness or previous expensive problem hitting lifetime max at a young age already knows how terrible it was.



Thumbs up to all.  I'm thinking of DD's "frequent flier" status in the ERs with fainting, concussions, and seizure-like activity....when you know the ambulance and ER personnel on a first name basis - multiple ambulance companies and multiple ERs....well, with all that, I'll bet she would now be uninsured.  

Instead she is a) on our plan for four more years till she hits age 26, b) no more lifetime cap so they can't stop covering her, c) when she hits 26 and/or gets a job with coverage, she can't be turned down, and d) if she and/or her DH go to the exchange, their income is relatively low so the rates aren't bad.  

And now her micro-preemie DS spent ~78 days in the NICU for hundreds of thousands, has already had three surgeries including one neurosurgery which must have cost a ton but we never saw a bill, two "cranial remolding" helmets which would have cost $3K apiece, and he's only ten months old.  He's covered.  (And he's doing well - some delays, but nothing permanent that we know of.)

Do those who don't like the ACA expect people to go bankrupt if they  happen to develop a major condition or have a preemie with birth defects?


----------



## SmithOp

bogey21 said:


> Don't get me wrong.  I think this is great for this individual.  What I wonder is will there be enough other individuals buying insurance (and not using it) to cover this individuals expenses?  If not, who pays?  The Government?
> 
> George



Everyone pays one way or another, either you have coverage or you pay the penalty tax next year when you file 2014 taxes, that's how it's being enforced.


----------



## pjrose

SmithOp said:


> Everyone pays one way or another, either you have coverage or you pay the penalty tax next year when you file 2014 taxes, that's how it's being enforced.



And if people choose the penalty over coverage, we all pay when the insurance and medical costs go up when/if they have serious accidents, serious illnesses, etc, and incur more costs than they can handle.


----------



## Kal

SmithOp said:


> Everyone pays one way or another, either you have coverage or you pay the penalty tax next year when you file 2014 taxes, that's how it's being enforced.


 
 Remember, a visit to the ER does not mean endless continuing coverage for a specific issue.  They get you on your feet and send you out the door.  A subsequent need for hospital repairs would be up to the hospital to accept that patient.

 Just because a person claims they can't pay, doesn't mean they don't get a bill.  Then they will have to deal with credit rating and bankruptcy.  "Free ER medical care" has continuing issues for the patient.  A smart person may eventually realize there is a Major cost difference between ER prices and "doc-in-the-box" prices.  There will be a learning period which will bend the curve for the number of uninsured people under the ACA.


----------



## ace2000

pjrose said:


> And if people choose the penalty over coverage, we all pay when the insurance and medical costs go up when/if they have serious accidents, serious illnesses, etc, and incur more costs than they can handle.


 
This year, the penalties start small.  In just a few years the penalty will be a major deterrent to those bypassing the insurance.


----------



## ace2000

bogey21 said:


> Don't get me wrong. I think this is great for this individual. What I wonder is will there be enough other individuals buying insurance (and not using it) to cover this individuals expenses? If not, who pays? The Government?
> 
> George


 
The government is going to cover the initial losses to the insurance comapanies and then the insurance companies will raise their rates for everyone to cover their risk. There will be winners and losers.


----------



## geekette

ace2000 said:


> The government is going to cover the initial losses to the insurance comapanies and then the insurance companies will raise their rates for everyone to cover their risk. There will be winners and losers.



I am keenly interested in info on govt covering insurance company losses.  Please point me to a link.


----------



## ace2000

geekette said:


> I am keenly interested in info on govt covering insurance company losses.  Please point me to a link.



I'm sorry I can't quote the Harvard Business Review or the Bureau of Labor Statistics, but here's one I found quickly from the WSJ.

http://blogs.wsj.com/washwire/2014/01/22/explaining-risk-corridors-the-next-obamacare-issue/

_The idea of risk corridors is to compensate insurance companies that end up with bigger costs than they expected. Under the law, they must sell policies equally to everyone, regardless of their medical history, so it’s possible some insurers could end up with an especially unhealthy pool of customers.

If an insurer’s actual claims in 2014 are at least 3% greater than the claims projected when the insurer set 2014 rates, the government must reimburse the insurer for half of the excess. *If actual claims jump 8% beyond projected claims, the government covers 80% of the excess*._


----------



## Passepartout

ace2000 said:


> I'm sorry I can't quote the Harvard Business Review or the Bureau of Labor Statistics, but here's one I found quickly from the WSJ.
> 
> http://blogs.wsj.com/washwire/2014/01/22/explaining-risk-corridors-the-next-obamacare-issue/



I couldn't resist.  And from the same blog: "A third provision, known as risk adjustment, calls for insurers that end up with a healthier mix of participants to compensate those that end up with riskier members. *This program is permanent but is less controversial because it doesn’t call for any federal spending*".

That's called 'covering all the bases'.


----------



## ace2000

Passepartout said:


> I couldn't resist.  And from the same blog: "A third provision, known as risk adjustment, calls for insurers that end up with a healthier mix of participants to compensate those that end up with riskier members. *This program is permanent but is less controversial because it doesn’t call for any federal spending*".
> 
> That's called 'covering all the bases'.



Jim, welcome back!  Seriously.  

Are you quoting blogs now?   

Just to be clear, the program you referenced may not call for federal spending, but the provision I referenced would definitely involve federal spending, if needed.


----------



## Kal

How many of these blog "experts" and others ever properly annotate to the ACA any of their so-called facts?  If so, it would be easy to cull out all the biased fiction. 

 Just grab a copy of PUBLIC LAW 111–148 and use the Adobe pdf search function to take you straight to the area of interest.


----------



## Passepartout

ace2000 said:


> Are you quoting blogs now?



Only re-quoting yours...

All I was doing, by quoting the very same WSJ that you did was to demonstrate that with just a smidgen of judicious editing, opposite views can be shown. One showing that gov't subsidy will be called for if claims are too high, the other stating that insurers with a healthier mix of customers will share the risk pool. In other words, help pay the claims of the insurers with a less healthy clientele.


----------



## ottawasquaw

momeason said:


> Know your facts, at least 80% of the young are paying much less than $100/mo.
> More than 60% of the all the previously uninsured who choose plans on the Marketplace pay less than $100. Among young people, most pay far less than $100.
> The prices of $100-$200/month are prices before the advance tax credits for those below 30 years old.


And, if I'm not mistaken, "catastrophic only" coverage is still available to those under 30. People under 30 can sign up for a limited policy which is not available to the rest of us. Perhaps that would explain the lower premium?


----------



## ottawasquaw

vacationhopeful said:


> Actually, most of us will be seeing NP or PA and other subsets of the medical establishment verses a DO or MD. I know my family practice has a 1 to 1 ratio -- and most of the time, 5-10 day wait to see a medical doctor; a day or less for the NP.


Linda, this has been my experience, too! It's why I feel that we are paying more for less.


----------



## geekette

ace2000 said:


> ...
> Just to be clear, the program you referenced may not call for federal spending, but the provision I referenced would definitely involve federal spending,* if needed.*



and also has a run-out clause, in 2016.

Good link, thanks for providing it.


----------



## pjrose

vacationhopeful said:


> Actually, most of us will be seeing NP or PA and other subsets of the medical establishment verses a DO or MD. I know my family practice has a 1 to 1 ratio -- and most of the time, 5-10 day wait to see a medical doctor; a day or less for the NP.





ottawasquaw said:


> Linda, this has been my experience, too! It's why I feel that we are paying more for less.



Well, perhaps paying "for less", depending on the MD, DO, NP, and/or PA and his/her knowledge, experience and ability to work with patients, but "paying more"?  

Some yes, and others, no.  Young and lower income, no. Formerly uninsurable will be paying more (but not more than others), because anything is more than nothing, which is what they paid and what they were covered for.


----------



## Conan

*Maybe there are no genuine Obamacare horror stories *
 http://www.latimes.com/business/hil...tories-20140220,0,3801120.story#ixzz2u5fUw2yO
​


----------



## Ron98GT

ace2000 said:


> I'm sorry I can't quote the Harvard Business Review or the Bureau of Labor Statistics, but here's one I found quickly from the WSJ.
> 
> http://blogs.wsj.com/washwire/2014/01/22/explaining-risk-corridors-the-next-obamacare-issue/
> 
> _The idea of risk corridors is to compensate insurance companies that end up with bigger costs than they expected. Under the law, they must sell policies equally to everyone, regardless of their medical history, so it’s possible some insurers could end up with an especially unhealthy pool of customers.
> 
> If an insurer’s actual claims in 2014 are at least 3% greater than the claims projected when the insurer set 2014 rates, the government must reimburse the insurer for half of the excess. *If actual claims jump 8% beyond projected claims, the government covers 80% of the excess*._


I guess you missed this one by the (right-wing) WSJ:

http://blogs.wsj.com/washwire/2014/...-health-corridors-doesnt-change-gop-concerns/

"
The CBO estimated the government would actually collect about $8 billion rather than pay moneyto insurance companies.  Previously, it had projected no returns for the government.


And I like this:

"
The panel’s top Democrat, Rep. Elijah Cummings of Maryland, said the risk-corridor program is nearly identical to one in Republican legislation that created the Medicare prescription drug benefit. “Why in the world would you eliminate a program you invented?” he asked
"


I guess for the same reason the republicans want to eliminate the ACA, a program that they created and were for, before they were against it.


----------



## momeason

Conan said:


> *Maybe there are no genuine Obamacare horror stories *
> http://www.latimes.com/business/hil...tories-20140220,0,3801120.story#ixzz2u5fUw2yO
> ​



I will give you some genuine stories...

Some of the people I have helped this week:

A 40 year old wife and mother and her husband and 2 kids. She will be paying $99/mo for coverage for her family. She had a "junk policy" from Assurant Health Access. She was recently diagnosed with Polycystic Kidney Disease and is going to Duke soon for testing for a transplant. She also has a problem with her liver. She has $80,000 in medical bills she ran up getting the diagnosis since her "junk" policy covers almost nothing. I wish she had seen me sooner. She would not have the $80,000 in debt. I am glad I can help her prevent more. Her maximum out of pocket now will be $700 because she qualifies for cost-sharing. There will be no lifetime limits. She can live to see her children grow up and not ever rack up those kind of bills again. I am also getting her legal advice to help her with the $80,000 in bills. This is NOT MADE UP,[deleted]

A farmer/produce stand owner/landscaper who works at least 14 hours most days. He is living right at the poverty line. He makes $11,741/yr. He is getting a plan for $20 a month that will cover 94% of his medical costs. He has high blood pressure, arthritis and gout. He had no insurance.

A flower shop owner who works 50 hours a week.
Too many hair stylists and barbers,fast food workers and retail workers to list and many other self-employed.

This is the real story.


----------



## Cheryl20772

ace2000 said:


> Not going into attack mode here, and not to beat a dead horse, but how can you keep repeating this statement that your entire 16% increase would have happened with or without the law?  And then you tell everyone that any increase up to that point is all on the insurance companies?
> 
> The insurance companies are now forced under ACA to cover pre-existing conditions as well as provide coverage to dependents less than age 26.  Those are major factors for insurance costs.
> 
> Please provide some support to the claim you have chosen to repeat several times.


I think you are failing to understand what was initially reported.  Momeason said that she is keeping a policy that is not in the ACA.  It does not cover maternity and was scheduled to be dropped, but then kept.  She reported only that her insurance company told her the rate increase was normal and not induced by the ACA implementation.  Ace2000, I think you are creating an issue where there is none.  It's great that Momeason can keep the policy she wants and which saves her money.  If her policy does not include maternity, it's illustrative that not all policies will be forced to include all coverages.  If it does now have to include maternity coverage, perhaps that means her premium increase is related to the ACA requirements.  Why is that an issue for you?  Are you trying to say that Momeason's insurance company has to have lied to her?


----------



## ace2000

Cheryl20772 said:


> I think you are failing to understand what was initially reported.  Momeason said that she is keeping a policy that is not in the ACA.  It does not cover maternity and was scheduled to be dropped, but then kept.  *She reported only that her insurance company told her the rate increase was normal and not induced by the ACA implementation.*  Ace2000, I think you are creating an issue where there is none.  It's great that Momeason can keep the policy she wants and which saves her money.  If her policy does not include maternity, it's illustrative that not all policies will be forced to include all coverages.  If it does now have to include maternity coverage, perhaps that means her premium increase is related to the ACA requirements.  Why is that an issue for you?  Are you trying to say that Momeason's insurance company has to have lied to her?



I'm saying that there is no way that the current benefits of the ACA are without cost.  We are all paying for them, and yes if insurance costs are rising, that would be a factor.  Do you think the insurance companies are covering the under-26 group and the pre-existing for free?  Wouldn't you think it would be logical that is part of her 16% increase?

What probably nobody understands is that I am in favor of sharing the risk among everyone - and I support these added benefits for the population.  I just would like to see comments based on reality.


----------



## BarbS

[Political post deleted]


----------



## DeniseM

Folks - As I'm sure you KNOW, political posts are not permitted on TUG, so if you want to keep this thread open, keep politics out of it.



> Avoid posting about *politics*, religion, or contentious social issues
> Unless directly related to timesharing, such discussions are prohibited in these forums, including TUG Lounge. We've been down that road before, it was ugly, and we are not going there again.


----------



## DeniseM

Folks - I have deleted the political posts from today - there may be more, but let's get a fresh start today, OK? 

Posts about *political donations* ARE POLITICAL.  Please discuss the insurance, and not the politics, or the thread will be closed.


----------



## ScoopKona

Kal said:


> Wonder how that measures up to the knuckle draggers who want to kill the ACA?



Count me among the knuckle draggers, then. ACA is turning into a nightmare. I am not affected. But many people I know are. Their costs are going WAY up and their coverage stays the same or even retreats a bit. The self-employed seem to be the hardest hit. And that's my peer group. Just because it's no skin off my back doesn't mean I shouldn't care about what it does to the self-employed accountant with a big family to insure.

We should have implemented the single-payer system. Insurance companies are the problem (nobody should profit on human misery), and ACA doesn't go far enough to fix that. Insurance adds an unnecessary and very expensive layer to healthcare. And that's why we pay more for prescriptions, procedures, doctor visits, surgery, recovery, therapy and every other damned thing associated with medicine compared to countries which went the single-payer route -- everyone except us, basically.

The rest of the civilized world sorted this out decades ago. We're the only developed country which has not. The insurance shareholders won't be happy*. Health insurance is a big, fat tumor on the healthcare industry -- adding nothing but misery -- and should be excised, pronto.


* Which is the only reason why we're stuck with this turkey.


----------



## ace2000

ScoopLV said:


> Count me among the knuckle draggers, then. ACA is turning into a nightmare. I am not affected. But many people I know are. Their costs are going WAY up and their coverage stays the same or even retreats a bit. The self-employed seem to be the hardest hit. And that's my peer group. Just because it's no skin off my back doesn't mean I shouldn't care about what it does to the self-employed accountant with a big family to insure.



How is that possible?  Some on here would like us to believe that the ACA requirements have nothing to do with ANY of the rising rates.  And that has to be true because one individual says that their insurance representative told her that.  Are you saying they are lying to her?  :hysterical:


----------



## ace2000

ScoopLV said:


> We should have implemented the single-payer system.



Can't mention single-payer here on TUG either since that will NEVER happen (exact words).  You have this plan now and you WILL like it.  :hysterical:


----------



## geekette

ScoopLV said:


> ...Insurance companies are the problem (nobody should profit on human misery), and ACA doesn't go far enough to fix that. Insurance adds an unnecessary and very expensive layer to healthcare. And that's why we pay more for prescriptions, procedures, doctor visits, surgery, recovery, therapy and every other damned thing associated with medicine compared to countries which went the single-payer route -- everyone except us, basically.
> 
> The rest of the civilized world sorted this out decades ago. We're the only developed country which has not. The insurance shareholders won't be happy*. Health insurance is a big, fat tumor on the healthcare industry -- adding nothing but misery -- and should be excised, pronto.
> ,,,.



While I also agree that insurance companies are the problem at least inroads have been made to force them to have more skin in the game vs dance away with profits, previously denying those who would actually use the product they sell.  

It's a huge industry with a powerful lobby quite entrenched between the patients and the providers.  Not so easy to stab that beast enough to make it go away or die.

This is about insurance reform, not health care reform, and at least we've made a start.


----------



## Kal

ScoopLV said:


> Count me among the knuckle draggers, then. ACA is turning into a nightmare...
> 
> We should have implemented the single-payer system...



You may be a unique knuckle dragger in that YOU have a plan. All the others are brain dead.

Pre-ACA days, the insurance premiums were going thru the roof year after year. Now that has stopped. Furthermore, all the junk policies are being eliminated thereby providing the insured with real coverage. Small businesses might be impacted, but one must look deeper into the reasons why. It might be simply a situation where that group had an inordinate high volume of junk policies largely as a cost savings issue.

Agree, the insurance industry is the problem. We have to start somewhere and the ACA is an excellent starting point. Sure it needs to be adjusted and we need to make SMART adjustments.

People don't get rid of a brand new car just because it needs a new set of tires or an oil change. Just take action to make it better.


----------



## ace2000

Kal said:


> Pre-ACA days, the insurance premiums were going thru the roof year after year. Now that has stopped.


 
Sorry, more bad information from Kal. Can you provide a source for that statement?

http://www.forbes.com/sites/theapot...miums-by-avg-of-41-subsidies-flow-to-elderly/

One of the fundamental flaws of the Affordable Care Act is that, despite its name, it makes health insurance more expensive. Today, the Manhattan Institute released the most comprehensive analysis yet conducted of premiums under Obamacare for people who shop for coverage on their own. Here’s what we learned. *In the average state, Obamacare will increase underlying premiums by 41 percent.*


----------



## ace2000

Here's a link to the research by the Manhattan Institute (the source of the article I referenced above), including a state-by-state map to see how much rates will be rising by age group. The young get hit the hardest, and it has less impact the older you are.

http://www.manhattan-institute.org/knowyourrates/


----------



## Kal

geekette said:


> ...This is about insurance reform, not health care reform, and at least we've made a start.


 
 The ACA includes many provisions which will improve health care.  The focus on big picture approach to a patient's single health issue (including global health history documentation) will hopefully limit an endless series of costly single tests and procedures.  Will be curious how the medical profession deals with solving "my back hurts patients" at a more-or-less fixed price approach.


----------



## Kal

ace2000 said:


> Sorry, more bad information from Kal. Can you provide a source for that statement?...


 
 Ya think?  Check your insurance premiums for the five years pre-ACA.


----------



## Conan

ace2000 said:


> Here's a link to the research by the Manhattan Institute (the source of the article I referenced above), including a state-by-state map to see how much rates will be rising by age group. The young get hit the hardest, and it has less impact the older you are.
> 
> http://www.manhattan-institute.org/knowyourrates/




The Manhattan Institute received over $31 million in grants from 1985 to 2012, from foundations such as the Koch Family Foundations, the John M. Olin Foundation, the Bradley Foundation, the Scaife Foundations, and the Smith Richardson Foundation.[13] The Manhattan Institute does not disclose its corporate funding, but the Capital Research Center listed its contributors as Bristol-Myers Squibb, ExxonMobil, Chase Manhattan, Cigna, Sprint Nextel, Reliant Energy, Lincoln Financial Group Foundation, and Merrill Lynch. Throughout the 1990s the Tobacco industry was a major funding source for the institute. [14]
http://en.wikipedia.org/wiki/Manhattan_Institute_for_Policy_Research


----------



## ace2000

Conan said:


> The Manhattan Institute received over $31 million in grants from 1985 to 2012, from foundations such as the Koch Family Foundations, the John M. Olin Foundation, the Bradley Foundation, the Scaife Foundations, and the Smith Richardson Foundation.[13] The Manhattan Institute does not disclose its corporate funding, but the Capital Research Center listed its contributors as Bristol-Myers Squibb, ExxonMobil, Chase Manhattan, Cigna, Sprint Nextel, Reliant Energy, Lincoln Financial Group Foundation, and Merrill Lynch. Throughout the 1990s the Tobacco industry was a major funding source for the institute. [14]
> http://en.wikipedia.org/wiki/Manhattan_Institute_for_Policy_Research


 
Provide your study for us then that states that health care premiums will stop rising under Obamacare, as Kal states. We won't be holding our breath.


----------



## ace2000

Kal said:


> Pre-ACA days, the insurance premiums were going thru the roof year after year. *Now that has stopped.*


 


Kal said:


> Ya think? Check your insurance premiums for the five years pre-ACA.


 
Are you backing off the second part of your statement now?


----------



## bogey21

ScoopLV said:


> We should have implemented the single-payer system.....Insurance adds an unnecessary and very expensive layer to healthcare.



Maybe yes.  Maybe no.  I'm on Medicare.  It looks to me like if the Doctors, Hospitals, etc. provide an acceptable code when they submit claims, Payment Agents pay them without question.  Could it be that the Insurance Companies add a layer of discipline in the claims process?

George


----------



## ace2000

Conan said:


> The Manhattan Institute received over $31 million in grants from 1985 to 2012, from foundations such as the Koch Family Foundations, the John M. Olin Foundation, the Bradley Foundation, the Scaife Foundations, and the Smith Richardson Foundation.[13] The Manhattan Institute does not disclose its corporate funding, but the Capital Research Center listed its contributors as Bristol-Myers Squibb, ExxonMobil, Chase Manhattan, Cigna, Sprint Nextel, Reliant Energy, Lincoln Financial Group Foundation, and Merrill Lynch. Throughout the 1990s the Tobacco industry was a major funding source for the institute. [14]
> http://en.wikipedia.org/wiki/Manhattan_Institute_for_Policy_Research


 
Besides Forbes, here's a link to a CBS article that cites the same Manhattan study... Is CBS also biased? 

*Study: Insurance costs to soar under Obamacare*

http://www.cbsnews.com/news/study-insurance-costs-to-soar-under-obamacare/


----------



## ace2000

bogey21 said:


> Could it be that the Insurance Companies add a layer of discipline in the claims process?
> 
> George


 
Exactly. Insurance companies prevent the doctors and hospitals from padding their billing and they provide defined limits on what they will pay for specific procedures. 

The short attention span crowd on here wants an easy scapegoat. The real truth is that insurance companies are just one piece of the puzzle on why the health costs are soaring.


----------



## Conan

ace2000 said:


> Besides Forbes, here's a link to a CBS article that cites the same Manhattan study... Is CBS also biased?



Maybe not biased, but surely lazy. Here's some background about the quoted "expert":

*Avik Roy* is a senior fellow at the Manhattan Institute and the author of the Forbes blog _The Apothecary_.[1] He has stated he is an "outside adviser to the Romney campaign on health care issues." [2] He is a contributor to National Review Online, where he was described as a member of Mitt Romney's Health Care Policy Advisory Group and holds no college level degrees

http://en.wikipedia.org/wiki/Avik_Roy


----------



## ace2000

Conan said:


> Maybe not biased, but surely lazy. Here's some background about the quoted "expert":
> 
> *Avik Roy* is a senior fellow at the Manhattan Institute and the author of the Forbes blog _The Apothecary_.[1] He has stated he is an "outside adviser to the Romney campaign on health care issues." [2] He is a contributor to National Review Online, where he was described as a member of Mitt Romney's Health Care Policy Advisory Group and holds no college level degrees
> 
> http://en.wikipedia.org/wiki/Avik_Roy


 
Ok, so the guy is good enough for CBS and Forbes (and every other major news outlet that referenced the study), but he's not good enough for you. Everyone else can decide for themselves. Thanks though.

In the meantime, you just keep believing that your health care costs are going to go down with the ACA.


----------



## Conan

Ace, it appears you've posted to this thread 42 times in 11 days.
What more could you have to say?


----------



## ace2000

Conan said:


> Ace, it appears you've posted to this thread 42 times in 11 days.
> What more could you have to say?


 
Those 42 times just proves how badly informed so many are.  Every time I've disagreed, I've cited a reference on my behalf.  If you don't like it, provide your facts. Can you provide us a post where you've added any substance to this thread?


----------



## Conan

*Adding to Ignore List*

Click on the poster's name in one of his/her posts, and select View Public Profile.

Select pull-down tab titled "User Lists" in the bar below the username

Click "Add [Username] to your Ignore List"


----------



## slip

I love this thread.


----------



## vacationhopeful

Just check by state, my sex and age for my current Individual health insurance premium ... CORRECT AMOUNT - EXACT DOLLAR AMOUNT. At my age and sex, the table has me paying just 4% MORE.

If I move to 3 other states where I could claim to live with relatives, my base line monthly (current) premium would go DOWN hundreds of dollars. 

All these figures are without an assistance in paying for health insurance.


----------



## ScoopKona

bogey21 said:


> Maybe yes.  Maybe no.  I'm on Medicare.  It looks to me like if the Doctors, Hospitals, etc. provide an acceptable code when they submit claims, Payment Agents pay them without question.  Could it be that the Insurance Companies add a layer of discipline in the claims process?
> 
> George



Medicare isn't insurance. If our healthcare plan was "Medicare for Everyone," then we wouldn't be having this discussion and people wouldn't hate ACA the way they do. (EDIT -- and there would STILL be room for insurance companies to offer supplemental insurance for people who think that Medicare isn't good enough.)

Have you driven past the Aetna campus in Hartford? It is a Behemoth. Every time we go to the doctor, we pay for all of that, PLUS the doctor and his or her expenses. Get rid of Aetna, and costs go down. 

Medicare isn't perfect, but people work jobs that they hate, and put off retirement just so they can make it to Medicare. So obviously, it's working for enough people that they breathe a sigh of relief when they get to Medicare coverage. My personal plan is basically the same plan that US Senators get. I think everyone should have THAT. And if we weren't paying all this unnecessary lucre to make Aetna happy, that's what we could do for everybody.

Is ACA better than the previous system of letting people go to financial ruin if they become gravely ill? Yes. But it isn't much better. And it's stupid to go halfway when other countries blazed that trail 50 years ago. We've basically accepted that Canada will have a better system than ours in perpetuity. But _Cuba_ has a better healthcare system than the United States does. That's just stupid.


----------



## bogey21

I'm not knocking Medicare.  I'm on Medicare.  I like my Medicare.  What I am saying is that they seem to pay any thing and every thing Doctors and Hospitals send in checking only to see that a legitimate code is entered on the claim.  There doesn't seem to be any check as to whether the procedure, etc. was necessary.  I'll bet if the Lab would submit a PSA test for me every week, they would pay for it.

George


----------



## ScoopKona

bogey21 said:


> I'm not knocking Medicare.  I'm on Medicare.  I like my Medicare.  What I am saying is that they seem to pay any thing and every thing Doctors and Hospitals send in checking only to see that a legitimate code is entered on the claim.  There doesn't seem to be any check as to whether the procedure, etc. was necessary.  I'll bet if the Lab would submit a PSA test for me every week, they would pay for it.



I'm not knocking Medicare either (although it has its waste and fraud). What I'm saying that even with it's faults, it's better than what many people are currently going through right now. People look forward to Medicare coverage -- although probably not to reaching the age of qualifying for it.

And if people had my coverage, they would insist on having that for the rest of their lives. But I'm lucky in that respect and I know it.


----------



## Kal

ace2000 said:


> Are you backing off the second part of your statement now?


 
 Nah, I just ignore your endless noise.


----------



## Passepartout

ace2000 said:


> Those 42 times just proves how badly informed so many are.  Every time I've disagreed, I've cited a reference on my behalf.  If you don't like it, provide your facts. Can you provide us a post where you've added any substance to this thread?



And you are the self nominated arbiter of who is or is not 'properly' informed?


----------



## ace2000

Passepartout said:


> And you are the self nominated arbiter of who is or is not 'properly' informed?




Nobody is the arbiter around here, it's called a debate - that's similar to what we're doing here.  Unfortunately some would like to post poor information and just let it stand unchecked.  In a debate, you post your rebuttal if you have one.  Unfortunately some would like to just make their attempt at a rebuttal and when proven wrong and if they can't support themselves any further, they decide it's time to bail or whine - not hard to see who they are.

Perhaps I should just bail out myself and let the wrong information stand.  Thinking about it... perhaps Conan is right, what else can be said?


----------



## ScoopKona

It would be a better debate if your facts didn't come financed-in-full by right-wing think tanks and political action committees. They're the ones who are trying to enforce the previous (awful) system. ACA is going to chip away at their profits, and these entities absolutely fear that once most Americans get a taste of the system that is enjoyed in Canada (and the rest of the developed world) it is only a matter of time before we start emulating them.

We may be in agreement that ACA is the wrong solution. But that's the only thing we agree on. Your "facts" contain a lot of half-truths, speculation, and blatent "pulled out of thin air" balderdash. Repeating them over and over isn't going to make them more factual.


----------



## Passepartout

Ace, what you don't seem to understand is that it NOT about whether to support ACA or go back to the non-healthcare, everyone for his/her self. For better or worse, like it or not, ACA is THE LAW. Whining about it and posting pseudo 'facts' lifted piecemeal from politically funded media sources before the law has even had a chance to show how well it works- (or doesn't), will not make it go away. ACA is not going away. It may well be modified. I hope toward something the rest of the world would recognize as universal healthcare, instead of nationwide group insurance  with a mandate to purchase. But whether it is modified or not, isn't up to you and me and a few timesharers.

Jim


----------



## ace2000

ScoopLV said:


> It would be a better debate if your facts didn't come financed-in-full by right-wing think tanks and political action committees. They're the ones who are trying to enforce the previous (awful) system. ACA is going to chip away at their profits, and these entities absolutely fear that once most Americans get a taste of the system that is enjoyed in Canada (and the rest of the developed world) it is only a matter of time before we start emulating them.
> 
> We may be in agreement that ACA is the wrong solution. But that's the only thing we agree on. Your "facts" contain a lot of half-truths, speculation, and blatent "pulled out of thin air" balderdash. Repeating them over and over isn't going to make them more factual.



Please be specific.  What "facts" of mine are you talking about?  I'm not going to defend en mass all the "facts" I've stated.  If someone wants to say the author is right-wing, that's fine, I haven't protested that.  I don't have time to find out whether something that supports my position is "right-wing" or not.  Everyone on here is spouting off untruths with nothing at all backing their opinions.  Are you just wanting us to just take your word for whatever you say, with nothing to back your statements?   Would that make you feel better?

For example, someone earlier today makes a groundless statement that health care insurance rates will finally stabilize after ACA.  I showed that was not the case, and backed it up with a study that was also cited by CBS news.  And then I'm the one that gets attacked on here?  It's too funny.     

And then we have another on here is "licensed" agent saying more untruths.  Again, are we just supposed to take her word for it, when I know otherwise?  When it comes time for her to support her statements, she's nowhere to be found.

Nobody says any of us have to agree on everything.  Just be ready to back up your opinions.  If I'm wrong, and you all want this to be just a thread of nonsense opinions, that's fine....  I'll be the whiner and take my ball and go home then.


----------



## ace2000

Passepartout said:


> Whining about it and posting pseudo 'facts' lifted piecemeal from politically funded media sources before the law has even had a chance to show how well it works- (or doesn't), will not make it go away. ACA is not going away.



Just so we're all on the same page, please provide one of my 'facts' you think is not true.  Please.  Again, you'd rather just make your statements (like the rest of your post above) with zero citations and that's better than what I'm doing?


----------



## ace2000

Passepartout said:


> For better or worse, like it or not, ACA is THE LAW. Whining about it and posting pseudo 'facts' lifted piecemeal from politically funded media sources before the law has even had a chance to show how well it works- (or doesn't), will not make it go away. ACA is not going away. It may well be modified. I hope toward something the rest of the world would recognize as universal healthcare, instead of nationwide group insurance  with a mandate to purchase. But whether it is modified or not, isn't up to you and me and a few timesharers.
> 
> Jim



I don't think it's going away either.  But, we're free to discuss the current law, right?  And we should provide factual information about it, right?  Not make some baseless statement like "future insurance rates are going down because of ACA", or even some of your previous statements.  Again, if someone calls you on one of your opinions, provide a reference please.


----------



## ScoopKona

Here's one from your cockamamie link:

_"New research from the Manhattan Institute estimates that insurance rates for young men will rise by 99 percent."_

Sure, the Manhattan Institute absolutely says "that insurance rates will rise by 99%." I'll bet you can go to the Manhattan Institute right now (if you can find the place or anyone there) and they'll tell you if you ask them.

But that doesn't make it so. It's exactly the sort of junk statistic that a certain segment latches onto and will not let go of. 

I am ALSO sure that insurance rates will rise -- get rid of all the bogus plans that existed pre-ACA, and make everyone who is currently uninsured (and thus has a basis of zero) start purchasing some kind of real health insurance, and those individuals' rates will rise. (They started from zero, after all.)

But for the young people who had health insurance, pre-ACA, their rates are very, very unlikely to nearly double. Even my most ticked-off, self-employed friends who are being burnt by ACA are seeing increases in the 40% range. And we're not done insuring everyone. We'll see some sort of equilibrium once the pool becomes larger.

And THEN we can discuss how much rates actually did rise. This malarkey from the Manhattan Institute is so much Chicken-Little, Sky-Is-Falling, Invest-in-precious-metals-and-ammo, PR crapola.

Specific enough?


----------



## ace2000

ScoopLV said:


> Here's one from your cockamamie link:
> 
> _"New research from the Manhattan Institute estimates that insurance rates for young men will rise by 99 percent."_
> 
> Specific enough?



Thank you.  My response is that Manhattan Institute study is also cited by CBS news right here below.  So, it's a cockamamie link to you, but CBS news can use it?  It's good enough for CBS, but not good enough for this thread on TUG.  And yet, everyone else on this thread gets a free pass with their groundless statements?   Too funny.    

*Study: Insurance costs to soar under Obamacare*

http://www.cbsnews.com/news/study-insurance-costs-to-soar-under-obamacare/


----------



## ScoopKona

Since when is any television news a reliable source of information? It's been a long time since any of them did much fact checking. 

I'm not saying that link is "good enough for CBS news." I'm saying it's not good enough to line my bird cage or to wrap fish. Garbage in, garbage out. And there is an awful lot of garbage being pumped into the airwaves by people with an agenda to keep America from having a real healthcare system.

If you would quit parroting them, this "debate" would be considerably better.


And _that's the way it is_, Monday, February 24, 2014. (Remember when people called Cronkite a "pinko" because he had the stones to say Vietnam was an un-winnable war? Cronkite would be appalled and disgusted. I'm sure he was appalled and disgusted with the way TV news was heading before he died.)


----------



## ace2000

ScoopLV said:


> Since when is any television news a reliable source of information? It's been a long time since any of them did much fact checking.
> 
> I'm not saying that link is "good enough for CBS news." I'm saying it's not good enough to line my bird cage or to wrap fish. Garbage in, garbage out. And there is an awful lot of garbage being pumped into the airwaves by people with an agenda to keep America from having a real healthcare system.



That's what's great about living in the US.  We all get to read this thread and choose for ourselves if we want to believe a so-called "right-wing" study that is also cited by CBS news.  Many don't agree with you, many do.  But, I still say, I've provided a lot more to back my statements than you have yours.


----------



## ScoopKona

ace2000 said:


> But, I still say, I've provided a lot more to back my statements than you have yours.



OK, now you're just being shrill. 

What "facts" would you like me to defend? I've only got a few posts on this entire thread, and all of them are some version of "it would be better if ACA hadn't half-assed it and we had gone the single-payer route which we know works elsewhere."

Not much to defend there. You are being willfully ignorant to the concerns and points of those who disagree with you. So sorry*, but you are not going to get your way. And posting ridiculous links on a timeshare forum isn't going to make ACA go away. It is very likely that once the plan is done being ****-blocked by half the governors, Americans will come to like it. (Just like they do for Medicare, which was also demonized by the same kind of people when it came out.) 

That's why there is SO much push-back against ACA. There is an entrenched segment of society whose very existence depends on Americans not coming to like things like universal healthcare.


* No, I'm not actually sorry. This is one lone bright spot in what I consider an otherwise bleak future.


----------



## ace2000

ScoopLV said:


> What "facts" would you like me to defend? I've only got a few posts on this entire thread, and all of them are some version of "it would be better if ACA hadn't half-assed it and we had gone the single-payer route which we know works elsewhere."



I have no problem with what you said, so why should I counter your statements?  

You made a statement earlier today and you stated that you know many friends that have seen their rates skyrocket under ACA (I have not gone back to quote your words exactly.)  Well, I've actually provided a link to a CBS story that supports your claim, and you want to argue with me about my source?


----------



## ScoopKona

Your link is chock full of bogus information and junk statistics, so I'm not interested in the "support." Get it now?

Incidentally, you'd only have to go up a page to see that I said that rates for self-employed families I know went WAY up. Roughly 40% if some of my friends have been exhaustive in their research. That hurts the monthly bottom line, and it's the reason ACA isn't getting the universal acceptance that many rose-colored optimists thought it would.

But scrapping it and going back to letting healthcare bankrupt those unfortunate enough to fall gravely ill isn't the answer. And good luck finding reasonable people who agree with scrapping the program and going back to the nightmare we had before.


----------



## ace2000

ScoopLV said:


> Your link is chock full of bogus information and junk statistics, so I'm not interested in the "support." Get it now?



I wasn't providing the link to give you "support".  I was providing the information to counter the previous claim that rates will now "stabilize" under the ACA.  It just so happens that my link also validated and supported your claim.  Your claim of having friends that have seen their rates go up has about the same merit as momseason reporting that all she knows is that rates are going down for her customers.  Which one of you do we believe?  Got it?


----------



## PStreet1

I still believe that rates constitute the least important part of the picture.  If anyone has had any major medical contact since the first of the year (I have), I suspect you've seen changes that you'd rather not see.  I can make comparisons to only a few months ago, and the changes aren't likely to make people happy.

There's a huge distance between "having insurance," and "having health care."  Unfortunately, I think people are going to begin to discover that.


----------



## pjrose

The subject of health care is interesting.  A discussion of health care would be interesting.  

But I haven't seen much about health care lately, just back-and-forth about whose "facts" are or are not "facts" and where they do or do not come from.

That, to me, is a discussion of how - or how not - to justify assertions and/or information, not a discussion of health care.

I'd hate to see this closed because of the tangent it's taken


----------



## pjrose

PStreet1 said:


> I still believe that rates constitute the least important part of the picture.  If anyone has had any major medical contact since the first of the year (I have), I suspect you've seen changes that you'd rather not see.  I can make comparisons to only a few months ago, and the changes aren't likely to make people happy.
> 
> There's a huge distance between "having insurance," and "having health care."  Unfortunately, I think people are going to begin to discover that.



You make a good point about the difference between "having insurance" and "having health care."  

Can you be more clear about the type of contact you are referring to and changes you've seen?  Without of course going to the point of violating your own privacy?


----------



## ScoopKona

PStreet1 said:


> I still believe that rates constitute the least important part of the picture.  If anyone has had any major medical contact since the first of the year (I have), I suspect you've seen changes that you'd rather not see.  I can make comparisons to only a few months ago, and the changes aren't likely to make people happy.
> 
> There's a huge distance between "having insurance," and "having health care."  Unfortunately, I think people are going to begin to discover that.



I'm one of the people ACA doesn't affect. (Happy with my plan, keeping it.) I haven't noticed any changes, and I had a big-deal incident this month.


----------



## ace2000

pjrose said:


> The subject of health care is interesting.  A discussion of health care would be interesting.
> 
> But I haven't seen much about health care lately, just back-and-forth about whose "facts" are or are not "facts" and where they do or do not come from.



It's more about opinions.  The discussion has been between those providing no links to back their opinions and one who has decided to provide links to back mine - from sources such as Forbes and CBS news.  Do we want to just stick to opinions only?  That's fine with me, if everyone agrees.

Anyway, I also agree with your statement... I do not want to see the thread get closed.  I would like to hear more from momseason on example stories she's encountered (without the political bent), and I honestly would like to learn from this thread.  Since I'm being accused of monopolizing this thread, I can see that.  I'll bail for a week or so myself... hopefully the thread will still be around.

Unfortunately, we only have one thread to discuss the very broad and important topic of "health care", and that means everything gets merged here.


----------



## pjrose

ace2000 said:


> The discussion has been between those providing no links to back their opinions and one who is choosing to provide links to back mine.  Do we want to just stick to opinions only?  That's fine, if the moderators agree.
> 
> Anyway, I also agree... I do not want to see the thread get closed.  I would like to hear more from momseason on example stories she's encountered (without the political bent), and I honestly would like to learn from this thread.
> 
> Unfortunately, we only have one thread to discuss the important topic of "health care".





pjrose said:


> . . .   I'm thinking of DD's "frequent flier" status in the ERs with fainting, concussions, and seizure-like activity....when you know the ambulance and ER personnel on a first name basis - multiple ambulance companies and multiple ERs....well, with all that, I'll bet she would now be uninsured.
> 
> Instead she is a) on our plan for four more years till she hits age 26, b) no more lifetime cap so they can't stop covering her, c) when she hits 26 and/or gets a job with coverage, she can't be turned down, and d) if she and/or her DH go to the exchange, their income is relatively low so the rates aren't bad.
> 
> And now her micro-preemie DS spent ~78 days in the NICU for hundreds of thousands, has already had three surgeries including one neurosurgery which must have cost a ton but we never saw a bill, two "cranial remolding" helmets which would have cost $3K apiece, and he's only ten months old.  He's covered.  (And he's doing well - some delays, but nothing permanent that we know of.)
> 
> Do those who don't like the ACA expect people to go bankrupt if they  happen to develop a major condition or have a preemie with birth defects?



ok, so here is an example that I have encountered, resurrected from a few pages ago.  No political bent.  Just facts.  Without the ACA DD would find it difficult if not impossible to be insured for anything having to do with cardiology, neurology, fainting, concussions, and so forth.  Now she - still - is on our plan, and in a few years, she won't be able to be denied her own plan or charged more for it.  Previously she would have been covered by our plan only until age 19, I believe, unless she was a full-time student.  She was a full-time student on and off for the last few years, but fell too many times to continue.  However even as a part-time student, and now as not a student at all due to caring for a special needs infant, she remains insured and receives healthcare.  This is true even though she is married.  

And what of her DS?  He too has had all of his costs covered, but more importantly, in the future (unless there are major changes in the law), he won't be denied coverage because he had neurosurgery and gastric surgery as an infant.  

DD and her DS can go to the doctor and hospital as needed, and get medications as prescribed, without financial worry.  DSIL is one of those lucky guys who doesn't get sick, but if he does, as a self-employed sole proprietor of a small business that doesn't make much money, he qualifies for coverage at an affordable rate.  Actually he has a recurrent growth/boil/?? that has to be taken care of with minor surgery in the physician's office a few times a year.  He used to be uninsured and paid for healthcare - only when really really needed - out of pocket.  That was a problem when he had a lean month.  Now the bulk of the cost is covered and he doesn't have to worry about what he did or didn't earn that month.


----------



## Patri

ace2000 said:


> Unfortunately, we only have one thread to discuss the very broad and important topic of "health care", and that means everything gets merged here.



I don't mind more than one thread on a topic. If someone comes late to the party, there are so many pages and so many posts, it is not worth it to join in.


----------



## PStreet1

I really can't, or don't want to, give specific details.  However, I saw changes.  I asked various medical personnel about the changes.  I was told, in each case, "The rules have changed.  Because of that __________ is the result."  The changes resulted in a decided difference in treatment and a difference in my costs.  Of the two, the difference in treatment is by far the more significant.


----------



## DeniseM

Patri said:


> I don't mind more than one thread on a topic. If someone comes late to the party, there are so many pages and so many posts, it is not worth it to join in.



It is TUG policy to keep the same topic in one thread.  There is no good reason to have multiple threads on the same topic, and it makes the management of a volatile topic even more difficult.  

If it's not worth plowing through - then just skip it.  

I predict that this thread isn't going to live much longer anyway, because [some]   folks just can't control the impulse to post political messages...


----------



## pjrose

DeniseM said:


> . . .
> 
> I predict that this thread isn't going to live much longer anyway, because folks just can't control the impulse to post political messages...



I would add the word "SOME" after "because" in the preceding sentence.  

I hope it stays open for the informative posts, and that the others just get zapped.  I know that's a lot of work for you though


----------



## momeason

ScoopLV said:


> Count me among the knuckle draggers, then. ACA is turning into a nightmare. I am not affected. But many people I know are. Their costs are going WAY up and their coverage stays the same or even retreats a bit. The self-employed seem to be the hardest hit. And that's my peer group. Just because it's no skin off my back doesn't mean I shouldn't care about what it does to the self-employed accountant with a big family to insure.
> 
> We should have implemented the single-payer system. Insurance companies are the problem (nobody should profit on human misery), and ACA doesn't go far enough to fix that. Insurance adds an unnecessary and very expensive layer to healthcare. And that's why we pay more for prescriptions, procedures, doctor visits, surgery, recovery, therapy and every other damned thing associated with medicine compared to countries which went the single-payer route -- everyone except us, basically.
> 
> The rest of the civilized world sorted this out decades ago. We're the only developed country which has not. The insurance shareholders won't be happy*. Health insurance is a big, fat tumor on the healthcare industry -- adding nothing but misery -- and should be excised, pronto.
> 
> 
> * Which is the only reason why we're stuck with this turkey.



Well over half I help are self employed and they are loving the assistance they are getting with their premiums. Most self-employed do not make a lot of money. Those that do make a lot are in the minority.
I am helping several small business owners and their employees also. Those that find me almost always end up being very happy. 
I agree single payer is more efficient but this is what we have.
At least many who could not afford to get quality medical care not can get it.


----------



## pjrose

momeason said:


> Well over half I help are self employed and they are loving the assistance they are getting with their premiums. Most self-employed do not make a lot of money. Those that do make a lot are in the minority.
> I am helping several small business owners and their employees also. Those that find me almost always end up being very happy.
> I agree single payer is more efficient but this is what we have.
> At least many who could not afford to get quality medical care not can get it.



 NOW can get it.....(last line)


----------



## Passepartout

I like to blame autospell for stuff like that.


----------



## Passepartout

*Health care anecdotal nightmares*

I'm a bad boy, and I know it. Mods, if you want to put this with the other healthcare thread, or just delete it, that's OK. I will try to keep  this economic What others choose to do with it is up to them.

This is a article written by noted economist Paul Krugman http://www.nytimes.com/2014/02/24/opinion/krugman-health-care-horror-hooey.html?ref=paulkrugman outlines several people who's health insurance costs increased with the ACA. 

People in Louisiana reported that their insurance had been canceled due to Obamacare.

A woman in Michigan says her insurance was canceled, depriving her of her Leukemia drugs, without which she will die. 

The problem, as pointed out in the article is that all these people are paid actors. It seems there is difficulty finding REAL people who are either cancelled or have vastly increased costs.

The most likely answer is that the true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.

What is needed are struggling average Americans, preferably women, facing financial devastation from health reform. So those are the tales they’re telling, even though they haven’t been able to come up with any real examples.

Read the article and draw your own conclusions

Jim


----------



## PStreet1

Krugman is, while well known, definitely a liberal, and his studies and views reflect that.  (from Wikipedia)  As a commentator, Krugman has written on a wide range of economic issues including income distribution, taxation, macroeconomics and international economics. Krugman considers himself a liberal, calling one of his books and his New York Times blog The Conscience of a Liberal.[11] His popular commentary has attracted considerable comment, both positive and negative.[12]

The same objections you had to the Manhattan Institute because the source is Conservative can be said of Krugman.  He leans left and his results always come out favoring leftist policies.  

It seems to me, it's necessary to read both and evaluate both knowing both have decided leanings.  To reject either totally because you don't like the political leanings seems to guarantee a limited perspective.


----------



## Passepartout

PStreet1 said:


> It seems to me, it's necessary to read both and evaluate both knowing both have decided leanings.  To reject either totally because you don't like the political leanings seems to guarantee a limited perspective.



Pat, I couldn't care less about the political, religious, or any other leanings of a writer. All I ask is that the people who say they are injured or should have been helped by ACA, yet weren't, at least be honest about it. If (right) leaning writers, or pundits find people genuinely hurt by it, they have my undivided attention. Problem is, that FAR more people are being helped by ACA than are being hurt.

Don't believe me? OK, Ask momeason.


----------



## ScoopKona

Passepartout said:


> The most likely answer is that the true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans.



I understand it's hard to shed tears over self-employed professionals making low-end six figures -- the self-employed pharmacist, accountant, and small business owner.

BUT, they think they've been asked for enough lately. They're not the 1% and they're not zipping around in their private planes. They're solidly Main Street, not Wall St. And they're the ones who do much of the employment in this country. My friends who fall into this category see this as just another example of them paying more so that others don't have to pay at all, or pay a fraction of what they're going to receive in benefits.

As it stands, the people who are signing up for ACA are:

A) The people who really NEED healthcare (not just insurance) right now. Today. They're going to be a drain on the system. They couldn't get insurance before. (And I'm glad they can now.) But let's be fair, they're going to receive a TON more in benefits than they will pay in premiums.

B) Responsible, higher income people, particularly with families. (People who don't NEED healthcare this very minute. But they recognize the value of HAVING healthcare insurance.) They're getting it in the pants right now until we get a much larger swath of the population into the pool to lower everyone's premiums to pay for group "A."


If the ACA was auto insurance and not health insurance, (and the auto insurance industry was as backward and heavy-handed as health insurance was last year), the people signing up right now would be the people that most insurers previously wouldn't touch with a 10-foot pole. Everyone else is waiting until the last possible minute so they don't have to subsidize all these high-risk pool entrants. And low-risk people with a decent salary who play by the rules are getting shafted because of it.

Implementation still stinks, and we should have done this right when we had the chance.


----------



## pgnewarkboy

ScoopLV said:


> I understand it's hard to shed tears over self-employed professionals making low-end six figures -- the self-employed pharmacist, accountant, and small business owner.
> 
> BUT, they think they've been asked for enough lately. They're not the 1% and they're not zipping around in their private planes. They're solidly Main Street, not Wall St. And they're the ones who do much of the employment in this country. My friends who fall into this category see this as just another example of them paying more so that others don't have to pay at all, or pay a fraction of what they're going to receive in benefits.
> 
> As it stands, the people who are signing up for ACA are:
> 
> A) The people who really NEED healthcare (not just insurance) right now. Today. They're going to be a drain on the system. They couldn't get insurance before. (And I'm glad they can now.) But let's be fair, they're going to receive a TON more in benefits than they will pay in premiums.
> 
> B) Responsible, higher income people, particularly with families. (People who don't NEED healthcare this very minute. But they recognize the value of HAVING healthcare insurance.) They're getting it in the pants right now until we get a much larger swath of the population into the pool to lower everyone's premiums to pay for group "A."
> 
> 
> If the ACA was auto insurance and not health insurance, (and the auto insurance industry was as backward and heavy-handed as health insurance was last year), the people signing up right now would be the people that most insurers previously wouldn't touch with a 10-foot pole. Everyone else is waiting until the last possible minute so they don't have to subsidize all these high-risk pool entrants. And low-risk people with a decent salary who play by the rules are getting shafted because of it.
> 
> Implementation still stinks, and we should have done this right when we had the chance.



Any calculation of the impact of the Affordable Care Act has on individuals must take into account the costs to society and the individuals that make up society of people NOT having health insurance.  

The entire economy has been economically burdened by those going to the Emergency Room for treatment because they lack health insurance.  The entire economy has been burdened by children who have not received proper vaccinations and other basic health care.  Similarly, people who don't take care of themselves for lack of knowing their cholesterol, and blood sugar levels are an economic burden.  Furthermore without health care people don't take care of their  back problems, bronchial problems, heart problems, cancers, etc. etc. which causes an extreme economic burden on everyone including employers who have employees who don't show up for work and the families of those who are sick who must take off from work or school to help their sick relative or friend.   Further the spread of disease caused by a lack of basic health care has a tremendous cost.


----------



## Conan

ScoopLV said:


> I understand it's hard to shed tears over self-employed professionals making low-end six figures -- the self-employed pharmacist, accountant, and small business owner.
> 
> BUT, they think they've been asked for enough lately.



Here's the percent of income that people earning $400,000 of salary get to keep, by country (so their tax rate is 100% minus the percent shown).  The example for the U.S. includes New York state tax (about 6.8%), so they're paying federal tax of about 35% on earned income. 

Do you think U.S. taxes are too high for someone earning $400,000? Do Mexico and Brazil have it right? How about Russia?


 Italy - 50.59% (takes home $202,360 out of $400,000 salary)
 India - 54.90%
 United Kingdom -    57.28%
 France - 58.10%
 Canada -    58.13%
 Japan - 58.68%
 Australia    - 59.30%
 United States - 60.45% (based on New York state tax)  [If a U.S. taxpayer's income is primarily from dividends and capital gains, or if they happen to run a hedge fund, their tax rate is 15% to 20% and they keep 80% to 85%.]
 Germany     - 60.61%
 South Africa - 61.78%
 China - 62.05%
 Argentina - 64.02%
 Turkey - 64.64%
 South Korea - 65.75%
 Indonesia - 69.78%
 Mexico -    70.60%
 Brazil - 73.32%
 Russia - 87%
 Saudi Arabia - 96.86% (so you take home $387,400 out of the $400,000 salary)

http://www.bbc.com/news/magazine-26327114


----------



## bogey21

pgnewarkboy said:


> The entire economy has been economically burdened by those going to the Emergency Room for treatment because they lack health insurance.



I'm curious.  Will those recently added to Medicaid continue to run to the Emergency Room for everything?  If they do, will the hospitals be reimbursed by Medicaid?  If so, how much?

George


----------



## vacationhopeful

bogey21 said:


> I'm curious.  Will those recently added to Medicaid *continue to run to the Emergency Room for everything*?  If they do, will the hospitals be reimbursed by Medicaid?  If so, how much?
> 
> George



George - 
My experience with a segment of the population who do the repeat trips to the ER has a multitude of REASONS:

1) Being awake from 3PM to 7AM (night-crawlers), the Emergency Room is the only medical facility OPEN and there is a shorter wait time at 4AM.
2) The FREE ride when you dial 911 only goes to the ER; no waiting if you take the FREE RIDE IN - ambulance entrance goes right into the trauma center.
3) The ER writes the best scripts and none of the ER seem to know that you visited other ERs just last week (or yesterday).
4) The ER staff is more respectful over the private practice no matter HOW many times you come there - they will always see you. Even if you GIVE them a FAKE NAME and ADDRESS.
5) Seeing a private practice office, involves PLANNING, waiting, following up and even making a token payment. And they like to see YOUR PHOTO ID and medical card every time you come to the office.


----------



## SMHarman

Conan said:


> Here's the percent of income that people earning $400,000 of salary get to keep, by country (so their tax rate is 100% minus the percent shown).  The example for the U.S. includes New York state tax (about 6.8%), so they're paying federal tax of about 35% on earned income.
> 
> Do you think U.S. taxes are too high for someone earning $400,000? Do Mexico and Brazil have it right? How about Russia?
> 
> 
> Italy - 50.59% (takes home $202,360 out of $400,000 salary)
> India - 54.90%
> United Kingdom -    57.28%
> France - 58.10%
> Canada -    58.13%
> Japan - 58.68%
> Australia    - 59.30%
> United States - 60.45% (based on New York state tax)  [If a U.S. taxpayer's income is primarily from dividends and capital gains, or if they happen to run a hedge fund, their tax rate is 15% to 20% and they keep 80% to 85%.]
> Germany     - 60.61%
> South Africa - 61.78%
> China - 62.05%
> Argentina - 64.02%
> Turkey - 64.64%
> South Korea - 65.75%
> Indonesia - 69.78%
> Mexico -    70.60%
> Brazil - 73.32%
> Russia - 87%
> Saudi Arabia - 96.86% (so you take home $387,400 out of the $400,000 salary)
> 
> http://www.bbc.com/news/magazine-26327114



These numbers are all very interesting but if you compare the UK and US (NY) two I have experienced, for the 42% tax rate (I'm 1-x ing the numbers above) in the UK you get the NHS, medical care that is free at the point of use and paid for in that tax rate above.

In NY I pay that 39.5% rate and then pay another say 6% of my salary as a medical insurance deduction so what would be considered a like for like deduction is 45.5%.  Now in the UK I paid for BUPA top up medical coverage, you still see the NHS primary care physician and the NHS ER but if you need elective surgery and the NHS will take too long to treat it then the top up cover takes you private - note this benefits both the person with the coverage as they get treated sooner, and all those on the NHS wait list as another person is not joining the list.  That coverage is pretty cheap, probably less than 2% of salary so takes the UK to 44%.

So now I am comparing UK 44% to US 46% but somehow the US does not manage to give adequate healthcare that is free at the point of use to all citizens.


----------



## Conan

*Let's add a few facts to the discussion regarding emergency room use*

22% of emergency room patients are under age 18

54% of emergency room patients are female

59% of emergency room patients are Non-Hispanic white

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123697/

New York University Hospital's Emergency Department categorizes emergency room visits as follows:

47.8% Non-Emergent: Most common codes were abdominal pain, headache, painful breathing, neck sprain or strain, and urinary tract infection.

40.2% Emergent: Most common codes were chest pain, multiple open wounds, asthma, syncope, and other general symptoms.

12% Intermediate: Most common codes were undiagnosed disease and nonspecified abnormal findings, open wound of fingers without complication, superficial foreign body (splinter), and closed fracture of rib.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881233/


----------



## Conan

SMHarman said:


> I am comparing UK 44% to US 46% but somehow the US does not manage to give adequate healthcare that is free at the point of use to all citizens.



No argument about that from me!


----------



## PStreet1

Passepartout said:


> Pat, I couldn't care less about the political, religious, or any other leanings of a writer. All I ask is that the people who say they are injured or should have been helped by ACA, yet weren't, at least be honest about it. If (right) leaning writers, or pundits find people genuinely hurt by it, they have my undivided attention. Problem is, that FAR more people are being helped by ACA than are being hurt.
> 
> Don't believe me? OK, Ask momeason.



I hope that's an accurate assessment.  However, as I said, there's many a slip between insurance and care.  Until they encounter medical care, they won't know anything.  I have encountered major medical care this year--and did in November 2013 for the same thing....as I have numerous times before.  I can tell you that despite the same hospital, same doctors, same insurance, there are changes, and personnel there told me it was because of "changes in the rules."  I don't have the problem of not being able to find a doctor who will accept Medicare patients, but many people are  experiencing the problem.  I don't have the problem of needing to find a hospital within my network, but many people are experiencing the problem.  As more doctors and hospitals see a change in payment schedule, more people will experience these problems I fear.

I don't think we know anything about where we are until people try to access health care; the rates they pay in premiums are the least of the issue, in my opinion; care trumps everything else--and there are some unpleasant changes taking place there.


----------



## Passepartout

Care changes? Yup. A few months ago, I got my annual physical. After the obligatory weight and blood pressure checks, I was directed to the exam table and hooked up to an EKG. I asked why, and was told "It's part of the new healthcare bill- we want a baseline EKG in case there is a change."

Then in the course of going over my labs with the doc, he said, "OK, Jim, I'm your 'Death Panel'. Do you have a Healthcare Directive? POA for healthcare? Living Will?" They wanted to have all that stuff in my electronic file (also mandated), so that no matter where or with which doc I presented, all the information would be together in one pile.

As a result of the law, healthcare DOES change. And as I see it, from where the rubber meets the road, all-in-all, for the better.

Perfect? Not by a long shot, but certainly better than before implementation of even the very first parts of ACA.


----------



## PStreet1

pgnewarkboy said:


> Any calculation of the impact of the Affordable Care Act has on individuals must take into account the costs to society and the individuals that make up society of people NOT having health insurance.
> 
> The entire economy has been economically burdened by those going to the Emergency Room for treatment because they lack health insurance.  The entire economy has been burdened by children who have not received proper vaccinations and other basic health care.  Similarly, people who don't take care of themselves for lack of knowing their cholesterol, and blood sugar levels are an economic burden.  Furthermore without health care people don't take care of their  back problems, bronchial problems, heart problems, cancers, etc. etc. which causes an extreme economic burden on everyone including employers who have employees who don't show up for work and the families of those who are sick who must take off from work or school to help their sick relative or friend.   Further the spread of disease caused by a lack of basic health care has a tremendous cost.



Unfortunately, they are continuing the same pattern.  To those of us who don't deal with medical care, it's difficult to believe, but they are.  In what has become known as "The Oregon Experiment," it was clearly shown that they continue the same behavior http://www.nber.org/oregon/  "◦Medicaid increased the likelihood of using outpatient care by 35 percent, using prescription drugs by 15 percent, but did not seem to have an effect on use of emergency departments"

Further,
"Medicaid Increases Emergency Department Use: Evidence from Oregon's Health Insurance Experiment" Science, 2014 Jan 17; 343(6168): 263-268. We found: 
Emergency department visits overall ◦Medicaid increased the probability of using the emergency department by 7 percentage points (an increase of about 20 percent, relative to a base of 34.5 percent). 
◦Medicaid increased the number of emergency department visits over the 18-month period by about 40 percent (0.41 visits, relative to a base of 1.02). "

Apparently, the preventive steps many had hoped for and the decrease in emergency room visits for non-emergency treatment simply didn't happen.  whether the population base at large will behave any differently from Oregonians remains to be seen, but it seems doubtful.  By a chance occurrance (the health insurance lottery), Oregon conducted the gold standard of studies.  That opportunity isn't likely to occur anyplace else, and I doubt the Oregonians are significantly different from Missourians, etc.


----------



## PStreet1

Passepartout said:


> Care changes? Yup. A few months ago, I got my annual physical. After the obligatory weight and blood pressure checks, I was directed to the exam table and hooked up to an EKG. I asked why, and was told "It's part of the new healthcare bill- we want a baseline EKG in case there is a change."
> 
> Then in the course of going over my labs with the doc, he said, "OK, Jim, I'm your 'Death Panel'. Do you have a Healthcare Directive? POA for healthcare? Living Will?" They wanted to have all that stuff in my electronic file (also mandated), so that no matter where or with which doc I presented, all the information would be together in one pile.
> 
> As a result of the law, healthcare DOES change. And as I see it, from where the rubber meets the road, all-in-all, for the better.
> 
> Perfect? Not by a long shot, but certainly better than before implementation of even the very first parts of ACA.



I'm not talking about routine stuff like that.  Again, until you have a major medical encounter, you won't know.  Unless it has occurred enough in the past to have a baseline, you won't know what the changes are.  I do.  Were the changes relatively significant?  Yes, they were.  Were they "all for the better"?  No, they weren't.  Were any "for the better" in terms of patient care?  No, they weren't.


----------



## PStreet1

vacationhopeful said:


> George -
> My experience with a segment of the population who do the repeat trips to the ER has a multitude of REASONS:
> 
> 1) Being awake from 3PM to 7AM (night-crawlers), the Emergency Room is the only medical facility OPEN and there is a shorter wait time at 4AM.
> 2) The FREE ride when you dial 911 only goes to the ER; no waiting if you take the FREE RIDE IN - ambulance entrance goes right into the trauma center.
> 3) The ER writes the best scripts and none of the ER seem to know that you visited other ERs just last week (or yesterday).
> 4) The ER staff is more respectful over the private practice no matter HOW many times you come there - they will always see you. Even if you GIVE them a FAKE NAME and ADDRESS.
> 5) Seeing a private practice office, involves PLANNING, waiting, following up and even making a token payment. And they like to see YOUR PHOTO ID and medical card every time you come to the office.



By implication, but not specifically, you covered the "emergency room runners."  I remember very well a nurse telling me about her first experience with one in an urban hospital's emergency room:  they come in with the complaint of chest pains because they know that gets them an immediate IV.  Once that is in, you have to not leave them alone a moment or they will run, as fast as possible, out of the hospital and back to the streets--it's so much easier to do a number of drugs with an IV in place.

Are those people going to cease their emergency room visits?  I don't think so.


----------



## vacationhopeful

PStreet1 said:


> By implication, but not specifically, you covered the "emergency room runners."  I remember very well a nurse telling me about her first experience with one in an urban hospital's emergency room:  they come in with the complaint of chest pains because they know that gets them an immediate IV.  Once that is in, you have to not leave them alone a moment or they will run, as fast as possible, out of the hospital and back to the streets--it's so much easier to do a number of drugs with an IV in place.
> 
> Are those people going to cease their emergency room visits?  I don't think so.



There are a number of persons who live a VERY ALTERNATIVE LIFE STYLE from the people who go to work and "have a life" within the "normal" range of life experiences. Some have self-induce mental health issues, some live a very alternative life (used to be call free spirits), some are immature & totally irresponsible ... some should be living in a structured setting, but are NOT MANDATED to (institutionalized personalities such as former convicts or mentally ill or limited intelligence) .... 

I know a person who would call 911 to get a ride to hospital which was a block from the probation office ... etc.

Maybe with the Medical Electronic Records System, these persons will be identified and convince some of them that idiot actions will incur really NOT so nice reaction by the legal system.

OR as my one acquaintance personally pleaded with me, "Don't call 911; the police are NOT very nice to me!"


----------



## Ken555

ace2000 said:


> Deal.



Excellent.  



> Here's a link to a Forbes article and I pull out a couple of quotes (I quoted some of this earlier also):
> 
> http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html
> 
> But the entities that will be most injurious to the nation’s health are not so much in the evil-mongers’ group but the first group, including the American Medical Association–a doctors’ cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. Instead of “palling up” with it, President Obama should do everything in his power to break its choke-hold and bring physician salaries–among the biggest drivers of health care costs–back down to Earth.
> 
> But that’s not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, *declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors.* The AMA convinced lawmakers to shut down “deficient” medical schools, drastically paring back the supply of doctors almost 30% over 30 years. No new medical schools have been allowed to open since the 1980s.



The line I bold above should be discussed before discarded out of hand, as done by Shikha Dalmia. Why was the AMA founded? What is it's goal? Is it a "good" organization improving healthcare? Has it's direction changed in the last few decades? Without context it is very difficult to believe everything we read about this issue. In the early part of the 1900s does anyone really question that the medical profession needed regulation and a consistent higher standard, both for education and service? 

It's hard for me to read and believe statements from someone who writes, in the third paragraph of the same article that



> The association has managed so far to escape the wrath of MoveOn.org and other Democratic apparatchiks by muting its opposition to their beloved public option–the proposed government-run health care plan–and joining a coalition of industry groups pledging to cut $80 billion in health care costs over the next decade.



This sentence proves that this author is biased. And while I completely understand and appreciate that it is very difficult for us to find objective information (on either side), it would be nice to at least reference supporting documents that show some balance. Original source material would always be best, and this article is just another interpretation - through a very blurry lens - of what is and has occurred in this country in terms of healthcare. 



> Doctors–and many Republicans–constantly carp about the costs of “defensive medicine” because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits.



This is a great point to discuss. Wikipedia (http://en.wikipedia.org/wiki/Defensive_medicine) defines this as:



> Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff. Defensive medicine is a reaction to the rising costs of malpractice insurance premiums and patients’ biases on suing for missed or delayed diagnosis or treatment but not for being overdiagnosed. U.S. physicians are at highest risk of being sued, and overtreatment is common. The number of lawsuits against physicians in the USA has increased within the last decades and has had a substantial impact on the behavior of physicians and medical practice. Physicians order tests and avoid treating high-risk patients in order to reduce their exposure to lawsuits, or are forced to discontinue practicing because of overly high insurance premiums.[1] This behavior has become known as defensive medicine, "a deviation from sound medical practice that is indicated primarily by a threat of liability."



However, wikipedia also states that the financial impact is:



> Defensive medical decision making has spread to many areas of clinical medicine and is seen as a major factor in the increase in health care costs, estimated at tens of billions of dollars annually in the USA.[8] An analysis of a random sample of 1452 closed malpractice claims from five U.S. liability insurers showed that the average time between injury and resolution was 5 years.[9] Indemnity costs were $376 million, and defense administration cost $73 million, resulting in total costs of $449 million. The system’s overhead costs were exorbitant: 35% of the indemnity payments went to the plaintiffs’ attorneys, and together with defense costs, the total costs of litigation amounted to 54% of the compensation paid to plaintiffs.



If these numbers are accurate then we should do what we can to lower them, but they are not a huge part of overall healthcare expenses. There are plenty of areas to focus our attention to lower overall healthcare costs. They make for a good rallying point for those opposed to the (current) right for us to sue without limits in court for medical malpractice. Note that many (if not all) of my doctors now require me to sign an agreement that I will not sue but will go to arbitration in the event of a problem - so it seems to me that the industry is finding its own ways to limit exposure, and the insurance industry will no doubt be the main beneficiary.



> But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does. “While the U.S. malpractice system is extraordinary,” the study notes, “it is only a small contributor to the higher cost of health care in the United States.”



Well, point made.



> Meanwhile, other studies have found that doctors’ salaries contribute more to soaring medical costs than the $40 billion or so that the uninsured cost in uncompensated care–the president’s bete noir.



Um...what are those other studies? The study referenced in this article, which I believe is "Accounting for the Cost of Health Care in the United States" from January 2007 by McKinsey Global Institute, states:



> This research builds on an earlier MGI effort in which we compared the health care systems in the United States, the United Kingdom, and Germany by assessing the productivity and treatment of four major diseases. Our aim is to provide a sound and unbiased fact base for use in the public debate on health care and to enable policy makers, regulators, intermediaries, payors, providers, employers, clinicians, and patients, to make more informed and therefore better decisions."



This report states that the US spends more than its "peer countries" (in this case the UK and Germany), specifically $1,645 per capita more. However, the same report includes that the US is lower than the others for long-term care and durable medical equipment.

The report continues that the higher spending in the US is due to:



> input costs - including doctors' and nurses' salaries, drugs, devices, and other medical supplies, and the profits of private participants in the system - explain the largest portion of high additional spending, accounting for $281 billion of spending above US ESAW. Inefficiencies and complexity in the system's operational processes and structure account for the second largest spend above ESAW of $147 billion. Finally, administration, regulation, and intermediation of the system cost another $98 billion in additional spending. Together, these three account for $526 billion of US spending above ESAW. Other miscellaneous expenditures in outpatient care (including durable medical equipment), as wella s in public investment, account for $36 billion. If we then include the spending below ESAW in long-term care, we reach out net figure of $477 billion spending above ESAW.



ESAW is "Using a sample of 13 OECD countries, we developed a measure we call Estimated Spending According to Wealth (ESAW)". (And OECD is http://www.oecd.org/about/membersandpartners/list-oecd-member-countries.htm).

The best quote from this study is on the last page which states:



> [...]our analysis shows that most components of the US health care system are economically distorted and that no single factor is either the cause, or the silver bullet, for reform actions. To be effective, reform in the US health care system will need to involve all key stakeholders and will require the proposal of solutions that are placed in the context of a coherent set of principles covering both the demand and supply sides of the system."



I'm accepting this study at face value, without any research into the authors or who paid for it. Even with it, it's fairly obvious that the Forbes article left out a significant portion of the balance between causes for the mess we're in with our health care system. And, when reading the study itself, I think even you will agree that there is more than just medical staff salaries causing the problem and we need much more than a single focus in order to bring costs under control.


----------



## ace2000

Ken555 said:


> As demand increases, so will the number of doctors and medical staff trained...as with any industry.



Are you still standing by your statement here that the amount of doctors in our system is controlled by supply and demand, just like any other industry?  

If you do, I can accept your position on that and I'll just disagree.


----------



## ace2000

P.S. I'm not saying I disagree with your post, it looks like it's very well written.  I just don't have time to review it all right now and couldn't find the answer to the above question.


----------



## Ken555

ace2000 said:


> P.S. I'm not saying I disagree with your post, it looks like it's very well written.  I just don't have time to review it all right now and couldn't find the answer to the above question.



Do me the courtesy to read what I wrote - take your time.

To answer your question, nothing I've read yet shows an unbiased objective fact that there is an artificial limit to the number of qualified doctors and medical staff in the USA. I want a high barrier to entry for doctors, so there should be excellent education and personnel in that field. I can't imagine anyone who wants an unqualified doctor treating them, can you?


----------



## vacationhopeful

Ken555 said:


> ..... I can't imagine anyone who *wants* an unqualified doctor treating them, can you?



Wanting and getting are 2 very different things ... And both a shortage and a surplus will create a quality issue for two different reasons.

One (Shortage) is "to get more NEW doctors working from WHERE ever" NOW and burn out of existing doctors by too many hours worked.

The other condition, is too many doctors (Surplus), drives down quality by having the experienced talent retiring (their idea or the corporate world's idea) as other doctors will work for less of money.


----------



## Ken555

vacationhopeful said:


> Wanting and getting are 2 very different things ... And both a shortage and a surplus will create a quality issue for two different reasons.
> 
> 
> 
> One (Shortage) is "to get more NEW doctors working from WHERE ever" NOW and burn out of existing doctors by too many hours worked.
> 
> 
> 
> The other condition, is too many doctors (Surplus), drives down quality by having the experienced talent retiring (their idea or the corporate world's idea) as other doctors will work for less of money.




I didn't say I have a single solution to this problem. But, having unqualified doctors in my view is simply not an option.


Sent from my iPad


----------



## ace2000

Ken555 said:


> Do me the courtesy to read what I wrote - take your time.
> 
> To answer your question, nothing I've read yet shows an unbiased objective fact that there is an artificial limit to the number of qualified doctors and medical staff in the USA. I want a high barrier to entry for doctors, so there should be excellent education and personnel in that field. I can't imagine anyone who wants an unqualified doctor treating them, can you?



I will read it through it tonight, but you threw in a lot of other variables.  We were only discussing that one question, and I was trying to find your opinion about our main topic in your very long post.

On your other question...  It has to be a balancing act.   If the doctors actually do control the amount of doctors (which I realize you don't agree), don't you think there might be a little bit of a conflict of interest?  Especially when their inflated salaries are at risk.


----------



## Ken555

ace2000 said:


> I will read it through it tonight, but you threw in a lot of other variables.  We were only discussing that one question, and I was trying to find your opinion about our main topic.



Um...no. I was responding to the article you posted. Also, the study it quoted did not say that the AMA is the reason we have issues with medical professional salaries.



> On your other question...  It has to be a balancing act.   If the doctors actually do control the amount of doctors (which I realize you don't agree), don't you think there might be a little bit of a conflict of interest?  Especially when their high salaries would be at stake.




It's not that I don't agree, it's that you haven't proven that your theory that "doctors actually do control the amount of doctors". But, I do realize that medical doctors are often administrators of hospitals, medical schools, and related educational and political organizations. I'm sure we can find other industries which have a similar situation. Rather than simply asking the question over and over and waiting for me to agree...convince me with proof that you are correct. All I did today was quote the article and study you presented, and it's definitely not agreeing with you. I suspect with a little research I could make a compelling argument that doctors are the root cause of our healthcare costs...but that's your job in this thread! 


Sent from my iPad


----------



## ace2000

Ken555 said:


> I suspect with a little research I could make a compelling argument that doctors are the root cause of our healthcare costs...but that's your job in this thread!
> 
> 
> Sent from my iPad



LOL - looks like you have your assignment then.  I'd rather watch The Voice on my DVR this evening...


----------



## Ken555

ace2000 said:


> LOL - looks like you have your assignment then.  I'd rather watch The Voice on my DVR this evening...




So...you give up, eh? No proof, just hot air...typical TUG. In other words, prove your point or else it's meaningless.


Sent from my iPad


----------



## ace2000

Ken555 said:


> So...you give up, eh? No proof, just hot air...typical TUG. In other words, prove your point or else it's meaningless.
> 
> 
> Sent from my iPad



Ok, I'll play along.  I've provided one citation already on this topic and several others in this thread, how many have you contributed so far?

Here's one that I found rather quickly.  I really do not intend on doing any more research.  If you can't accept my previous reference and this one, then you'll have to look into it further yourself.

http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/

In his classic book Capitalism and Freedom, Milton Friedman describes the American Medical Association (AMA) as the “strongest trade union in the United States” and documents the ways in which the AMA vigorously restricts competition. The Council on Medical Education and Hospitals of the AMA approves both medical schools and hospitals. By restricting the number of approved medical schools and the number of applicants to those schools, the AMA limits the supply of physicians. In the same way that OPEC was able to quadruple the price of oil in the 1970s by restricting output, the AMA has increased their fees by restricting the supply of physicians.


----------



## vacationhopeful

Ken555 said:


> I didn't say I have a single solution to this problem. But, having unqualified doctors in my view is simply not an option....



I am so sick of all the unqualified people who are employed or promoted for reasons which have NOTHING to do with the job they can/can't do OR their skill set OR people skills ....

And if you think it is any different with doctors, better re-think that evaluation.


----------



## Ken555

ace2000 said:


> Ok, I'll play along.  I've provided one citation already on this topic and several others in this thread, how many have you contributed so far?
> 
> Here's one that I found rather quickly.  I really do not intend on doing any more research.  If you can't accept my previous reference and this one, then you'll have to look into it further yourself.




On more than one occasion I have responded to your posts and the referenced material. You have not responded in kind. You assume I, and perhaps others, will simply accept your opinion without facts to back them up, even after you agreed to do so. How much of a farce is this thread? You need to back up your opinions with proof. You ignore my comments and simply post another link instead, repeatedly. If you want to convince me, and others, then you need to do so factually. "Play along" is an insult to the time I've spent reviewing the study and articles you put forth as defense of your opinion that the AMA controls the number of doctors in America...yet there was no reference to the AMA in the study I reviewed today.

Until and unless you take this discussion seriously, I have no choice but to agree with others that your opinion is simply irrelevant.


Sent from my iPad


----------



## Ken555

vacationhopeful said:


> I am so sick of all the unqualified people who are employed or promoted for reasons which have NOTHING to do with the job they can/can't do OR their skill set OR people skills ....
> 
> 
> 
> And if you think it is any different with doctors, better re-think that evaluation.




I absolutely agree. But then why would anyone want to lower the standards for admittance to the medical profession?


Sent from my iPad


----------



## ace2000

Ken555 said:


> On more than one occasion I have responded to your posts and the referenced material. You have not responded in kind. You assume I, and perhaps others, will simply accept your opinion without facts to back them up, even after you agreed to do so. How much of a farce is this thread? You need to back up your opinions with proof. You ignore my comments and simply post another link instead, repeatedly. If you want to convince me, and others, then you need to do so factually. "Play along" is an insult to the time I've spent reviewing the study and articles you put forth as defense of your opinion that the AMA controls the number of doctors in America...yet there was no reference to the AMA in the study I reviewed today.
> 
> Until and unless you take this discussion seriously, I have no choice but to agree with others that your opinion is simply irrelevant.
> 
> 
> Sent from my iPad



Thanks Ken.  My previous post specifically addresses the AMA.  I've provided more backing to my opinions than anyone else on the thread has provided for theirs.  

You've provided nothing to back your own opinion, other than to attack my references.  We can move on and agree to disagree.


----------



## Ken555

ace2000 said:


> Thanks Ken.  My previous post specifically addresses the AMA.  I've provided more backing to my opinions than anyone else on the thread has provided for theirs.
> 
> 
> 
> You've provided nothing to back your side, other than to attack my references.  We can move on and agree to disagree.




Taking the easy way out, again. So much for the time I spent reviewing and commenting on the Forbes article and study today. Rather than change the question, how about focusing on simply defending your opinion with facts (plural)? Support your argument from multiple original sources - not other opinions - and you may convince me you are correct. If you don't know how to defend your argument then I completely understand why you continually try to deflect the issue and paint my contradictory opinion in a poor light. I think others can see what you are trying to do.


Sent from my iPad


----------



## ace2000

Ken555 said:


> Taking the easy way out, again.



Yes, everyone will be able to judge for themselves.  I posted references to back my opinion and you don't like them.  We get it.  You and anyone else can put my posts on ignore, if it bothers you.  Please do.


----------



## Ken555

ace2000 said:


> Yes, everyone will be able to judge for themselves.  You and anyone else can put my posts on ignore, if it bothers you.  Please do.




Your posts don't bother me, they tend to make me sad. I want you to critique my posts and refute them intelligently, not out of hand. I'm not discounting your opinion out of hand as you do with mine, and I've quoted your references with differing results. Running away from the discussion, as you are now doing, does not help your cause - the easy way out of this discussion won't solve the problem and is, fundamentally, a cause why our country has this problem...since generations have passed without fundamental reform. If you won't engage in civilized discussion on this topic, then how can you believe that your opinion is correct?

The facts I quoted in my earlier posts from Wikipedia illustrate, in a small way, that the salaries of doctors contribute to the overall high cost of health care but are not the only, nor even the highest, contributor to the overall cost. Yet you continue to push that this one issue is of paramount importance, and without facts - just opinion. Bring on the facts!


Sent from my iPad


----------



## ace2000

Ken555 said:


> I want you to critique my posts and refute them intelligently, not out of hand.



Ken, I DO respect your opinion and you're very articulate.  But, you keep wanting me to critique your posts and it seems that all they do is counter something in the article I posted.  I'm not going to quibble over an author's motives, etc, etc.  I'm not going to defend another paragraph in the reference I've provided that has nothing to do with the original topic.  I'm not going to provide the Bureau of Labor Statistics or Harvard Business Review (as was suggested earlier), when you've provided no sources to back your opinion.

Also, I'm sorry I can't bring my sources to a high enough level for you and the others here.  I state my opinion and if necessary, I provide a link to a Forbes article or a CBS news article and that's not good enough for people here.   But, for some reason, I'm the only one providing links supporting my opinion and everyone else gets a free pass.


----------



## ace2000

Ken555 said:


> Your posts don't bother me, they tend to make me sad.



Lighten up a little... we're on a timeshare BBS discussing health care.  There really is nothing to be sad about.


----------



## ace2000

Again, for those interested in the topic of doctors controlling the number of doctors, the link I found today lays it out pretty well.  I have no idea whether the author is right-wing or not, you all can judge the content for yourselves.

http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/


----------



## Ken555

ace2000 said:


> Ken, I DO respect your opinion and you're very articulate.  But, you keep wanting me to critique your posts and it seems that all they do is counter something in the article I posted.  I'm not going to quibble over an author's motives, etc, etc.  I'm not going to defend another paragraph in the reference I've provided that has nothing to do with the original topic.  I'm not going to provide the Bureau of Labor Statistics or Harvard Business Review (as was suggested earlier), when you've provided no sources to back your opinion.
> 
> Also, I'm sorry I can't bring my sources to a high enough level for you and the others here.  I state my opinion and if necessary, I provide a link to a Forbes article or a CBS news article and that's not good enough for people here.   But, for some reason, I'm the only one providing links supporting my opinion and everyone else gets a free pass.




Wait, now I'm confused. Are we reading the same thread? I posted the quotes from the Harvard Business Review and BLS to support the opinion I wrote about...so how is it exactly that I got "a free pass" with the links? 

As for "high enough level"...that's not it at all. Source documents are different from opinion articles, which is primarily what you've posted. The BLS and HBR offer more, and you should be able to do the same. Pick your own sources - but keep in mind that the sources will either make or break your argument.

Also, the first step to reviewing a supporting document is understanding the motivations of the author. Who is the author, and what experience do they have to justify an expert opinion on the topic? Is their publication biased, politically or with other influence by certain lobbyists, etc? Once you understand the context the article was written, only then should you read what it contains with comprehension of their goal. Then, look at their source documents...do they support the opinion the author wrote in the article? 

I hope this helps you understand how I approach this type of review. It's very important to know why the article as written and confirm the facts, especially for something as important as your allegation that the AMA is acting without consideration of the healthcare system. Too many people these days don't "quibble" over the motivations of the source of information, and that is how we are losing to the special interests. We need to question everything. Why does this author have a particular opinion? What is their supporting documents? Are they biased? Who paid for the study used to justify their opinion? Why is the study years older than the article - isn't there anything more current? Are there contradictory studies and if so then why did the author not acknowledge them? Etc etc etc. This, as I was taught in college, is the basis for critical thinking and understanding. I admit that I may be wrong with my opinion, and I challenged you to convince me otherwise. 


Sent from my iPad


----------



## Ken555

ace2000 said:


> Lighten up a little... we're on a timeshare BBS discussing health care.  There really is nothing to be sad about.




It's sad that you don't bother to answer the questions I pose, respond to my critique of your posts, and expect us to simply accept your opinion. You wanted to discuss this issue and I am agreeing to do so. You may be right. I may be wrong. But simply saying that you're right over and over again won't do the job. And that's sad. 

As for being on a timeshare forum discussing health care...yes, exactly. We are, and there is so much misinformation going on that I felt I had to step up and at least push us to collectively discuss this issue intelligently and with respect. If you believe you are correct then you should be able to support your position with facts. You haven't, and you aren't, and you are trying to change the topic and ignore the points I have made. 


Sent from my iPad


----------



## PStreet1

Ken555 said:


> I absolutely agree. But then why would anyone want to lower the standards for admittance to the medical profession?
> 
> 
> Sent from my iPad



You could ask the same question about any profession.  Why do some schools consistently turn out teachers of low quality?  Why do some schools consistently turn out engineers of low quality, etc.?  Schools of all sorts (including medical schools) turn out a differing quality of graduate.  Poor schools may turn out a good, or even outstanding, graduate, but it isn't their norm.  Good schools may turn out a poor graduate, but it isn't their norm.  Outstanding schools generally manage to weed out the poor specimens before graduation.

Some doctors are sub-standard just as some ______________ are substandard.  Since there is a higher demand to enter medical school than there are openings to attend, some new schools with, as yet, unproven credentials are springing up.  They may produce substandard graduates:  they are new; they don't have the same funding; therefore they lack the same facilities, including labs; they don't attract the top names as professors, and the list goes on.  The strong possibility is they will, for some time at least, produce sub-standard graduates.


----------



## ace2000

Ken555 said:


> Wait, now I'm confused. Are we reading the same thread? I posted the quotes from the Harvard Business Review and BLS to support the opinion I wrote about...so how is it exactly that I got "a free pass" with the links?



So, in your own words, where do you currently stand on the topic?  You've already answered earlier that you don't know.  I'm willing to accept that.  I'll be the first to admit I have a hard time following some of the reading you posted earlier - especially from those sources.  If I missed parts where you defended your original position of doctor positions being filled just like any other industry (my paraphrase here), then I apologize, sincerely.


----------



## Ken555

ace2000 said:


> So, in your own words, where do you currently stand on the topic?  You've already answered earlier that you don't know.  I'm willing to accept that.  I'll be the first to admit I have a hard time following some of the reading you posted earlier - especially from those sources.  If I missed parts where you defended your original position of doctor positions will be filled just like any other industry (my paraphrase here), then I apologize, sincerely.




I'm still waiting for you to include references to original sources with facts on your allegation regarding the AMA. You have posted opinions only, unless I missed it. Where are your facts?


Sent from my iPad


----------



## Ken555

PStreet1 said:


> You could ask the same question about any profession.  Why do some schools consistently turn out teachers of low quality?  Why do some schools consistently turn out engineers of low quality, etc.?  Schools of all sorts (including medical schools) turn out a differing quality of graduate.  Poor schools may turn out a good, or even outstanding, graduate, but it isn't their norm.  Good schools may turn out a poor graduate, but it isn't their norm.  Outstanding schools generally manage to weed out the poor specimens before graduation.
> 
> 
> 
> Some doctors are sub-standard just as some ______________ are substandard.  Since there is a higher demand to enter medical school than there are openings to attend, some new schools with, as yet, unproven credentials are springing up.  They may produce substandard graduates:  they are new; they don't have the same funding; therefore they lack the same facilities, including labs; they don't attract the top names as professors, and the list goes on.  The strong possibility is they will, for some time at least, produce sub-standard graduates.




Again, I agree completely. I have this issue with my colleagues often...many are unqualified and it causes problems and reflects poorly on all of us, though there are many who are excellent. 

But, shouldn't the medical profession be held to a higher standard? These are people who are charged with saving our lives, keeping us healthy, diagnosing correctly (the first time!) we have issues, etc. Why should we accept poor doctors, or encourage poor doctors with a supposed relaxing of medical school entry requirements and inferior medical school teachers, just because the same is true with other industries? You're really making my point for me here. 

As for new medical schools...well, I know several who went abroad to get their MD because they weren't accepted in a US based program. Luckily, a few of them went to schools that were affiliated with schools in the US and were then able to learn here for a time as well. 


Sent from my iPad


----------



## PStreet1

It's easy to say they should be, and I agree that they should be.  However, you could say the same thing about teachers:  they are in charge of our most precious asset, our children; or about engineers:  they calculate how much stress a given material can take--if it breaks, it kills people, and the list goes on.


----------



## ace2000

Ken555 said:


> I'm still waiting for you to include references to original sources with facts on your allegation regarding the AMA. You have posted opinions only, unless I missed it. Where are your facts?
> 
> 
> Sent from my iPad



You may have missed it when I posted it earlier.  Or you may have a disagreement with Milton Friedman - a Nobel Prize winner in economics.  If this isn't factual enough for you then so be it.  

http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/

In his classic book Capitalism and Freedom, Milton Friedman describes the American Medical Association (AMA) as the “strongest trade union in the United States” and documents the ways in which the AMA vigorously restricts competition. The Council on Medical Education and Hospitals of the AMA approves both medical schools and hospitals. By restricting the number of approved medical schools and the number of applicants to those schools, the AMA limits the supply of physicians. In the same way that OPEC was able to quadruple the price of oil in the 1970s by restricting output, the AMA has increased their fees by restricting the supply of physicians.


----------



## ace2000

Ken555 said:


> It's sad that you don't bother to answer the questions I pose, respond to my critique of your posts, and expect us to simply accept your opinion. You wanted to discuss this issue and I am agreeing to do so. You may be right. I may be wrong. But simply saying that you're right over and over again won't do the job. And that's sad.
> 
> As for being on a timeshare forum discussing health care...yes, exactly. We are, and there is so much misinformation going on that I felt I had to step up and at least push us to collectively discuss this issue intelligently and with respect. If you believe you are correct then you should be able to support your position with facts. You haven't, and you aren't, and you are trying to change the topic and ignore the points I have made.
> 
> 
> Sent from my iPad



I just re-read your original points and I do appreciate the feedback. I've provided my source and you've refuted it. As I've thought all along, you've provided zero support for your original premise on the doctor supply being filled just like any other industry. That's what we were discussing and you want to dissect the article I've referenced, which is fine. I've mentioned that you've made valid points concerning the article and I have nothing else to add. I only provided the link to support my position. Everyone can judge for themselves where they stand on the links I've provided vs. your information which attacks my article.


----------



## Passepartout

Ace, take a look at your posts. I know (or at least think) that you feel that you are doing SOMETHING to warn the masses about impending disaster. Problem is that no matter what you do, or say, or quote pundits, lauded experts, or anyone else, what you are doing doesn't matter.

You are running around like a panicked Chicken Licken. "The sky is falling!, the sky is falling! You are shouting "Watch out! They're out to get you!" But have you noticed that you are virtually the only one?

So continue to shout. Keep quoting whoever you get your 'talking points' from. Keep shoveling sand against the tide. The tide will keep coming and eventually cover you up. No one expects you to change your mind, but frankly, your continuing tirade has become tedious.

Jim


----------



## ace2000

Passepartout said:


> Ace, take a look at your posts. I know (or at least think) that you feel that you are doing SOMETHING to warn the masses about impending disaster. Problem is that no matter what you do, or say, or quote pundits, lauded experts, or anyone else, what you are doing doesn't matter.



Thanks for the feedback Jim.

 My posts have contradicted the opinions of many on this thread, and so I've stepped on a few toes.  I don't see impending disaster, it'll work itself out.  

 If you notice, I'm responding to people that have directly responded to me.  If you don't like the posts, did you know that TUG has an ignore feature?  Please use it.


----------



## Ken555

*It's the prices, stupid!*



ace2000 said:


> I just re-read your original points and I do appreciate the feedback. I've provided my source and you've refuted it. As I've thought all along, you've provided zero support for your original premise on the doctor supply being filled just like any other industry. That's what we were discussing and you want to dissect the article I've referenced, which is fine. I've mentioned that you've made valid points concerning the article and I have nothing else to add. I only provided the link to support my position. Everyone can judge for themselves where they stand on the links I've provided vs. your information which attacks my article.



Ok, here we go! I'll try to be impartial with my comments (since I have an open mind on this issue and simply want to know the truth unbiased by any political party or lobbyist). It's a good thing I've been exhausted today and can't focus on work so I have time for this thread. 

So I searched for comparisons of medical professionals to other industries. Not so surprisingly, I found a number of healthcare cost articles comparing the US to other countries (several interesting links and quotes below). 

I did run across this job review site, which shows wage ranges for nurses, physical therapists and EMTs and medical tech positions, amongst others. I don't know if it's accurate, but it has school info and relative job availability info. It seems there's plenty of jobs available, if this is any guide, with over the next 10 years growth anticipated as little as 9% (dietitians and EMTs) to as high as 30% (PTs).

http://medical-careers-review.toptenreviews.com/

From The New York Times in 2009: How Much Do Doctors in Other Countries Make?
http://economix.blogs.nytimes.com/2...er-countries-make/?_php=true&_type=blogs&_r=0

It summarizes:



> They [a graph] show that American general practitioners and nurses earn more than their counterparts in other developed countries, and American specialists are close to the top of the pack.



If accurate, this info shows that specialists in the Netherlands and Australia earn more than those in the US. And, it goes on to say that when comparing countries GDP to medical salaries the US overpays by a lot. However:



> doctors and nurses in the rest of the industrialized world start their medical careers with much less student loan debt compared to medical graduates in the United States.



The NY Times article references this CRS Report for Congress from 2007 called U.S. Health Spending: Comparison with Other OECD Countries
http://assets.opencrs.com/rpts/RL34175_20070917.pdf


Health Costs: How the U.S. Compares With Other Countries
http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/
from 10/22/2012

In your favor, this article states:



> There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1.



and



> The number of hospital beds in the U.S. was 2.6 per 1,000 population in 2009, lower than the OECD average of 3.4 beds.



But



> The U.S. leads the world in health care research and cancer treatment, for instance. The five-year survival rate for breast cancer is higher in the U.S. than in other OECD countries and survival from colorectal cancer is also among the best, according to the group.



Lots of other great info in this article, and I encourage everyone to read it, including:



> The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person.



When comparing the US to Japan and France:



> They use a common fee schedule so that hospitals, doctors and health services are paid similar rates for most of the patients they see. In the U.S., how much a health care service gets paid depends on the kind of insurance a patient has. This means that health care services can choose patients who have an insurance policy that pays them more generously than other patients who have lower-paying insurers, such as Medicaid.
> 
> They are flexible in responding if they think certain costs are exceeding what they budgeted for. In Japan, if spending in a specific area seems to be growing faster than projected, they lower fees for that area. Similarly, in France an organization called CNMATS closely monitors spending across all kinds of services and if they see a particular area is growing faster than they expected (or deem it in the public interest), they can intervene by lowering the price for that service. These countries also supplement lowering fees with other tools. For example, they monitor how many generic drugs a physician is prescribing and can send someone from the insurance fund to visit physicians’ offices to encourage them to use cheaper generic drugs where appropriate. In comparison, U.S. payment rates are much less flexible. They are often statutory and Medicare cannot change the rates without approval by Congress. This makes the system very inflexible for cost containment.
> 
> There are few methods for controlling rising costs in private insurance in the U.S. In running their business, private health insurers continually face a choice between asking health care providers to contain their costs or passing on higher costs to patients in higher premiums. Many of them find it hard to do the former.




BIG MED
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande?currentPage=all
(note: this is written by a doctor; context matters!)

This is a light article regarding health care costs in general. In regards to medical doctors:



> Medicine, though, had held out against the trend. Physicians were always predominantly self-employed, working alone or in small private-practice groups. American hospitals tended to be community-based. But that’s changing. Hospitals and clinics have been forming into large conglomerates. And physicians—facing escalating demands to lower costs, adopt expensive information technology, and account for performance—have been flocking to join them. According to the Bureau of Labor Statistics, only a quarter of doctors are self-employed—an extraordinary turnabout from a decade ago, when a majority were independent. They’ve decided to become employees, and health systems have become chains.
> 
> [...]
> 
> Historically, doctors have been paid for services, not results. In the eighteenth century B.C., Hammurabi’s code instructed that a surgeon be paid ten shekels of silver every time he performed a procedure for a patrician—opening an abscess or treating a cataract with his bronze lancet. It also instructed that if the patient should die or lose an eye, the surgeon’s hands be cut off. Apparently, the Mesopotamian surgeons’ lobby got this results clause dropped. Since then, we’ve generally been paid for what we do, whatever happens. The consequence is the system we have, with plenty of individual transactions—procedures, tests, specialist consultations—and uncertain attention to how the patient ultimately fares.




Why an MRI costs $1,080 in America and $280 in France
http://www.washingtonpost.com/blogs...280-in-france/2011/08/25/gIQAVHztoR_blog.html



> In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.
> There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”




An insurance industry CEO explains why American health care costs so much
http://voices.washingtonpost.com/ezra-klein/2009/11/an_insurance_industry_ceo_expl.html



> There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same -- the volume of procedures, the days we spend in the hospital, the number of surgeries we need -- but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.
> 
> In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn't set those rates for private insurers, which is why the prices paid by Medicare, as you'll see on some of these graphs, are much lower than those paid by private insurers.




This is an interesting report from The Commonwealth Fund titled Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality
http://www.commonwealthfund.org/~/m...laining_high_hlt_care_spending_intl_brief.pdf


In my quick search just now I wasn't able to locate specific examples of comparison of healthcare with other industries. Interestingly, I found a number of articles that postulated that healthcare is not like other industries, but didn't provide details. I'll continue to search and if I find something relevant I'll post it. So, I'll have to stay on the fence on this issue regarding equating healthcare to other industries. You haven't convinced me you're right, but you have made me consider that it may be different than other industries. 

What I have confirmed through this thread is that there are significant number of articles and studies that show there are a number of reasons why healthcare is so expensive in the US. Salaries is part of the reason, but not the only reason. And without a concerted effort to reform the entire industry (including medical school costs), the profession won't attract the brightest and we will end up with a sorry health system. No one wants that. 

From a personal perspective, I know a number of doctors. They are *all* concerned, and have been for years, about their ability to continue paying the overhead necessary to run their practice with the shrinking insurance (and medicare) payments while at the same time increasing reporting and compliance costs. I know a number who have switched to concierge medical practices where they charge an annual fee from the patient in addition to the money they receive from insurance. Many doctors, as shown above, are now joining larger groups and are no longer in private practice in order that they simply earn a salary like any other job. 

Also, I think it's important to point out that not all medical doctors earn a lot of money. You may think they do, and they may earn more than many other fields, but when you consider the cost of their education and the costs for staying current in a regulated industry that isn't always the case. The same may be said of lawyers, though there do seem to be many more of them (!) and probably shouldn't be compared with each other... And, shouldn't doctors earn a nice wage? I'd rather the doctor earned more and the insurance industry earn less, but that doesn't seem like an option right now.

I suggest you focus on this line of questioning to bolster your argument (and post facts!): Why is medical school more expensive in the US than elsewhere? Is that due to the AMA? Other? You may be surprised at the answer you discover.


----------



## Ken555

Passepartout said:


> Ace, take a look at your posts. I know (or at least think) that you feel that you are doing SOMETHING to warn the masses about impending disaster. Problem is that no matter what you do, or say, or quote pundits, lauded experts, or anyone else, what you are doing doesn't matter.
> 
> You are running around like a panicked Chicken Licken. "The sky is falling!, the sky is falling! You are shouting "Watch out! They're out to get you!" But have you noticed that you are virtually the only one?
> 
> So continue to shout. Keep quoting whoever you get your 'talking points' from. Keep shoveling sand against the tide. The tide will keep coming and eventually cover you up. No one expects you to change your mind, but frankly, your continuing tirade has become tedious.
> 
> Jim



Everyone is entitled to their opinion. They may be right. They may be wrong. But without civil discourse we won't improve our healthcare system since it should only be reformed with overwhelming approval for a new plan. We're not there yet.


----------



## ace2000

Good post Ken... the one link that intrigued me was this one that you provided below - which you must have enjoyed also since it contains the title of your post.  As I mentioned at least twice in this thread...  The health insurance companies are singled out as the bad guys in several posts, however, the blame for this current mess can be spread out all over.

http://www.washingtonpost.com/blogs...280-in-france/2011/08/25/gIQAVHztoR_blog.html

_The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States — the pharmaceuticals industry and the medical device industry — sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability._

_The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers._


----------



## ace2000

Ken555 said:


> I suggest you focus on this line of questioning to bolster your argument (and post facts!): Why is medical school more expensive in the US than elsewhere? Is that due to the AMA? Other? You may be surprised at the answer you discover.



I don't plan on bolstering my argument on the doctor shortage any further.  My argument has been consistent - it is because the doctors control the number of doctors.  If someone disagrees with my premise then they can state specifically why, and I'll be happy to address that.  I don't think you disagree with that now.

The AMA is one part of it.  The government also controls the number of residencies with the financial aid they provide.  They purposely limit the amount of financial aid.  Why?  Because of the lobbying efforts of groups like the AMA - there are also other doctor lobbying groups besides the AMA.  They are the group that has the name most recognized.


----------



## momeason

Passepartout said:


> I like to blame autospell for stuff like that.



thanks to you and Pjrose


----------



## Ken555

ace2000 said:


> I don't plan on bolstering my argument on the doctor shortage any further.  My argument has been consistent - it is because the doctors control the number of doctors.  If someone disagrees with my premise then they can state specifically why, and I'll be happy to address that.  I don't think you disagree with that now.
> 
> The AMA is one part of it.  The government also controls the number of seats in the medical schools with the financial aid they provide.  They purposely limit the amount of financial aid.  Why?  Because of the lobbying efforts of groups like the AMA - there are also other doctor lobbying groups besides the AMA.  They are the group that has the name most recognized.




Provide proof to support your new claims here... /sigh


Sent from my iPad


----------



## ace2000

Ken555 said:


> Provide proof to support your new claims here... /sigh
> 
> 
> Sent from my iPad



Sure, perhaps later if I have time today.  I would like to clarify something about my post though.  I was referring to the financial aid dispersed for the residency part of the medical training.  That's what I was thinking about.


----------



## Conan

I can't vouch for this pollster, but for what it's worth:


----------



## ScoopKona

Assuming that poll is accurate, it is almost certain the 23% of Republicans who want to keep ACA are the 23% who either have health issues that meant getting insurance was impossible, or have close family members who could say the same thing.


----------



## Conan

ScoopLV said:


> Assuming that poll is accurate, it is almost certain the 23% of Republicans who want to keep ACA are the 23% who either have health issues that meant getting insurance was impossible, or have close family members who could say the same thing.



Surely there are some whose values extend to doing for others what they would want others to do for them.


----------



## ScoopKona

Conan said:


> Surely there are some whose values extend to doing for others what they would want others to do for them.



I can only assume by this post that you do not live in America. We haven't acted like that in a very long time.


----------



## SueDonJ

ScoopLV said:


> Assuming that poll is accurate, it is almost certain the 23% of Republicans who want to keep ACA are the 23% who either have health issues that meant getting insurance was impossible, or have close family members who could say the same thing.



Or they're from Massachusetts and they already know that a health care/coverage law can work, despite necessary tweaking after it's enacted and regardless of who took the initiative to implement it.


----------



## DeniseM

I was afraid that this thread would have to be closed, but now I see that people are going to bore us to death by arguing about arguing, and they will kill it with no assistance...


----------



## rleigh

Self-deleted


----------



## ace2000

Ken555 said:


> So it's more than a few rough years. In the long run, nothing will change unless we force it to, since the healthcare industry ("industry") is comprised of insurance companies that have only one mandate - profit. No doubt pricing will change with availability, and there will be lots of good (and bad) individual experiences with the system (as there are now), yet I'm still positive about these changes.
> 
> *As demand increases, so will the number of doctors and medical staff trained...as with any industry.*





ace2000 said:


> The AMA is one part of it.  The government also controls the number of residencies with the financial aid they provide.  They purposely limit the amount of financial aid.  Why?  Because of the lobbying efforts of groups like the AMA - there are also other doctor lobbying groups besides the AMA.  They are the group that has the name most recognized.





Ken555 said:


> Provide proof to support your new claims here... /sigh



Since you asked for proof, I'll provide some.  First, I'm not really making new claims here as you mentioned above.  I've mentioned at least twice in this thread that the government has control of the doctors also.  

I think this reporter from USA Today is making the exact same case I am.  


Article excerpt:

*The marketplace doesn't determine how many doctors the nation has, as it does for engineers, pilots and other professions. The number of doctors is a political decision, heavily influenced by doctors themselves.*

Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors.

To become a physician, students spend four years in medical school. Graduates then spend three to seven years training as residents, usually treating patients under supervision at a hospital. Residents work long hours for $35,000 to $50,000 a year. Even doctors trained in other countries must serve medical residencies in the USA to practice here.

Medicare, which provides health care to the nation's seniors, also is the primary federal agency that controls the supply of doctors. It reimburses hospitals for the cost of training medical residents.

The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The number of residents has hovered at this level for the past decade, according to the Accreditation Council for Graduate Medical Education.

In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor. Teaching hospitals pay for a small number of residents without government assistance.

http://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm


----------



## ace2000

Conan said:


> I can't vouch for this pollster, but for what it's worth:



Nothing wrong with the pollster.  Let's take a look at the same question in a year or two.  It's interesting.  The ACA is front-loaded with the popular items first and then the unpopular items are at the end.  This summer will be a critical point in the process when next year's company sponsored health premiums are announced.


----------



## pgnewarkboy

ace2000 said:


> Nothing wrong with the pollster.  Let's take a look at the same question in a year or two.  It's interesting.  The ACA is front-loaded with the popular items first and then the unpopular items are at the end.  This summer will be a critical point in the process when next year's company sponsored health premiums are announced.



Yes, very unpopular to get health insurance for your family when you don't have a job or when you are a self employed entrepreneur.  Very very unpopular. The progressive  closing of the donut hole for medicines for seniors very very unpopular.  BTW, a year or two is nothing in the history of programs for the good of the average person like medicare and social security.   

Our society gets sicker and sicker as the Ayn Rand supermen continue to pollute the air, the water, and the soil.  The only way out is for the supermen in the Medical Industry to create more expensive tests and procedures that might not even be necessary if the first group of supermen stopped making everyone sick.

Of course we know that those who point out the pollution and the growing health problems do it for MONEY. There are just so many BILLIONAIRES making a fortune from pointing out these horrifying problems.  Unlike the oil industry, agri industry, plastics industry, and others where they work for a pittance for the public good.

If you could just make money off of the gullibility, and ignorance of other people.   Oh wait,l I think you can.  You go into banking industry for one.


----------



## ace2000

pgnewarkboy said:


> Yes, very unpopular to get health insurance for your family when you don't have a job or when you are a self employed entrepreneur.  Very very unpopular. The progressive  closing of the donut hole for medicines for seniors very very unpopular.  BTW, a year or two is nothing in the history of programs for the good of the average person like medicare and social security.



Good points.  I don't believe the "popular" items you've mentioned will ever go away.  Personally, I'm happy these individuals and others are getting coverage for a reasonable price...


----------



## momeason

[political post deleted]


----------



## momeason

ace2000 said:


> Good points.  I don't believe the "popular" items you've mentioned will ever go away.  Personally, I'm happy these individuals and others are getting coverage for a reasonable price...



Thank you Ace. I am glad also. I am actually agreeing with a statement you made.


----------



## ScoopKona

[political post deleted]


----------



## pgnewarkboy

I am sure this has been mentioned somewhere in this humongous thread elsewhere BUT - Healthcare for profit cannot work in a society where Greed is Good.  In a society where people needed a small profit to lead a decent life and continue their business, in a society where getting a profit was not more important than helping fellow human beings, perhaps health care for profit could work.  

We don't live in such a society.  We live in a society where a CEO reduced 401 K benefits because of the health care costs for a few unhealthy babies.  We live I a society where any attempt to reign in the earnings of a multi=billionaire or create a liveable minimum wage  is attacked as socialism.  We live in Ayn Rand's nightmare of a world where the only people that count are the super super wealthy and everyone else can rot.


----------



## rapmarks

[Political post deleted]


----------



## momeason

I do not believe the ACA in its current form is the solution. I do believe that it is important to get access to healthcare for as many as possible as soon as possible. if this system fails, we will not go back to where we were. 

Fact: This law is helping millions get the access they did not have. 
Fact: It is helping many millions more be protected from future catastrophies and bankruptcies.
Fact: It is protecting consumers from the junk policies many millions have been scammed with.

Now for the theory. Once they above has been accomplished, it will be difficult, if not impossible, to take these new protections away. This will lead to future improvements which may or may not involve the insurance industry. 

In the long run, I am confident we will all be better off. Change is hard, but always necessary to grow.


----------



## bogey21

IMO it would have been simpler if Congress had simply expanded Medicaid, decreed that Insurance companies couldn't turn down prospective customers for pre-existing conditions, allowed kids to stay on parent's policies until age 26, eliminated life time caps and left everything else like it was.  Sure premiums would have gone up but what else is new?

George


----------



## Patri

bogey21 said:


> IMO it would have been simpler if Congress had simply expanded Medicaid, decreed that Insurance companies couldn't turn down prospective customers for pre-existing conditions, allowed kids to stay on parent's policies until age 26, eliminated life time caps and left everything else like it was.  Sure premiums would have gone up but what else is new?
> 
> George




Why would Congress do something that was common sense and so much easier?


----------



## momeason

Patri said:


> Why would Congress do something that was common sense and so much easier?



Have they ever?


----------



## ace2000

*Consumers can keep old health plans into 2017, administration says*

The Obama administration announced Wednesday that some Americans with health insurance policies that don’t meet consumer standards set by the Affordable Care Act will be allowed to keep their plans into 2017, three years later than originally envisioned.

http://www.latimes.com/nation/polit...ension-20140305,0,1033254.story#axzz2v8EZfOdc


----------



## slip

So why would he do that?


----------



## Passepartout

ace2000 said:


> The Obama administration announced Wednesday that some Americans with health insurance policies that don’t meet consumer standards set by the Affordable Care Act will be allowed to keep their plans into 2017



Can't say I agree, because the sooner people are incentivised to get ACA coverage instead of older insurance that doesn't carry ACA standards, the better. But from a practical standpoint, this is a mid-term election year, and doing this diffuses the argument that "I lost my health insurance'". It takes some of the wind out of the opposition's sails.


----------



## geekette

Passepartout said:


> Can't say I agree, because the sooner people are incentivised to get ACA coverage instead of older insurance that doesn't carry ACA standards, the better. But from a practical standpoint, this is a mid-term election year, and doing this diffuses the argument that "I lost my health insurance'". It takes some of the wind out of the opposition's sails.



It still is at the discretion of the insurance company.  So far as I know, they are not compelled to continue any policy they don't want to.


----------



## Tia

Oh so very true 




pgnewarkboy said:


> .....
> 
> If you could just make money off of the gullibility, and ignorance of other people.   Oh wait,l I think you can.  You go into banking industry for one.


----------



## momeason

Today is the deadline for April 1 coverage. I have enrolled a few people for totally free insurance. I have enrolled the majority of my clients for under $50/mo. This is for great BCBSNC coverage. 90% of North Carolinians have received assistance when they applied through for advance tax credits. NC has the 5th highest enrollment numbers. By law, everyone is supposed to have health insurance coverage for at least 9 months of the year. I personally doubt the tax penalty will be accessed this year, but the law allows the IRS to access a small penalty called a "shared responsibility payment".  This penalty is part of the law because at some point everyone needs medical services. If individuals refuse to get coverage, we all pay for it through increased costs because of unpaid bills at our hospitals. 
Our hospitals are huge advocates and proponents of the new ACA law. Small, rural hospitals are closing at an alarming rate because of large numbers of uninsured patients. These costs are passed on to all of us and are a real burden to our hospitals. I am working to get all who are eligible for coverage insured. In NC and 22 other states, there has been no Medicaid Expansion. NC rejected the federal funds to provide this Medicaid coverage for hundreds of thousands of our citizens. Those who do not have enough income to qualify for the advance tax credits will be exempt from the requirement to carry insurance, but they will
not get any type of coverage. If your income is below the federal poverty line, you still need to call the Marketplace so the numbers of uninsured will be recorded. 27 states will offer Medicaid to those below 133% of the Federal Poverty Line.
Contact me if you do not know if you qualify for advance tax credits and I can answer that easily. If you know you do not qualify for tax credits because your income is too low, call the Marketplace at 1-800-318-2596 to be counted among the uninsured, qualify for an exemption or get Medicaid if your state expanded Medicaid. Tomorrow will be less busy than today.

You must enroll today if you want April 1 coverage. You can change your mind next week on your plan as long as you do not pay for your plan today. Most insurance providers will not allow any changes to your enrollment after you pay for your plan. If you want any 2014 individual coverage, the final enrollment deadline is March 31 (for May 1 coverage) The enrollment deadline applies to any individual policy sold both on and off the exchange.


----------



## bogey21

momeason said:


> . 90% of North Carolinians have received assistance when they applied through for advance tax credits.QUOTE]
> 
> I know you think this is great but it is my tax dollars that are paying for it.
> 
> George


----------



## momeason

bogey21 said:


> momeason said:
> 
> 
> 
> . 90% of North Carolinians have received assistance when they applied through for advance tax credits.QUOTE]
> 
> I know you think this is great but it is my tax dollars that are paying for it.
> 
> George
> 
> 
> 
> 
> And your tax dollars have been paying for unnecessary trips to the emergency room and leaving hospitals straddled with unpaid bills for a lifetime. All of the people I am signing up have jobs. Insurance is far too expensive for the vast majority of people who are not offered group coverage. Group coverage for spouses and dependents is also far too expensive for the spouses of our teachers and many others who are offered group coverage.
> I help your contractors, your hair stylists, your barbers, your painters, artists, musicians, retail workers, food service workers, small business owners and small farm owners. Do you think all of them deserve to go without healthcare? I bet you have group coverage and never had to shop for individual coverage. Walk a mile in their shoes. They are not criminals or lazy. In NC, 90% of the uninsured need assistance paying for healthcare.
Click to expand...


----------



## Passepartout

bogey21 said:


> I know you think this is great but it is my tax dollars that are paying for it.
> 
> George



And your tax dollars pay for the fire trucks that roll when someone's house is burning. It's your tax dollars that keep the library open. It's your tax dollars they use to fix the potholes. It's your tax dollars that pay the cops, and the teachers.

Stow it George. Part of the cost of living in a civilized society is sharing the costs and the risks. Those who can afford to pay help those less fortunate.

If you were not as fortunate, the shoe might well be on the other foot and you would be the one being helped. Consider yourself lucky- you can afford to help others. Any of those being helped would happily trade places with you.

Jim


----------



## Passepartout

Deleted...


----------



## Patri

I thought the deadline to enroll was quietly dropped for another year or so. No big fanfare announcement about it, but it was in the Wall Street Journal, if I remember what I heard on the radio today.


----------



## Passepartout

Patri said:


> I thought the deadline to enroll was quietly dropped for another year or so. No big fanfare announcement about it, but it was in the Wall Street Journal, if I remember what I heard on the radio today.



Nope. But if (a) you want insurance on 4/1/14, you MUST sign and pay today. Or (b) If you just want to avoid a penalty (I suspect it's going to be minimal) in your 2014 taxes, you have until March 31 to enroll. Or (c) If you don't want insurance, AND want to pay for the priveledge, and the risk of bankruptcy is I'd no concern, no one will hold a gun to your head and force you to buy. But don't come around crying that you didn't know that going to the ER could easily cost you your house and bankrupt you. The rest of us are through paying. Your hospital will stabilize people with life threatening conditions, but then they will bill for it and send them on their way.

Jim


----------



## bogey21

Passepartout said:


> Stow it George. Part of the cost of living in a civilized society is sharing the costs and the risks. Those who can afford to pay help those less fortunate.
> 
> If you were not as fortunate, the shoe might well be on the other foot and you would be the one being helped. Consider yourself lucky- you can afford to help others. Any of those being helped would happily trade places with you.



Thanks for the "Stow it George".  

Yes, we disagree.  Personally, I like to choose whom I help.  For example members of my family, members of my church and my charity of choice which provides food and shelter for the down and out.  And I'll guarantee that my "contributions"  (which are significant) are more efficiently spent than my tax dollars that support the ACA.

George


----------



## Passepartout

bogey21 said:


> Personally, I like to choose whom I help.  For example members of my family, members of my church and my charity of choice which provides food and shelter for the down and out.



You may be the most generous person alive, George, but unfortunately, you don't have the luxury of deciding who buys health insurance- at the price dictated by the insurance companies- not the government- and who doesn't.

All that is dictated is the type of coverage offered. It does no good to sell people coverage that requires that a person who earns well under poverty level has to spend half a year's wages on healthcare before their (non) insurance pays 50% of ongoing medical expenses. That is no help. 

I wish that a 'Medicare for everyone' single payer plan had been possible, like the other 90+ % of civilized nations provide for their citizens, but that was just not possible under the current political climate.

Jim


----------



## momeason

Passepartout said:


> Nope. But if (a) you want insurance on 4/1/14, you MUST sign and pay today. Or (b) If you just want to avoid a penalty (I suspect it's going to be minimal) in your 2014 taxes, you have until March 31 to enroll. Or (c) If you don't want insurance, AND want to pay for the priveledge, and the risk of bankruptcy is I'd no concern, no one will hold a gun to your head and force you to buy. But don't come around crying that you didn't know that going to the ER could easily cost you your house and bankrupt you. The rest of us are through paying. Your hospital will stabilize people with life threatening conditions, but then they will bill for it and send them on their way.
> 
> Jim



You do not have to pay today in many states. You do have to pick the plan and confirm enrollment. With BCBSNC, you can pay until the end of the month. You will not have your member cards by April 1 though you have coverage if something happened.
Just 16 more days to get signed up for any 2014 coverage


----------



## momeason

Passepartout said:


> And your tax dollars pay for the fire trucks that roll when someone's house is burning. It's your tax dollars that keep the library open. It's your tax dollars they use to fix the potholes. It's your tax dollars that pay the cops, and the teachers.
> 
> Stow it George. Part of the cost of living in a civilized society is sharing the costs and the risks. Those who can afford to pay help those less fortunate.
> 
> If you were not as fortunate, the shoe might well be on the other foot and you would be the one being helped. Consider yourself lucky- you can afford to help others. Any of those being helped would happily trade places with you.
> 
> Jim



My feelings exactly. 
I am blessed to be able to share with the less fortunate. It keeps me happy and healthy. Complaining and whining about life being unfair depresses me. I have discovered that actively working to improve the lives of others, not my own life, makes me a happier person.


----------



## bogey21

momeason said:


> I am blessed to be able to share with the less fortunate. It keeps me happy and healthy. Complaining and whining about life being unfair depresses me.



Believe it or not I pretty much agree with you.  I give a lot of money to local charaties.  You know the kind you can walk into and see how effeciently they deliver their services to the less fortunate.  I just happen to believe that when all the costs pertaining to the ACA are added up (like the coming bail out of the Insurance Companies) that our elected Representatives should have come up with something better.

George


----------



## Ken555

bogey21 said:


> I just happen to believe that [...] our elected Representatives should have come up with something better.




This is so very true, and it's been true for dozens of issues over decades. We should not be surprised to discover it affect healthcare, especially considering that the same issues have been discussed for a very long time, and we now have a watered down "solution". But, at least it moves us in the right direction. Stopping progress on critically important social issues that will affect the lives of many people just because it isn't good enough is, in my opinion, no longer an option on issues which have plagued us for decades. Either fix the underlying cause of the dysfunction (not likely due to the extreme amounts of money involved) or be happy some progress, any progress, is being made. 

And for what it's worth, be sure you verify with the independent oversight organizations that verify how much of a non-profits budget goes to administration and other expenses. You might be surprised to discover that those organizations you believe in really aren't as efficient as you think.


Sent from my iPad


----------



## pjrose

Passepartout said:


> And your tax dollars pay for the fire trucks that roll when someone's house is burning. It's your tax dollars that keep the library open. It's your tax dollars they use to fix the potholes. It's your tax dollars that pay the cops, and the teachers.
> 
> . . .  Part of the cost of living in a civilized society is sharing the costs and the risks. Those who can afford to pay help those less fortunate.
> 
> If you were not as fortunate, the shoe might well be on the other foot and you would be the one being helped. Consider yourself lucky- you can afford to help others. Any of those being helped would happily trade places with you.
> 
> Jim





momeason said:


> My feelings exactly.
> I am blessed to be able to share with the less fortunate. It keeps me happy and healthy. Complaining and whining about life being unfair depresses me. I have discovered that actively working to improve the lives of others, not my own life, makes me a happier person.



Plus many thumbs up to both of you.


----------



## ScoopKona

Passepartout said:


> And your tax dollars pay for the fire trucks that roll when someone's house is burning. It's your tax dollars that keep the library open. It's your tax dollars they use to fix the potholes. It's your tax dollars that pay the cops, and the teachers.



Stephen King wrote what I consider the best article thus far explaining what's wrong with society. Google it if you'd like, just be warned that the language is very coarse: Tax Me, for F@%&’s Sake!

Here's an excerpt:

_"What charitable 1 percenters can’t do is assume responsibility—America’s national responsibilities: the care of its sick and its poor, the education of its young, the repair of its failing infrastructure, the repayment of its staggering war debts. Charity from the rich can’t fix global warming or lower the price of gasoline by one single red penny. That kind of salvation does not come from Mark Zuckerberg or Steve Ballmer saying, “OK, I’ll write a $2 million bonus check to the IRS.” That annoying responsibility stuff comes from three words that are anathema to the Tea Partiers: *United American citizenry*."_

What we're sorely lacking in this country is United American citizenry. We haven't had any for quite awhile. And any time someone introduces a bill that might foster a "we're all on the same team" attitude, it gets shouted down with cries of "But not with my precious money!"

I think one of the main reasons the years following WWII were so productive is that legislators had the common experience of fighting side by side -- the entire nation. After going through that, it was easier for people to work together. Compromise was easier.

Today, it's all about ideological purity -- the very thing we fought so hard to eliminate 70 years ago.


----------



## Passepartout

I tend to agree. Maybe what it will take is a common enemy. Hitler fueled WWII. The Cold War fueled the military in the '50s and '60's'. An incoming space rock might unite the nation unlike just as big a threat- that of climate change hasn't. Yet. Perhaps when the waves lap at the doors of the rich and powerful, and there are no more inland poor to tax to fund relief.... But by then I feel certain I will be below the lawn instead of above it.

Meanwhile, I'm on vacation and think another lap in the pool to cool off (it's 90) is called for.

Jim


----------



## ace2000

According to the numbers, the ACA has now insured less than 10% of the previously uninsured population.  Yes, I guess you can say the plan has helped some, but has it been worth the costs involved?  Regardless of how we feel on TUG, the voters will have the final say on that question in the 2014 and 2016 elections.  

Personally, I like the under 26 provision and the mandatory coverage of pre-existing conditions, but the plan has been built on a one-party solution and a bundle of lies and misinformation.  Because of those facts, the plan may or may not succeed in the future.  However, the popular provisions are here to stay, nobody should worry about that.


----------



## SMHarman

ScoopLV said:


> What we're sorely lacking in this country is United American citizenry. We haven't had any for quite awhile. And any time someone introduces a bill that might foster a "we're all on the same team" attitude, it gets shouted down with cries of "But not with my precious money!"


There is a meme going around on the interwebs that says something like



> If a man has an apartment stacked to the ceiling with newspapers, we call him crazy.  If a woman has a trailer house full of cats, we call her nuts.
> But when people pathalogically hoard so much cash that they impoverissh the entire nation, we put them on the cover of Fortune and pretend that they are role models.
> - B. Lester


----------



## SMHarman

ace2000 said:


> According to the numbers, the ACA has now insured less than 10% of the previously uninsured population.  Yes, I guess you can say the plan has helped some, but has it been worth the costs involved?  Regardless of how we feel on TUG, the voters will have the final say on that question in the 2014 and 2016 elections.
> 
> Personally, I like the under 26 provision and the mandatory coverage of pre-existing conditions, but the plan has been built on a one-party solution and a bundle of lies and misinformation.  Because of those facts, the plan may or may not succeed in the future.  However, the popular provisions are here to stay, nobody should worry about that.



Is that including those that were picked up in Medicaid expansion and u26 coverage etc?  I belive romneycare in Mass had a slow start and then picked up steam over Y2 and Y3 as more realised it covered them and the education and word of mouth spread.


----------



## ace2000

SMHarman said:


> Is that including those that were picked up in Medicaid expansion and u26 coverage etc?  I belive romneycare in Mass had a slow start and then picked up steam over Y2 and Y3 as more realised it covered them and the education and word of mouth spread.



Of course it's going to grow, nobody questions that.  But, the key is the impact on the next two elections - that's how the future of the ACA is going to be decided.  The 10% figure is based on the original estimates of 47 million people were uninsured and the fact that the administration just released a 4.2 million enrollment number as of last week (that 4.2 million number is enrollment numbers, not actually paid).  

Edit:  One other comment, there are rumors that the administration is going to back off the penalty for not signing up.  If that happens, we will all pay our fair share for the new changes - not just mainly the uninsured young population, which is what the current premiums are based on.


----------



## geekette

ace2000 said:


> ...
> Edit:  One other comment, there are rumors that the administration is going to back off the penalty for not signing up.  If that happens, we will all pay our fair share for the new changes - *not just mainly the uninsured young population, which is what the current premiums are based on*.



I do not believe that premiums were set with only young people in mind, given that everyone under 65 requires insurance.  Can you provide some kind of link to prove that all premiums from all ins cos were based only on the young, that insurance companies did not expect anyone over the age of 26 to buy insurance and therefore the rest of us were left out of the risk pool assessment?

I think you are greatly mistaken and assume that you misspoke but if not, I would appreciate enlightenment on how premiums for all under age 65 were set based on the under 26 crowd.


----------



## Blues

ace2000 said:


> ARegardless of how we feel on TUG, the voters will have the final say on that question in the 2014 and 2016 elections.



Actually, they had the final say in the 2012 elections.  I know memories are short, but it was a huge issue in the 2012 presidential elections.  And guess what?  Obama won.


----------



## ace2000

geekette said:


> I do not believe that premiums were set with only young people in mind, given that everyone under 65 requires insurance.  Can you provide some kind of link to prove that all premiums from all ins cos were based only on the young, that insurance companies did not expect anyone over the age of 26 to buy insurance and therefore the rest of us were left out of the risk pool assessment?
> 
> I think you are greatly mistaken and assume that you misspoke but if not, I would appreciate enlightenment on how premiums for all under age 65 were set based on the under 26 crowd.



Nobody said it was solely based on young people.  The premiums were estimated based on the 7 million enrollment projection, which included the young uninsured.


----------



## ace2000

Blues said:


> Actually, they had the final say in the 2012 elections.  I know memories are short, but it was a huge issue in the 2012 presidential elections.  And guess what?  Obama won.



The final say is not over.  It may not be repealed, but there is a lot that will still be worked out and modified over the next several elections.


----------



## BarbS

Blues said:


> Actually, they had the final say in the 2012 elections.  I know memories are short, but it was a huge issue in the 2012 presidential elections.  And guess what?  Obama won.



If everyone had known the truth about Obamacare and had known they were being deceived and lied to before the election, then IMO there mostly likely would have been a different outcome.


----------



## geekette

BarbS said:


> If everyone had known the truth about Obamacare and had known they were being deceived and lied to before the election, then IMO there mostly likely would have been a different outcome.



Right.  Luckily, on every other issue throughout time, politicians on the campaign trail have always told the entire truth about their plans once in office so that voters could make a fully-informed decision and never find reality varying at all from expectations.


----------



## bogey21

Ken555 said:


> And for what it's worth, be sure you verify with the independent oversight organizations that verify how much of a non-profits budget goes to administration and other expenses. You might be surprised to discover that those organizations you believe in really aren't as efficient as you think.



This is what is nice about the local charity I donate to.  First, I can visit and see if they are actually doing what they say they will do; second, I can review their financial records and see how much is going to administration; and third, I can verify their business plan personally with outside Directors. 

George


----------



## BarbS

ace2000 said:


> The final say is not over.  It may not be repealed, but there is a lot that will still be worked out and modified over the next several elections.



I don't believe the final say is over either.  I was just reading about a new Republican health care plan that sounds very promising.  

http://www.washingtonpost.com/polit...8db274-ab7e-11e3-98f6-8e3c562f9996_story.html


----------



## geekette

BarbS said:


> I don't believe the final say is over either.  I was just reading about a new Republican health care plan that sounds very promising.
> 
> http://www.washingtonpost.com/polit...8db274-ab7e-11e3-98f6-8e3c562f9996_story.html



I followed the link but apparently didn't see where they spell out their plan that sounds promising?

This part is promising:
“It’s not enough to say, ‘I told you so,’ ” McCarthy said. “The country has changed since Obamacare has come in — we understand that. But we’re going to offer specific ideas, making the big-picture case and on the micro level.”


----------



## Beefnot

BarbS said:


> I don't believe the final say is over either. I was just reading about a new Republican health care plan that sounds very promising.
> 
> http://www.washingtonpost.com/polit...8db274-ab7e-11e3-98f6-8e3c562f9996_story.html


 
Interesting.  Would be great to finally see an alternative coherent vision and corresponding detail rather than perpetual mind-numbing opposition.


----------



## SMHarman

BarbS said:


> I don't believe the final say is over either.  I was just reading about a new Republican health care plan that sounds very promising.
> 
> http://www.washingtonpost.com/polit...8db274-ab7e-11e3-98f6-8e3c562f9996_story.html





Beefnot said:


> Interesting.  Would be great to finally see an alternative coherent vision and corresponding detail rather than perpetual mind-numbing opposition.





geekette said:


> I followed the link but apparently didn't see where they spell out their plan that sounds promising?
> This part is promising:
> “It’s not enough to say, ‘I told you so,’ ” McCarthy said. “The country has changed since Obamacare has come in — we understand that. But we’re going to offer specific ideas, making the big-picture case and on the micro level.”



http://thinkprogress.org/health/201...care-alternative-sounds-a-lot-like-obamacare/

According to the Post, lawmakers will endorse “ability to buy insurance across state lines, guaranteed renewability of policies and changes to medical-malpractice regulations.” Once Obama’s health care reform law is repealed, insurers will be able to discriminate against individuals with pre-existing conditions, though the GOP-backed proposal will offer sicker individuals coverage through “high-risk insurance pools” managed and subsidized by the states.” The alternative will also promote health savings accounts, allow small businesses “to purchase coverage together” and permit young people to stay on their parents’ health care plan until age 26.

If that last plank sounds a whole lot like the Affordable Care Act, that’s because it is. Of the seven provisions outlined by the Post, five — save health savings accounts and malpractice reform — are already included in the law in one way or another. The provisions may not be drafted exactly the GOP’s liking, but they accomplish very similar goals: 


– Buying insurance across state lines. SEC. 1333 of the ACA creates “Health Care Choice Compacts,” which allows insurers to sell policies within the confines of state compacts, so long as the companies follow the consumer protection standards designed and agreed to by the states.

– Renewability. SEC. 2703 of the ACA states that “if a health insurance issuer offers health insurance coverage in the individual or group market, the issuer must renew or continue in force such coverage at the option of the plan sponsor or the individual, as applicable.”

– High-risk insurance pools. SEC. 1001 of the ACA created a temporary program that provided immediate access to insurance for individuals with pre-existing conditions. Ultimately, the initiative — which provided coverage only to sick people — proved unsustainable and ran out of money earlier than expected. 

– Small business purchase coverage together. SEC. 1311 of the ACA “provides for the establishment of a Small Business Health Options Program (in this title referred to as a ‘‘SHOP Exchange’’) that is designed to assist qualified employers in the State who are small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State.” 

– Children on their parents’ plans. SEC. 2714 of the ACA states that “A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child until the child turns 26 years of age.”


----------



## Elan

Beefnot said:


> Interesting.  Would be great to finally see an alternative coherent vision and corresponding detail rather than perpetual mind-numbing opposition.



  Amen to that.  Burying one's head in the sand (or elsewhere ) isn't a solution.  In this regard, ACA has been a success, regardless of it's failures.


----------



## geekette

Last piece from the ThinkProgress link:


> *A GOP alternative is not a certainty*, however. Republicans had promised to introduce a single party-backed alternative to the law since 2009 and have *repeatedly reneged on that pledge*. Some conservative lawmakers are still “wary of the push to have House Republicans sing as a unified chorus,” arguing that the party out of power does not have to offer a detailed governing agenda and *could make gains in 2014 by criticizing the unpopular law*. A detailed proposal could also open the party up to policy criticism. When Republicans last offered a leadership-supported plan in 2009 — which closely resembles the above mentioned principles — the Congressional Budget Office estimated that “the number of nonelderly people without health insurance would be reduced by about 3 million relative to current law, leaving about 52 million nonelderly residents uninsured.”


----------



## ScoopKona

Elan said:


> Amen to that.  Burying one's head in the sand (or elsewhere ) isn't a solution.  In this regard, ACA has been a success, regardless of it's failures.



The only thing worse than ACA is what we did before: Forcing people to bankrupt themselves before they become eligible for "free" healthcare in the event of a major health problem; forcing retirees to bankrupt themselves before they're eligible for "free" assisted-living housing; denying people who paid a lifetime into insurance only to have it cancelled on a whim (and then down the path to the bankruptcy merry-go-round); forcing families to go without health care because they cannot afford a place to live, food on the table, AND healthcare; and forcing entire communities to pick up the tab for indigent patients who use the emergency room as their healthcare plan.

When I hear ANY group come up with a plan that is an improvement on the current system; and the "system" we had prior to ACA, I'm all ears. But right now all I hear is the immediate gainsay of the opposition because they have nothing better to offer.


----------



## momeason

geekette said:


> I do not believe that premiums were set with only young people in mind, given that everyone under 65 requires insurance.  Can you provide some kind of link to prove that all premiums from all ins cos were based only on the young, that insurance companies did not expect anyone over the age of 26 to buy insurance and therefore the rest of us were left out of the risk pool assessment?
> 
> I think you are greatly mistaken and assume that you misspoke but if not, I would appreciate enlightenment on how premiums for all under age 65 were set based on the under 26 crowd.



The premiums for the young are 1/3 the premiums for 64 year olds. I do this all day every day. Where did this poster get his facts...Fox News?


----------



## Passepartout

BarbS said:


> I don't believe the final say is over either.  I was just reading about a new Republican health care plan that sounds very promising.
> 
> http://www.washingtonpost.com/polit...8db274-ab7e-11e3-98f6-8e3c562f9996_story.html



I would love to get down to hashing this out over who said what and what the expectations are, but in keeping with the TUG guidlines, i am going to muffle myself. The ice is getting a little thin for skating on this pond. If we keep it up, the pond will close.

Jim


----------



## SMHarman

Passepartout said:


> I would love to get down to hashing this out over who said what and what the expectations are, but in keeping with the TUG guidlines, i am going to muffle myself. The ice is getting a little thin for skating on this pond. If we keep it up, the pond will close.
> 
> Jim


Wise words


----------



## rapmarks

My son in law, age 36, misdiagnosed with pneumonia, had a stroke during the night right side paralysis, heart only working at 20%, heart rate can't get below 150, has health insurance but job doesn't provide disability or sick pay. We are hoping for the best, it may not happen, but at least he can still get health insurance.  this happened ten days ago


----------



## Passepartout

rapmarks said:


> My son in law, age 36, misdiagnosed with pneumonia, had a stroke during the night right side paralysis, heart only working at 20%, heart rate can't get below 150, has health insurance but job doesn't provide disability or sick pay.  We  are hoping for the best, it may not happen, but at least he can still get health insurance.



Was this recent? Best wishes for a speedy and complete recovery.


----------



## Ken555

bogey21 said:


> This is what is nice about the local charity I donate to.  First, I can visit and see if they are actually doing what they say they will do; second, I can review their financial records and see how much is going to administration; and third, I can verify their business plan personally with outside Directors.
> 
> 
> 
> George




That's fantastic. But, I'm sure you appreciate that 99.99% of those who donate to non-profits don't have such access and many don't take the time to verify the info which is publicly available online. You are definitely the exception, and while I think that's wonderful it doesn't change my opinion that there are reasons for a government, and providing social services appears to be one of the main benefits in this modern age.


Sent from my iPad


----------



## Ken555

ace2000 said:


> The premiums were estimated based on the 7 million enrollment projection, which included the young uninsured.




Earlier you wrote:



> The 10% figure is based on the original estimates of 47 million people were uninsured and the fact that the administration just released a 4.2 million enrollment number as of last week (that 4.2 million number is enrollment numbers, not actually paid).



To be clear, the govt said that they anticipated 7 million people to enroll in the ACA, and so far 4.2m have done so. Assuming my calc is correct, that means that the govt was hoping 14.8% of those uninsured would be insured now. Instead, 11.19% have enrolled. I think it's important to keep things in perspective, and this presents a very different appreciation, at least to me, of what has so far been accomplished. I'm sure the 10% figure is popular in certain circles, but I don't see how it's relevant, unless you think the government should hold itself to a much higher standard than even it's own projections to satisfy everyone. It's all about perspective and expectations. 


Sent from my iPad


----------



## Ken555

Blues said:


> Actually, they had the final say in the 2012 elections.  I know memories are short, but it was a huge issue in the 2012 presidential elections.  And guess what?  Obama won.




Unfortunately, healthcare has been a political hot potato for decades and it doesn't look like that will change anytime soon.


Sent from my iPad


----------



## Ken555

BarbS said:


> If everyone had known the truth about Obamacare and had known they were being deceived and lied to before the election, then IMO there mostly likely would have been a different outcome.




Oh please. As if the other side didn't politicize...everything...before their wins? Give me a break.


Sent from my iPad


----------



## Ken555

SMHarman said:


> http://thinkprogress.org/health/201...care-alternative-sounds-a-lot-like-obamacare/
> 
> 
> 
> According to the Post, lawmakers will endorse “ability to buy insurance across state lines, guaranteed renewability of policies and changes to medical-malpractice regulations.” Once Obama’s health care reform law is repealed, insurers will be able to discriminate against individuals with pre-existing conditions, though the GOP-backed proposal will offer sicker individuals coverage through “high-risk insurance pools” managed and subsidized by the states.” The alternative will also promote health savings accounts, allow small businesses “to purchase coverage together” and permit young people to stay on their parents’ health care plan until age 26.
> 
> 
> 
> If that last plank sounds a whole lot like the Affordable Care Act, that’s because it is. Of the seven provisions outlined by the Post, five — save health savings accounts and malpractice reform — are already included in the law in one way or another. The provisions may not be drafted exactly the GOP’s liking, but they accomplish very similar goals:




Thanks for the summary.


Sent from my iPad


----------



## geekette

rapmarks said:


> My son in law, age 36, misdiagnosed with pneumonia, had a stroke during the night right side paralysis, heart only working at 20%, heart rate can't get below 150, has health insurance but job doesn't provide disability or sick pay.  We  are hoping for the best, it may not happen, but at least he can still get health insurance.



I am pulling for him.  I'm sorry for such a strange and sudden turn of events.  You are in my thoughts.


----------



## ace2000

Ken555 said:


> Earlier you wrote:
> 
> To be clear, the govt said that they anticipated 7 million people to enroll in the ACA, and so far 4.2m have done so. Assuming my calc is correct, that means that the govt was hoping 14.8% of those uninsured would be insured now. Instead, 11.19% have enrolled. I think it's important to keep things in perspective, and this presents a very different appreciation, at least to me, of what has so far been accomplished. I'm sure the 10% figure is popular in certain circles, but I don't see how it's relevant, unless you think the government should hold itself to a much higher standard than even it's own projections to satisfy everyone. It's all about perspective and expectations.


 
I think you might have miscalculated the 11.19% figure and you definitely have completely missed the point. First, let's make the stretch and say that the government will get all 7 million enrollees as projected. Even if that's the case you can't say that anywhere close to that amount was previously uninsured. In fact, I have seen estimates as low as only 1 million of the current enrollees were previously uninsured. Even under the most optimistic scenario, we still end up with over 40 million uninsured.

Will the changes and the upheaval be worth the cost? I can definitely understand why some would say no.


----------



## ace2000

momeason said:


> The premiums for the young are 1/3 the premiums for 64 year olds. I do this all day every day. Where did this poster get his facts...Fox News?


 
I think the point is that the current rates are based on getting many of the young uninsured enrolled.  The young uninsured are the target market.  That is why you see the president and his wife out there pitching the plan to the young this past couple of weeks.  It had nothing to do with the rates that individuals are paying.

Thanks for bringing Fox News into the conversation.  That helped your cause when you added that to your post.


----------



## Conan

ace2000 said:


> *Thanks for bringing Fox News into the conversation.  That helped your cause when you added that to your post.*


..........


----------



## geekette

ace2000 said:


> I think the point is that the current rates are based on getting many of the young uninsured enrolled.  The young uninsured are the target market.  That is why you see the president and his wife out there pitching the plan to the young this past couple of weeks.  It had nothing to do with the rates that individuals are paying.



The young and healthy are not 'the target market' as the target is The Uninsured.

There is a theory that the young are by and large healthy while the older are by and large unhealthy, so from that standpoint there is a push to gain the young folks.  but, it is a Shared Risk Pool and current rates were set knowing that insurers HAD TO COVER those already sick Of Any Age and those healthy Of Any Age.  The theory goes on that The Already Sick will be first to sign up and so we need The Healthy to balance.  Nobody knows what rates will be next year because nobody knows if the rates are set correctly this year.

The current very visible outreach to the young has more to do with undoing the Uncle Sam in the exam room scare tactics that were designed to keep the young from signing up.  If the young do indeed go without insurance, it seems that early attempts to dissuade the young may not be overcome or the not-ready-for-prime-time website in the early days turned them off.  There is much blame to go around for why we might not have The Young onboard in the numbers desired.


----------



## ace2000

geekette said:


> The young and healthy are not 'the target market' as the target is The Uninsured.


 
Do you understand what "target marketing" means?  

A target market is a group of customers towards which a business has decided to aim its marketing efforts and ultimately its merchandise.  The young uninsured have definitely been "targeted".


----------



## geekette

ace2000 said:


> Do you understand what "target marketing" means?
> 
> A target market is a group of customers towards which a business has decided to aim its marketing efforts and ultimately its merchandise.  The young uninsured have definitely been "targeted".




You imply that the ACA and its marketing are for none other than the young and you are mistaken.


----------



## ace2000

geekette said:


> You imply that the ACA and its marketing are for none other than the young and you are mistaken.


 
Thanks for the clarification.  I never said that.  If you understood the meaning of target marketing, you would've have understood what I meant.


----------



## Passepartout

Targeted or not, truth is that the young and healthy are more likely to have jobs that don't provide insurance, and are less likely to buy insurance on their own. If you don't have disposable income, what is your priority, food on the family table, a shiny car, the latest electronic gadget, or insurance you don't need- after all, it's only old people who get sick.

It will take subsidies, incentives, and yes, targeted marketing to get the 26-to 50 age group to enroll and pay for coverage. 

Jim


----------



## bogey21

Ken555 said:


> To be clear, the govt said that they anticipated 7 million people to enroll in the ACA, and so far 4.2m have done so.....



An interesting question is "How many of the 4.2 million already had insurance before the ACA was enacted?".  I have no idea but assume that a good number may have.

George


----------



## ScoopKona

ace2000 said:


> Thanks for bringing Fox News into the conversation.  That helped your cause when you added that to your post.



Why is this? People who don't watch any news at all are better informed than people who watch Fox News.

From the study, other news formats are "less likely to degenerate into people shouting at each other." And surprise, surprise, people learn more when they aren't watching people shouting at each other.

If I wanted to have a productive discussion about the ACA, the last thing I'd want is anyone who gets their news from Fox in the room. They're misinformed and their debate "tactics" are to ask ridiculous, unanswerable questions and to shout at people. That's what they see on TV. Monkey see, monkey do.


----------



## ace2000

bogey21 said:


> An interesting question is "How many of the 4.2 million already had insurance before the ACA was enacted?". I have no idea but assume that a good number may have.
> 
> George


 
Good question.  Going back to post #641.  The current estimate based on the current enrollment is about 1 million being previously uninsured.  I have seen estimates that out of the 7 million enrollment projection, 3 million would be previously uninsured.


----------



## Conan

Re: Fox News and ACA
https://www.google.com/search?q=fox...la:en-US:official&client=firefox-a&channel=sb


----------



## ace2000

We should create another thread and discuss Fox News (it would last about 2 minutes).  It really doesn't belong here.


----------



## ScoopKona

Conan said:


> Re: Fox News and ACA
> https://www.google.com/search?q=fox...la:en-US:official&client=firefox-a&channel=sb



Thank you. Just scanning down the list of links shows a great deal of what's wrong with this country today. A democracy stands on two legs: An informed electorate and a free and unfettered press. We currently have neither. We have informed individuals, but not an informed public. And the press is now beholden to anyone willing to buy advertising. The Internet killed the newspaper as we know it.* We just haven't seen what the outcome will be.

I'm against the ACA. I don't like it. I think it's a turkey. I also think the only thing worse than the ACA was the way we were going about things prior to the ACA.

* That link is very insightful. I hope everyone reads it.


----------



## Conan

The latest from Fox is on my Google News screen this morning. It's not misinformation per se but I love the spin they give it.
Here's the headline:
*Vegas man stuck with $407000 medical bill after ObamaCare breakdown*
The substance of the article is that a 62-year-old tried to sign up with the ACA but there's an issue whether he was enrolled before he suffered a heart attack.
http://www.foxnews.com/politics/201...07000-medical-bill-after-obamacare-breakdown/

It seems to me an alternate headline could be 
*Surprise heart attack shows importance of signing up with Obamacare ASAP*


----------



## Beefnot

Conan said:


> The latest from Fox is on my Google News screen this morning. It's not misinformation per se but I love the spin they give it.
> Here's the headline:
> *Vegas man stuck with $407000 medical bill after ObamaCare breakdown*
> The substance of the article is that a 62-year-old tried to sign up with the ACA but there's an issue whether he was enrolled before he suffered a heart attack.
> http://www.foxnews.com/politics/201...07000-medical-bill-after-obamacare-breakdown/
> 
> It seems to me an alternate headline could be
> *Surprise heart attack shows importance of signing up with Obamacare ASAP*


 

Haha.  Rush, Hannity, and Levin will have a field day trying to blast ACA until someone points out the obvious.


----------



## BarbS

Well it won't be much longer before we should have the real number of people who are actually enrolled, unless they can somehow delay it and continue to claim they don't know.  

Does anyone really believe they don't actually know how many have paid their premiums?


----------



## ScoopKona

BarbS said:


> Well it won't be much longer before we should have the real number of people who are actually enrolled, unless they can somehow delay it and continue to claim they don't know.
> 
> Does anyone really believe they don't actually know how many have paid their premiums?



We don't need politics to see this problem for what it is. All we need is math.

We have the few remaining members of "The Greatest Generation," then we have the Baby Boomers, and then we have everyone else.

The Greatest Generation was great, but they got through their insurance and retirement thanks to the massive work output by the Boomers. They were able to literally ride their kids coattails all the way through to the end of their lives. (Morbid, but true.)

The Baby Boomers didn't produce enough offspring to do the same. For instance, the worker-to-recipient ratio of Social Security has fallen from more than 8:1 to less than 3:1. Google it. This is basic population mathematics.

This has been coming for a very, very long time. And only now that the problem of "what are we going to do when the Boomers leave the workforce" is right on top of us are we doing anything at all about it. And since we're in a rush, we're going about things in a stupid, inefficient manner.

Of COURSE the dynamics of healthcare and retirement are changing. There's no other way it can be given the numbers. The boomers should have looked at the population landscape in the 1970s and 1980s and said, "What are we going to do about retirement and our health needs?" (Individual Boomers certainly did. They're the ones who aren't worrying about this mess. But the generation as a whole punted and punted and punted until we got to this point.)


----------



## Passepartout

BarbS said:


> Well it won't be much longer before we should have the real number of people who are actually enrolled, unless they can somehow delay it and continue to claim they don't know.
> 
> Does anyone really believe they don't actually know how many have paid their premiums?



Who is this "they" you refer to? There are hundreds of insurance companies selling policies, and the numbers of enrollees is not exactly public knowledge.

A common misconception is that there is one 'Obamacare'. It's just a law that establishes minimum standards. Separate insurance companies in every state choose what policies to offer and at what price. 

Whether Joe gets his health insurance through his job, or Mary buys hers online, or face-to-face from the same broker she buys car insurance from, it's all subject to the same minimum standards.

This is the reason there is no "they" who knows from one day to the next how many people are enrolled. It may eventually come out how many are getting subsidies, but many will choose to forego the subsidy- like out own bogie21 who pays for his son's insurance. Those who get insurance through their jobs will also not be included in the total of subsidized insured.

Jim


----------



## SMHarman

BarbS said:


> Well it won't be much longer before we should have the real number of people who are actually enrolled, unless they can somehow delay it and continue to claim they don't know.
> 
> Does anyone really believe they don't actually know how many have paid their premiums?



Likely manual data collection exercise spanning the different insurance companies in the different states. 

We know the interfaces between the Federal site and insurers became day 2 requirements and MIS requirements were not implemented, including a site health dashboard. 

So yes I do believe they don't know. 

Sent from my LT26i using Tapatalk


----------



## BarbS

By "they", I mean the administration, or Kathleen Sebelius in particular.  Don't you think the insurance companies know how many have paid.  And don't you think all it would take is for Kathleen to ask them?  Of course, I doubt if she really wants to know.


----------



## geekette

BarbS said:


> By "they", I mean the administration, or Kathleen Sebelius in particular.  Don't you think the insurance companies know how many have paid.  And don't you think all it would take is for Kathleen to ask them?  Of course, I doubt if she really wants to know.



I actually do not think it would be so easy for an insurance company to untangle who bought via exchange or another way since it is unlikely any insurer put all of its eggs into the exchanges, but instead continued to sell the old-fashioned way.

Each insurer would have had to make room for a "source flag" to know exactly where/how a policy was purchased.  Presumably insurers all have their own system of record that would have had to be modified.

Or maybe they could have put special numbers onto exchange policies to make them obvious, but I don't believe they were compelled to do so.

I do not think it as easy to "provide a number" as you think it might be.  But certainly they could tell you what they collected in total premiums last month because that has always been a normal business number.  Probably they could tell you how many policies were instituted in the past few months and pay/nonpayment ratio, but, again, without that 'sourced from' flag, they can't tell you whether it was exchange policy or not.

I would think that most large insurers could indeed provide the numbers you seek, but the smaller ones are the wildcards.


----------



## BarbS

Beefnot said:


> Haha.  Rush, Hannity, and Levin will have a field day trying to blast ACA until someone points out the obvious.



So he signed up for insurance (or thought he did) and paid his premium, but it's his fault he didn't have insurance?


----------



## ScoopKona

BarbS said:


> So he signed up for insurance (or thought he did) and paid his premium, but it's his fault he didn't have insurance?



He shouldn't have waited. There was nothing stopping him from getting his healthcare straight PRIOR to him needing it. He is a textbook example of why the prior "system" wasn't just bad, it was uncivilized.

The prior system was happy to take every last penny before offering "free" healthcare. The motto: "Once you're destitute, we've got your back." Freakin' _loan sharks_ have more compassion than insurance adjusters.


----------



## Beefnot

BarbS said:


> So he signed up for insurance (or thought he did) and paid his premium, but it's his fault he didn't have insurance?


 
Not at all his fault. Incompetence is incompetence. I was more alluding to folks who wish to attack ACA when enexpected health events underscore the intended benefit of ACA, as well as the irony of a abject lack of real alternatives presented by these very critics. By the way, I think that someone other than this guy will ultimately be forced to absorb the cost.


----------



## ace2000

ScoopLV said:


> The Baby Boomers didn't produce enough offspring to do the same. For instance, the worker-to-recipient ratio of Social Security has fallen from more than 8:1 to less than 3:1. *Google it*.


 
I was able to Google your figures was able to confirm those numbers. Only problem was my source was Fox News. Knowing you, you'll probably want to revalidate your numbers.


----------



## ScoopKona

You could have gone to justfacts.com and found the same information without any of the political spin. 

The big elephant in the room is the Baby Boomers. They don't want to hear that they're the problem, and the younger generations don't want to say that their parents (and grandparents) are the problem. It's a math problem anyway -- not enough workers to support the recipients. We had every opportunity to do something about this 20 years ago. We chose to ignore the problem, and kick this can down the road. Well, we can't kick it any more. Not without unraveling the social compact. Change must happen -- our adversaries are sheer numbers, not policies.


----------



## geekette

Beefnot said:


> Not at all his fault. Incompetence is incompetence. I was more alluding to folks who wish to attack ACA when enexpected health events underscore the intended benefit of ACA, as well as the irony of a abject lack of real alternatives presented by these very critics. By the way, I think that someone other than this guy will ultimately be forced to absorb the cost.



Yes, presumably whomever it was that continued to assure him that he was covered.

I'm with you, Beef, this is not the fault of the law nor any politician nor political party, this was a company that dropped the ball in servicing a customer.

If he never paid a premium, however, I put the blame back onto the patient.  There is no free lunch, he would know that no $ to insurance company = no insurance.

I feel bad for the guy, he doesn't need this crap on top of heart problems.  And he will sadly be The Example of "be sure that you actually Have Insurance" if you did pay the bill.


----------



## pjrose

Passepartout said:


> I would love to get down to hashing this out over who said what and what the expectations are, but in keeping with the TUG guidlines, i am going to muffle myself. The ice is getting a little thin for skating on this pond. If we keep it up, the pond will close.
> 
> Jim





SMHarman said:


> Wise words



Plus many thumbs up.


----------



## Passepartout

BarbS said:


> So he signed up for insurance (or thought he did) and paid his premium, but it's his fault he didn't have insurance?



Whenever you buy some fairly large ticket item, or reserve a condo, or rent a car, don't you somehow write down, print, or otherwise save a record of the transaction confirmation? Woe unto the person who does not cover their backside on financial dealings.

If this individual can produce a dated confirmation showing coverage before the medical need, the insurer would have no choice but to pay the agreed amount. If he cannot, or the confirmation shows a date after the event, the insurer seems to be off the hook.

Or absent insurance, this individual is in exactly the same position as before ACA.

Note that in the original linked article, the gentleman had the heart attack in late December. Coverage even for early enrollees of ACA didn't begin until 1/1/14.


----------



## ScoopKona

Passepartout said:


> Or absent insurance, this individual is in exactly the same position as before ACA.



As usual, I agree with you. I would be much happier with this debate (both here and in the larger real-world arena) if the people who were so vehemently against ACA would either:

1) Come out and say that they want to return to the pre-ACA system. "Give us back our bankruptcy, and using Emergency Rooms as our primary healthcare option, and then making our neighbors pay for it through their property taxes." Seriously, if that's what they want they should have the intestinal fortitude to say it.

2) Offer up an alternative. My alternative is "take Canada's plan and duplicate it." We know that works. The seriously wealthy can continue to have their concierge doctors and private care facilities so they don't have to rub elbows with us "common folk." If people don't like the alternative ideas, that's fine. But offer up SOMETHING.

This current "I don't like ACA because I don't like ACA" discourse is maddening.


----------



## geekette

Passepartout said:


> ...
> Note that in the original linked article, the gentleman had the heart attack in late December. Coverage even for early enrollees of ACA didn't begin until 1/1/14.



nice pickup.  I hope the guy already had insurance thru end of year and it is the old insurer on the hook.  That should be quickly resolvable.

eta:  I mean, I hope the old insurance policy was still in force And Will Cover everything involved with his heart attack.  I'm not sure when the pre-existing condition and lifetime caps lifted - was that this year or 2010?  Either way, I hope previous policy was a good one and that this guy isn't forced into bk.


----------



## ace2000

Passepartout said:


> Note that in the original linked article, the gentleman had the heart attack in late December. Coverage even for early enrollees of ACA didn't begin until 1/1/14.


 
In the original linked article it explains it this way...


Thing is, he should be covered. Basich, 62, bought a plan through the state’s Nevada Health Link insurance exchange in the fall. He’s been paying monthly premiums since November.

Yet the Las Vegan is stranded in a no-man’s-land where no carrier claims him, and his tab is mounting: *Basich owes $407,000 for care received in January and February*, *when his policy was supposed to be in effect*. Instead, he’s covered only for March and beyond.

http://www.reviewjournal.com/news/obamacare-leaves-las-vegas-man-owing-407000-doctor-bills


----------



## pjrose

BarbS said:


> If everyone had known the truth about Obamacare and had known they were being deceived and lied to before the election, then IMO there mostly likely would have been a different outcome.



I respectfully suggest that "IMO" also applies to the first clause of your statement, not just the second clause.  

Your opinions regarding "truth" "deceived" and "lied" about the Affordable Care Act are not fact, and should be clarified with "IMO".


----------



## rapmarks

our neighbor in Florida, a Canadian, had a stroke, the day he was released from the hospital his insurance informed him he had 7 days to get back to Canada or he was not covered if he had another one.   They headed to Canada with their daughter helping, but he was sick and in Atlanta, they got on a plane to Canada.  He went straight to the hospital where he had another stroke. He then had a third, and he is currently back in hospital (in Toronto).


----------



## ScoopKona

rapmarks said:


> our neighbor in Florida, a Canadian, had a stroke, the day he was released from the hospital his insurance informed him he had 7 days to get back to Canada or he was not covered if he had another one.   They headed to Canada with their daughter helping, but he was sick and in Atlanta, they got on a plane to Canada.  He went straight to the hospital where he had another stroke. He then had a third, and he is currently back in hospital (in Toronto).



This is why our previous system is best described as "uncivilized." We shouldn't do this to people. I have had health issues (albiet minor) in Europe, and all I got when leaving the hospital was a "Hope you enjoy the rest of your stay in our country. Thanks for visiting." No bills, no hassle. 

Your Canadian neighbor surely pays property taxes. And I know your Canadian neighbor pays sales taxes. He helps pay for his state and local government, and gets THAT kind of treatment in return. That's unacceptable.


----------



## Ken555

ScoopLV said:


> The big elephant in the room is the Baby Boomers. They don't want to hear that they're the problem, and the younger generations don't want to say that their parents (and grandparents) are the problem. It's a math problem anyway -- not enough workers to support the recipients. We had every opportunity to do something about this 20 years ago. We chose to ignore the problem, and kick this can down the road. Well, we can't kick it any more. Not without unraveling the social compact. Change must happen -- our adversaries are sheer numbers, not policies.




I'll say it. In fact, I've been saying it for years. My parents and their parents created this mess. They didn't fix the problem when it was small and (more) easily managed. The eventual outcome was predicted at the time and still they ignored it. Politicians encouraged this belief, since they wanted to stay in office and couldn't stay in office and say taxes need to be increased to pay the bill. It's gross negligence by any definition. I'm sure those of you who are part of those generations will think otherwise, but forgive me for being blunt but my generation and those after me will not look kindly on this legacy you left for us.


Sent from my iPad


----------



## Passepartout

Ken555 said:


> I'll say it. In fact, I've been saying it for years. My parents and their parents created this mess. They didn't fix the problem when it was small and (more) easily managed. The eventual outcome was predicted at the time and still they ignored it. Politicians encouraged this belief, since they wanted to stay in office and couldn't stay in office and say taxes need to be increased to pay the bill. It's gross negligence by any definition. I'm sure those of you who are part of those generations will think otherwise, but forgive me for being blunt but my generation and those after me will not look kindly on this legacy you left for us.
> 
> 
> Sent from my iPad



And on top of that, our elected representatives chose to in essence steal from us and our predecessors by 'borrowing' from the squishy Social Security Trust Fund, that was allegedly for our old age and that of our offspring. Instead, they issued low-interest IOUs and took the money to support the military-industrial complex.


----------



## ace2000

Ken555 said:


> I'll say it. In fact, I've been saying it for years. My parents and their parents created this mess. They didn't fix the problem when it was small and (more) easily managed. The eventual outcome was predicted at the time and still they ignored it. Politicians encouraged this belief, since they wanted to stay in office and couldn't stay in office and say taxes need to be increased to pay the bill. It's gross negligence by any definition. I'm sure those of you who are part of those generations will think otherwise, but forgive me for being blunt but my generation and those after me will not look kindly on this legacy you left for us.
> 
> 
> Sent from my iPad


 
Good post. And are we any different today? Just look at our current deficits and the corresponding debt we are passing to our future generations.  Does anyone care?  We may say we do, but nothing is done.


----------



## VivianLynne

ScoopLV said:


> We don't need politics to see this problem for what it is. All we need is math.
> 
> We have the few remaining members of "The Greatest Generation," then we have the Baby Boomers, and then we have everyone else.
> 
> The Greatest Generation was great, but they got through their insurance and retirement thanks to the massive work output by the Boomers. They were able to literally ride their kids coattails all the way through to the end of their lives. (Morbid, but true.)
> 
> The Baby Boomers didn't produce enough offspring to do the same. For instance, the worker-to-recipient ratio of Social Security has fallen from more than 8:1 to less than 3:1. Google it. This is basic population mathematics.
> 
> This has been coming for a very, very long time. And only now that the problem of "what are we going to do when the Boomers leave the workforce" is right on top of us are we doing anything at all about it. And since we're in a rush, we're going about things in a stupid, inefficient manner.
> 
> Of COURSE the dynamics of healthcare and retirement are changing. There's no other way it can be given the numbers. The boomers should have looked at the population landscape in the 1970s and 1980s and said, "What are we going to do about retirement and our health needs?" (Individual Boomers certainly did. They're the ones who aren't worrying about this mess. But the generation as a whole punted and punted and punted until we got to this point.)



ScoopLV -- agree with you, but Corporate America got too many "breaks" to cheat employees of their retirement future. They lobbied for changes in company funded pensions to totally "self" pensions, got massive bonus to outsourcing jobs, created the "professional temp" who NEVER gets a job with benefits AT all pay grades. And our elected government officials are more interested in KEEPING their status (and truly in enriching their bank accounts) than in running a government efficiently for all its people.


----------



## momeason

BarbS said:


> Well it won't be much longer before we should have the real number of people who are actually enrolled, unless they can somehow delay it and continue to claim they don't know.
> 
> Does anyone really believe they don't actually know how many have paid their premiums?



Since I know how it works, yes, the healthcare.gov site does not know. This is my job to enroll people and take payments. I am a BCBSNC agent. There is a link on Healthcare.gov that takes one to their chosen insurer to pay or one can call the insurer to pay or one can mail in your premium. The only insurer in my region is BCBSNC and they are weeks behind and the last priority BCBSNC would have would be tracking numbers. They are trying to catch up with getting cards out to the 200,000 who have signed up in NC through the ACA, all the ones who signed up directly through BCBSNC without subsidies and all their previous clients before the ACA.

So the answer is it will be months before the final paid enrollment figures are known. Those with May 1 coverage dates have until April 30 to pay in my state and then it takes weeks to process. Healthcare.gov will not know until all the insurance companies report final payments. HEALTHCARE.GOV TAKES NO PAYMENTS.
It is a learning curve. It will get better.


----------



## ScoopKona

ace2000 said:


> Good post. And are we any different today? Just look at our current deficits and the corresponding debt we are passing to our future generations.  Does anyone care?  We may say we do, but nothing is done.



Yes, we are MUCH different today because there is no longer ANY time to do anything about this problem other than damage control. When the Boomers were still in the workforce, we could have tweaked and saved to insure that Gen X and Gen Y got some sort of reasonable plan. That bus left the station, empty, in the 1980s. We have more people taking retirement benefits (which they earned -- don't get me wrong) than we have people who can keep the system propped up.

Throughout my life, friends and family in the Boomer age group and the Greatest age group warned me that this was going to happen. "I'll get my retirement. Maybe your parents will get their retirement. When you are my age there will be nothing left over for you. Plan accordingly." They knew the population numbers simply wouldn't work once the Boomers started to retire. This was (and is) common knowledge. No surprises at all. We saw this coming decades ago, and did nothing. Worse, we did our level best to ruin our chances.

It seems that every couple years in the 1980s and 1990s, a good in-depth news story would ring the alarm about what would happen after 2010 when the Boomers started retiring en masse. And -- society ignored those reports and raided the social security fund, basically ruining the social compact of Social Security and Medicare.

ACA is just one of what is going to be a slew of changes to the social compact. There's no way around this -- we cannot afford to give the Boomers the same kind of retirement that their parents got. Not enough workers, too many retirees.

We cannot simultaneously pay retirement and Medicare benefits, maintain the largest military (we spend nearly one third of the worldwide military budget), and pay down what is becoming a crippling national debt. Something has to give. Frankly, I think it is inevitable that some TWO things are going to give. And I'm planning accordingly.


----------



## rapmarks

as I mentioned, son in law had stroke less than two weeks ago, works in the trades on the road, had health insurance, but no sick days, disability, so his insurance will stop at end of month, after all he isn't working.


----------



## Tia

rapmarks said:


> as I mentioned, son in law had stroke less than two weeks ago, works in the trades on the road, had health insurance, but no sick days, disability, so his insurance will stop at end of month, after all he isn't working.




Can someone else help pay his insurance until social services at the hospital  figures it out? 

Heard a couple days ago about someone getting a pill for cancer that was costing supposedly $7000/dose....... it came from someone who knew that person, think Medicare was paying . Crazy


----------



## rapmarks

they can do cobra , they are working it out. 
I have to get thyrogen shots, two in a row, once a year, they are 3000 each, but after medicare steps in, they are a lot less, my share was $50 each.  and when I had to take radioactive iodine pill, it was $23,000.


----------



## ace2000

ScoopLV said:


> Yes, we are MUCH different today because there is no longer ANY time to do anything about this problem other than damage control.



No, it's really not any different today.  If anything, we've gotten worse with our spending habits.  Ken mentions the "gross negligence" and the "legacy" of the baby boomers.  What about our "gross negligence" and the legacy we're leaving behind to our future generations?  I realize you're talking about Social Security which is supposed to stand on it's own, but the spending is really all related - and we're all just selfish, period.  

Take a look at the deficits over the last 10 years and then look at what is projected in the next 10 years.  Do we care?  Let's assume our average age between us is 50 years old.  We've been voting for over 30 years.  Did we make the deficits and spending our number one issue when we voted?  No.  Sorry, I can't place the blame on just the baby-boomers for the current mess.

If we haven't had the discipline on our government spending habits, who are we to point fingers at the baby boomers and say they should have done otherwise?


----------



## ace2000

ScoopLV said:


> Yes, we are MUCH different today because there is no longer ANY time to do anything about this problem other than damage control. When the Boomers were still in the workforce, we could have tweaked and saved to insure that Gen X and Gen Y got some sort of reasonable plan.



You mention it's too late on Social Security.  No, it's not too late.  The current projections are that the Social Security trust fund is fully and completely funded to pay out until at least 2033.  That's almost 20 years from now.   

And let's look at it another way.  Even if no changes are implemented at all, in 2033, just the current inflow of taxes would support a 75% payout.  Yes, it would be wise to save for retirement through alternate routes and I'd recommend that to cover any future developments, but the program is not going away.  The retirement age may be raised, there may be a reduction in benefits, the payroll taxes may be increased.  But, it is a problem that can be solved.

Sorry, I'm not part of the doom and gloom crowd on this issue as you are.  It can be fixed and it will be.


----------



## ace2000

rapmarks said:


> they can do cobra , they are working it out.
> I have to get thyrogen shots, two in a row, once a year, they are 3000 each, but after medicare steps in, they are a lot less, my share was $50 each.  and when I had to take radioactive iodine pill, it was $23,000.



Rapmarks - first, I wish you and your son in law the best in your situation.

Would Cobra be cheaper than the new plans offered through the ACA?   I recall the Cobra rates I was quoted when I changed jobs 10 years ago and it wasn't pretty.


----------



## geekette

ace2000 said:


> Sorry, I'm not part of the doom and gloom crowd on this issue as you are.  It can be fixed and it will be.



Also not on the doom and gloom brigade.  

Seems to me that those just now entering the workforce with a college degree make a lot more starting salary than I did at that age. So they are contributing more.  This doesn't solve everything but is a factor.  Newbies can be making a lot more than ending salary for many new retirees.  

It is time to move the goal post to age 68 FRA for those now age 20-25.  I would be in favor of boosting early retirement to 63.  I fear there will be drastic changes, but they need to be spread out into small changes over time.  It is not ok to wait for the current 20somethings to turn 40 to make these changes.  Every generation should know by their mid 20s what their retirement ages are.

We also need to raise the ceiling on wages subject to payroll taxes even though this also means we have to boost the payout to those top earners.


----------



## Elan

There are easy ways to address the projected SS shortfall.  Remove the taxable income cap and means test recipients.  Problem solved.

  I have a question with regard to ACA.  Am I correct in assuming that the subsidies are based on income only?  In other words, if I'm worth $10M, but I only have $20K income, do I qualify for subsidized healthcare?


----------



## rapmarks

Elan said:


> There are easy ways to address the projected SS shortfall. Remove the taxable income cap and means test recipients. Problem solved.
> 
> I have a question with regard to ACA. Am I correct in assuming that the subsidies are based on income only? In other words, if I'm worth $10M, but I only have $20K income, do I qualify for subsidized healthcare?




 I have the same question


----------



## SMHarman

Elan said:


> There are easy ways to address the projected SS shortfall.  Remove the taxable income cap and means test recipients.  Problem solved.


Why if I make an effort to save and have a compulsory SS saved should I not be able to take my SS out.  SS is not a 'benefit' it is a compulsory retirement saving.  There should be no compulsory saving that does not pay out.  That is compulsory siezure of assets.


Elan said:


> I have a question with regard to ACA.  Am I correct in assuming that the subsidies are based on income only?  In other words, if I'm worth $10M, but I only have $20K income, do I qualify for subsidized healthcare?


If you are worrth $10m, your assets should be throwing off say 4% income or $400,000.  Even at 1% that is $100,000.  If that is real property, then the property taxes are say $100,000 and if you are not paying those taxes and earning enought to pay them then you won't be worth $10m for very long as the property is siezed.
I get where you are coming from in this question but in general it is pretty hard to hide assets and pay the cost to carry and declare near 0 income.


----------



## Conan

Elan said:


> I have a question with regard to ACA.  Am I correct in assuming that the subsidies are based on income only?  In other words, if I'm worth $10M, but I only have $20K income, do I qualify for subsidized healthcare?



ACA uses the same income test as applies when determining what premium Medicare requires for Part B coverage.

It's purely an income test, but the measure is Modified Adjusted Gross Income (MAGI) so tax-exempt income is added in.
https://www.healthcare.gov/glossary/modified-adjusted-gross-income-magi/


----------



## bogey21

ScoopLV said:


> We cannot simultaneously pay retirement and Medicare benefits, maintain the largest military (we spend nearly one third of the worldwide military budget), and pay down what is becoming a crippling national debt. Something has to give.



When interest rates rise again (which they inevitably will) debt service will consume a huge amount of the Government's revenue.  At that time the issues you identify will have to be addressed and we probably won't like the solution.

George


----------



## ace2000

Elan said:


> I have a question with regard to ACA.  Am I correct in assuming that the subsidies are based on income only?  In other words, if I'm worth $10M, but I only have $20K income, do I qualify for subsidized healthcare?



It is definitely tied to income.  Here's a subsidy estimate calculator that I posted awhile back.  You can play with different scenarios.

http://kff.org/interactive/subsidy-calculator/


----------



## Passepartout

Interesting. I ran my scenario for the years after I retired and before Medicare. Turns out we would have qualified for a substantial subsidy (on my income if DW wasn't earning anything). As it truly was, with both incomes, we would be paying close to what my COBRA came in at. Of course COBRA is just good for 18 months and is not renewable, portable, and could be refused for pre-existing conditions.


----------



## geekette

Passepartout said:


> ...Of course COBRA is just good for 18 months and is not renewable, portable, and could be refused for pre-existing conditions.



are you sure a person could be turned down for COBRA for pre-existing?  I thought that if they covered you before, and you term'd employment, COBRA "had to be" offered to you, full freight (since employer no longer pays any on your behalf).

I have always avoided COBRA due to high cost, but I do know some ... unhealthy people ... that did go on COBRA, they were not prevented via pre-existing (and this is also pre-ACA)


----------



## Passepartout

geekette said:


> are you sure a person could be turned down for COBRA for pre-existing?



I am honestly not sure if they can or not. I didn't take it due to it's cost when I left my last job. I am fairly sure that COBRA is simply a continuation of employer's insurance plan, but with the term'd employee paying the entire premium.

Since ACA, there would be even less reason to go with COBRA than before.


----------



## ScoopKona

ace2000 said:


> You mention it's too late on Social Security.  No, it's not too late.  The current projections are that the Social Security trust fund is fully and completely funded to pay out until at least 2033.  That's almost 20 years from now.



Assuming the fund isn't raided again to pay for whatever short-term project the government wants this time. It's not like we haven't seen this before.

Also, those numbers are based on expected lifespan -- which is increasing dramatically. The longer the average person lives, the quicker we're going to run through those reserves. And as medical costs rise, we're going to run through Medicare reserves faster and faster. You can wish that this won't happen, but the numbers say otherwise.

Finally, 2033 is when I'm going to be retiring. The program will be insolvent by then, assuming we don't break it further between now and then. I treat Social Security as "money down a hole." I've gone through life assuming that I will never see a penny of that again, and planned accordingly. If I turn out to be wrong, that means extra income during retirement. Win-win.



ace2000 said:


> Sorry, I'm not part of the doom and gloom crowd on this issue as you are.  It can be fixed and it will be.



Point to one area where we're tightening our financial belt and acting responsibly. One. You already said it that we're saddling future generations with crippling debt and nobody seems to care. Frankly, anyone who promises to implement responsible fiscal policies is essentially unelectable. 

We are heading (quickly, I may add), into what the Chinese call "Interesting times."


----------



## geekette

Passepartout said:


> I am honestly not sure if they can or not. I didn't take it due to it's cost when I left my last job. I am fairly sure that COBRA is simply a continuation of employer's insurance plan, but with the term'd employee paying the entire premium.
> 
> Since ACA, there would be even less reason to go with COBRA than before.



agree completely.  That was in fact one of my first thoughts when ACA showed up - no need to COBRA.   

Agree also, COBRA is continuation of what insured had with employee, converted to contract between that insurer and patient, employer removed from situation.


----------



## ace2000

ScoopLV - I'm in agreement with you probably more than you realize and appreciate your posts.

Here's a decent source in today's news...



> The United States faces "fundamental fiscal challenges" stemming from the growth in spending for Social Security and major health care programs," CBO Director Douglas Elmendorf told a gathering in Washington on Tuesday.
> 
> The rising cost of those programs leaves Americans with "unpleasant" choices to make, but the sooner they're made, the better, he said:
> 
> "So we have a choice as a society to either scale back those programs relative to what is promised under current law; or to raise tax revenue above its historical average to pay for the expansion of those programs; or to cut back on all other spending even more sharply than we already are," Elmendorf said.
> 
> "And we haven't actually decided as a society...what we're going to do. But some combination of those three choices will be needed."
> 
> Elmendorf said there are various ways to proceed: "But they tend to be unpleasant in one way or another, and we have not, as a society, decided how much of that sort of unpleasantness to inflict on whom."




http://www.cnsnews.com/news/article...e-advance-warning-about-coming-changes-social


----------



## ace2000

And I want to highlight this part... it's all tied together.



> The United States faces "fundamental fiscal challenges" *stemming from the growth in spending for Social Security and major health care programs*," CBO Director Douglas Elmendorf told a gathering in Washington on Tuesday.


----------



## Elan

SMHarman said:


> Why if I make an effort to save and have a compulsory SS saved should I not be able to take my SS out.  SS is not a 'benefit' it is a compulsory retirement saving.  There should be no compulsory saving that does not pay out.  That is compulsory siezure of assets.



  I didn't say it would be a popular solution, nor did I say it's the only solution.  There's going to be a tradeoff between what's appealing, and what works.  Being an engineer, I tend to focus on what works.  If there was a solution that worked and appealed to everyone, I have to presume we'd be on that path already.



SMHarman said:


> If you are worrth $10m, your assets should be throwing off say 4% income or $400,000.  Even at 1% that is $100,000.  If that is real property, then the property taxes are say $100,000 and if you are not paying those taxes and earning enought to pay them then you won't be worth $10m for very long as the property is siezed.
> I get where you are coming from in this question but in general it is pretty hard to hide assets and pay the cost to carry and declare near 0 income.


 
  The $10M was an exaggeration for illustrative purposes.  Specifically, my question pertained to retiring early.  If, between my wife's income (she's a teacher at a private school, so calling it income is almost a stretch) and my investment income we could make ends meet, I'd more seriously consider retiring early or at least finding a less demanding job that paid measurably less.  Every time I've run napkin type numbers for this scenario, family healthcare is a big part of the monthly expense.  Last night, I quickly plugged some numbers into our state's ACA portal assuming a much lower income than I had when I visited the site previously, and noted that my healthcare would be subsidized.  I spent about 2 minutes on the site and didn't double check anything, so I might be mistaken.


----------



## geekette

Elan said:


> There are easy ways to address the projected SS shortfall.  Remove the taxable income cap and means test recipients.  Problem solved.


Against means testing.  We all paid in.  I would instead hope that the very highest earners never claim it because they don't need it and neither do their heirs.

but, they paid in, I am not in favor of preventing their return of long ago forgone income simply because they now make more than someone thinks they should.


----------



## ScoopKona

geekette said:


> but, they paid in, I am not in favor of preventing their return of long ago forgone income simply because they now make more than someone thinks they should.



I AM in favor of that. What's $2,500 per month to someone with a net worth in the tens of millions? There aren't that many of those people, but this all goes back to the United American Citizenry bit Stephen King mentions in the article upthread.

I'm nowhere near retirement age. Is there an easy mechanism to opt out of receiving benefits? If not, what do you think Warren Buffet does with his $2,500 per month benefit checks?


----------



## geekette

Elan said:


> I didn't say it would be a popular solution, nor did I say it's the only solution.  There's going to be a tradeoff between what's appealing, and what works.  Being an engineer, I tend to focus on what works.  If there was a solution that worked and appealed to everyone, I have to presume we'd be on that path already....


unfortunately, anyone with a good idea becomes The Changer and is immediately unelectable.

Surely you've had one of those jobs where all that mattered was status quo - do what you do, don't make any waves.  Build a better mousetrap?  Boss doesn't want to know because his boss might not like the idea of changing in order to build the better mousetrap.  Let's just keep what we have and the new boss can deal with it...

Any time SS is mentioned, those already receiving it get real ancy.  They got theirs, yours is not their problem.  

With Scoop on that - plan to not receive it vs counting on it.  Hopefully extra bonus in retirement, but far from a sure thing, in any amount.


----------



## Elan

geekette said:


> Against means testing.  We all paid in.  I would instead hope that the very highest earners never claim it because they don't need it and neither do their heirs.
> 
> but, they paid in, I am not in favor of preventing their return of long ago forgone income simply because they now make more than someone thinks they should.



  As I said, it's not the only solution.  But, I can't state strongly enough that I'm against half-assed "solutions" that don't fix the problem for the foreseeable future.  If we're going to fix SS, then let's bite the bullet and fix it.  Any change to the program basically means that someone was lied to at some point in time.  That's the nature of a society with ever-changing demographics.  We can deny it, or we can deal with it.  

  FWIW, I don't plan on getting anything.  But if the rules were changed today such that someone could _guarantee_ me that I'd get .75X or even .5X, where X is what I'm currently projected to get, I'd be completely in favor.


----------



## Passepartout

geekette said:


> Against means testing.  We all paid in.  I would instead hope that the very highest earners never claim it because they don't need it and neither do their heirs.
> 
> but, they paid in, I am not in favor of preventing their return of long ago forgone income simply because they now make more than someone thinks they should.



I like the idea of means testing, but with some mechanism to return what was paid in. Now the 'but if' part. Nobody returns anything to the working stiff that pays his/her FICA dutifully for 40 years then keels over dead a month after retiring. Or the month before retiring and whose family doesn't even get the princely sum of $255 to help bury the departed. 

There is a reason Social Security is called the '3rd rail of politics'. No politician will touch it.

Jim


----------



## SMHarman

Elan said:


> I didn't say it would be a popular solution, nor did I say it's the only solution.  There's going to be a tradeoff between what's appealing, and what works.  Being an engineer, I tend to focus on what works.  If there was a solution that worked and appealed to everyone, I have to presume we'd be on that path already.


But the fact is that SS is not a government benefit it is a government managed / guaranteed social fund.  I contribute and get an annuity at the other end.  If I don't contribute I don't get an annuity and if I contribute less I get a smaller annuity.  You can't make such a fund that I contribute and get nowt at the end.  My money goes in, my money comes out.
Now, if i pay a tax and get a benefit, you are welcome to means test that but not SS, it is not a tax.  


Elan said:


> The $10M was an exaggeration for illustrative purposes.  Specifically, my question pertained to retiring early.  If, between my wife's income (she's a teacher at a private school, so calling it income is almost a stretch) and my investment income we could make ends meet, I'd more seriously consider retiring early or at least finding a less demanding job that paid measurably less.  Every time I've run napkin type numbers for this scenario, family healthcare is a big part of the monthly expense.  Last night, I quickly plugged some numbers into our state's ACA portal assuming a much lower income than I had when I visited the site previously, and noted that my healthcare would be subsidized.  I spent about 2 minutes on the site and didn't double check anything, so I might be mistaken.


Thats great, it seems a little 'socialist' for many Americans but it means you can scale back, have a less demanding job and still have healthcare, or even consider a second career later in life and not be beholden to your employer and their healthcover.  Wonder why employers don't like ACA?


----------



## Beefnot

Passepartout said:


> I like the idea of means testing, but with some mechanism to return what was paid in. Now the 'but if' part. Nobody returns anything to the working stiff that pays his/her FICA dutifully for 40 years then keels over dead a month after retiring. Or the month before retiring and whose family doesn't even get the princely sum of $255 to help bury the departed.
> 
> There is a reason Social Security is called the '3rd rail of politics'. No politician will touch it.
> 
> Jim


 
I have always loved the idea of means testing, with NO mechanism for returning what was paid in.  A form of mandatory insurance/tax, and if you end up not needing it, then thanks for playing and go on your way.


----------



## Beefnot

SMHarman said:


> Thats great, it seems a little 'socialist' for many Americans but it means you can scale back, have a less demanding job and still have healthcare, or even consider a second career later in life and not be beholden to your employer and their healthcover. Wonder why employers don't like ACA?


 
I am a strong proponent of the concept "you don't work, you don't eat", but I find health care--like education and public safety (e.g., police, fire, etc.)--to be a social service that should be a de facto right in any civilized society. So if someone wants to scale back and make less money, they can still have health coverage of some sort. 

However, I do not subscribe to the idea of a single universal standard of care. There should be a foundational level of managed care available to all Americans, with the option for those who can afford it to have access to enhanced services at incremental cost. Effectively, a tiered system.


----------



## SMHarman

Beefnot said:


> I have always loved the idea of means testing, with NO mechanism for returning what was paid in.  A form of mandatory insurance/tax, and if you end up not needing it, then thanks for playing and go on your way.



The UK did this with an opt out system.  

You have the Basic State Pension.  A non means tested defined benefit.

Then you have State Earnings Related Pension.  You could opt out of SERPS and have that money diverted to your Personal Pension Plan (UK 401k) instead.  On retirement you now get the Basic State Pension and the money you would have paid into SERPS (SS) comes to you as part of your PPP(401k).

This of course created its own problem (laws of unintended consequences and all that) as SERPS had guaranteed minimum payouts and some are now worse off as shady financial advisors got them to opt out, took a commisssion for opening their PPP and now joe public is left with less retirement income.

It's another alternateive.

http://en.wikipedia.org/wiki/State_Earnings-Related_Pension_Scheme


----------



## Beefnot

SMHarman said:


> The UK did this with an opt out system.
> 
> You have the Basic State Pension. A non means tested defined benefit.
> 
> Then you have State Earnings Related Pension. You could opt out of SERPS and have that money diverted to your Personal Pension Plan (UK 401k) instead. On retirement you now get the Basic State Pension and the money you would have paid into SERPS (SS) comes to you as part of your PPP(401k).
> 
> This of course created its own problem as SERPS had guaranteed minimum payouts and some are now worse off as shady financial advisors got them to opt out, took a commisssion for opening their PPP and now joe public is left with less retirement income.
> 
> It's another alternateive.


 
No, no likey the opt-out.  You pay in, and if you're wealthy, you will never see one red cent (where did that term come from anyway?) returned to you.  Thanks for playing.


----------



## ScoopKona

Beefnot said:


> No, no likey the opt-out.  You pay in, and if you're wealthy, you will never see one red cent (where did that term come from anyway?) returned to you.  Thanks for playing.



The wealthy don't need all those red cents returned. I would much rather be wealthy and lose a minor amount of money playing "social roulette" than be poor or middle class and need that benefit money. (And if FICA contributions aren't considered "a minor amount of money" then the person isn't really wealthy, right?)

Think of it like a hedge against destitution and that should cover it.


----------



## SMHarman

http://www.thefreedictionary.com/red+cent

But then you are creating a movable goal post of 'wealthy'.  The 1%?  The 5%?  The Upper Quartile?

How do you deal with the single home asset rich cash poor retiree who worked in NY all their life and owns a $2M apartment and has some 401k money?  Are they rich?

$100k a year goes a very different distance in this country in Florida than it does in say NY.


----------



## ScoopKona

SMHarman said:


> But then you are creating a movable goal post of 'wealthy'.  The 1%?  The 5%?  The Upper Quartile?
> 
> How do you deal with the single home asset rich cash poor retiree who worked in NY all their life and owns a $2M apartment and has some 401k money?  Are they rich?
> 
> $100k a year goes a very different distance in this country in Florida than it does in say NY.



$100k a year isn't wealthy in my book, anywhere in the country. It isn't even "well off." I only really care about net worth for my personal finances, anyway. 

This doesn't have to be hard. Even Warren Buffet will agree that he doesn't need any social security benefits. Only the most miserly, ideologically-pure nimrod would try to argue that. What's $2,500 to someone who makes millions per day, just in dividends?

So we can toss Buffet out of the pool. Going back to Stephen King, I think with his half-billion we can toss him out, too. He isn't going to mind. He's said so. We keep working down the net worth ladder until we reach the rung where reasonable people are divided about whether that $2,500 per month would make a difference for the recipient. That's the cutoff point -- give the wealthy retiree the benefit of the doubt.

This won't actually save much money, nor will it save social security. But it does help to foster a sense of United American Citizenry.


----------



## SMHarman

ScoopLV said:


> So we can toss Buffet out of the pool. Going back to Stephen King, I think with his half-billion we can toss him out, too. He isn't going to mind. He's said so. We keep working down the net worth ladder until we reach the rung where reasonable people are divided about whether that $2,500 per month would make a difference for the recipient. That's the cutoff point -- give the wealthy retiree the benefit of the doubt.


OK but where is that cut-off?  $30k a year is a 10% income difference to someone earning $300k.  5% at $500k.
I guess $1m a year would be a good cut off line for income, but if you strategise and move your assets into a trust and have that trust maintain those assets then you can manipulate your income down quite effectively.
Again it becomes a hit on the middle class that don't proactivly manage their taxes.


----------



## Beefnot

SMHarman said:


> OK but where is that cut-off? $30k a year is a 10% income difference to someone earning $300k. 5% at $500k.
> I guess $1m a year would be a good cut off line for income, but if you strategise and move your assets into a trust and have that trust maintain those assets then you can manipulate your income down quite effectively.
> Again it becomes a hit on the middle class that don't proactivly manage their taxes.


 
Tie it to IRS filings, maybe even add a form/worksheet.  If total current assets exceeds $X OR total asset classes exceed $Y OR total income and financial benefit from all sources (including trusts) exceeds $Z OR some combined formula accounting for X, Y, and Z exceeds <whatever metric>, then benefits will continue to be withheld.  I say "continue to be withheld", meaning that the onus remains on the individual every year to demonstrate that they should collect.

I'm sure there are holes a mile wide in what I monkeyed up, but the point is that anything can be solved for.  Maybe complex, but with enough brainpower, it can be solved for.  I find it somewhat of a red herring to suggest that because the solution is not simple then therefore the concept is without merit.


----------



## Ken555

ace2000 said:


> Good post. And are we any different today? Just look at our current deficits and the corresponding debt we are passing to our future generations.  Does anyone care?  We may say we do, but nothing is done.




I've always voted for those politicians gutsy enough to say they intend on raising taxes in order to pay off the debt. Obviously, they haven't been very successful. Of course some debt is fine, and as a ratio of GDP we aren't really in horrible shape, but assuming that our economy continues to grow is an assumption I no longer want to make. Even so, we need more people to step up and say enough, let's pay it off. Neither popular party has been financially prudent, and there is little incentive for them to change.

Focusing on containing healthcare costs is reasonable, but the manner in which the criticism has been done hasn't been very productive. As has been pointed out multiple times in this thread, the ACA will reduce overall healthcare costs compared to where we have been. But, there is a lot more we can do. In perspective, this is a major step forward toward fixing healthcare but definitely isn't enough. 



Sent from my iPad


----------



## momeason

rapmarks said:


> as I mentioned, son in law had stroke less than two weeks ago, works in the trades on the road, had health insurance, but no sick days, disability, so his insurance will stop at end of month, after all he isn't working.



If his wife has some income, he can sign up for the ACA or get Medicaid in 27 states with no or very low income. They just need $15,700 a year which can include what he already made in 2014.


----------



## ScoopKona

Beefnot said:


> I find it somewhat of a red herring to suggest that because the solution is not simple then therefore the concept is without merit.



Agreed. And we can string together a bunch of small tweaks into something that could give the next generation or two a shot at a decent (not spectacular) retirement package. 

(Everyone can do their own retirement planning. But many (most? I think the answer is "most") won't. I don't want to go back to the days of seniors choosing between healthcare and food. Social security was always supposed to be the fall-back position, anyway. The "at the very least you can count on this" option.)


----------



## ace2000

Again, one more time.  If no action is taken, current projections state that there is enough in the trust fund to last until at least 2033 - almost 20 years.  

Even at that point, if nothing is done, the payroll taxes alone in 2033 would be high enough to continue to pay out at a 75% rate.   So, it may not look the same as today, but something will be done, and it's not going to require draconian changes to solve the problem.  The sky is not falling and it is not too late to make changes..  

But, I'm kind of glad the media is alarming everyone, because that's what it will take to motivate our government.  Obviously, the best thing to do is put away money for your retirement regardless.


----------



## Tia

SMHarman said:


> http://www.thefreedictionary.com/red+cent
> 
> But then you are creating a movable goal post of 'wealthy'.  The 1%?  The 5%?  The Upper Quartile?
> 
> How do you deal with the single home asset rich cash poor retiree who worked in NY all their life and owns a $2M apartment and has some 401k money?  Are they rich?
> 
> $100k a year goes a very different distance in this country in Florida than it does in say NY.



Maybe someone with a valuable home can take equity out of it to continue to live off the asset. Or a Reverse mortgage. It also happens people transfer their assets to others ( ? trust)  then qualify for government aid later, and to protect assets from the government. They have a look back period of time, it depends on the timing of all.   I know someone personally who years ago was giving her SS to her grown successful children as she didn't need the income... as had inherited a valuable amount of stock from her parents. 

How much is enough has many answers


----------



## SMHarman

^indeed "How much is enough has many answers", but to disqualify someone for SS it requires only one answer and as with any rules driven approach the clever lawyer will find a compliant path through the rules.


----------



## Tia

SMHarman said:


> .... the clever lawyer will find a compliant path through the rules.




Totally agree re the clever lawyer ...


----------



## Passepartout

SMHarman said:


> ^indeed "How much is enough has many answers", but to disqualify someone for SS it requires only one answer and as with any rules driven approach the *clever lawyer will find a compliant path *through the rules.



Not exactly sure how we detoured from ACA to 'what if' Social Security and taxation questions, but why not?

Lest we forget, it's clever lawyers who craft those rules so as to make exceptions that other clever lawyers go to school to learn to take advantage of.


----------



## ScoopKona

Passepartout said:


> Not exactly sure how we detoured from ACA to 'what if' Social Security and taxation questions



ACA, at it's core, is a means to deal with the fact that 75 million baby boomers have all hit medicare age. Since our medicals costs are on a spiral that is only comparable to the spiraling costs of a college education, we need to do something to pump a LOT more money into our healthcare system.

Once of my long-dead relatives explained the Baby boom generation in a rather curious way -- he compared that generation and America to a boa constrictor eating a pig. 
_
"We had to build staggering amount of schools to educate them all, and then we got stuck with the cost of having all those schools in the 1970s for the 'baby bust.' We had to create a staggering amount of jobs for them all. And when they retire, they're going to wreck social security."
_
Not a direct quote because this conversation happened 25 years ago. But the jist of the conversation (and the enormity of processing such a large chunk of population through their life stages) stuck with me.


----------



## Passepartout

ScoopLV said:


> ACA, at it's core, is a means to deal with the fact that 75 million baby boomers have all hit medicare age.



Not really. Once one hits the Big Six-Five, Medicare kicks in and one couldn't care less about ACA. ACA is for people between 26 and 64 and 364 days. It is to keep people from bankrupting themselves and from using the ER for primary care.


----------



## ace2000

*Social Security and Health Care*

It's all related if you think of it from an overall budget perspective.  If we continue to tax and spend ourselves into a downward debt spiral and/or our long term economy stops growing, all of these government programs and handouts will become very much intertwined and then you are going to see the draconian measures on government spending.

The excess in the Social Security trust fund is currently invested in treasury bonds.  Is there a chance for default in our long term future?  I hope we get our act together soon on the deficits, but nothing indicates that.  And with the ACA on the horizon, the deficit projections get even worse over the next 7-10 years.

There's your gloom and doom scenario.  Yep, call me Chicken Little on that front.


----------



## ScoopKona

ace2000 said:


> If we continue to tax and spend ourselves into a downward debt spiral and/or our long term economy stops growing, all of these government programs and handouts will become very much intertwined and then you are going to see the draconian measures on government spending.



If only we taxed and spent. But we don't. We BORROW and spend. Otherwise, I agree with your assessment.


----------



## ace2000

I thought I covered the borrowing aspect by mentioning the "downward debt spiral".  Anyway, we're lucky.  Since we're the economic power of the world, we'll get to see a preview of our economic future first in Europe (which is going to get ten times worse during the next economic downturn).  Hopefully, we'll watch and learn before it's too late.


----------



## ScoopKona

Passepartout said:


> Not really. Once one hits the Big Six-Five, Medicare kicks in and one couldn't care less about ACA. ACA is for people between 26 and 64 and 364 days. It is to keep people from bankrupting themselves and from using the ER for primary care.



I guess I wasn't clear -- when 75 million Boomers start descending on the healthcare system en masse with major medical issues, the system is going to break down (even more so than it is currently). ACA's short-term benefit is not using the ER as a primary healthcare source and not bankrupting younger people. But that's really more of a side-effect.

Why do you think we're finally getting around to not using the ER as a primary healthcare source? Seventy-five million boomers needing those ERs, of course.

We need to beef up the healthcare network in America because the Baby Boomers are going to put a strain on the system, just like they did with the public school system when Boomers were at the other end of their lifespan. And on a more morbid note -- during the height of the boom, more than 10,000 people were being born each day. Think about the strain that's going to put on the funeral industry and burial plots when Boomers start passing away at similar rates. There's going to be waiting lists for funeral homes. "Mortician" is likely to be a great career choice for about 15 years. And then it will all die down (morbid pun intended) as the "pig finally passes through the boa constrictor" as my Greatest Generation ancestor broke it down for me all those years ago.

We've known this was coming for decades, after all...


----------



## SMHarman

Passepartout said:


> Not really. Once one hits the Big Six-Five, Medicare kicks in and one couldn't care less about ACA. ACA is for people between 26 and 64 and 364 days. It is to keep people from bankrupting themselves and from using the ER for primary care.


Y Yes really.  The Boomers need to hit 65 and retire.  Or before 65 retire and let Gen X and Y and the Millenials into the sandbox.  Right now in the US the Boomers are still working away, many of them for the healthcare.

You can trickle down a lot of jobs if you let those hoping to serve time and keep medical until they hit 65 have an affordable glide path into full retirement.


----------



## Passepartout

ScoopLV said:


> a more morbid note -- during the height of the boom, more than 10,000 people were being born each day. Think about the strain that's going to put on the funeral industry.....



I was thinking that as well as tattoo removal. Both have growth potential. Only one has repeat customers.


----------



## Elan

SMHarman said:


> Y Yes really.  The Boomers need to hit 65 and retire.  Or before 65 retire and let Gen X and Y and the Millenials into the sandbox.  Right now in the US the Boomers are still working away, many of them for the healthcare.
> 
> You can trickle down a lot of jobs if you let those hoping to serve time and keep medical until they hit 65 have an affordable glide path into full retirement.



    I had these exact same thoughts WRT early retirement.  Is enabling some to ease into earlier retirement an intended or unintended aspect of ACA?


----------



## geekette

Elan said:


> I had these exact same thoughts WRT early retirement.  Is enabling some to ease into earlier retirement an intended or unintended aspect of ACA?



absolutely intended.  the idea was to untether health insurance from jobs.


----------



## Elan

geekette said:


> the idea was to untether health insurance from jobs.



  Sure, that's true, and that's a good thing.  But to what extent?  If every person over 55 quits their job because they can now get partially subsidized healthcare, I doubt the numbers work.  Maybe I'm wrong?

  Maybe I should have more accurately asked "To what extent did ACA anticipate people leaving the workforce?".


----------



## ace2000

Elan said:


> Maybe I should have more accurately asked "To what extent did ACA anticipate people leaving the workforce?".



It's a good question and it was recently addressed by the CBO... to be fair, many of these two million will be workers that will voluntarily leave the workforce just as you've described.

*Obamacare will shrink workforce by 2 million, report says*



> The CBO report notes that the reduction in labor “stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.”
> 
> People will choose to work less because of a variety of new factors to consider. For instance, some will retire early since they will no longer have to rely on their employer for insurance. Others will choose to work less because more work income would make them eligible for less in Obamacare subsidies.
> 
> Since these workers will be choosing to work less, the reduction in labor will not register as a rise in “unemployment” figures, which only count workers who are actively looking for work.
> 
> The budget office also noted that its estimate of the law’s impact on the labor market is “subject to substantial uncertainty.”



http://www.cbsnews.com/news/obamacare-will-shrink-workforce-by-2-million-report-says/


----------



## SMHarman

The numbers work as such trickle down improves many aspects of the economy.  Now these new hires are paying taxes and not claiming benefits etc.  Earning money and spending that money increasing the demand side of the economy which is currently lacking.


----------



## Passepartout

ace2000 said:


> It's a good question and it was recently asessed by the CBO... to be fair, many of these two million will be workers that will voluntarily leave the workforce just as you've described.
> 
> *Obamacare will shrink workforce by 2 million, report says*
> 
> 
> 
> http://www.cbsnews.com/news/obamacare-will-shrink-workforce-by-2-million-report-says/



It is a "Glass half empty/Glass half full" deal. Yes, a certn number will leave jobs that employers choose to cut hours, possibly (if they want to keep up production) more people will be hired. We just don't know. Some people will choose to retire early. But some of those will be entrepenurial, and start their own businesses. Again, we don't know.  As we get deeper into the ACA, more people, both employees and employers will work out their own individual plan. Then an overall picture will develop, like a black and white print in the chemicals. Then we will know.


----------



## Elan

SMHarman said:


> The numbers work as such trickle down improves many aspects of the economy.  Now these new hires are paying taxes and not claiming benefits etc.  Earning money and spending that money increasing the demand side of the economy which is currently lacking.



  Maybe.  You're taking out 50 or 60 somethings, putting them on (perhaps) subsidized healthcare (which they'll likely use) and replacing them with healthy 20 somethings who although they won't use much healthcare, also will likely opt for minimum cost coverage (if not covered by employer).  

  I guess I'd have to go with "TBD" for now.


----------



## Elan

ace2000 said:


> It's a good question and it was recently addressed by the CBO... to be fair, many of these two million will be workers that will voluntarily leave the workforce just as you've described.
> 
> *Obamacare will shrink workforce by 2 million, report says*
> 
> 
> 
> http://www.cbsnews.com/news/obamacare-will-shrink-workforce-by-2-million-report-says/



  Thanks for the info.


----------



## ScoopKona

Passepartout said:


> But some of those will be entrepenurial, and start their own businesses.




That would be the best thing that could happen. Think of all the businesses that started immediately during the post-WWII years. The entrepreneurs of that era had the additional "advantage" of having just lived through a horrific experience -- vowing to do what they wanted to do for the rest of their lives. I knew a lot of people who once fit that description. They succeeded because there was no way in hell they were going to let themselves fail.

I don't know if society has that kind of grit anymore. But if thousands of people open a business, a certain percentage will thrive and grow the economy. And those who don't? At least they spent money getting the business off the ground.


----------



## bogey21

Passepartout said:


> It is to keep people from bankrupting themselves *and from using the ER for primary care*.



What happens when someone who bought a low cost plan with a high deductible goes to the ER?  Does the hospital say "I see you have a high deductible, please pay now"?  What if the person with the high deductible doesn't pay?  Is the hospital still in the same boat?  Any thoughts?

George


----------



## Passepartout

bogey21 said:


> What happens when someone who bought a low cost plan with a high deductible goes to the ER?  Does the hospital say "I see you have a high deductible, please pay now"?  What if the person with the high deductible doesn't pay?  Is the hospital still in the same boat?  Any thoughts?
> 
> George



There are no more- or will be no more after those reinstated for 2014- high deductible insurance plans. But to your question, people will either be told what an ER visit will cost and pay up front or fill out a consumer loan application, or will be billed by the hospital, or will be turned away when stable enough to get to another facility- like a private doc, doc-in-a-box, or home. ERs are to treat true emergencies, and life threatening situations. Then to bill for treatment.


----------



## Ken555

Passepartout said:


> There are no more- or will be no more after those reinstated for 2014- high deductible insurance plans.




No, I believe there will still be high deductible HSA plans, and perhaps others.


Sent from my iPad


----------



## ace2000

Ken555 said:


> No, I believe there will still be high deductible HSA plans, and perhaps others.



True... the name of that category is catastrophic and provides minimal coverage with high deductibles.  

They're designed for the under 30 age group and there are some exceptions for older adults.  

They were made available to stop the uproar that occurred when many were complaining about their increasing premiums.


----------



## Ken555

ace2000 said:


> True... the name of that category is catastrophic and provides minimal coverage with high deductibles.
> 
> 
> 
> They're designed for the under 30 age group and there are some exceptions for older adults.
> 
> 
> 
> They were made available to stop the uproar that occurred when many were complaining about their increasing premiums.




You are correct in regards to lower premiums but in all else absolutely wrong. I don't have time for a complete reply, so I suggest you lookup the history and purpose of HSAs (lots of info online). 


Sent from my iPad


----------



## ace2000

Ken555 said:


> You are correct in regards to lower premiums but in all else absolutely wrong. I don't have time for a complete reply, so I suggest you lookup the history and purpose of HSAs (lots of info online).
> 
> 
> Sent from my iPad



I'm not talking about the HSAs.  I mentioned what I thought Jim was talking about in his previous post... I don't think he was talking about HSAs.  I thought he was talking about the high deductible "catastrophic" category of health plans.  

I'll suggest you do the research.  And please tell us one thing that is factually "wrong" with the information that I posted.  I'll be open to learn from you on that.


----------



## ace2000

Passepartout said:


> There are no more- or will be no more after those reinstated for 2014- high deductible insurance plans.



He mentioned "reinstated for 2014".  That is definitely not HSAs.


----------



## Passepartout

I don't know anymore who said what. I was not referring to HSAs w/high deductible policies. I was referring to the noncompliant to ACA standard policies that offer little to no benefits, and extremely high deductibles that insurance companies dropped- quit selling- then (purely politically) when the cry of "He said I could keep my insurance, and they cancelled it", carriers were allowed to resurrect them if they wanted to. For one year.

Clear as mud, huh?


----------



## momeason

Ken555 said:


> No, I believe there will still be high deductible HSA plans, and perhaps others.
> 
> 
> Sent from my iPad



There are still high deductible plans but they could not have a deductible of more than $6350 since by law that is the out of pocket maximum.
High Deductible is now usually $5500 per individual. The out of pocket max now cannot be more than $6350 on any ACA compliant plan. This is the law. My husband has a new ACA compliant High Deductible plan....$5500 deductible/$6350 out of pocket max. BCBSNC only offers 2 HSA eligible plans. We each have one, mine is a grandfathered plan with a $5000 deductible and a $5000 out of pocket max. 
If people have a grandfathered non ACA compliant plan the deductible could be higher.


----------



## ace2000

Passepartout said:


> Clear as mud, huh?



Actually it's pretty clear that we're both talking about the same thing.  I'll save Ken the research time.

From Healthcare.gov...



> Catastrophic Health Insurance Plan
> 
> *A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness.* Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher. This means you must pay thousands of dollars out-of-pocket before full coverage kicks in.
> 
> 
> *In the Marketplace, catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received "hardship exemptions".* Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer. People with catastrophic plans are not eligible for lower costs on their monthly premiums or out-of-pocket costs.



https://www.healthcare.gov/what-are-the-different-types-of-health-insurance/


----------



## Tia

Spoke with a friend today who said she went to the web for new health insurance family policy and got a ZERO premium , due to low reported income last year. It's a safety net for them as has been a rough couple years.


----------



## geekette

I have a high deductible plan via employer.  it is not 'catastrophic' nor 'minimal coverage' and I can assure you that most of us are past 30.  It's simply a very low premium policy with pretty much everything I always had, but comes with HSA.  

At least for what we have here, there is a boatload of no-out-of-pocket preventive services.  Beyond that, I pay full negotiated rates until deductible met then am mostly covered for everything at 100%.


----------



## bogey21

I think there is a good chance that the deductibles are going to be a problem.  How many newly insureds will react negatively, maybe even cancel their insurance, when they find out that they will have to pay the first $5,000 or so out of pocket?  Will they cancel their policies figuring why pay monthly premiums when they still have to pay for a lot of their healthcare out of pocket?

George


----------



## ScoopKona

bogey21 said:


> I think there is a good chance that the deductibles are going to be a problem.  How many newly insureds will react negatively, maybe even cancel their insurance, when they find out that they will have to pay the first $5,000 or so out of pocket?  Will they cancel their policies figuring why pay monthly premiums when they still have to pay for a lot of their healthcare out of pocket?



They don't do that for car insurance. Why would they for health insurance?


----------



## presley

bogey21 said:


> Will they cancel their policies figuring why pay monthly premiums when they still have to pay for a lot of their healthcare out of pocket?



We sorta tried that.  Our premium was going up too high for us to pay.  Then, we would each have the $6350. deductible/out of pocket.  We couldn't buy in the exchange because they said we didn't make enough money.  Overall, all of our insurances, taxes, etc are going up like mad in California.  Anyway, decided to self insure by saving $500. month and just paying cash for stuff, which usually has a lot lower rates than the negotiated insurance agreements.

Then, I had to go the ER last month.    I gave them the state card that says I "may be eligible for some stuff" at check in.  ERs doing what they do, needed to run certain tests before they could actually do the CT scan that it looked like I needed.  While waiting between tests, the receptionist came and asked me to sign something saying they could bill the Blue Shield that I let lapse due to the high premium.  I told her I hadn't paid in 2 months, but I could still call them and reinstate it and yes they could bill it if that is what they wanted to do.  I was thinking I had appendicitis at the time.  

After all my tests/treatments, I found out I had diverticulitis and wouldn't be needing emergency surgery - yay.  When checking out, they said according to my insurance, I needed to pay $400. right then.  I did.  Next day, called insurance and removed my daughter to reduce our premium (she has insurance at her job now) and paid $2700. to bring my account current.  We will be paying over $900./month and we will all have the $6350. deductible.

Looking online at my overall out of pocket for that, including medicine and follow up appt, I am going to pay about $1100. at the negotiated rates.  If I was paying as a cash person, I'd pay less as cash gets a 40% discount.  If I knew what I had going in to the ER, I would have just paid cash, but didn't know and had all the symptoms of appendicitis which could have become tens of thousands of dollars and I don't have enough cash for that.

Okay, so that long story summarizes as we did try to just not have insurance, but after a scare, I bought the insurance.  We are cutting back in other areas to keep up with our insurance payments.  Our other insurances have skyrocketed, too.


----------



## ScoopKona

presley said:


> After all my tests/treatments, I found out I had diverticulitis and wouldn't be needing emergency surgery - yay.



I had the exact same problem recently. I went to an urgent care clinic instead of the emergency room and my total out of pocket cost was $40. If I had no insurance at all, it would have cost $400. 

I always go to the urgent care clinic first -- unless I experience a massive laceration, coronary distress, bee sting or similar "better get to the ER within the golden hour or you're dead" emergency. The way I look at it -- the urgent care clinic takes less time to process me. I see a doctor sooner. And if it turns out to be fairly minor I don't spend much at all out of pocket. (Diverticulitis isn't exactly minor -- you may end up needing that surgery someday. I recommend seeing someone about diet/lifestyle changes to avoid more complications. And there's a lot of conflicting info about what to do about diverticulitis -- whether or not it's OK to eat nuts, seeds and popcorn, for instance.)

And if the health scare turns out to be major, they're going to send me to the ER anyway, no real harm done. At least the tests and initial evaluation were done at the urgent care clinic that way, and I don't have to pay for the ER to do it.


I think one of our big goals should be diverting much of the ER traffic elsewhere -- it makes sense financially and medically.


----------



## geekette

bogey21 said:


> I think there is a good chance that the deductibles are going to be a problem.  How many newly insureds will react negatively, maybe even cancel their insurance, when they find out that they will have to pay the first $5,000 or so out of pocket?  Will they cancel their policies figuring why pay monthly premiums when they still have to pay for a lot of their healthcare out of pocket?
> 
> George


"When they find out..."???  
why would they not know what their insurance was when they bought it?  

and how is this any different than having to cough up bucks without insurance?  At least there is a cap on that with insurance.  Having a 'not to exceed this amount' is greatly more comforting than 'until your pockets are empty and we've taken your home...'

Further, much preventive care is included so it's not foreseeable that they would "still have to pay for a lot of their healthcare out of pocket..."


----------



## ace2000

Tia said:


> Spoke with a friend today who said she went to the web for new health insurance family policy and got a ZERO premium , due to low reported income last year. It's a safety net for them as has been a rough couple years.



That's good information.  Do you have any idea what type of plan they have - bronze, silver, gold, etc.?  Medicaid?


----------



## ace2000

geekette said:


> I have a high deductible plan via employer.  it is not 'catastrophic' nor 'minimal coverage' and I can assure you that most of us are past 30.  It's simply a very low premium policy with pretty much everything I always had, but comes with HSA.



That sounds similar to the structure Ken was describing last night, right?  Look at the High Deductible Health Plan (HDHP) category on healthcare.gov.  



> High Deductible Health Plan (HDHP)
> High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans with a minimum deductible of $1250 per year for individual coverage and $2500 for family coverage.
> 
> If you have an HDHP, you can use a health savings account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. This can lower the amount of federal tax you owe.



https://www.healthcare.gov/what-are-the-different-types-of-health-insurance/


----------



## ace2000

ScoopLV said:


> They don't do that for car insurance. Why would they for health insurance?



That's a good point, but I'm with George on this one.  I'll bet at least 75% of the first timers have no clue what a deductible means.

But, the mandate penalty is going to keep going up over the next few years.  That will be the incentive to stay on the plan.  And that will be the incentive for more people to enroll.


----------



## presley

ScoopLV said:


> I think one of our big goals should be diverting much of the ER traffic elsewhere -- it makes sense financially and medically.



I was next to the nurses station when I finally got a room.  I got to hear some of the reasons why people were there.

*A woman brought 2 very young children in.  One had an earache and one had diarreaha for 2 days.  Nurses said they could examine and treat in the hallway and get them out in 15mins.

*A man hurt his arm at work (but no work comp?) and wasn't going to get an Xray because he didn't have insurance.  

*A man next to me (don't know what for) kept requesting more morphine and his nurse kept dragging it out.  He'd say his pain was an 11 on a scale of 1 -10 and she'd finally bring his drugs an hour later.  

*A woman came from an urgent care and didn't want to wait again since she already waited at urgent care.  She got mad and left.  The nurses said she was a b1tch went she left.  

I asked if they were busier than normal and they said yes.  I had to go to the lobby after my vitals and then to the lobby again after my blood, urine and ultrasound because there were no beds open.  My nurse said that the night before, they were sitting around and chatting all night with nothing to do.  

I do live close to the border and we have many, many illegal residents here.  That's probably why the hurt arm guy didn't have work comp.  I was still very surprised that he wasn't getting an Xray, but maybe the doctor said she didn't think it was broken.  

RE: diverticulitis and urgent care  - the urgent cares here don't do CT scans.  We have to go to ER for that.  Now that I have the diagnosis on my record, I can just call my doctor for meds whenever it hurts to walk.  She said I won't need to come in at all.  So, maybe that is a long term savings, idk.  My husband had this years ago and eventually had a large part of his colon removed.


----------



## ScoopKona

ace2000 said:


> That's a good point, but I'm with George on this one.  I'll bet at least 75% of the first timers have no clue what a deductible means.



OK, it's pretty clear that I think the average American is stupid. But even I won't go as far as to say that 75% of us don't know what a deductible is. Most of us already have auto insurance and know what a deductible is. 

_Some people? _Absolutely.

_An appalling number of people?_ OK, sure thing.

_Most people?_ I don't think so. Not even me.

_75%?_ I can't buy that for a single moment. We're not a third-world country.... yet.


----------



## ace2000

ScoopLV said:


> OK, it's pretty clear that I think the average American is stupid. But even I won't go as far as to say that 75% of us don't know what a deductible is. Most of us already have auto insurance and know what a deductible is.
> 
> _Some people? _Absolutely.
> 
> _An appalling number of people?_ OK, sure thing.
> 
> _Most people?_ I don't think so. Not even me.
> 
> _75%?_ I can't buy that for a single moment. We're not a third-world country.... yet.



Could've been a little bit of a stretch...    Everyone knows what a car insurance deductible is.  But, do they associate it with health care as a first timer?  I wouldn't bet the house either way on that question.


----------



## ace2000

ScoopLV said:


> OK, it's pretty clear that I think the average American is stupid. But even I won't go as far as to say that 75% of us don't know what a deductible is.



Also, I *think* George was referring to first timers too.  I know I was.


----------



## ScoopKona

ace2000 said:


> Also, I *think* George was referring to first timers too.  I know I was.



I knew you were referring to first-timers. But it is certain that most of these first-timers drive a car, probably have auto insurance, and know what "deductible" means.

If we truly are that stupid a country, I'm moving. But lets face it, even the most mouth-breathing, knuckle-dragging imbecile who doesn't understand what he or she is buying is better off than under the old system of bankruptcy healthcare.


----------



## geekette

ace2000 said:


> That sounds similar to the structure Ken was describing last night, right?  Look at the High Deductible Health Plan (HDHP) category on healthcare.gov.
> 
> https://www.healthcare.gov/what-are-the-different-types-of-health-insurance/



Yes, I believe so.  I had a choice of 2-3 plans this year and deductibles were in the neighborhood of either 2500 - 3500 (covering myself only).  I took the latter in order to get 100% if ever I need it.

I think my teammate with wife + very young child has $6500 family deduct??  

I would encourage anyone eligible to get an HSA.  You can't pay premiums from it, but it is nice to have a couple years of deductibles saved up and ready to go on a credit card in my wallet behind my ins card.  I generally pay everything out of pocket and let that HSA money ride, treating it like a healthcare 401k.  It does pay interest and investments are available.  Like a 401k, the money goes in pre-tax but when used, it is treated like ordinary income.  

After age...  59.5?  65?  "retirement age", I can use it for anything, the restrictions that it be used for med-related expenses is waived.  I'm far enough from The Age that I am not sure what it is. If you're near, check on that.    

For someone like me, middle age but reasonably healthy, it's a great deal to have low monthly premiums, preventive covered, and if ever something Bad happens, I have the money set aside to pay it.  In some ways, it also untethers me from an employer if I'm between early retirement and Medicare age.  Few of us set aside healthcare dollars but via payroll deduction, I plan to contribute the max every year and hopefully not use it.

From where I sit, I can't afford NOT to contribute max to it.  I plan to live another 40 years or more and probably will have more car crashes, stupid injuries and random illnesses.   And quite possibly I will have a different employer in the future and not have high deduct plan and not be able to contribute.  I'm making hay while the sun shines.


----------



## momeason

ace2000 said:


> Actually it's pretty clear that we're both talking about the same thing.  I'll save Ken the research time.
> 
> From Healthcare.gov...
> 
> 
> 
> https://www.healthcare.gov/what-are-the-different-types-of-health-insurance/



I do not consider $6350 a very high deductible. Depends on your point of reference. Catastrophic still is regulated to a $6350 deductible.  The plan here in NC also includes Three $35 co pay visits and all preventative care. It is a good deal for many. We bought it for our son.


----------



## ace2000

ace2000 said:


> That's good information.  Do you have any idea what type of plan they have - bronze, silver, gold, etc.?  Medicaid?



Hi momeason, do you have any knowledge about this question?  Would it be possible to get a high subsidized amount and still be able to purchase a gold or platinum plan, assuming they could afford the difference?  Is it possible for someone get fully subsidized for a mid-level plan?  Or just the bronze perhaps?  I'm curious about that.


----------



## ace2000

One more question for you momseason - what level do your customers typically purchase?  I would assume bronze, since it appears to be the most popular.  If so, is it by a large margin?


----------



## Tia

ace2000 said:


> That's good information.  Do you have any idea what type of plan they have - bronze, silver, gold, etc.?  Medicaid?



Well I didn't ask , but have since the inquiry. The reply received was probably hard to admit but it was the last one , Medicaid. I feel terrible for them now knowing that. 

When we hear/read the economy is picking up , I look around and hope it comes soon to our area as it's pretty poor here still. Was even in the local news paper this week , can't link as you have to subscribe. Only thing going up is gas prices etc.


----------



## ace2000

Tia said:


> Well I didn't ask , but have since the inquiry. The reply received was probably hard to admit but it was the last one , Medicaid. I feel terrible for them now knowing that.



Yes, I added Medicaid to my post 15 minutes after I posted.  I thought that may have been the one.  The personal story you shared about your friend makes me appreciate that Medicaid is there - it doesn't sound like they're abusers of the "system", that's for sure, and perhaps anyone of us could be in the same boat.

Thanks for providing the details Tia.


----------



## Patri

ScoopLV said:


> I knew you were referring to first-timers. But it is certain that most of these first-timers drive a car, probably have auto insurance, and know what "deductible" means.
> 
> If we truly are that stupid a country, I'm moving.



Bye-bye, although I don't think these people are stupid. For young folks, just out of college, or getting out on their own for the first time, health insurance lingo is a foreign language. They are not familiar with deductibles, premiums, co-pays, HSA, FSA, in-network and out-of-network. It is tough enough for all of us to choose the right healthcare plan, and try to figure out what our annual costs might be. The 20-somethings are also focusing on a myriad of other things as they settle down, which are probably more important to them than health insurance.
It is really not useful to judge or get upset about these types of things; being pleasant is always good.


----------



## Elan

Patri said:


> Bye-bye, although I don't think these people are stupid. For young folks, just out of college, or getting out on their own for the first time, health insurance lingo is a foreign language. They are not familiar with deductibles, premiums, co-pays, HSA, FSA, in-network and out-of-network. It is tough enough for all of us to choose the right healthcare plan, and try to figure out what our annual costs might be. The 20-somethings are also focusing on a myriad of other things as they settle down, which are probably more important to them than health insurance.
> It is really not useful to judge or get upset about these types of things; being pleasant is always good.



  Wouldn't you agree that anyone who has experience with car insurance should already know the concepts of premiums, deductibles, coverage limits, etc?  Sure health ins has a few more concepts, but it's still insurance.  I was taught the basics of insurance in a high school Personal Finance class.


----------



## ace2000

I think George's point is how are they going to feel after the first year when they realize that the insurance covered nothing for them, after paying $100 or $200 a month and getting nothing tangible back?  I think there will be some frustration next year.  But again, as long a there is the increasing mandate penalty, it won't matter.  They're locked in.

And yes, they should know what a health insurance deductible means, but definitely not all of them will realize how that relates to health insurance.  For that matter, they may not even realize that their plan had a deductible at all until they started using it.  In the end, it's not a big deal, they'll learn.


----------



## Tia

One appendicitis, gall bladder surgery or bone fracture needing surgery will save them thousands and should open some eyes. I remember we were in our 20's and other half had a fracture requiring surgery and time in the hospital, we saved thousands.  Life is full of hard lessons for those who don't plan ahead for whatever reason isn't it?



ace2000 said:


> I think George's point is how are they going to feel after the first year when they realize that the insurance covered nothing for them, after paying $100 or $200 a month and getting nothing tangible back?  I think there will be some frustration next year.  But again, as long a there is the increasing mandate penalty, it won't matter.  They're locked in.
> 
> And yes, they should know what a health insurance deductible means, but definitely not all of them will realize how that relates to health insurance.  For that matter, they may not even realize that their plan had a deductible at all until they started using it.  In the end, it's not a big deal, they'll learn.


----------



## momeason

We all insure our homes and cars and the risk of loss of our home is so much less than the risk of high medical bills. the difference is most of us are required to carry home instance by our lender.
Just about everyone is going to need to use their insurance at some point and everyone should get their screenings which are included in the cost of insurance.
In 33 years of home ownership, we only used our home insurance one year and the claims were relatively minor. I do not know anyone who has health insurance who has been 33 years without using it.
Also, the vast majority of individuals under 35 will pay less than $100/mo. If you are required to pay more, you are doing very well on the income scale and you should be glad to protect your health and your credit standing. Medical bills can and do wipe people out.
Until, we get something better, the ACA is a vast improvement. I am amazed at how many people will not even attempt to find out what their costs will be. 
I always prefer to make informed decisions.


----------



## SMHarman

ace2000 said:


> I think George's point is how are they going to feel after the first year when they realize that the insurance covered nothing for them, after paying $100 or $200 a month and getting nothing tangible back?  I think there will be some frustration next year.  But again, as long a there is the increasing mandate penalty, it won't matter.  They're locked in.
> 
> And yes, they should know what a health insurance deductible means, but definitely not all of them will realize how that relates to health insurance.  For that matter, they may not even realize that their plan had a deductible at all until they started using it.  In the end, it's not a big deal, they'll learn.



But if they pay $100-300 a month for car insurance and get nothing back for the drinks and dings their car gets. It covers the damage that immobilized or injuries others. 

Sent from my LT26i using Tapatalk


----------



## Ken555

Elan said:


> Wouldn't you agree that anyone who has experience with car insurance should already know the concepts of premiums, deductibles, coverage limits, etc?  Sure health ins has a few more concepts, but it's still insurance.




I agree. I learned about the basic concepts of health insurance in high school (or perhaps before) since every time I went to a doctor for a checkup or more I was asked "is your insurance the same or do you have a new policy?". 

This isn't rocket science, and in my opinion everyone has the responsibility to know what they're buying. Of course if some haven't had any kind of insurance before it may seem daunting, especially the legalize which insurance companies love to throw at their customers - no other insurance I have for personal or business needs sends me info like the health insurance companies. But this doesn't change the basic benefits of the health plan - deductibles, copays, maximum out of pocket (which seems to be confused with deductible in this thread lately), in/out networks etc.




Sent from my iPad


----------



## ScoopKona

Patri said:


> It is really not useful to judge or get upset about these types of things; being pleasant is always good.



I disagree. We mollycoddle the ignorant to our great, great detriment. Our society is the way it is from decades of letting people believe that the earth is flat (and similar). They know everything there is to know about "Dancing with a Bachelor Millionaire Survivor Ice-Road Duck Hunter" and nothing at all about the important things, like healthcare.

Much of the vitriol I see about ACA (elsewhere, not from the even-tempered folks at TUG) comes from people who are led by televised pied pipers. This is where concepts like "death panels" and similar come from.


----------



## Beefnot

Current HMOs are way closer to "death panels" than any gov't healthcare system.


----------



## Tia

Beefnot said:


> Current HMOs are way closer to "death panels" than any gov't healthcare system.




 you might be right!


----------



## Patri

Elan said:


> I was taught the basics of insurance in a high school Personal Finance class.



Trust me, that curriculum is gone in many, if not most, high schools. With all the state and federal mandates on testing (which takes an incredible number of days over the course of the school year), plus other educational requirements, plus cutting programs to ease taxes and budgeting issues, personal finance is at the bottom of the priority list. If it is taught in the Family Consumer Science department, (used to be Home Ec!) which seems most likely, that department has been eliminated in many schools. And even I, in school back in the good old days, didn't get insurance info in any class. Was it an elective or required for you? Every district is different, and you can't assume students were taught this.


----------



## Passepartout

ace2000 said:


> I think George's point is how are they going to feel after the first year when they realize that the insurance covered nothing for them, after paying $100 or $200 a month and getting nothing tangible back?



But even with the most basic high deductible plan, they DO get something tangible back. Several office visits a year (for a small co-pay) and all diagnostics. A physical exam (for a small co-pay). and perhaps most important, a personal relationship with a PCP. Having a care provider, who has baseline health history and information, and who provides guidance, can add years to even a young person's life, and life to a young person's years.


----------



## Passepartout

Beefnot said:


> Current HMOs are way closer to "death panels" than any *gov't healthcare system*.



What is this 'Gov't healthcare system' ? The only Gov't healthcare systems we have are Veteran's Health Service, and Medicare. And yes, when my PCP asked me about my Will, Personal Healthcare directive, and POA for healthcare, he prefaced the conversation with, "OK, now I'm your 'Death panel'.

ACA is NOT a 'Gov't healthcare system'. 

As an aside, I'm happy I don't live in an area widely served by HMO's. That IS a little too 'big brother-ish' for me.

Jim


----------



## ace2000

Beefnot said:


> Current HMOs are way closer to "death panels" than any gov't healthcare system.



I'm going to assume you're talking about government insurance - and we can use Medicare as an example.  How is Medicare any different than an HMO when you say it's "closer to death panels"?  They both have the same sort of decision making process.  Personally, I don't see it.


----------



## pjrose

ScoopLV said:


> . . .  They know everything there is to know about "Dancing with a Bachelor Millionaire Survivor Ice-Road Duck Hunter" and nothing at all about the important things, like healthcare.
> 
> Much of the vitriol I see about ACA (elsewhere, not from the even-tempered folks at TUG) comes from people who are led by televised pied pipers. This is where concepts like "death panels" and similar come from.



So very true, Scoop.


----------



## Beefnot

ace2000 said:


> I'm going to assume you're talking about government insurance - and we can use Medicare as an example.  How is Medicare any different than an HMO when you say it's "closer to death panels"?  They both have the same sort of decision making process.  Personally, I don't see it.



Privately run, for-profit managed care has a greater incentive to deny care than government run or mandated insurance.  HMOs in particular, more so than PPOs, where the structure and reimbursement structure is intended to better align the interests of doctors with those of the HMO rather than the patient.


----------



## momeason

Passepartout said:


> But even with the most basic high deductible plan, they DO get something tangible back. Several office visits a year (for a small co-pay) and all diagnostics. A physical exam (for a small co-pay). and perhaps most important, a personal relationship with a PCP. Having a care provider, who has baseline health history and information, and who provides guidance, can add years to even a young person's life, and life to a young person's years.



A yearly physical is at no cost. All screenings including mammograms. pap smears, prostate exams and colonoscopies(if of age) and screening lab work are all included at no cost. if you go get your preventative care, you do not get nothing. You protect your health.


----------



## geekette

Beefnot said:


> Privately run, for-profit managed care has a greater incentive to deny care than government run or mandated insurance.  HMOs in particular, more so than PPOs, where the structure and reimbursement structure is intended to better align the interests of doctors with those of the HMO rather than the patient.



Yes, I am not an HMO fan.  

It was late 90s, my company had been bought and in came an HMO from parent company.  Pay more, get less was how it worked out.  You had to declare your primary and regardless of your problem, had to go there first to get referred out.  I think the idea is to make it harder and less convenient.  I remember telling my HR lady that I would forego the insurance and she was horrified, but it was one more benefit yanked away from us (I was up to 5 weeks vaca and zapped back to 1, which I wouldn't have access to for 12 months).  I did not stay at that job more than a couple more months due to the serious disincentives to stay.  Have not encountered an HMO since and am happy with that.  I will of course allow for the possibility that the plan offered us was not the norm and that HMOs have improved.

But from my experience, yes, the focus was not on patient access, it was hoops to jump thru that all started with being able to get in to see your Primary.


----------



## rapmarks

momeason said:


> A yearly physical is at no cost. All screenings including mammograms. pap smears, prostate exams and colonoscopies(if of age) and screening lab work are all included at no cost. if you go get your preventative care, you do not get nothing. You protect your health.



I don't get these things at NO cost.  For example, at yearly physical, dr can add office call charge, so you owe there.  I always have a bill with mammogram, such as charge for interpreting it,  

 As far as young people NOT needing doctors, after my son in law had his stroke and he never visited a doctor before that)  several people came up to me to tell me how their son, etc died of a heart attack or stroke in their 30's.  In fact my friends nephew, age 38, died in his sleep last Thursday.


----------



## Passepartout

rapmarks said:


> I don't get these things at NO cost. * For example, at yearly physical, dr can add office call charge, so you owe there.  I always have a bill with mammogram, such as charge for interpreting it,  *
> 
> As far as young people NOT needing doctors, after my son in law had his stroke and *he never visited a doctor* before that)  several people came up to me to tell me how their son, etc died of a heart attack or stroke in their 30's.  In fact my friends nephew, age 38, died in his sleep last Thursday.



Are these under ACA? I think not, because unless there is an office call co-pay. (Mine is $10 for the PCP, or $20 for a specialist) And under ACA, there is NO cost.

Obviously we are very sad over your SIL's condition, and stroke often comes on without warning, but in many, if not most of these cases, warning signs exist that can be uncovered in an annual physical. Paid for, under ACA at no cost.


----------



## Passepartout

*Very important*

Right now, it is very important to stress to people we know, or just know of. Enrollment ends in just a few days. Not to re-open until late in the year.

While ACA allows for no exemption for pre-existing conditions, one cannot be uninsured, suffer illness or accident, then sign up. There won't be any sign ups until (iirc) October or November with an actual 'insured' date of 1-1-15.

Ask them, point blank, "*Do you have health insurance?*" You might be saving a life, or saving someone from bankruptcy. There is just a week to sign up.

Jim


----------



## ScoopKona

Passepartout said:


> Right now, it is very important to stress to people we know, or just know of.



Unfortunately, the people in my life fall into two groups: 1) The people who are financially responsible and have always had healthcare; and 2) The people living on the fringes who aren't going to purchase any damned gubmint insurance because it would cut into their liquor and cigarettes budget. (And I suppose, 3) The people who think ACA is a giant conspiracy, which includes death panels.)

Sometimes you can't even lead the horse to water.


----------



## bogey21

bogey21 said:


> IMO it would have been simpler if Congress had simply expanded Medicaid, decreed that Insurance companies couldn't turn down prospective customers for pre-existing conditions, allowed kids to stay on parent's policies until age 26, eliminated life time caps and left everything else like it was.  Sure premiums would have gone up but what else is new?



I'll add one thing to the above.  If Congress wanted to subsidize health insurance, they could have established  a tax credit for those at or below certain income levels.  For those with no tax liability the credit could have been structured to be paid to the taxpayer.  

George


----------



## pjrose

ScoopLV said:


> Unfortunately, the people in my life fall into two groups: 1) The people who are financially responsible and have always had healthcare; and 2) The people living on the fringes who aren't going to purchase any damned gubmint insurance because it would cut into their liquor and cigarettes budget. (And I suppose, 3) The people who think ACA is a giant conspiracy, which includes death panels.)
> 
> Sometimes you can't even lead the horse to water.



Yup, I know the same three groups.  The list of Group three conspiracies is long.   Groups two and three tend to overlap.


----------



## ace2000

bogey21 said:


> IMO it would have been simpler if Congress had simply expanded Medicaid, decreed that Insurance companies couldn't turn down prospective customers for pre-existing conditions, allowed kids to stay on parent's policies until age 26, eliminated life time caps and left everything else like it was.  Sure premiums would have gone up but what else is new?





bogey21 said:


> I'll add one thing to the above.  If Congress wanted to subsidize health insurance, they could have established  a tax credit for those at or below certain income levels.  For those with no tax liability the credit could have been structured to be paid to the taxpayer.
> 
> George



You pretty much have summed up exactly where we are right now.  Up to this point, no mandates have been enforced on business or individuals, and some are saying the (individual mandates) never will be.  Is that going to be a bad thing?  I don't like it, since the overall cost of the program go up, but I'm not sure what the American public's reaction will be.


----------



## Passepartout

Since we are really just at the beginning of some kind of civilized healthcare for Americans, it may well morph into 'expanded Medicare', or 'Single Payer', or who knows what, but the way ACA was written, it gives a nod to those who were (are) dead set against 'Gummint Healthcare. I can't say I don't share some misgivings about that possibility. It has resulted in 'retail' healthcare in most of the world where National healthcare exists (Canada, Great Britain, Germany, France, Mexico, that I am aware of off the top of my head) alongside the nationalized care for those unable or unwilling to pay extra.

For instance, in Thailand, they have some great hospitals providing elective surgeries, cosmetic, dental/facial, other, to mainly foreigners, when local people wait for basic healthcare.

Maybe the above is a picture of what American healthcare will become. Or maybe something different. 

Whatever it becomes, it will be an improvement of pre-ACA American healthcare for many previously uninsured Americans.


----------



## pjrose

*Question for Momeason*

Momeason,

For a low income 67 year old with basic medicare, does the ACA help with the costs for supplemental or medigap plans ?  Even with medicare this person hesitates to go to the ER or stay in the hospital because of the costs (or because of fear of the costs).  He has had a tracheotomy for years; apparently the insert is supposed to be replaced every 6 months but he can't afford it and says it isn't covered (?????).  

Same low income family, forty-something amputee, prosthesis doesn't fit right which recently led to an infection.  The man says he doesn't have any health coverage and was told he couldn't get any for two years (????), so he took someone's leftover antibiotics and managed to clear up the infection this time. 

These people need someone like you; how does someone in PA find a person like you to help navigate the maze?

PJ


----------



## Conan

While waiting for the real expert I'll tell you that as I understand it, although the ACA law made some improvements to Medicare (preventive care and Part D drug coverage), the ACA insurance contracts that are obtained through exchanges or via the healthcare.gov website are exclusively for people under age 65.


----------



## Passepartout

*PJ*

As I understand it, ACA and Medicare supplements are totally different animals. The 67 y.o. would need to speak with a healthcare provider, because he is beyond the open enrollment period for supplemental until late this year- like Oct.

The 40something needs to get to www.healthcare.gov and sign up for ACA. PRONTO! He will be directed to a PA provider. It is only through the website that he will get qualified for the rebates (iirc). He doesn't need to wait any 2 years for anything. If he gets signed up this week (and paid) he will have insurance soon (May 1?) and not have to wait until open enrollment.


----------



## bogey21

Passepartout said:


> Whatever it becomes, it will be an improvement of pre-ACA American healthcare for many previously uninsured Americans.



Ah, the $64 question.  They say 5 million have signed up on the exchanges.  How many had insurance before and went to the exchange for the subsidy?  Are the new Medicaid enrollees included in the 5 million?  Is it possible that there are more uninsured after the ACA was enacted?

George

PS  Even though we in Texas didn't take the money with which to expand Medicaid, I would have been ok with it had we taken the money.


----------



## Passepartout

bogey21 said:


> (*A*)They say 5 million have signed up on the exchanges. (*B*) How many had insurance before and went to the exchange for the subsidy? (*C*) Are the new Medicaid enrollees included in the 5 million? (*D*) Is it possible that there are more uninsured after the ACA was enacted?



*A*- It appears you doubt the number. Why? Does it matter if the real number is 4 million or 7 million? These are people who for the most part had no health insurance previously.
*B*- Unknown. But the people who had self-paid insurance would be stupid not to. Most Americans have employer-paid health coverage. Why would they choose to self-insure if they got it at work for no- or limited out-of-pocket cost?
*C*-I would assume so. They ARE after all ACA enrollees.
*D*-Very doubtful. There is no reason to believe that when insurance became available at significantly lower cost, and have greater benefits, that less people would purchase it. Again I refer you to your question I labeled (B). Most Americans get their health insurance at work.


----------



## Ken555

bogey21 said:


> They say 5 million have signed up on the exchanges.




I read earlier this week an estimate that six million will have signed up by the end of the month, assuming projections are accurate. I'm sure we'll find out one way or another soon. If they did get six million to sign up, given that the original estimate was seven and complicated by the initial rollout problems, I think that's not bad. More would be better, of course. Remember, even before it was released the government said signups would start slow and then increase over time, similar to the experience in Massachusetts.

There's a lot of misinformation out there, and the politics doesn't help.


Sent from my iPad


----------



## ace2000

Passepartout said:


> These are people who for the most part had no health insurance previously.


 
 Not true.  The enrollees are for the most part people that HAD insurance previously.


----------



## ace2000

Enrollees won't matter.  It will be the ones that have actually paid that count.  That number is lower - 10 to 20 percent lower, based on estimates.

 However, I'm with Jim.  I don't think the numbers are going to matter at this point.  I think they've done well enough.


----------



## Passepartout

ace2000 said:


> Not true.  The enrollees are for the most part people that HAD insurance previously.



Had this all happened between the time I left employment (brought about by the 2008 recession, but that's another story) and this year, I would have been counted in that number. On one level, I HAD insurance. Trouble is, I had to pay the first $5,000 a year out of pocket, and after that, it paid 50%, and no prescription coverage. It was cheap, but it wasn't insurance. The month I turned 65, and was covered by Medicare, it was an occasion to rejoice!


----------



## momeason

rapmarks said:


> I don't get these things at NO cost.  For example, at yearly physical, dr can add office call charge, so you owe there.  I always have a bill with mammogram, such as charge for interpreting it,
> 
> As far as young people NOT needing doctors, after my son in law had his stroke and he never visited a doctor before that)  several people came up to me to tell me how their son, etc died of a heart attack or stroke in their 30's.  In fact my friends nephew, age 38, died in his sleep last Thursday.



All preventative care is free. If your doctor codes the tests as diagnostic because of your history, you can be charged. Screenings are at no charge. I have had many doctor's offices recode my physical as a sick visit after the fact. I dispute this often and usually win. You are better off leaving concerns for a separate visit so all your screening labs can be coded as screenings. Also talk with your doctor ahead of time about coding.
I have not been charged anything for my mammogram or bone density scan since 2010. Preventative screenings are supposed to be free. Do you stay in your network?


----------



## rapmarks

momseason,  I am on Medicare perhaps this is a difference.  Medicare allows the dr to add a charge for an office visit as well as the preventative visit.   then most drs will ask for blood work and other tests, these all add up as they are partially covered.   I am merely saying that you can go in for your free exam, but you are going to end up with a bill.  
 and the mammogram - it is covered but  the dr visit to give you the order for it isn't covered, the radiologist who reads it isn't covered.   I have no experience signing people up for insurance, but I have way too much experience paying medical bills.

 I just went and checked for my preventative visit
 preventative charge 280   covered
 office visit at same time 220, only partially covered.
 throw in the ekg, the urinalysis, the blood work to follow, then the doplar she thought would be helpful, and the previous year a chest xray.  then she wanted me to come back and review all hose test results and pay for that visit.  I can see why  young person wouldn't even bother with making an office visit.  
 I will say that my first preventative visit found cancer, so I am not saying don't do it, but if a doctor finds anything to question, you are going to be stacking up the bills.


----------



## Tia

Doctors offices are getting good at figuring out how to get paid. The insurance game has created a monsters imo.  Bet the preventable visit though listed at $280 makes the doctors office nowhere near that $ number in real dollars.  

Heard an anesthesiologist say his mother would of had lots more medical procedures had he not said "NO", the answer why  he went on to say was because they make $ so were ordering things. Lots of people don't realize you can say no to the doctor.  



rapmarks said:


> ....
> 
> I just went and checked for my preventative visit
> preventative charge 280   covered
> office visit at same time 220, only partially covered.
> throw in the ekg, the urinalysis, the blood work to follow, then the doplar she thought would be helpful, and the previous year a chest xray.  then she wanted me to come back and review all hose test results and pay for that visit.  I can see why  young person wouldn't even bother with making an office visit.
> I will say that my first preventative visit found cancer, so I am not saying don't do it, but if a doctor finds anything to question, you are going to be stacking up the bills.


----------



## Beefnot

Tia said:


> Heard an anesthesiologist say his mother would of had lots more medical procedures had he not said "NO", the answer why he went on to say was because they make $ so were ordering things. Lots of people don't realize you can say no to the doctor.


 
There are also lots of people who realize you can say no, but may be somewhat hesitant to do so when they don't have sufficient expertise to understand the implications to their health of saying no.  I am one of those people.


----------



## Tia

Beefnot said:


> There are also lots of people who realize you can say no, but may be somewhat hesitant to do so when they don't have sufficient expertise to understand the implications to their health of saying no.  I am one of those people.



I understand that _very true_ statement. One way I ask my own doctor is would you order this for your mother/wife??  Ask them the pro's and cons re, it's their job to educate their patients. If you have a friend who is a healthcare provider might also ask them, have one friend who has lots of her friends asking her what she thinks re.


----------



## Passepartout

rapmarks said:


> momseason, * I am on Medicare perhaps this is a difference.*  Medicare allows the dr to add a charge for an office visit as well as the preventative visit.
> 
> *I will say that my first preventative visit found cancer*, so I am not saying don't do it, but if a doctor finds anything to question, you are going to be stacking up the bills.



Medicare is an entirely different cat than ACA compliant insurance. AND, I might add, you can buy a medicare supplement that covers what Medicare doesn't. Medicare was never intended to be all-inclusive medical care. It is designed to cover about 80% of care for seniors. You want more coverage? Buy it.  

And to the second highlighted part, It looks like you got your money's worth there!

Jim


----------



## ace2000

Passepartout said:


> Medicare is an entirely different cat than ACA compliant insurance.



How would it be any different in rapmarks example?  The test may be covered, but anything beyond that would not be.  Seems like it would work the same to me.  

And to the original point about the deductibles.  I was just thinking to myself, I have no idea how much my current deductible is.  I wonder how many of these new enrollees that previously had no coverage are going to know?   Luckily my family has been healthy though.


----------



## Passepartout

ace2000 said:


> How would it be any different in rapmarks example?  The test may be covered, but anything beyond that would not be.  Seems like it would work the same to me.
> 
> And to the original point about the deductibles.  I was just thinking to myself, I have no idea how much my current deductible is.  I wonder how many of these new enrollees that previously had no coverage are going to know?   Luckily my family has been healthy though.



Rapmark's example would be different because on Medicare, one can buy a supplement, or 'Medigap' that will cover much of the difference between what the provider charges and what Medicare covers (and 'script's if Part 'D' is chosen). This is not available to 'under 65, ACA 'metal' policies. Diagnostics and a few office visits are covered, then the individual pays, up to the deductible. Then insurance pays their agreed-upon amounts.

You can call your carrier and ask what your deductible is. It was on the form you filled out when you signed up for insurance, and is on any EOB's (Explanation of Benefits) you receive after your insurer pays anything on your behalf. Yes, if you are healthy enough to not have much to do with the 'healthcare industrial complex', you are lucky. Not everyone is.


----------



## ace2000

Passepartout said:


> You can call your carrier and ask what your deductible is.



Or HR.  I'm not worried about it though, because I really can't think of a single year (except perhaps over 20 years ago when the kids were born), where I went over the deductible - and that's with a deductible of $1500.


----------



## Passepartout

ace2000 said:


> Or HR.



Yup. Again...you've been lucky. So far.

One concern I had back in my working (and getting insurance through work). I had a DVT. A blocked leg vein. Thousand$ in meds and off work sitting at home for it turned out to be 12 weeks. My company told me that they would terminate me and stop my insurance at 3 months of being off. This is a danger when one gets company paid insurance. What if you get something that takes months- or years- to cure, or recover from? Of course, the AFLAC duck spent time around the offices selling insurance to cover just such a situation, but most employees don't buy it. I didn't.


----------



## ace2000

Passepartout said:


> Yup. Again...you've been lucky. So far.
> 
> One concern I had back in my working (and getting insurance through work). I had a DVT. A blocked leg vein. Thousand$ in meds and off work sitting at home for it turned out to be 12 weeks. My company told me that they would terminate me and stop my insurance at 3 months of being off. This is a danger when one gets company paid insurance. What if you get something that takes months- or years- to cure, or recover from? Of course, the AFLAC duck spent time around the offices selling insurance to cover just such a situation, but most employees don't buy it. I didn't.



I agree that risk is always there.  I also can understand the points made about how everyone is getting something worthwhile for their investment in their healthcare insurance, regardless of how much they use it.  

I'm just not so sure everyone else is going to see it the same way.  And I think that's what George was talking about.


----------



## Passepartout

ace2000 said:


> I think that's what George was talking about.



With all due respect to George, his questions are less about seeking answers to help him make an informed decision, but speculation on the macro 'overall' view of nationally (mandated) health insurance. His decision was made early on. He's on Medicare, with a supplement, and he's chosen to privately pay for insurance for his son who has no income, who can qualify for Medicaid.

George continues to ask questions that were either covered while the legislation was pending, or were unanswerable. As if the bill can be 'undone'. Even if the Republicans take both houses of Congress, AND the White House, the law- or the primary tenets of it will be carried on. The 'individual mandate' has been upheld by the Supreme Court. Even House Republicans admit that insurance should be portable, available across State lines, able to keep kids on their parents' policies, no longer subject to restrictions against pre-existing conditions. About all they can do is to put in some tort reform. Which is fine unless or until you are the one hurt by negligence.

ACA is LAW, and is not going away.


----------



## geekette

Passepartout said:


> Yup. Again...you've been lucky. So far.
> 
> One concern I had back in my working (and getting insurance through work). I had a DVT. A blocked leg vein. Thousand$ in meds and off work sitting at home for it turned out to be 12 weeks. My company told me that they would terminate me and stop my insurance at 3 months of being off. This is a danger when one gets company paid insurance. What if you get something that takes months- or years- to cure, or recover from? Of course, the AFLAC duck spent time around the offices selling insurance to cover just such a situation, but most employees don't buy it. I didn't.



This is what makes Medicaid expansion so important.

me, I'm fine, "I got mine", as I have employer disability (short and long) and carry a private disability policy on myself.  COBRA is available once out of employer coverage but I think ends at 18 months.  I would expect exchange policies to be cheaper than COBRA but hopefully would never have to find out.

But the point is, if you become unable to be employed, you should still be able to have coverage with that pre-existing hurdle gone.  Unless you are in a state without expanded Medicaid and you can't get it nor exchange policy.  one can be too rich for medicaid yet too poor for exchange coverage.


----------



## ace2000

Passepartout said:


> ACA is LAW, and is not going away.



I see you added this.  You could be right about that.  IMO, most of the benefits will remain, but the law will probably go away.  I'll base that on the fact that the current supporters and the administration doesn't have the political capital to enforce it.  And that is fact because of what we've already seen over the past year with the enforcement delays.


----------



## Passepartout

ace2000 said:


> You could be right about that.  IMO, most of the benefits will remain, but the law will probably go away.



As usual, I see our opinions differ, but that's OK. We'll see. As long as the benefits and mandate remain what difference does it make? One thing for sure, after Jan 20, 2017, ACA will no longer be called Obamacare. What do you think they'll call it?


----------



## bogey21

Passepartout said:


> .One thing for sure, after Jan 20, 2017, ACA will no longer be called Obamacare. What do you think they'll call it?



"Budget Buster"

George


----------



## bogey21

Passepartout said:


> About all they can do is to put in some tort reform. Which is fine unless or until you are the one hurt by negligence.



My Son-in-Law just finished his residency as an anesthesiologist.  He graduated right at the top of his Med School Class and had offers from all over the country.  He decided to stay in Texas primarily because his Liability Insurance will cost so much less as Texas implamented Tort Reform a number of years ago.  He told me that many of his classmates are also taking into account the cost of Liability Insurance in making their decisions.

George


----------



## SMHarman

ace2000 said:


> Or HR.  I'm not worried about it though, because I really can't think of a single year (except perhaps over 20 years ago when the kids were born), where I went over the deductible - and that's with a deductible of $1500.


I notice how much the system has changed in the last few years on my employer sponsored plan.
Mrs SMHarman is giving birth any day now and the hospital billing department has called me in advance of arrival to get a credit card to bill the estimated $1,000 copayments on!
Un frikking believable, you want $1k of my money based on a service you anticipate performing at an undetermined date in the future!
I would love my employer to be able to bill like that!


----------



## SMHarman

ace2000 said:


> I see you added this.  You could be right about that.  IMO, most of the benefits will remain, but the law will probably go away.  I'll base that on the fact that the current supporters and the administration doesn't have the political capital to enforce it.  And that is fact because of what we've already seen over the past year with the enforcement delays.


Not that they get the same publicity but there have been numerous enforcement delays on Dodd-Frank as well where the parties required to comply cannot keep up with the flurry of system and process changes required and also the cascade of these changes.
Just take a look at Central Counterparty Clearing and the up to 10 parties involved in every transaction.
http://en.wikipedia.org/wiki/Central_Counterparty_Clearing
All message types have to be agreed on, tested and so on, delays in rolling out complex legislative changes are the nature of changing the complex beast.

Similarly, on the consolidated medical deductible on employee sponsored plans, the deductible used needs to messaged and consolidated and then the consolidated use reported back to each of the insurers and remember with all the choices on an employee plan you could have
Employee A on Med BXBS Vision Delta, Dental Delta
Employee B on Med Cigna Vision VSP, Dental Delta
and so on and all these companies need to consolidate their deductible data up and read back the cumulative used deductible.  Similar to CCC above that is a lot of messages and message formatting to consider and implement.


----------



## ace2000

bogey21 said:


> "Budget Buster"
> 
> George




Yep, you see it like I see it.  If they would've said we'll take money from here and put it there to cover this "budget buster", I'd be 100% behind it, and I'd be on TUG right now singing the praises of the ACA.  

However, we're stuck with the alternative - another government program added onto our increasing deficits.  That's my biggest concern right there.  When do we reach the breaking point... I don't know, but hope I don't see it.


----------



## Passepartout

Did anyone think this would be free?


----------



## ace2000

Passepartout said:


> Did anyone think this would be free?



No, and I currently don't see the advantages outweighing the disadvantages.  If you look at what we gain, I think the plan was very poorly designed.  But, as you all keep saying, it is a step forward.  If this is a step that leads us towards single payer, then I'm all in favor.  Unfortunately, I think it will drive us away from single payer ever being implemented in the future.  I really believe the plan is that poorly written.


----------



## geekette

ace2000 said:


> No, and I currently don't see the advantages outweighing the disadvantages.  If you look at what we gain, I think the plan was very poorly designed.  But, as you all keep saying, it is a step forward.  If this is a step that leads us towards single payer, then I'm all in favor.  Unfortunately, I think it will drive us away from single payer ever being implemented in the future.  I really believe the plan is that poorly written.



yes, but, I wasn't one that was going to gain from this, most of us weren't.  I have had employer-sponsored ins for a long time, nothing was broken for me.  This was primarily to benefit those unable to get insurance before - the pre-existing conditions, hit lifetime cap, self-employed, etc., and the lack of affordability.  health care ins is expensive, but not much govt can do about that unless there is One Chargemaster put out by the feds and all providers must adhere.  can't see that happening, and restricts competition.  and so the negotiations between providers and insurers will continue and no 2 deals will look exactly alike.  

The previous method divided people into Haves and Have Nots where one big life changing event could change which bucket you belonged in and a second big event past that could bankrupt you.  

I don't think the plan was badly designed (but I have read only small passages, not the whole thing), but implementation was problematic.   There were plenty of folks trying to make sure implementation was problematic, starving it of funds and throwing up roadblocks wherever possible.  we will never know what a bipartisan effort to implement would have looked like, but I really doubt this gets us closer to single payer just because there are many that would Do Anything to keep that from happening, either.


----------



## ace2000

geekette said:


> yes, but, I wasn't one that was going to gain from this, most of us weren't.  I have had employer-sponsored ins for a long time, nothing was broken for me.



True.  I don't mind the fact that I'm not gaining anything (yet).  I can live with that.  It's about the budget with me.

The ACA ideas about coverage for all and then covering pre-existing conditions, etc, are not the huge problem on the budget, it's the medicaid expansion and subsidies that are the huge problem.  There's your budget buster.  I'm all in favor of expanding medicaid, but have the courage to announce and make cuts somewhere else to pay for it.  Or have the courage to raise taxes to pay for it.  

And then don't promise me that it's going to be budget neutral when it's not.


----------



## geekette

ace2000 said:


> True.  I don't mind the fact that I'm not gaining anything (yet).  I can live with that.  It's about the budget with me.
> 
> The ACA ideas about coverage for all and then covering pre-existing conditions, etc, are not the huge problem on the budget, it's the medicaid expansion and subsidies that are the huge problem.  There's your budget buster.  I'm all in favor of expanding medicaid, but have the courage to announce and make cuts somewhere else to pay for it.  Or have the courage to raise taxes to pay for it.
> 
> And then don't promise me that it's going to be budget neutral when it's not.


are you forgetting that insurers now have skin in the game?  Or that there had been a med device tax to help pay for it?  It's not all coming from your wallet and mine.  Well, wasn't supposed to, anyway...

I am mildly surprised that medicare tax didn't increase for it, but admit I might have missed that sneak in a few years ago as it is a small removal from paycheck...


----------



## momeason

pjrose said:


> Momeason,
> 
> For a low income 67 year old with basic medicare, does the ACA help with the costs for supplemental or medigap plans ?  Even with medicare this person hesitates to go to the ER or stay in the hospital because of the costs (or because of fear of the costs).  He has had a tracheotomy for years; apparently the insert is supposed to be replaced every 6 months but he can't afford it and says it isn't covered (?????).
> 
> Same low income family, forty-something amputee, prosthesis doesn't fit right which recently led to an infection.  The man says he doesn't have any health coverage and was told he couldn't get any for two years (????), so he took someone's leftover antibiotics and managed to clear up the infection this time.
> 
> These people need someone like you; how does someone in PA find a person like you to help navigate the maze?
> 
> PJ


Pennsylvania, like NC, rejected Medicaid Expansion. If individuals are living below the poverty line, they are S.O.L.. Disability income, SSA, can be used to qualify for the subsidies. For a household of 1, income needs to be about $970/mo. For each additional person filing taxes with you, the yearly income must increase $4,020. Your best bet would probably contacting "Get Covered America" which is a volunteer organization or go to healthcare.gov and put in your zip code. the list is not very complete. I know I am not on the list where I live. Some agents did not complete the Federal Marketplace training and some others did but are in it for the money and try to sign up as many as they can without explaining everything. I take an extraordinary amount of time with my clients and provide them with other resources to improve their health.
Here are 2 links I found in Pennsylvania.
http://www.phlp.org
http://www.consumerhealthcoalition.org

You can go to Localhelp.healthcare.gov and put in your zip code and a list of organizations will pop up.

I am a licensed agent. Most agents are not happy about the subsidy process because it is time and labor intensive. I became an agent so I could help with the subsidy process. I also have extensive training in the plans available so my help is more comprehensive than most volunteers. Unfortunately, I do not think there are many like me. I am thinking of tackling Medicare next, possibly getting certified later this year.. Medicare is also very confusing. If someone has only the hospitalization part of Medicare, they still qualify to apply for full insurance through the Marketplace. If they have Medicare Part A and Part B, they do not qualify for ACA assistance.
I hoped I helped a little. Only 1 week left to enroll!


----------



## geekette

Thanks for helping people, mom!  

Good for you in attempting to tackle Medicare!!  Hope someone like you is available when it's my turn to unravel the mystery of it.


----------



## rapmarks

Passepartout said:


> Rapmark's example would be different because on Medicare, one can buy a supplement, or 'Medigap' that will cover much of the difference between what the provider charges and what Medicare covers (and 'script's if Part 'D' is chosen). This is not available to 'under 65, ACA 'metal' policies. Diagnostics and a few office visits are covered, then the individual pays, up to the deductible. Then insurance pays their agreed-upon amounts.
> 
> You can call your carrier and ask what your deductible is. It was on the form you filled out when you signed up for insurance, and is on any EOB's (Explanation of Benefits) you receive after your insurer pays anything on your behalf. Yes, if you are healthy enough to not have much to do with the 'healthcare industrial complex', you are lucky. Not everyone is.


 
 unfortunately, our retirement sponsored Medicare supplement plan changed in July, so that we had a big deductible, and then a copay after the deductible was met   then changed again in Feb so we are meeting the deductible again.  I know I could have jumped to a different plan, but with a bad health history I am not taking any chances on being dropped in the future and would be unable to get back on old plan.


----------



## rapmarks

SMHarman said:


> I notice how much the system has changed in the last few years on my employer sponsored plan.
> Mrs SMHarman is giving birth any day now and the hospital billing department has called me in advance of arrival to get a credit card to bill the estimated $1,000 copayments on!
> Un frikking believable, you want $1k of my money based on a service you anticipate performing at an undetermined date in the future!
> I would love my employer to be able to bill like that!


 
 Because our state withheld insurance payments for 7 weeks or more after approval, some drs and facilities insisted we pay in advance and they would return our money after the insurance paid (after we called for three months), and our copay was in advance too.


----------



## bogey21

geekette said:


> are you forgetting that insurers now have skin in the game?



Didn't I read somewhere that if the Insurance Companies lose money because premiums collected don't cover what they pay out, the Gov't (you and me) will cover the shortfall?   Hope I'm wrong on this.  If not, isn't there a chance that Insurance Companies might have set premiums low to build volume.

George


----------



## Passepartout

bogey21 said:


> Didn't I read somewhere that if the Insurance Companies lose money because premiums collected don't cover what they pay out, the Gov't (you and me) will cover the shortfall?   Hope I'm wrong on this.  If not, isn't there a chance that Insurance Companies might have set premiums low to build volume.
> 
> George



Actually, that's the flip side of the coin that says insurance companies MUST spend 92% (iirc) of premium dollars on care. If, as happened last year, their 'administrative expenses' exceed that, they have to rebate it to the insureds. We got a check last year. It wasn't much.

Jim


----------



## Ken555

bogey21 said:


> Didn't I read somewhere that if the Insurance Companies lose money because premiums collected don't cover what they pay out, the Gov't (you and me) will cover the shortfall?   Hope I'm wrong on this.  If not, isn't there a chance that Insurance Companies might have set premiums low to build volume.
> 
> 
> 
> George




Isn't that the insurance industry justification for increasing rates for subsequent years?


Sent from my iPad


----------



## pjrose

*Momeason?*



momeason said:


> Pennsylvania, like NC, rejected Medicaid Expansion. If individuals are living below the poverty line, they are S.O.L.. Disability income, SSA, can be used to qualify for the subsidies. For a household of 1, income needs to be about $970/mo. For each additional person filing taxes with you, the yearly income must increase $4,020. Your best bet would probably contacting "Get Covered America" which is a volunteer organization or go to healthcare.gov and put in your zip code. the list is not very complete. I know I am not on the list where I live. Some agents did not complete the Federal Marketplace training and some others did but are in it for the money and try to sign up as many as they can without explaining everything. I take an extraordinary amount of time with my clients and provide them with other resources to improve their health.
> Here are 2 links I found in Pennsylvania.
> http://www.phlp.org
> http://www.consumerhealthcoalition.org
> 
> You can go to Localhelp.healthcare.gov and put in your zip code and a list of organizations will pop up.
> 
> I am a licensed agent. Most agents are not happy about the subsidy process because it is time and labor intensive. I became an agent so I could help with the subsidy process. I also have extensive training in the plans available so my help is more comprehensive than most volunteers. Unfortunately, I do not think there are many like me. I am thinking of tackling Medicare next, possibly getting certified later this year.. Medicare is also very confusing. If someone has only the hospitalization part of Medicare, they still qualify to apply for full insurance through the Marketplace. If they have Medicare Part A and Part B, they do not qualify for ACA assistance.
> I hoped I helped a little. Only 1 week left to enroll!



This is a household of four: Grandparents (granddad is the one with the trach, getting disability, and happens to be in the hospital right now; likely has only the hospital part of Medicare b/c I doubt they are paying for anything extra), their son (the amputee, also disability but not any medical coverage), and their granddaughter (cardiac condition, has had four open-heart surgeries, covered I believe by her father's employer's insurance).  Living on the edge.  

What does this mean: "... Disability income, SSA, can be used to qualify for the subsidies."  If they ARE on Disability they can qualify? Or Disability Income is part of the income calculation for receiving the subsidies?  Even though PA didn't accept the Medicaid expansion, there are still people receiving it - I'd think they'd qualify for it, but can people get Medicaid as well as Disability and/or Medicare? 

Oh my, probably few if any others like you.  How about moving to PA LOL?


----------



## geekette

bogey21 said:


> Didn't I read somewhere that if the Insurance Companies lose money because premiums collected don't cover what they pay out, the Gov't (you and me) will cover the shortfall?   Hope I'm wrong on this.  If not, isn't there a chance that Insurance Companies might have set premiums low to build volume.
> 
> George



I think you're right, George, there is some kind of modest 'guarantee' that had to be given so they would play ball.  I think it's small and has a fast runout clause.  

Not sure where I saw that, it's been a while, I'll dig around and post it if I find it.


----------



## momeason

pjrose said:


> This is a household of four: Grandparents (granddad is the one with the trach, getting disability, and happens to be in the hospital right now; likely has only the hospital part of Medicare b/c I doubt they are paying for anything extra), their son (the amputee, also disability but not any medical coverage), and their granddaughter (cardiac condition, has had four open-heart surgeries, covered I believe by her father's employer's insurance).  Living on the edge.
> 
> What does this mean: "... Disability income, SSA, can be used to qualify for the subsidies."  If they ARE on Disability they can qualify? Or Disability Income is part of the income calculation for receiving the subsidies?  Even though PA didn't accept the Medicaid expansion, there are still people receiving it - I'd think they'd qualify for it, but can people get Medicaid as well as Disability and/or Medicare?
> 
> Oh my, probably few if any others like you.  How about moving to PA LOL?



SSA disability income is used as income in the healthcare.gov eligibility process as are regular SS retirement benefits. SSI payments are not included. No one should get Medicaid and Medicare. There is a 2 year qualifying period after one starts getting SSA disability benefits before Medicare starts. Many qualify for Medicaid during this 2 year period. In our state and many others, Medicaid is very difficult to get if you are not a child under 19 or a pregnant female or very disabled.


----------



## Tia

Passepartout said:


> Actually, that's the flip side of the coin that says insurance companies MUST spend 92% (iirc) of premium dollars on care. If, as happened last year, their 'administrative expenses' exceed that, they have to rebate it to the insureds. We got a check last year. It wasn't much.
> 
> Jim




Only place I ever worked that gave out huge Xmass bonus was a health insurance company........  ( this was 20 years ago so not sure what's was going on in more recent times.


----------



## rapmarks

one year my husband's school negotiated a rebate of insurance money if they didn't have excessive claims, they got a rebate three years running and it was added to the base salary.   those years were the biggest increases in income we ever had.


----------



## b2bailey

*Now I am really confused...*

Early January we signed up my husband for coverage through Marketplace. He had been covered through PCIP because of his brain tumor. That expired on 12/31/13. I did not include myself for coverage because we chose the BEST coverage plan for his needs, and the premium to include me was cost prohibitive. 

Effective March 01, 2014 he now has Medicare. 

I went back into Marketplace to sign myself up for a low coverage, low cost plan. The premium was to be nearly $500 per month -- more than my husband's high end plan premium.

We can't afford that premium price per month -- so here I am, back where I started -- uninsured.


----------



## Conan

b2bailey said:


> The premium was to be nearly $500 per month -- more than my husband's high end plan premium.
> 
> We can't afford that premium price per month -- so here I am, back where I started -- uninsured.



Have you determined how much of a subsidy you might qualify for?

You may find that a silver plan is bottom-line cheaper for you than a bronze plan. Either plan can qualify for the tax credits, but only silver plans can qualify for what are called "cost sharing reductions"

The tax credits, which  reduce premium costs, are available to all levels of plan, for  individuals and families earning up to 400% of the federal poverty level  (FPL). People receiving subsidies can apply their subsidy toward  the  purchase of more or less expensive plans, but must pay the  difference  between the premium in the selected plan and the subsidy.
http://kff.org/interactive/subsidy-calculator/

The 400% of FPL (2013) figure by family size in the 48 mainland states is
1 $45,960
2 $62,040

 On the other hand, cost sharing reductions are not available in bronze  plans. They are available to individuals and families with incomes below  250% of the FPL who enroll in silver plans. These cost sharing  reductions reduce consumer costs (such as out-of-pocket maximums,  copays, and coinsurance) at the point of service, whereas tax credits  reduce only premiums. 

The 250% of FPL (2013) figure by family size in the 48 mainland states is
1  $28,725
2  $38,775

[I'm guessing that you're a family of 2 for these purposes even though your husband is on Medicare, but I may be wrong about that.]


----------



## pgnewarkboy

Just a reminder.  The problem with healthcare in the United States is the Drug Company Cartels, the Medical Equipment maker Cartels, and now the Chain Hospital Cartels that are gobbling up small practices.  These cartels work on the GREED motive.  They care more about money than they care about people.  The public is being denied effective and affordable health care by people and institutions that are basically immoral.


----------



## ace2000

pgnewarkboy said:


> Just a reminder.  The problem with healthcare in the United States is the Drug Company Cartels, the Medical Equipment maker Cartels, and now the Chain Hospital Cartels that are gobbling up small practices.  These cartels work on the GREED motive.  They care more about money than they care about people.  The public is being denied effective and affordable health care by people and institutions that are basically immoral.



Absolutely true.  The drug companies and the medical equipment industry currently have almost a 20 percent profit margin, and make up two of the most profitable segments in our entire US economy.  The health insurance segment averages at a 2 percent margin and most on this thread have chosen to vilify the insurance industry.  Oh well.


----------



## bogey21

Conan said:


> Have you determined how much of a subsidy you might qualify for?



This "subsidy" thing is confusing and complicates the whole process.  Why not just have an "Iron" plan that is 100% free for those below a certain level of income and above the Medicaid level?  The plan could have relatively high co-pays to discourage abuse.  Imagine how much simpler the Exchange would be and how many more would sign up.

George

PS  Yes, I hate the ACA but am realistic enough to know it isn't going away so why not make it better.


----------



## ace2000

bogey21 said:


> PS  Yes, I hate the ACA but am realistic enough to know it isn't going away so why not make it better.



LOL - good point.  It is going to evolve from here.  What we have right now is a very decent start.  The sooner we get to a real fix-it plan, the better.


----------



## Elan

bogey21 said:


> This "subsidy" thing is confusing and complicates the whole process.  Why not just have an "Iron" plan that is 100% free for those below a certain level of income and above the Medicaid level?  The plan could have relatively high co-pays to discourage abuse.  Imagine how much simpler the Exchange would be and how many more would sign up.
> 
> George
> 
> PS  Yes, I hate the ACA but am realistic enough to know it isn't going away so why not make it better.



  Rome wasn't built in a day.  There's no question a program this encompassing is going to need tweaks.  Give it time.

  I don't see any confusion in the subsidy.  In less than 2 minutes one can go to the web site, put in basic info, and have a good idea of what premiums would be (subsidized and without subsidy) for tens of plans.  Have you tried it?  It's really quite simple.


----------



## SMHarman

ace2000 said:


> Absolutely true.  The drug companies and the medical equipment industry currently have almost a 20 percent profit margin, and make up two of the most profitable segments in our entire US economy.  The health insurance segment averages at a 2 percent margin and most on this thread have chosen to vilify the insurance industry.  Oh well.



2% of 18% of the GDP is still a pretty sweet number.

United States gdp
15.68 trillion US$ (2012)
Data from Wikipedia

$15,680,000,000,000 x 18% = $2,822,400,000,000
$2,822,400,000,000 x 2% = *$56,448,000,000*

I know some of that is distributed through Medicare / Medicade and Direct Billing but consider that even the payments to the DME and Drug companies are often directed through the Insurers and they are taking their 2% vig on those transactions the number above has some merit.


----------



## ace2000

SMHarman said:


> 2% of 18% of the GDP is still a pretty sweet number.
> 
> United States gdp
> 15.68 trillion US$ (2012)
> Data from Wikipedia
> 
> $15,680,000,000,000 x 18% = $2,822,400,000,000
> $2,822,400,000,000 x 2% = *$56,448,000,000*
> 
> I know some of that is distributed through Medicare / Medicade and Direct Billing but consider that even the payments to the DME and Drug companies are often directed through the Insurers and they are taking their 2% vig on those transactions the number above has some merit.



Good points.  But many are blaming the insurance companies for their increasing premiums.  Look at the increases in the drug, DME, and hospital costs.  Why wouldn't premiums have to rise?

It's just an easy scapegoat directed at the uninformed.  I'm not saying the insurance industry has no blame either, they're just getting more than their fair share IMO.


----------



## geekette

ace2000 said:


> Good points.  But many are blaming the insurance companies for their increasing premiums.  Look at the increases in the drug, DME, and hospital costs.  Why wouldn't premiums have to rise?
> 
> It's just an easy scapegoat directed at the uninformed.  I'm not saying the insurance industry has no blame either, they're just getting more than their fair share IMO.



While I understand what you are saying, the insurers gave themselves ample protection by turning down the sick and then the lifetime cap.  They also frequently deny payment.  

Further, the rates are negotiated between insurer and provider.  Providers eat it, too.  

We would be better off if profit motive was removed all around, but I don't see that happening in my lifetime.

There are a lot of complexities because there are many parties involved.  It's not like the old days when you just went to see the doctor and brought a chicken.  Imagine if in the old wild west one had to get pre-certified from insurance before having that bullet removed ...   

today it's all CYA and try to siphon off whatever you can to your coffers.  Actual Patient Care kind of gets lost.


----------



## ace2000

geekette said:


> While I understand what you are saying, the insurers gave themselves ample protection by turning down the sick and then the lifetime cap.  They also frequently deny payment.
> 
> Further, the rates are negotiated between insurer and provider.  Providers eat it, too.



True, and also good points.  But, there's no way you're going to get the entire insurance industry to make those necessary changes unless you pass a law.  So, that's what was done.  However, the ACA has a ton of extra baggage, most of which is still to be seen.


----------



## geekette

ace2000 said:


> True, and also good points.  But, there's no way you're going to get the entire insurance industry to make those necessary changes unless you pass a law.  So, that's what was done.  However, the ACA has a ton of extra baggage, most of which is still to be seen.



If you haven't seen this ton of extra baggage, how do you know it exists?  Can you elaborate on what you mean by that?

Probably we can all agree that there have been ripple effects, unintended consequences.


----------



## ace2000

geekette said:


> If you haven't seen this ton of extra baggage, how do you know it exists?  Can you elaborate on what you mean by that?
> 
> Probably we can all agree that there have been ripple effects, unintended consequences.



Elaborate on the baggage?  Just look at all that's being delayed.  

Mandates for the individuals and business, increasing costs, higher budget deficits, unkept promises, etc., etc., etc.   That's real baggage for the future of the program.  

And then you have the political aspect where it's very likely the "other" party is going to control both sides of Congress and they were the ones completely shut out of the decision making process.  Do you think they're going to be receptive to making real progress on the "changes"?


----------



## geekette

We're getting into dangerous territory so will comment only on 'baggage'.  Not a fan of the label you put on it, but, at least you've defined it, so, thank you for that.

this is still very new.  Sometimes things get delayed because implementation is more complicated than expected, the pushback much more enormous than could have been imagined.  You would have been happy if there were no delays?  Which way do you want it?

who has increasing costs?  Everyone?  No, not due to the law.  costs were already increasing FOR EVERYONE before the law - did that not happen to you at all in the past decade +??  Costs would have continued to SKYROCKET unchecked if nothing were done.  double digit increases annually for some policies - this should be the status quo?  pay more, get less, insurer keeps the excess?

unkept promises?  Have you ever been denied by insurance?  THAT is an unkept promise that policy holders have to contend with.  Ever had your rates jack on home/car after submitting a claim?  That is also an unkept promise.  Insurance has never been about the insured, it's about the insurance company and their power to look after themselves to the detriment of their loyal customers who regularly hand over premium payments without any real assurance that the insurance will actually do what it should.  or maybe it will, but not for the originally-agreed-upon=price.

Further, let's be clear that the pres has no ability to force a business to offer a product.  The Law did NOT cancel policies that were compliant.  The law DID NOT force your doctor off your plan.  Those were decisions made by private companies/providers.  Either you want govt in every aspect or you don't, so pick which bag you wanna run with.

We do not know that this will result in larger budget deficit.  This is not a test of 2014 and then it's over.  Things Take Time.  No one has the results, just projections.

You are free to bottom line it all right now and decide for yourself the whole thing is a failure, but most of us are waiting to see how it goes for the next few years because it will take that long to state much of anything factually about 'baggage'.

Further, the fight is not over, there continue to be efforts to jettison the whole thing and new misleading advertising every week (new commercial yesterday).  That's my idea of baggage.



ace2000 said:


> Elaborate on the baggage?  Just look at all that's being delayed.
> 
> Mandates for the individuals and business, increasing costs, higher budget deficits, unkept promises, etc., etc., etc.   That's real baggage for the future of the program.
> 
> And then you have the political aspect where it's very likely the "other" party is going to control both sides of Congress and they were the ones completely shut out of the decision making process.  Do you think they're going to be receptive to making real progress on the "changes"?


----------



## ace2000

geekette said:


> You are free to bottom line it all right now and decide for yourself the whole thing is a failure, but most of us are waiting to see how it goes for the next few years because it will take that long to state much of anything factually about 'baggage'.
> 
> Further, the fight is not over, there continue to be efforts to jettison the whole thing and new misleading advertising every week (new commercial yesterday).  That's my idea of baggage.



You have a habit of misrepresenting what I've said.  I could probably find a handful of examples in this thread.  I never said the "whole thing is a failure".  In fact, earlier this morning I said it was a "decent start".  Consistently through the thread I've mentioned there are good parts of the bill, and there are bad parts of the bill.  Nobody is "bottom lining" it all right now.  In fact, almost all of my concerns relate to the future.  I can back up anything I've mentioned.  Tell me one item that I've described that you'd like to see more information about.

The "other" side is talking about repeal, but that doesn't mean all the changes would go away.  In fact, I don't see either side having the political will to do anything unpopular right now or in the near future.  Don't worry, the sky is not falling.


----------



## ace2000

geekette said:


> That's my idea of baggage.



My idea of baggage is anything that will cause the bill to be unpopular in the future.  Because, in the end, it will be the voters that will have the final say on the ACA.  The 2014 and 2016 elections are critical for the continued viability of the program.


----------



## Passepartout

ace2000 said:


> My idea of baggage is anything that will cause the *bill* to be unpopular in the future.  Because, in the end, it will be the voters that will have the final say on the ACA.  The 2014 and 2016 elections are critical for the continued viability of the program.



I know that you know, ACA isn't a 'bill'. It's a LAW! Laws are not based on popularity. They are based on the amount of good they can do for the society as a whole.  To continue to say otherwise leads one to think that you feel that it is likely to 'go away' if only the 'other party' takes control.

Yes, ACA will be a major issue in the '14 and '16 elections. Just as it was in the 2012 elections, and I doubt I need to remind you of the outcome. 

Now, if as 'the other party' and it's minions hope, they should prevail and take both houses of congress, the White House, AND then put another conservative or two in the Supreme Court, ACA may change. I doubt though that there is any way of kicking millions of people off of healthcare that they've become used to. Ending healthcare of young people on their parents' policies isn't likely to happen. Allowing insurance companies to erect roadblocks to insurance for people with pre-existing conditions isn't likely to fly.

SO, what do you suppose they'll do? My guess- and please know that it's only a guess, is to change the name of it. Maybe they'll add some tort reform, and call it the 'New Improved Republicare' or something, but who cares. The seed is planted, and while the final fruit is still unknown, there is no way that elected officials will have the political nerve to reset U.S. healthcare back to the way it was in 2010.


----------



## geekette

I'm sorry, internet is terrible at tone, I do not intentionally misrepresent, I go by the words because that is all there is.  no need to go backwards, mostly to save time, but partially because I don't care if you have 'proof' of something I maybe wrote weeks ago at midnight that cast you in a bad light. I interpret as I read, sorry if I have misrepresented your meaning by absorbing the words in a way other than you intended.  happens to all of us.

you identify 'baggage" that you presume to be dragged onward to negatively impact the future  (this is the meaning I took from what you wrote), some baggage we don't even know about yet (you said that: "remains to be seen").  This seems to imply that you think it might get much worse!!  

I disagree.  I think that the baggage is temporary and a growing pain like any other massive change that ripples through society would have (like big Medicare change a few years ago, 401ks vs pensions more years ago).  It's not an omen, I do not assume MORE BIG PROBLEMS, but there could surely be more.  I just don't have much hangup on what has already transpired nor a belief that there is more baggage we don't yet know about.  

While baggage isn't the worst term for it, it does imply a never-going-away blame game that we all could do without.  Maybe had you called it something else that didn't give me the visual of hauling a steamer trunk of "WE WILL NEVER LET YOU FORGET THE WEBSITE SUCKED" or some such...  as I am concerned that we all keep moving forward and not be stuck in the past where the bumps and bruises occurred.  Who is going to care in 5 years that their first 3 attempts to log in to the website resulted in wasted time?  Let's dump that baggage at the curb (note:  you said nothing about the website, I'm using that example because it's not only an easy target but was a nearly universal disappointment to everyone so a really good example of 'baggage', imo)

I said you were free to bottom line it for yourself, everyone is (plenty have, some made up their minds about ACA when news of crappy website came out, as if the website = the law).  Seems like that is the statement you have most issues with, so, sorry about that.  I am not in any way deciding/declaring what you do think nor should think, only pointing out that folks can call the race at any time and I can't do anything about that, but for myself, I will wait several years to decide if I think it was a success or not.  before that, there just isn't enough data for me, just selected anecdotes.  

I think you and I agree on more than we disagree, but I know for sure that I have learned a lot more about the whole thing because of this thread.  I appreciate your contributions, especially the ones that corrected a misunderstanding I had or brought new info to light.  

And I am sorry if you feel that I have misrepresented your position.  I will in the future ask for elaboration if I don't get your drift, as I did this morning as you so kindly complied in defining 'baggage.'



ace2000 said:


> You have a habit of misrepresenting what I've said.  I could probably find a handful of examples in this thread.  I never said the "whole thing is a failure".  In fact, earlier this morning I said it was a "decent start".  Consistently through the thread I've mentioned there are good parts of the bill, and there are bad parts of the bill.  Nobody is "bottom lining" it all right now.  In fact, almost all of my concerns relate to the future.  I can back up anything I've mentioned.  Tell me one item that I've described that you'd like to see more information about.
> 
> The "other" side is talking about repeal, but that doesn't mean all the changes would go away.  In fact, I don't see either side having the political will to do anything unpopular right now.


----------



## geekette

ace2000 said:


> My idea of baggage is anything that will cause the bill to be unpopular in the future.  Because, in the end, it will be the voters that will have the final say on the ACA.  The 2014 and 2016 elections are critical for the continued viability of the program.



No, voters do not get the final say, the elected representatives will decide for us.


----------



## SMHarman

ace2000 said:


> My idea of baggage is anything that will cause the bill to be unpopular in the future.  Because, in the end, it will be the voters that will have the final say on the ACA.  The 2014 and 2016 elections are critical for the continued viability of the program.


I would be surprised if the lobbyist groups let ACA get shut down once the premiums and the premium subsidies start flowing into the insurance companies.
Money talks...


----------



## ace2000

geekette said:


> I'm sorry, internet is terrible at tone, I do not intentionally misrepresent, I go by the words because that is all there is.  no need to go backwards, mostly to save time, but partially because I don't care if you have 'proof' of something I maybe wrote weeks ago at midnight that cast you in a bad light. I interpret as I read, sorry if I have misrepresented your meaning by absorbing the words in a way other than you intended.  happens to all of us.
> 
> you identify 'baggage" that you presume to be dragged onward to negatively impact the future  (this is the meaning I took from what you wrote), some baggage we don't even know about yet (you said that: "remains to be seen").  This seems to imply that you think it might get much worse!!
> 
> I disagree.  I think that the baggage is temporary and a growing pain like any other massive change that ripples through society would have (like big Medicare change a few years ago, 401ks vs pensions more years ago).  It's not an omen, I do not assume MORE BIG PROBLEMS, but there could surely be more.  I just don't have much hangup on what has already transpired nor a belief that there is more baggage we don't yet know about.
> 
> While baggage isn't the worst term for it, it does imply a never-going-away blame game that we all could do without.  Maybe had you called it something else that didn't give me the visual of hauling a steamer trunk of "WE WILL NEVER LET YOU FORGET THE WEBSITE SUCKED" or some such...  as I am concerned that we all keep moving forward and not be stuck in the past where the bumps and bruises occurred.  Who is going to care in 5 years that their first 3 attempts to log in to the website resulted in wasted time?  Let's dump that baggage at the curb (note:  you said nothing about the website, I'm using that example because it's not only an easy target but was a nearly universal disappointment to everyone so a really good example of 'baggage', imo)
> 
> I said you were free to bottom line it for yourself, everyone is (plenty have, some made up their minds about ACA when news of crappy website came out, as if the website = the law).  Seems like that is the statement you have most issues with, so, sorry about that.  I am not in any way deciding/declaring what you do think nor should think, only pointing out that folks can call the race at any time and I can't do anything about that, but for myself, I will wait several years to decide if I think it was a success or not.  before that, there just isn't enough data for me, just selected anecdotes.
> 
> I think you and I agree on more than we disagree, but I know for sure that I have learned a lot more about the whole thing because of this thread.  I appreciate your contributions, especially the ones that corrected a misunderstanding I had or brought new info to light.



No problem.  You mentioned "tone" on the Internet, and I feel the same as you.  I was not making that a big deal, just that it's hard to defend something I didn't really mean.  

I have a lot of respect for ALL the contributors on this thread.  I think it's been a great discussion and I've learned a LOT from hearing all sides.  Thanks to you and everyone else on this thread!  I really mean that.


----------



## ace2000

Passepartout said:


> SO, what do you suppose they'll do?



If they decide not to enforce the mandates, the "law" will have to change.  If the "other" side wins the next two elections, it'll also change - probably drastically - maybe not even in a bad way.  Right now, it's all speculation though.  Just good for discussion purposes only.


----------



## bogey21

Not to muddy the waters but I am sure I will.  Just saw that one of the District Courts has a case in front of it regarding the subsidy.  Apparently the ACA very specifically says the subsidy can be applied to policies issue via *State* Exchanges.  Obviously subsidies are being applied to policies issued via the *Federal* Exchange also.  Some entity has apparently taken this to court.

George


----------



## ace2000

SMHarman said:


> I would be surprised if the lobbyist groups let ACA get shut down once the premiums and the premium subsidies start flowing into the insurance companies.
> Money talks...



Which is also why the bill is so poorly designed.  

Again, I said it is a "decent" start.  I have to keep reminding myself that I said that.  Also, the current president deserves a tremendous amount of credit for having the courage to even try to take on this challenge.  Like the law or not, I've give him credit for that.


----------



## SMHarman

bogey21 said:


> Not to muddy the waters but I am sure I will.  Just saw that one of the District Courts has a case in front of it regarding the subsidy.  Apparently the ACA very specifically says the subsidy can be applied to policies issue via *State* Exchanges.  Obviously subsidies are being applied to policies issued via the *Federal* Exchange also.  Some entity has apparently taken this to court.
> 
> George


And I am sure there are thousands of other internal inconsistencies in a 2,409 page act.  Intent and actions mean a lot in any law.


----------



## Passepartout

bogey21 said:


> Just saw that one of the District Courts has a case in front of it regarding the subsidy.  Apparently the ACA very specifically says the subsidy can be applied to policies issue via *State* Exchanges.  Obviously subsidies are being applied to policies issued via the *Federal* Exchange also.  Some entity has apparently taken this to court.
> 
> George



Hereabouts, if one signs on to the State exchange, (www.yourhealthidaho.com[or .gov]) they are automatically redirected to the main ACA site. It is my understanding that the subsidy is a federal thing. If, for instance, one simply calls and signs up at Blue Cross (or any other provider) there is no subsidy. To get the subsidy, you HAVE to go through www.healthcare.gov.

Of course, Texas may be different, as it is in many things.

Jim


----------



## momeason

b2bailey said:


> Early January we signed up my husband for coverage through Marketplace. He had been covered through PCIP because of his brain tumor. That expired on 12/31/13. I did not include myself for coverage because we chose the BEST coverage plan for his needs, and the premium to include me was cost prohibitive.
> 
> Effective March 01, 2014 he now has Medicare.
> 
> I went back into Marketplace to sign myself up for a low coverage, low cost plan. The premium was to be nearly $500 per month -- more than my husband's high end plan premium.
> 
> We can't afford that premium price per month -- so here I am, back where I started -- uninsured.



Did you qualify for subsidies? I can help with that. if your household income is under $62,000, you should get assistance. If you are near that threshold and you are near retirement age, $500 would be about right. I pay $451 for a high deductible plan without subsidies. ( I do not qualify)
IF your insurance is $500, your income must be good. We just make insurance a priority. I WILL TAKE CARE OF MY HEALTH. I do not even have a smart phone. I go without many things I can do without. I will not do without good health. Just my choice.
IF you did the application correctly and that is your premium, I have to assume your income is decent. We all decide what is important to us.
Maybe one day, we will all have Medicare.


----------



## momeason

Passepartout said:


> Hereabouts, if one signs on to the State exchange, (www.yourhealthidaho.com[or .gov]) they are automatically redirected to the main ACA site. It is my understanding that the subsidy is a federal thing. If, for instance, one simply calls and signs up at Blue Cross (or any other provider) there is no subsidy. To get the subsidy, you HAVE to go through www.healthcare.gov.
> 
> Of course, Texas may be different, as it is in many things.
> 
> Jim



As an agent, I have to go thru healthcare.gov to get a subsidy for a client. If your insurance provider does not participate in the exchange, they cannot offer a subsidy to you. If you get help, make sure your agent or navigator is certified on the Federal Marketplace.( additional training)
Certified agents sometimes understand the plans better. A lot of agencies can get the subsidies for you. Here it is part of the BCBSNC process unless you turn it down. You should beaked if you want to apply for assistance. The other insurance companies may not ask if they do not participate in the subsidy program. Subsidies are paid directly to the insurer as long as the insured keeps paying their portion and stays qualified.


----------



## Conan

Although the gap is narrowing, currently a majority of the *uninsured* have an unfavorable view of the ACA. Is this an expression of the wisdom of crowds, or is it the power of disinformation?


----------



## Beefnot

Conan said:


> Although the gap is narrowing, currently a majority of the *uninsured* have an unfavorable view of the ACA. Is this an expression of the wisdom of crowds, or is it the power of disinformation?


 
Or, the rule of stupid.


----------



## ScoopKona

Beefnot said:


> Or, the rule of stupid.



"Nobody ever went broke underestimating the intelligence of the American public."

The older I get, the more I realize H. L. Mencken was right all along.... sigh.


----------



## Passepartout

*Like it or not, it's the law*

With apologies for the political tone of this article. Not partisan, just that it has to do with the parties working together. 

An article on the tweaking of healthcare to either make it work or for it to be a crashing defeat. The author compares tweaking the ACA to the tweaking that took place to make Social Security into the program we all know and love. (tongue firmly in cheek)

An excerpt: "The truth is that whether it takes six weeks or six months to meet the next arbitrary benchmark, the health care law is now embedded in the society, and it’s not going anywhere. So the only important, longer-term question, and the one that almost no one is talking about, is whether our ailing political system can actually function well enough to make it work."

Read it all here: http://news.yahoo.com/what-really-matters-on-health-care--making-it-work-234038897.html

Credit to author Matt Bai.

Jim


----------



## ace2000

Passepartout said:


> An excerpt: "The truth is that whether it takes six weeks or six months to meet the next arbitrary benchmark, the health care law is now embedded in the society, and it’s not going anywhere. So the only important, longer-term question, and the one that almost no one is talking about, is whether our ailing political system can actually function well enough to make it work."



If the law doesn't "work", it will go elsewhere.  Your two sentences by the author contradict each other.


----------



## Passepartout

ace2000 said:


> If the law doesn't "work", it will go elsewhere.  Your two sentences by the author contradict each other.



I don't see the contradiction. But whatever. It seems like you spend effort rebutting sentences pulled out of a body of work meant to illustrate the basic gist of the article rather than actually reading and commenting on the article itself. 

Does the above comment mean that you just disagree with my choice of sentences to quote, or that you feel I should have just quoted one of the sentences? 

Maybe you'll like this discussion of Social Security better. I paraphrase: Social Security was passed in 1935, and was modified over the years to cover more workers. It was not until the Nixon Administration that it became untouchable. Here: 

"Look at Social Security, which Franklin Roosevelt signed into law in 1935, over the objections of factions in both parties. Just four years later, Congress made sweeping changes to the new program, expanding its reach to widows and fatherless children while also tinkering with the financing mechanism so that workers could see benefits sooner. It wasn’t until the 1950s that agricultural and workers in service industries — many of them African-Americans who had been left out of the initial law — became beneficiaries, too. The Harvard sociologist Theda Skocpol, who has written extensively on the program, says it wasn’t until the Nixon administration that Social Security really became enshrined as the untouchable program we know today."

This will give you more to peck at.


----------



## Ken555

Announced today that enrollment is now over 6 million, which apparently exceeds the revised estimates made after the initial rollout difficulties. The 7 million number was before enrollment began and before the estimate was revised. Also, apparently 80-85% of those enrolled have already paid their first month premium, which shouldn't be a surprise since many enrolled this month. These numbers look promising.


Sent from my iPad


----------



## momeason

Great numbers report today. I will be ready for a party on the 1st!!


----------



## ace2000

Passepartout said:


> I don't see the contradiction. But whatever. It seems like you spend effort rebutting sentences pulled out of a body of work meant to illustrate the basic gist of the article rather than actually reading and commenting on the article itself.
> 
> Does the above comment mean that you just disagree with my choice of sentences to quote, or that you feel I should have just quoted one of the sentences?



The Social Security comparison is interesting.  I just see the two sentences contradicting each other - the author states that "it's not going anywhere" and then in the next sentence asks if our current political climate can make it "work".  If the law is not working, the politicians on both sides will run from this thing faster than anything you've ever seen.

In my opinion, it will take enforcement of the mandates before I'm convinced it's working (the latest signup numbers are a good preliminary indicator though).  If they don't enforce the mandate, the law will have to be scrapped or revised and called something else.  I really believe that will be the future of the ACA.  But, that's long-term.  For now...

Kudos to the administration for getting 6 million signed!


----------



## bogey21

Ken555 said:


> Announced today that enrollment is now over 6 million, which apparently exceeds the revised estimates made after the initial rollout difficulties......These numbers look promising.



Curious as to how many of the 6 million are Medicaid; how many were already insured; and how many uninsured we still have in the US.  Tough for me to make a judgment as to effectiveness of ACA until I know these numbers.

George


----------



## pgnewarkboy

Name all the laws in the United States that have been repealed.

NOW LETS ALL SING TOGETHER, 


"They fought the law but the law won, they fought the law but the law won."

Very good job class!


----------



## ace2000

pgnewarkboy said:


> Name all the laws in the United States that have been repealed.



Nobody is talking about repeal.  I'm talking about replacing.


----------



## ace2000

bogey21 said:


> Curious as to how many of the 6 million are Medicaid; how many were already insured; and how many uninsured we still have in the US.  Tough for me to make a judgment as to effectiveness of ACA until I know these numbers.
> 
> George



I'm in agreement with you.  There's two ways to look at this.  Our own individual opinions and how this will be judged by the voters.  I think the 6 million number is going to be the focus by the general population and the news media.

However, like I mentioned in a previous post.  Estimates are only 2 million will be previously uninsured (out of the total of 47 million uninsured).  Was it worth it?


----------



## ace2000

ace2000 said:


> Nobody is talking about repeal.  I'm talking about replacing.



Replacing with something hopefully better.  And better will be measured by how many uninsured remain.  The ACA is not the final answer.


----------



## Conan

ace2000 said:


> Estimates are only 2 million will be previously uninsured (out of the total of 47 million uninsured).  Was it worth it?



The truth-checkers at Politifact disagree with you.  They say, "[t]he fact is, we have no clear data and to say most of the people already  had insurance sidesteps an information gap. We rate this claim Mostly  False."
http://www.politifact.com/punditfac...ost-obamacare-sign-ups-people-who-had-insura/


----------



## ace2000

Conan said:


> The truth-checkers at Politifact disagree with you.  They say, "[t]he fact is, we have no clear data and to say most of the people already  had insurance sidesteps an information gap. We rate this claim Mostly  False."
> http://www.politifact.com/punditfac...ost-obamacare-sign-ups-people-who-had-insura/



That's an interesting read and it would provide a good debate.  So your source is saying 3 million out of 48 million, instead of 2 million out of 47 million.  I'm not sure why we're quibbling over that, but I'll provides some sources that say it's closer to 2 million.  And please note that I've said all along it's "estimated".

From your source...


> So what’s the real number? That’s tough to say.
> 
> Laszewski has spoken to some of the largest insurance carriers who are selling through the marketplaces. From that, he guesses that about half of the people buying there were previously insured.


----------



## ace2000

ace2000 said:


> I'm not sure why we're quibbling over that, but I'll provides some sources that say it's closer to 2 million.



I won't have time until this evening to provide those sources.  Please don't wait on the edge of your seat for that.


----------



## SMHarman

ace2000 said:


> That's an interesting read and it would provide a good debate.  So your source is saying 3 million out of 48 million, instead of 2 million out of 47 million.  I'm not sure why we're quibbling over that, but I'll provides some sources that say it's closer to 2 million.  And please note that I've said all along it's "estimated".
> 
> From your source...



6.25% of the population or 4.25% of the population.  Us accountants like to think of the threshold of materiality as 5%.  Both those numbers are near that threshold so in fluffly language you could say

ACA has resulted in a material increase in the number of Americans with health insurance.

And for those 3 million people, 2 million, 6 million who now have coverage without caps, that covers pre existing conditions etc, this could be a lifesaving change.

That is a great factcheck and highlights something else


> "The main goal of the law was to expand insurance coverage, not necessarily to enroll people on the exchanges," Eibner said. "Medicaid and (exchange) sign-ups are both important in assessing the ACA, since the law expanded coverage using both programs."
> 
> Beware of fuzzy language
> 
> When you hear pundits and politicians talk about the success or failures of Obamacare, there are two factors that tend to cloud the debate. First, the expansion of Medicaid has a big impact on reducing the ranks of the uninsured. But it has proven to be very tough to tease out the people who gained Medicaid coverage thanks to the higher income limit by itself. Plenty of people who are signing up were eligible before.


Many were unaware they could apply for Medicaid, this extra publicity has got people insured that were already able to be insured.  That itself is a benefit and I am not sure if that is covered in the 6m people above.


----------



## ace2000

SMHarman said:


> 6.25% of the population or 4.25% of the population.  Us accountants like to think of the threshold of materiality as 5%.  Both those numbers are near that threshold so in fluffly language you could say
> 
> ACA has resulted in a material increase in the number of Americans with health insurance.



I don't know if the "threshold of materiality" applies to health care insurance numbers or not.  

A better counterpoint would be to focus on future enrollees.  Because the numbers are going to continue to increase in future years, especially if they have the political will to enforce the mandates and penalties.


----------



## ace2000

SMHarman said:


> ACA has resulted in a material increase in the number of Americans with health insurance.



I guess you're basing that on the 3 million number, which you really cannot do.  Even if you subscribe to "half" as the article says, it would have to be "half" of the paid enrollees.  That number will be less than 6 million (some estimates say 20% less), I think everyone is in agreement about that.


----------



## Passepartout

ace2000 said:


> ..... the numbers are going to continue to increase in future years, especially if they have the political will to enforce the mandates and penalties.



You have brought up this 'enforcement of mandates' a number of times in the last couple of days. Please elaborate.

Mandate is the root of 'mandatory'. Like it isn't optional. If someone has to have insurance or pay a penalty, or won't be eligible for a rebate or supplement, isn't that 'enforcement?' Or are you expecting jack-booted insurance police to go from house to house asking for "insurance papers, please". And if one can't produce a BCBS card (or equivalent), hauling them off to the hoosegow. 

Jim


----------



## ace2000

SMHarman said:


> Many were unaware they could apply for Medicaid, this extra publicity has got people insured that were already able to be insured.  That itself is a benefit and I am not sure if that is covered in the 6m people above.



You added this after my other replies, so allow me to address it also.  I've mentioned the Medicaid expansion aspect of the ACA several times in the thread.  It's a great thing, but that is what is going to have the biggest impact on our increasing deficits in the future. The rapidly increasing deficits are not going to come from solely the exchanges.  

Again, is it worth it?  Possibly, I haven't come to a definite conclusion on that aspect.


----------



## ace2000

Passepartout said:


> You have brought up this 'enforcement of mandates' a number of times in the last couple of days. Please elaborate.



Search it on Google.  Look for "ACA mandate delays".  Those mandates affect the individuals who choose not to play - and the businesses.  Those mandates on businesses have been delayed because of the potential impact on this year's elections.  Some are saying the individual mandates will never be enforced.   I don't know for sure, but it's an important aspect of the ACA.  

If they decide to not enforce the law on how it was written, the ACA will have to be replaced.  Right now, they can get away with it because they have only "delayed" implementation.


----------



## geekette

ace2000 said:


> You added this after my other replies, so allow me to address it also.  I've mentioned the Medicaid expansion aspect of the ACA several times in the thread.  It's a great thing, but that is what is going to have the biggest impact on our increasing deficits in the future. The rapidly increasing deficits are not going to come from solely the exchanges.
> 
> Again, is it worth it?  Possibly, I haven't come to a definite conclusion on that aspect.



While Medicaid is its own beast, presumably as the economy improves and unemployment decreases, folks will transition from Medicaid as their income rises.  "once a medicaid enrollee always a Medicaid enrollee" doesn't track.  true, some will never make enough to 'graduate' from Medicaid but others will and start paying into the system.  

The question of Is It Worth It is YES for me.  I was insured, I didn't need this.  But I, like every other human, am just one terrible health event away from losing everything, and after that being uninsurable.  The illegality of the pre-existing barrier and lifetime caps make it WORTH IT for every one of us, whether or not one ever ends up in what used to be the "untouchables" bucket.  Everyone's risk of bankruptcy via healthcare is now greatly decreased.


----------



## geekette

ace2000 said:


> I don't know if the "threshold of materiality" applies to health care insurance numbers or not.
> 
> A better counterpoint would be to focus on future enrollees.  Because the numbers are going to continue to increase in future years, especially if they have the political will to enforce the mandates and penalties.



I think that folks will 'self-enforce' after an unfortunate health event of theirs or someone they know reminds them of the high cost of paying as you go.  Is it going to be easier to publicize the horrors of being insured or the horrors of being uninsured?  

Further, plenty are addicted to tax refunds and we know that's where the penalty funds will be extracted from.  People are not going to forgo their Spring Bonus in order to avoid a penalty that may or may not be taken.

I do think the penalties will be enforced, when possible, and that more will sign up as they begin to understand that the penalty is not $95, it's 1% of income this year and going higher afterwards.  Possibly cheaper for some folks and imo a viable option.  don't want insurance?  no problem, exercise your choice to be penalized instead.  And maybe some will escape the penalty due to difficulty of enforcement.   I'm not too concerned about that, we have some level noncompliance in most every aspect of our society.


----------



## ace2000

ace2000 said:


> Search it on Google.  Look for "ACA mandate delays".



Jim, I didn't mean that flippantly.  I just can't provide you a listing of all of them right now.


----------



## ace2000

geekette said:


> *The illegality of the pre-existing barrier and lifetime caps make it WORTH IT for every one of us*, whether or not one ever ends up in what used to be the "untouchables" bucket.  Everyone's risk of bankruptcy via healthcare is now greatly decreased.



I think that part was worth it also.  And when you say "everyone", I guess you're only talking about the 2-3 million (out of 47 million) that chose to sign up, right?


----------



## SMHarman

ace2000 said:


> You added this after my other replies, so allow me to address it also.  I've mentioned the Medicaid expansion aspect of the ACA several times in the thread.  It's a great thing, but that is what is going to have the biggest impact on our increasing deficits in the future. The rapidly increasing deficits are not going to come from solely the exchanges.
> 
> Again, is it worth it?  Possibly, I haven't come to a definite conclusion on that aspect.



But I was not refering to medicaid expansion but those that should have enrolled in medicade before ACA even existed but were unaware they could do so!


----------



## SMHarman

ace2000 said:


> I think that part was worth it also.  And when you say "everyone", I guess you're only talking about the 2-3 million (out of 47 million) that chose to sign up, right?



Tle lifetime caps and pre-existing conditions applies to every insured person in the US, regardless of where they bought their insurance (including employee sponsored).


----------



## ace2000

geekette said:


> Everyone's risk of bankruptcy via healthcare is now greatly decreased.





SMHarman said:


> Tle lifetime caps and pre-existing conditions applies to every insured person in the US, regardless of where they bought their insurance (including employee sponsored).



True.  I was referring to her mention of "everyone's" risk of bankruptcy though.


----------



## ace2000

SMHarman said:


> But I was not refering to medicaid expansion but those that should have enrolled in medicade before ACA even existed but were unaware they could do so!



I see...  sorry.


----------



## geekette

ace2000 said:


> True.  I was referring to her mention of "everyone's" risk of bankruptcy though.



Yes, if you do not sign up for insurance, your bk risk remains, there is no ceiling on what you may be expected to pay.  not per year, not per lifetime.  That is a choice that the uninsured are making, to not have that ceiling.

They are also foregoing the pre-negotiated rates for services.  They can pay 'rack rate' or attempt negotiation themselves.  The uninsured should always declare themselves "self-pay" and ask for lower rates.

It is always up to the provider whether or not they will accept a patient.


----------



## Ken555

Question. How much has the ACA cost the government to date? Is there a projection for cost for 2013-2014? What are the projections for 2015? I haven't seen these numbers, though I know there were projections for the longer term. Obviously there were startup costs, the website [typical govt project and cost way too much], etc. I would hope that 2015 would be the first year where we would have a basis for what the recurring annual costs will be. 

It's been said here that this program will cost too much [for the derived benefits]. We have lately been focusing on not whether the law will survive but rather will it be a good investment for the country. Well, what is that investment, exactly?

From what I know by speaking with clients and insurance agents, along with what I've read, the insurance industry has been fighting this law and spending a fortune on lobbyists. Then the insurance industry has been "educating" their sales reps (ie. agents) that their costs will increase, their commissions reduced, and in general have a bad time of it, all because of the ACA. One of my clients - a successful and decades old agency - decided to sell to another firm to get out from the anticipated losses by having a large focus on health insurance. Not one experienced agent I have known has been in favor of the ACA. Why should they be? The insurance companies have cut their commission. The government requires them to have new training to assist with signing up new accounts with the ACA. So here's another question...are the insurance companies themselves actually losing profit with the ACA, or are they passing on this anticipated loss to their own agents in the form of lower commissions? My prediction is that the big companies will keep their profits at the expense of...anyone, including their own loyal and experienced agents.

Thoughts?


Sent from my iPad


----------



## ace2000

Ken, I'll provide a little bit of information to start.  It's important to take a look at the ACA as a whole and not just the impact of the exchanges only.  The link is to the recent CBO report. 

http://www.cbo.gov/publication/44176


----------



## Passepartout

Passepartout said:


> "Look at Social Security, which Franklin Roosevelt signed into law in 1935, over the objections of factions in both parties. Just four years later, Congress made sweeping changes to the new program, expanding its reach to widows and fatherless children while also tinkering with the financing mechanism so that workers could see benefits sooner. It wasn’t until the 1950s that agricultural and workers in service industries — many of them African-Americans who had been left out of the initial law — became beneficiaries, too. The Harvard sociologist Theda Skocpol, who has written extensively on the program, says it wasn’t until the Nixon administration that Social Security really became enshrined as the untouchable program we know today."



The reason I pointed out the comparison here between ACA and Social Security, was to point out that when SS was passed, it was full of holes, exclusions, exemptions. Some people were covered, some were not. Politicians from all sides of the issue had problems with working across aisles modifying it. In the end, it took the better part of 40 years to get Social Security to where it is now. Perfect? No. But in truth, it works. Elderly Americans and the disabled have a financial safety net.  Taken for it's comparison, ACA will need to be tweaked. There will have to be hands shaken across aisles. Holes will need to be plugged. It will take time, just like it did with SS. But in the end, Americans will have a healthcare 'safety net' to go hand-in hand with SS's financial one. SS isn't free (see that FICA withdrawal from your paycheck), so why think that there shouldn't be some similar sort of automatic 'payroll deduction' for ACA? Voluntary sign-up and payment to insurance companies will only go just so far toward 'universal coverage'. It's a short step from the individual mandate- but a long leap for congress.

Jim


----------



## geekette

Ken555 said:


> Question. How much has the ACA cost the government to date? Is there a projection for cost for 2013-2014? What are the projections for 2015? I haven't seen these numbers, though I know there were projections for the longer term. Obviously there were startup costs, the website [typical govt project and cost way too much], etc. I would hope that 2015 would be the first year where we would have a basis for what the recurring annual costs will be.
> 
> It's been said here that this program will cost too much [for the derived benefits]. We have lately been focusing on not whether the law will survive but rather will it be a good investment for the country. Well, what is that investment, exactly?
> 
> From what I know by speaking with clients and insurance agents, along with what I've read, the insurance industry has been fighting this law and spending a fortune on lobbyists. Then the insurance industry has been "educating" their sales reps (ie. agents) that their costs will increase, their commissions reduced, and in general have a bad time of it, all because of the ACA. One of my clients - a successful and decades old agency - decided to sell to another firm to get out from the anticipated losses by having a large focus on health insurance. Not one experienced agent I have known has been in favor of the ACA. Why should they be? The insurance companies have cut their commission. The government requires them to have new training to assist with signing up new accounts with the ACA. So here's another question...are the insurance companies themselves actually losing profit with the ACA, or are they passing on this anticipated loss to their own agents in the form of lower commissions? My prediction is that the big companies will keep their profits at the expense of...anyone, including their own loyal and experienced agents.
> 
> Thoughts?
> 
> 
> Sent from my iPad


Insurance lobby is big and powerful, of course they fought and will continue to fight.  They have controls now where they didn't before, they got to select their clients before, now they have to accept every applicant, they got to quit paying at a certain level (lifetime max) now they don't.  I can't imagine they would want single payer system, either.

I personally think there should not be profit motive in health care, but that's where we are, ins execs can pocket millions in bonuses.  Shouldn't those dollars either be going to providers or maybe never extracted from us to start with?  Now there is some metric they must adhere to in using certain percentage of collected premiums towards actual health care and return the overage to the insured.  At least a few people on this board have received a rebate.  Better in your pocket than float over to someone already making millions in salary a year.

My personal opinion is that ACA is a long term investment in the health of our people.  Healthy people are productive people.  It is not ok to decide some humans aren't worthy of health because they are not wealthy or were simply born ill.


----------



## Passepartout

Nothin' like a good testimonial:

Good afternoon,                                                                                                                                                                           


I am a staunch Republican, a self-proclaimed Fox News addict, and I didn't vote for the President. And I'm here to tell you that Obamacare works. I'm living proof.                       


I'm a chemotherapy patient, and was previously paying $428 a month for my health coverage. I was not thrilled when it was cancelled.                                                      


Then I submitted an application at HealthCare.gov. I looked at my options. And I signed up for a plan for $62 a month.                                                                    


It's the best health care I have ever had.                                                                                                                                                


So right now, here's what I want to tell anyone who still needs health insurance, or knows someone who does:                                                                              


Sign up. Follow the instructions on the website. Apply, and look at your options. You still have time, and take it from me: This is something you want to do.                             


I wrote a letter to President Obama this past February to tell him about my experience with the Health Insurance Marketplace. I hoped he'd read it, and he did.                           


I may not be a supporter of the President. But now, I get mad when I see Obamacare dragged through the mud on television.                                                                 


And even though I regularly tune in to conservative pundits, I'd like to tell them they're getting it wrong. Obamacare works.                                                             


So one more time: If you still need health insurance, you have just three days to get it. Do what I did. Go to HealthCare.gov, submit an application, and pick a plan that works for you. 


It just might change your life.                                                                                                                                                           


Mark D. Bearden, Ph.D.                                                                                                                                                                    
Monroe, North Carolina


----------



## bogey21

Passepartout said:


> #  I'm a chemotherapy patient, and was previously paying $428 a month for my health coverage. I was not thrilled when it was cancelled.
> 
> #  Then I submitted an application at HealthCare.gov. I looked at my options. And I signed up for a plan for $62 a month.



I'm happy for the individual involved.  He is saving almost $4,500 and getting the health care he needs.  Who is incurring the costs he is not paying?  If it is others who have bought insurance and have no claims, I am ok with it.  If it is by increasing the deficit, I'm not so sure.

George


----------



## Passepartout

bogey21 said:


> I'm happy for the individual involved.  He is saving almost $4,500 and getting the health care he needs.  Who is incurring the costs he is not paying?  If it is others who have bought insurance and have no claims, I am ok with it.  If it is by increasing the deficit, I'm not so sure.
> 
> George



George, it's an INSURANCE COMPANY he's paying. They set rates. They sell policies. They pay claims. It's shared risk. Just like before. Remember? 

You're the one who said you would have preferred a 'Medicare for all', single payer system instead of mandated insurance marketed by insurance companies.  Which is it that you want?


----------



## Passepartout

I just heard on the TV that a poll taken in Texas, showed that a huge number of people are under the (mis)conception that Obamacare has been banned in Texas. The Governor or representatives have done nothing to dispel this misinformation.

You have to wonder what's in it for even officials who are supposed to be looking out for the best interests of their constituents, who discourage other people from buying health insurance? What in the world could possibly be in it for them to keep people from getting coverage?

Have these people no shame????

Jim


----------



## SMHarman

bogey21 said:


> I'm happy for the individual involved.  He is saving almost $4,500 and getting the health care he needs.  Who is incurring the costs he is not paying?  If it is others who have bought insurance and have no claims, I am ok with it.  If it is by increasing the deficit, I'm not so sure.
> 
> George





Passepartout said:


> George, it's an INSURANCE COMPANY he's paying. They set rates. They sell policies. They pay claims. It's shared risk. Just like before. Remember?
> 
> You're the one who said you would have preferred a 'Medicare for all', single payer system instead of mandated insurance marketed by insurance companies.  Which is it that you want?



LOL.  Be well Passepartout.


----------



## momeason

bogey21 said:


> Curious as to how many of the 6 million are Medicaid; how many were already insured; and how many uninsured we still have in the US.  Tough for me to make a judgment as to effectiveness of ACA until I know these numbers.
> 
> George



The 6 million is the number enrolled in QHPs-Qualified Health Plans.
The Medicaid enrollment is an additional number to be determined.
It is a wonderful by-product. Results of the application are passed through to the Medicaid offices in the State for final determination of eligibility. It is a single stream application


----------



## bogey21

Passepartout said:


> George, it's an INSURANCE COMPANY he's paying. They set rates. They sell policies. They pay claims. It's shared risk. Just like before. Remember?



If that's the end of it, I'm happy.  If the taxpayer has to come in and bail out the insurance companies, I may not be so happy.  I keep reading that there is a provision in the ACH that provides for the Government to cover Insurance Company losses in certain circumstances.  If it is a small amount, no big deal.  If it is billions, that may be another story.  I guess we won't know until after all the dust from 2014 settles down.

George


----------



## bogey21

momeason said:


> The 6 million is the number enrolled in QHPs-Qualified Health Plans.
> The Medicaid enrollment is an additional number to be determined.



Thanks for the info.  It clearly makes the 6 million number more meaningful.

Another question.  After you take into account the 6 million who have signed up and those added to Medicaid, how many uninsured still remain.

George


----------



## bogey21

Passepartout said:


> You're the one who said you would have preferred a 'Medicare for all', single payer system instead of mandated insurance marketed by insurance companies.  Which is it that you want?



I'm ok with Medicare for All if those insured are paying most of the freight.  When I say "insured" I am referring to the entire body of the insured.  I'm ok with those with greater income or greater resources paying more.  All I want is to be sure that total premiums (from whomever collected) are close to equaling total health care expenditures.

George


----------



## bogey21

Passepartout said:


> I just heard on the TV that a poll taken in Texas, showed that a huge number of people are under the (mis)conception that Obamacare has been banned in Texas. The Governor or representatives have done nothing to dispel this misinformation.
> 
> You have to wonder what's in it for even officials who are supposed to be looking out for the best interests of their constituents, who discourage other people from buying health insurance? What in the world could possibly be in it for them to keep people from getting coverage?
> 
> Have these people no shame????



I think most of us who live in Texas are happy with the cost of housing, reasonable property taxes, the absence  of a State Income Tax, and the availability of jobs.  I think I read somewhere that Texas is either number one or number two in new people moving into the State.  Somebody must be doing something right down here.

George


----------



## Passepartout

bogey21 said:


> I think most of us who live in Texas are happy with the cost of housing, reasonable property taxes, the absence  of a State Income Tax, and the availability of jobs.  I think I read somewhere that Texas is either number one or number two in new people moving into the State.  Somebody must be doing something right down here.
> 
> George



Not saying that Texas isn't a nice place. I have enjoyed all my visits there. The question I'd like to see an answer to is, "What's in it for politicians and wealthy individuals who pour resources into dissuading other people from buying health insurance?" 

Put another way, they have, and can afford, or get at work, health insurance. Why erect barricades for others? What gives them the right?


----------



## ace2000

Ken555 said:


> From what I know by speaking with clients and insurance agents, along with what I've read, the insurance industry has been fighting this law and spending a fortune on lobbyists. Then the insurance industry has been "educating" their sales reps (ie. agents) that their costs will increase, their commissions reduced, and in general have a bad time of it, all because of the ACA.



First, only two people have responded to your points so far.  It's interesting that very few want to really think about the costs of the ACA - especially here on TUG.  It's a great thing to provide all these current benefits and be able to put it on the backs of our younger and future generations, isn't it?

On the insurance companies, I don't think you can say they're against ACA en masse.  Some actually paid for advertising opposing it in the early days, but now they seem to realize it's better to make it work as opposed to letting it unravel.  Just look at how they responded when the President unraveled the "if you lose your plan you can keep it" at the end of last year.  The insurance companies chose to play along and allow that change.  They could have easily caused major problems and just refused to corporate.  

In many ways the insurance industry benefits from the ACA.  Just look at the mandates.  They actually are probably salivating over the additional new members.

It's been mentioned several times on this thread that the insurance companies are against Obamacare.  I'll go counter to those opinions and say it's closer to a mixed bag, with most of them strongly in favor now of making it work.


----------



## ace2000

geekette said:


> Insurance lobby is big and powerful, of course they fought and will continue to fight.



Show us a source where they are continuing to fight the ACA please.


----------



## ace2000

Passepartout said:


> George, it's an INSURANCE COMPANY he's paying. They set rates. They sell policies. They pay claims. It's shared risk. Just like before. Remember?



The ACA goes way beyond dealing with only health insurance and shared risk.  George is right, it's a "budget buster", but I'll grant the fact that is looking at the plan in it's totality.


----------



## ace2000

Passepartout said:


> The question I'd like to see an answer to is, "What's in it for politicians and wealthy individuals who pour resources into dissuading other people from buying health insurance?"



Nobody can answer your question Jim, because it's vague and probably exaggerated.  Do you have some kind of a quote or something we can work off from?


----------



## ace2000

geekette said:


> I personally think there should not be profit motive in health care



It's the evil profit motive vs. the inefficiencies and costs of another government program.  I'm not taking a side on this, just saying there's advantages and disadvantages for both.


----------



## Passepartout

ace2000 said:


> Nobody can answer your question Jim, because it's vague and probably exaggerated.  Do you have some kind of a quote or something we can work off from?



Every opinion doesn't need to be prefaced by a quote so someone (I wonder who) can parse the words.

Seems simple to me. Like back in the day when in order to have your house fire put out, the fire department first checked to see if you had contracted for fire protection. Some of the rich didn't want to pay for fire protection in poorer neighborhoods, saying in essence, 'I have mine, now you get yours.' Sound familiar?

After Chicago and San Francisco burned to the ground, it was decided that universal fire protection was good for society as a whole. It's the same with healthcare. The more people who are protected, the better for society as a whole. Universal sharing of the risk, for universal paying for the benefit, was not possible in the political climate of the last 5 years. So we got what we got.

Kwitcherbellyachin'.


----------



## ScoopKona

Basically, "I've got mine, Jack," is not a reasonable basis for a decent society. I wish we could say that everyone agrees on that. But just look at the American landscape.

See, no need for quotes every time.


----------



## ace2000

Passepartout said:


> Every opinion doesn't need to be prefaced by a quote so someone (I wonder who) can parse the words.



You asked us twice to respond to the same topic about why some choose to steer people away from the ACA.  I'm just letting you know why nobody had responded.  I have no idea what the rest of your post had to do with that topic.

Trust me, I've had my posts parsed plenty on this thread... (including several by "I wonder who").


----------



## vacationhopeful

Got the email saying to complete and enroll by March 31 or I will have to wait til 2015 to enroll.

Trust me, I hit my $5000 co-insurance last year with cancer surgery. And had $3500 bill from the 2012 year food poisoning hospital visit. That was in addition to all my co-pays, monthly perscriptions of $150 and $8400+ insurance premiums.

This is on my TO DO list for tonight and tomorrow ... My new policy would start on May 1 2014 ... just got to pick which one.


----------



## Ken555

ace2000 said:


> First, only two people have responded to your points so far.  It's interesting that very few want to really think about the costs of the ACA - especially here on TUG.  It's a great thing to provide all these current benefits and be able to put it on the backs of our younger and future generations, isn't it?



Yup, I've noticed. It's not particularly surprising. Many in the nation simply want to protect themselves, and that's a reasonable position. Unfortunately, it's not very forward looking for the nation, and definitely leaves the next few generations with even more of a problem. "As long as I don't pay" seems to be a national position. This attitude of not assuming responsibility for our national expenses started a while ago and has developed into a national mantra which will fundamentally change the USA. Somehow we have been convinced that we pay too much in taxes, so every extra governmental cost is excessive (I would remind everyone to research the tax rates under Reagon, for comparison). 



> On the insurance companies, I don't think you can say they're against ACA en masse.  Some actually paid for advertising opposing it in the early days, but now they seem to realize it's better to make it work as opposed to letting it unravel.  Just look at how they responded when the President unraveled the "if you lose your plan you can keep it" at the end of last year.  The insurance companies chose to play along and allow that change.  They could have easily caused major problems and just refused to corporate.
> 
> In many ways the insurance industry benefits from the ACA.  Just look at the mandates.  They actually are probably salivating over the additional new members.
> 
> It's been mentioned several times on this thread that the insurance companies are against Obamacare.  I'll go counter to those opinions and say it's closer to a mixed bag, with most of them strongly in favor now of making it work.




I think you may be confusing pragmatic behavior by the insurance companies vs what they've told their industry. That they may not have actively paid for advertising against the program doesn't mean they are for it. It will be interesting to see if how they act during the upcoming election. 

The new members was the carrot the government offered the insurance companies as part of the plan, and there's no question they want those people. 

Again, all the health insurance agents I know (and I know many, via networking groups I visit, clients, neighbors, etc) have been almost indoctrinated by their industry to be anti-ACA. In the early days I asked some of them specific questions regarding why it was bad, and none could provide an answer other than what you would hear on Fox. It was unbelievable! They're supposed to advise their clients on the best plan for their needs yet don't understand how they are being manipulated by the insurance companies. One of my health agent clients finally admitted some truth to me when we had lunch one day after the plans were announced last fall when I said my small business group would save money and increase benefits for my staff if I went to the ACA...and he was almost speechless, as this was contrary to everything he had been told by the industry. Of course, one of the comments he did make was that it may be slightly more affordable for me since the agents don't receive as much commission.

Some agents have been certified to provide assistance for the new plans. But all I know - other than some notable exceptions like our fellow TUG member! - have lost money by doing so compared to previous years, since they don't earn as much, at least from what I understand. Am I wrong?


Sent from my iPad


----------



## Ken555

ace2000 said:


> It's the evil profit motive vs. the inefficiencies and costs of another government program.  I'm not taking a side on this, just saying there's advantages and disadvantages for both.




There's a reason profit is often perceived as evil. When profit dictates benefits, prices, and approval for health related actions then it can easily be thought as evil. Government waste is a related but different issue. There is every reason to have a single payer system as many other countries have done so successfully.


Sent from my iPad


----------



## Ken555

Passepartout said:


> Not saying that Texas isn't a nice place. I have enjoyed all my visits there. The question I'd like to see an answer to is, "What's in it for politicians and wealthy individuals who pour resources into dissuading other people from buying health insurance?"
> 
> 
> 
> Put another way, they have, and can afford, or get at work, health insurance. Why erect barricades for others? What gives them the right?




FWIW, in the last week or so I've seen several commercials on local tv in Los Angeles by Rick Perry encouraging us to move to Texas, since everything is better there...especially costs to businesses. California isn't the most business friendly State, so we are likely a prime target for outreach by Texas. 


Sent from my iPad


----------



## SMHarman

bogey21 said:


> I'm ok with Medicare for All if those insured are paying most of the freight.  When I say "insured" I am referring to the entire body of the insured.  I'm ok with those with greater income or greater resources paying more.  All I want is to be sure that total premiums (from whomever collected) are close to equaling total health care expenditures.
> 
> George



This would be a wonderfully simple system.  The system takes about 10% of everybodys income as a health tax (and before you consider that high add up what you and your employer (the employer bit is on your W2) pay your current insurer).

The system would also pay to train the doctors so when they come out of med school they don't need as high a pay check to pay off the student loans.  The system could also self insure tort liability.

This would both take cost out of the system and inefficiency and could be a win win win.  Dr would still be able to afford their porsche, it is just the part of their salary going to liability insurance and student loans they would no longer see, but they dont really see that part anyway.


----------



## SMHarman

ace2000 said:


> It's the evil profit motive vs. the inefficiencies and costs of another government program.  I'm not taking a side on this, just saying there's advantages and disadvantages for both.


Please list these inefficient government programs.  Most government programs operate more efficiently than similar private programs.


----------



## momeason

Ken555 said:


> Question. How much has the ACA cost the government to date? Is there a projection for cost for 2013-2014? What are the projections for 2015? I haven't seen these numbers, though I know there were projections for the longer term. Obviously there were startup costs, the website [typical govt project and cost way too much], etc. I would hope that 2015 would be the first year where we would have a basis for what the recurring annual costs will be.
> 
> It's been said here that this program will cost too much [for the derived benefits]. We have lately been focusing on not whether the law will survive but rather will it be a good investment for the country. Well, what is that investment, exactly?
> 
> From what I know by speaking with clients and insurance agents, along with what I've read, the insurance industry has been fighting this law and spending a fortune on lobbyists. Then the insurance industry has been "educating" their sales reps (ie. agents) that their costs will increase, their commissions reduced, and in general have a bad time of it, all because of the ACA. One of my clients - a successful and decades old agency - decided to sell to another firm to get out from the anticipated losses by having a large focus on health insurance. Not one experienced agent I have known has been in favor of the ACA. Why should they be? The insurance companies have cut their commission. The government requires them to have new training to assist with signing up new accounts with the ACA. So here's another question...are the insurance companies themselves actually losing profit with the ACA, or are they passing on this anticipated loss to their own agents in the form of lower commissions? My prediction is that the big companies will keep their profits at the expense of...anyone, including their own loyal and experienced agents.
> 
> Thoughts?
> 
> 
> Sent from my iPad



There are a few like me who became agents and did all the extra training so we can help people get the subsidies. I do not rely on my commissions. This is the first paid job I have had in 10 years. I do not count my dollars, I count how many success stories I help create.
My perspective is different than an established agent who has seen the time per client increase dramatically and the commission drop. I know my motivation is very different than the average agent.  I love what I do because I love helping people get great access to Healthcare. This includes many who had pre-existing conditions and many who have modest incomes.
The law of the land before was you must be employed by a large company with benefits to have good benefits at an affordable price. Now most of our work force can afford insurance and affordable healthcare.
Those "Death Panels" Fox News made up to scare people. They were real in the past, but never created by Obamacare. The insurance companies created them. The ACA has dismantled those death panels. There are death panels no more!!


----------



## ace2000

Ken555 said:


> I think you may be confusing pragmatic behavior by the insurance companies vs what they've told their industry. That they may not have actively paid for advertising against the program doesn't mean they are for it. It will be interesting to see if how they act during the upcoming election.



No, I'd say you may be talking to people who just don't like change, just because it's change.  The health insurance industry as a group, is now on board with the ACA, and even helped formulate the structure of the ACA.  Yes, I will grant that "some" groups campaigned against it originally.  But, this deal is done and they are on board, and even have a vested interest now in making it work.

I challenge you or any of the others claiming otherwise to provide a source supporting their case.  I'd be happy to do the same if you want to go down that path.


----------



## ace2000

SMHarman said:


> Please list these inefficient government programs.  Most government programs operate more efficiently than similar private programs.



Seriously ???  Go down the list... Post Office, Medicare, Medicaid, Disability, Social Security.  They all are notorious for being inefficient with fraud, waste, and abuse.  Things happen in those programs that just don't happen in private enterprise.  

Are you saying otherwise?


----------



## bogey21

bogey21 said:


> I think most of us who live in Texas are happy with the cost of housing, reasonable property taxes, the absence  of a State Income Tax, and the availability of jobs.  I think I read somewhere that Texas is either number one or number two in new people moving into the State.  Somebody must be doing something right down here.
> 
> George



Forgot to mention that Texas has tort reform also.  My Son-In-Law just finished his residency and tells me that he and many of his (now) Doctor classmates are taking less money and staying in Texas to practice due to the tort reform induced lower Malpractice Insurance Premiums. 

George


----------



## ace2000

SMHarman said:


> Most government programs operate more efficiently than similar private programs.



Maybe we need to understand where you're coming from.  Can you provide a government program that DOES operate more efficiently as you have chosen to claim here ???


----------



## ace2000

momeason said:


> Those "Death Panels" Fox News made up to scare people. They were real in the past, but never created by Obamacare. The insurance companies created them. The ACA has dismantled those death panels. There are death panels no more!!



You're wrong on this one.  The same "panels" you're referring to are still around with the ACA.  Both the ACA and the private insurance have panels that decide what they will or will not cover and will also take on appeals.  

It's kind of funny, the only people talking about "death panels" in this entire thread are the so-called "supporters" of the ACA.  Kind of odd really.


----------



## ace2000

Ken555 said:


> Some agents have been certified to provide assistance for the new plans. But all I know - other than some notable exceptions like our fellow TUG member! - have lost money by doing so compared to previous years, since they don't earn as much, at least from what I understand. Am I wrong?



I'd say that would be good reason to be anti-Obamacare.  It's hard to believe they're seeing a drastic drop in their commissions based on the current 5-6 million enrolled, and most of those sign ups have occurred in just the last 2-3 months.

You're example of a business letting their employees go to the exchanges is an interesting case.


----------



## ScoopKona

ace2000 said:


> Seriously ???  Go down the list... Post Office, Medicare, Medicaid, Disability, Social Security.  They all are notorious for being inefficient with fraud, waste, and abuse.  Things happen in those programs that just don't happen in private enterprise.
> 
> Are you saying otherwise?




Have you never spent time in a country that actually DOES have a fraudulent, wasteful, abusive post office? (I'm not being sarcastic.) There is nothing like spending extended periods of time in an area that has unreliable post to really make you appreciate the USPS.

Only Canada, the UK, Germany and Japan have a mail system on par with ours. When diamond merchants need to send multi-million dollar jewels, they do so via USPS. Why? It's the safest, most reliable option. 

It's posts like this which make me think you're just parroting what you hear on AM radio.


----------



## Tia

Why do they do it? Follow the money

 jmho




Passepartout said:


> ...The question I'd like to see an answer to is, "What's in it for politicians and wealthy individuals who pour resources into dissuading other people from buying health insurance?"
> 
> Put another way, they have, and can afford, or get at work, health insurance. Why erect barricades for others? What gives them the right?


----------



## Passepartout

ace2000 said:


> Seriously ???  Go down the list... Post Office, Medicare, Medicaid, Disability, Social Security.  They all are notorious for being inefficient with fraud, waste, and abuse.  Things happen in those programs that just don't happen in private enterprise.
> 
> Are you saying otherwise?



How can you say that? In the examples you cite, there are no comparable private enterprises.


----------



## ace2000

ScoopLV said:


> Have you never spent time in a country that actually DOES have a fraudulent, wasteful, abusive post office? (I'm not being sarcastic.) There is nothing like spending extended periods of time in an area that has unreliable post to really make you appreciate the USPS.
> 
> Only Canada, the UK, Germany and Japan have a mail system on par with ours. When diamond merchants need to send multi-million dollar jewels, they do so via USPS. Why? It's the safest, most reliable option.
> 
> It's posts like this which make me think you're just parroting what you hear on AM radio.



Uh, sure I have.  You want to compare our government waste with another's countries government waste?  That's not what was brought up.  Go back and read what we're talking about here.


----------



## ace2000

Passepartout said:


> How can you say that? In the examples you cite, there are no comparable private enterprises.



It's pretty easy to compare the Post Office vs. Fed Ex and UPS.  It's pretty simple to compare private vs. government health insurance - they're both providing the same overall service.  It's pretty easy to compare how a typical private company is run vs. a typical government bureaucracy.


----------



## Passepartout

ace2000 said:


> You're wrong on this one.  The same "panels" you're referring to are still around with the ACA.  Both the ACA and the private insurance have panels that decide what they will or will not cover and will also take on appeals.



BALONEY!

Feel free to name names of these 'victims' if you can find them.


----------



## ace2000

I said this...



ace2000 said:


> The same "panels" you're referring to are still around with the ACA. Both the ACA and the private insurance have panels that decide what they will or will not cover and will also take on appeals.



And you said this...



Passepartout said:


> BALONEY!



What part of my quote are you saying is BALONEY ???


----------



## Passepartout

ace2000 said:


> It's pretty easy to compare the Post Office vs. Fed Ex and UPS.  It's pretty simple to compare private vs. government health insurance - they're both providing the same overall service.  It's pretty easy to compare how a typical private company is run vs. a typical government bureaucracy.



Neiither UPS nor FedEx are charged with delivering to every address in USA, 6 days a week and do it with a letter with under a half buck postage. Unless you want a letter to cost $10 or more to deliver, don't use the courier services, and don't ask them for 'certified w/return receipt.'

And try getting anything equivalent in private healthcare for long-term, poor, elderly people with no assets on Medicaid. It doesn't exist.

Please show us how to help these people otherwise.

I really think you are just parroting right wingnut talking points. There is no substance to what you say.


----------



## ace2000

Passepartout said:


> Neiither UPS nor FedEx are charged with delivering to every address in USA, 6 days a week and do it with a letter with under a half buck postage. Unless you want a letter to cost $10 or more to deliver, don't use the courier services, and don't ask them for 'certified w/return receipt.'
> 
> And try getting anything equivalent in private healthcare for long-term, poor, elderly people with no assets on Medicaid. It doesn't exist.



You can compare the services that overlap between them.  



> I really think you are just parroting right wingnut talking points. There is no substance to what you say.



Nice point here Jim.  If you don't have a good argument it's always a good idea to add this to end of your case.


----------



## Passepartout

ace2000 said:


> You can compare the services that overlap between them.



Like what?


----------



## ace2000

Passepartout said:


> Like what?



Which path are you wanting to go down - package delivery or providing health insurance?


----------



## Passepartout

ace2000 said:


> If you don't have a good argument it's always a good idea to add this to end of your case.



I think my arguments are darn good, and I hear nothing from yours that I can't hear on partisan right wing pied piper radio. 

Hell, if Obamacare is so bad, how come they can't even find authentic people who have been hurt by it? Every time they quote 'Joe Blow from Hoboken' who's rate quintupled, and whose non-English-speaking immigrant new doc, refused to treat him 'cause he was gonna die anyway, it turns out that the fact checkers find 'ol Joe to be a paid actor who makes a bundle and has employer paid insurance.


----------



## ace2000

Passepartout said:


> I think my arguments are darn good, and I hear nothing from yours that I can't hear on partisan right wing pied piper radio.



If your arguments are good, let them stand alone.  I don't try to ridicule you by saying I could hear your side on MSNBC.  Let's have a civil discussion please.  If you're trying to convince anyone, does that help?


----------



## Passepartout

ace2000 said:


> Which path are you wanting to go down - package delivery or providing health insurance?



Since you are the one who brought it up as gospel, show us how both compare private vs. Federal.

My position is there is no private comparison between mail delivery systems. And no viable private healthcare system for ALL the poor, aged, mentally deficient, or for that matter, disabled veterans.

Your turn.


----------



## ace2000

Passepartout said:


> Since you are the one who brought it up as gospel, show us how both compare private vs. Federal.
> 
> My position is there is no private comparison between mail delivery systems. And no viable private healthcare system for ALL the poor, aged, mentally deficient, or for that matter, disabled veterans.
> 
> Your turn.



I mentioned earlier that you compare the services that overlap.  You've chosen areas that don't overlap.  So, it looks like you've taken us back to square one.  

I'm sorry but I'm headed out tonight.  I'll be back tomorrow morning for a little while.  Go ahead and provide your case on how government is more efficient than private enterprise when they're providing the same service.


----------



## Passepartout

ace2000 said:


> Go ahead and provide your case on how government is more efficient than private enterprise when they're providing the same service.



That is the problem. You said there is 'waste, fraud, and abuse' (your words) when they provide the same services, but they don't provide the same services.

There IS no service overlap. USPS delivers a half-buck or less letter from your house to mine, 6 days a week. No courier or package service does this. So no comparison. No courier or package service has anything like Certified mail, with a signature returned so the sender knows when a package was received, and by whom. I cannot put a letter or package outside my door with appropriate postage with a reasonable expectation that it will be picked up by an authorized carrier and delivered in a timely manner. No courier service will do this without prior notice and pay.

And there is no private healthcare provider who will put the 90 year-old woman who is only getting $500-$600 a month Social Security and fell, breaking her hip, into a nursing home and see that she is not put out on the street. It doesn't exist. No private insurer will rehab a soldier who had a leg blown off or who has brain injury. No private insurer will care for a single mom who has chronic headaches and can't get out of bed most days, unable to hold ANY sort of job in the society, and has small children at home.

So don't bother going on about how someone will fix this 'waste, fraud, and abuse' until there is an alternative.


----------



## SMHarman

ace2000 said:


> Maybe we need to understand where you're coming from.  Can you provide a government program that DOES operate more efficiently as you have chosen to claim here ???



Huh I'm being challenged to provide efficient government programs because I'm challenging the prior assertion that government is inefficient. Nothing like a straw man!!!

Sent from my LT26i using Tapatalk


----------



## Ken555

SMHarman said:


> Huh I'm being challenged to provide efficient government programs because I'm challenging the prior assertion that government is inefficient. Nothing like a straw man!!!
> 
> Sent from my LT26i using Tapatalk




This has been his game since this thread started. Some days I play, others I stay away... 


Sent from my iPad


----------



## Ken555

momeason said:


> There are a few like me who became agents and did all the extra training so we can help people get the subsidies. I do not rely on my commissions. This is the first paid job I have had in 10 years. I do not count my dollars, I count how many success stories I help create.
> My perspective is different than an established agent who has seen the time per client increase dramatically and the commission drop. I know my motivation is very different than the average agent.  I love what I do because I love helping people get great access to Healthcare. This includes many who had pre-existing conditions and many who have modest incomes.
> The law of the land before was you must be employed by a large company with benefits to have good benefits at an affordable price. Now most of our work force can afford insurance and affordable healthcare.
> Those "Death Panels" Fox News made up to scare people. They were real in the past, but never created by Obamacare. The insurance companies created them. The ACA has dismantled those death panels. There are death panels no more!!




As I posted previously, I think what you're doing is fantastic. But, you must appreciate that the system needs to be able to support those who are employed to provide services for it...such as agents. Earning less than a reasonable salary when providing such advice will not encourage support for this system. The commissions need to be reasonable. Based on the examples you've posted, I suspect you aren't even earning minimum wage given the time investment you are making with each of your clients.

From what I've learned by those who are local agents, it's clear that they universally resent the changes with the ACA in large part because the insurance companies took this opportunity to cut their commission, again. My last agent told me straight up, at the end, that they can't provide the level of support they once did since they can't spend as much time on each account anymore. This is, for all intents, a reduction of service quality - so I responded by firing them and going alone (I decided I don't need an agent right now, though it would be nice to have one as I always have until now)...which makes me suspect this may be the outcome the insurance companies desire, since now they don't need to spend anything on commissions for my policy which is a direct increase of profit for them.


Sent from my iPad


----------



## Passepartout

ace2000 said:


> Go down the list... Post Office, Medicare, Medicaid, Disability, Social Security.  They all are notorious for being inefficient with fraud, waste, and abuse.



Name ANY that have equivalent civil- or private- counterparts. There aren't any!


----------



## ScoopKona

ace2000 said:


> Go ahead and provide your case on how government is more efficient than private enterprise when they're providing the same service.



Can't be done. You are asking the impossible. 

Let's stick with the mail for this example:

No private company provides the same level of service as the USPS. No other government in the world outside of Canada can say they can, either. Only Canada Post is equivalent to the USPS. If you mail a letter with a check made out to "cash" for 100 million dollars, it will arrive at it's destination, unmolested, in a timely manner. If I had to send a check for an amount that large, I'd send it USPS registered mail -- just like the diamond merchants do for their multi-million dollar gems. I'd be just as secure sending it via Canada Post. The letter will arrive at it's destination. These agencies lose so little mail that the percentage may as well be 0%

The UK's Royal Mail is just as good -- but the UK is tiny compared to the US and Canada. I can send my check to Deadhorse, Alaska (zip code 99734) and it will get there in a matter of days. No private company can replicate that. Think about this: The USPS maintains a post office for freakin' Deadhorse, Alaska. It would be financially foolhardy for FedEx or UPS to do so. Google Deadhorse, Alaska to get an idea what the difference is between a corporate "service" and a government *service*. Corporations get to cherry pick. The government doesn't have that convenience. They have to get the mail to Wake Island for the same price as a letter posted between two neighbors.

USPS will pick up my letter from East Bumbletruck, KY and deliver it to Middle-Of-Nowhere, NV for 50 cents. That isn't waste, inefficiency or fraud. It's freakin' amazing.

I don't trust the Poste Italiane with a postcard, let alone cash or a diamond. And I absolutely love Italy. But I don't love their postal system. I've lived places where you have to watch the postal clerk cancel the stamp, because otherwise they'll remove it, trash your mail, and re-sell the stamp.

Meanwhile, USPS will pick up the Hope Diamond from New York, NY and deliver it to Washington, DC. I know this because they've done it already.

And you want me to name you a corporation that can replicate this? Absolutely impossible. Can't be done. USPS and Canada Post are the top two mail delivery systems on the planet; followed by the Royal Mail, Bundespost and JP Post. FedEx and UPS are amateur hour compared to any of these mail systems.

To even suggest otherwise tells me that you are going to automatically gainsay anything the government does because you are basically an anarchist. If someone asked me to list the things the US Government does well, the Post Office would be right behind NASA at the top of the list. (And yes, I'm well aware that the Post Office isn't exactly part of the US Government. They aren't taxpayer funded. But they get their marching orders from Congress, so that's good enough for me.)

N.B. The US Postmaster General position has been around longer than the US Constitution, and even the Declaration of Independence. Ben Franklin helped set up our mail system because he was a genius who realized how important reliable mail is to a free nation.

PS -- I have never worked for the USPS. I just know a lot about it because I send a LOT of mail, and have done so from many, many countries.


----------



## ace2000

SMHarman said:


> Huh I'm being challenged to provide efficient government programs because I'm challenging the prior assertion that government is inefficient. Nothing like a straw man!!!



Seriously, straw man?  LOL - nice try on the diversion.  

You said this...



SMHarman said:


> Please list these inefficient government programs.  *Most government programs operate more efficiently than similar private programs.*



And then I quoted that post and said this...



ace2000 said:


> Maybe we need to understand where you're coming from.  Can you provide a government program that DOES operate more efficiently as you have chosen to claim here ???



I don't think anymore needs to be said.  Again, nice try.


----------



## ace2000

Ken555 said:


> This has been his game since this thread started. Some days I play, others I stay away...



See my previous post. This is what I'm up against with you and SMHarmon.  I'm starting to realize with both, that's it's best to just show the record of what was previously said.


----------



## ace2000

I said this...



ace2000 said:


> I mentioned earlier that you compare the services that overlap.  You've chosen areas that don't overlap.  So, it looks like you've taken us back to square one.



You said...



Passepartout said:


> That is the problem. You said there is 'waste, fraud, and abuse' (your words) when they provide the same services, but they don't provide the same services.
> 
> There IS no service overlap.




My reply... 

There are overlaps in services and it's not hard to analyze the inefficiencies.  You keep wanting to compare government agencies in their entirety and I've used the word "services" over and over.     

There are plenty of overlapping services.  I can think of a handful right now - health insurance, security, public vs. private schools, and package delivery (ups, fedex, etc.).  Are we on the same page now?


----------



## ace2000

ScoopLV said:


> Can't be done. You are asking the impossible.



Sure it can be done and it's not impossible.  See my previous post to Jim.


----------



## pgnewarkboy

Corporate efficiency?  American corporations are mind numbingly inefficient and corrupt.   Remember the couple of trillion we the taxpayers had to hand out to Wall Street AND Banks because of a combination of Stupidity, Greed, Abuse, and Corruption.   Corporate efficiency is a MYTH that cannot be backed up by the facts, history, or common sense.

I know, I have provided an incontrovertible fact. Sorry to do that.   The   financial sector infested with imbeciles, and corrupt corporate officials, who lied and cheated their way into destroying the U.S. Economy.

Now various people whose eyes are closed, have no memory, and lack understanding can blame the government.

How efficient are the oil companies?  Huh.  How much oil and other pollutants do they just SPILL into U.S Waters every year.  Spilling your product.  Yeah, that is very efficient.   

How many companies go BUST every year losing their investors money.  Is that because they are efficient and smart or because they are incompetent.  Oh yes the MYTH that excuses and hides all truth about U.S Business.  They failed because of better more efficient OTHER Companies.  Right, prove it.  Many companies exist even though they are awful companies because they BRIBE their way in or use family power connections, or simply use illegal methods to sabotage other companies through spying and stealing.  I guess some of you never heard of it.  You can look it up.  Occasionally there are criminal charges.

Google and Apple and several other big U.S companies have been charged with conspiring NOT to hire each other tech employees effectively keeping the wages for low for these tech people who have nowhere else to go for better pay.  What exactly is that kind of behavior?  Efficiency or corruption or monopolization?   What efficiency!

The United States has LOST over 70,000 manufacturing plants since the 1970s and continue to lose them, close them, shutter them.   What happened to all the brilliant job creators.  They have been busing destroying U.S. jobs.  It must be because they are not only efficient, they are patriotic.  What plants in the United States have replaced them.  Oh, it is not their fault.  It is another example of now the World marketplace.  Blame the World - not these businesses and their leaders who still made fortunes while they closed their plants.    

The people of the united states are drowning because too many U.S businesses are incompetent, wasteful, and corrupt.  NOT because of the United States Postal Service.


----------



## ace2000

pgnewarkboy said:


> Corporate efficiency?  American corporations are mind numbingly inefficient and corrupt.   Remember the couple of trillion we the taxpayers had to hand out to Wall Street AND Banks because of a combination of Stupidity, Greed, Abuse, and Corruption.   Corporate efficiency is a MYTH that cannot be backed up by the facts, history, or common sense.



First, great post...  I mean that.  I see a difference though.  If a corporation is inefficient, it generally won't survive.  If a government entity is inefficient, we just continue to pay with no incentive to improve.  That's a big difference.


----------



## bogey21

The way I look at this is that there is a place for Government providing services and a place for Private Enterprise to provide services.  The argument seems to be into  whose bucket a service belongs.

George


----------



## momeason

ace2000 said:


> You're wrong on this one.  The same "panels" you're referring to are still around with the ACA.  Both the ACA and the private insurance have panels that decide what they will or will not cover and will also take on appeals.
> 
> It's kind of funny, the only people talking about "death panels" in this entire thread are the so-called "supporters" of the ACA.  Kind of odd really.



The death panels I was referring to are the ones where the insurance company decided who to sell insurance to in the first place and who to deny for coverage because of pre-existing conditions and lifetime limits. 
The ACA panels have absolutely no power over individual cases. They make overall cost saving recommendations to Medicare.

The insurance companies still do the same panels they have always done to discuss individual treatment decisions. The ACA does not do this.


----------



## momeason

Ken555 said:


> As I posted previously, I think what you're doing is fantastic. But, you must appreciate that the system needs to be able to support those who are employed to provide services for it...such as agents. Earning less than a reasonable salary when providing such advice will not encourage support for this system. The commissions need to be reasonable. Based on the examples you've posted, I suspect you aren't even earning minimum wage given the time investment you are making with each of your clients.
> 
> From what I've learned by those who are local agents, it's clear that they universally resent the changes with the ACA in large part because the insurance companies took this opportunity to cut their commission, again. My last agent told me straight up, at the end, that they can't provide the level of support they once did since they can't spend as much time on each account anymore. This is, for all intents, a reduction of service quality - so I responded by firing them and going alone (I decided I don't need an agent right now, though it would be nice to have one as I always have until now)...which makes me suspect this may be the outcome the insurance companies desire, since now they don't need to spend anything on commissions for my policy which is a direct increase of profit for them.
> 
> 
> Sent from my iPad



I believe there will be less and less paid agents for individual policies. healthcare.gov is a consumer driven site. I think the idea was not to need agents as it reduces costs. I guess they hope the lower costs will help keep down premium costs. I believe as people get more educated about insurance, the need for agents will diminish. For first time insurance buyers and for the first year or two of applying for subsidies I think a great agent is invaluable. An agent is better than a volunteer navigator because of their understanding of the plans. If you want to qualify for a subsidy, I recommend finding an agent who is truly supportive of the ACA. Business is always evolving. I figure I am going to educate my consumers and work myself out of a job. 
I can understand why established agents may not be supporters due to increased work and lower commissions. The news media and the management of the insurance companies have not helped with the negative messages.


----------



## ScoopKona

ace2000 said:


> Sure it can be done and it's not impossible.  See my previous post to Jim.



You have been challenged by more than one person to back up your claims that corporations do a better job delivering the mail than the government.

Do so. 

You are ducking the question. And I have strong suspicions as to why.


----------



## ace2000

momeason said:


> Those "Death Panels" Fox News made up to scare people. They were real in the past, but never created by Obamacare. The insurance companies created them.





momeason said:


> The death panels I was referring to are the ones where the insurance company decided who to sell insurance to in the first place and who to deny for coverage because of pre-existing conditions and lifetime limits.





If you research the "death panels" that Fox News and Palin were referring to, it has nothing to do with what you've chosen to label as such in your post.  

Edit:  You mention that Fox News created the term to "scare people".  You are really guilty of the exact same thing and and are using the term to scare people also.  Besides the fact that it's just extremely misleading.


----------



## vacationhopeful

Back to TOPIC -

Today is the last day to *START your application* until November 2014 of Open Enrollment for Jan 2015. You can complete or NOT complete the application until Jun 15 .... 

*LAST CHANCE FOR 2014*

By the way, buried in somewhere in my insurance bills in small print, was the YOUR POLICY WILL NOT BE RENEWED due to not meeting the New Health Insurance Guideline. My policy's renewal date is OCT 1 each year. 

And I had major CANCER SURGURY LAST YEAR - how expensive would have been my "regular" insurance's new policy.


----------



## ace2000

momeason said:


> *The ACA panels have absolutely no power over individual cases.* They make overall cost saving recommendations to Medicare.
> 
> The insurance companies still do the same panels they have always done to discuss individual treatment decisions. *The ACA does not do this.*



The ACA does provide an appeal process where decisions are reviewed by a "panel".  It is still decided by the insurance companies.   I'll provide a source below.  They don't get involved directly in the appeal process since Obamacare is relying on the health insurer to provide the insurance. 

https://www.healthcare.gov/how-do-i-appeal-a-health-insurance-companys-decision/



> If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party.
> 
> You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions.


----------



## ace2000

ScoopLV said:


> You have been challenged by more than one person to back up your claims that corporations do a better job delivering the mail than the government.
> 
> Do so.
> 
> You are ducking the question. And I have strong suspicions as to why.





Really?  Every time I've been asked to provide a source for my claims on this thread, I've done so.  There were other times where I was misquoted or my quote was been twisted into something I never said, which I chose to clarify.  

A strange thing happens though when I ask for a source from someone else to back up their claims... I get no reply - not even a clarification.  To use your words... "I have strong suspicions why".


----------



## ace2000

ScoopLV said:


> You are ducking the question. And I have strong suspicions as to why.



Can you provide a link to a post where I even used the term "mail" in the broad terms that you keep going on and on about?  The only fair comparison is to look at "services" that overlap.  I have posted several times that I was referring to "package delivery" and even mentioned UPS and FEDEX a couple of times.  Would you like a source on why people prefer those two over the Post Office?


----------



## ace2000

vacationhopeful said:


> And I had major CANCER SURGURY LAST YEAR - how expensive would have been my "regular" insurance's new policy.



That would be a good question to know.  Why would the ACA pay more than what you had before?


----------



## ace2000

ace2000 said:


> That would be a good question to know.  Why would the ACA pay more than what you had before?



I see... you're referring to the price of your new plan for this year.  Sorry.


----------



## Passepartout

ace2000 said:


> Can you provide a link to a post where I even used the term "mail" in the broad terms that you keep going on and on about?  The only fair comparison is to look at "services" that overlap.  I have posted several times that I was referring to "package delivery" and even mentioned UPS and FEDEX a couple of times.  Would you like a source on why people prefer those two over the Post Office?



Even by your narrow definition, USPS does package delivery more efficiently, and at lower cost to the user than either UPS or FedEx, with greater security, and while we're at it, hires more veterans than any other single company. 

But what does this have to do with health insurance? Oh, I remember. Private Enterprise vs. government service. I was just considering this. Hereabouts one can sign up with the city contracted trash removal company (private enterprise), or with any of several others, or take their trash to the dump themselves. Nobody cares. But every dwelling or business gets billed by the city for wastewater treatment. No private company has stepped up to open a sewage treatment plant. The only difference is that one is (mostly) solid, while the other is (mostly) liquid. I don't know that there is a law that says a private company can't do it, but they don't.

I really don't wonder why, do you? Surely people would pay to have their liquid waste removed. And if private enterprise could do it more efficiently with less 'waste, fraud, and abuse', why wouldn't they?

Jim


----------



## Beefnot

I don't necessarily believe the government is efficient at anything, even the post office (USPS is losing money hand over fist). But they are highly effective.  There is a difference. Police, fire, military, mail, motor vehicles, etc. Local, state, and federal government provide generally very effective services, even if the are operated inefficiently.


----------



## SMHarman

ace2000 said:


> Can you provide a link to a post where I even used the term "mail" in the broad terms that you keep going on and on about?  The only fair comparison is to look at "services" that overlap.  I have posted several times that I was referring to "package delivery" and even mentioned UPS and FEDEX a couple of times.  Would you like a source on why people prefer those two over the Post Office?



Why people prefer, again you use anecdotal statements, a bit like these hypothetical 'people that have suffred under ACA'

So I dug for hard facts.

http://about.usps.com/publications/...ement-2013/annualreport2013_032.htm#ep1003809

Seems the USPS ships about 3,711,000,000 packages a year thats 14,273,076 a day based on a 260 working day year.

On to UPS

http://www.ups.com/content/us/en/about/facts/worldwide.html#

Daily delivery volume is 16.3 million packages and documents - Though that is worldwide, not US specific.

FedEx

http://investors.fedex.com/phoenix.zhtml?c=73289&p=irol-statbooks

If you have the time to dig.
http://wiki.answers.com/Q/How_many_packages_does_fedex_ship_a_day
Says 3.4m

So USPS and UPS seem about the same size.

If you want to look at profitability then you need to adjust for the USPS pension funding model that is mandated by congress and requires their pension to be currrent funded (overfunded) compared to any competition.


----------



## SMHarman

Beefnot said:


> I don't necessarily believe the government is efficient at anything, even the post office (USPS is losing money hand over fist). But they are highly effective.  There is a difference. Police, fire, military, mail, motor vehicles, etc. Local, state, and federal government provide generally very effective services, even if the are operated inefficiently.


Actually the USPS has been in the black since 1982.

The 2006 Postal Accountability and Enhancement Act mandate causes the accounting and cashflow loss. In that law they required the USPS to prefund it's retiree health care benefits for the next 50 years. Does your employer do that?

https://answers.yahoo.com/question/index?qid=20100724002941AAvehGg


----------



## ace2000

SMHarman said:


> Why people prefer, again you use anecdotal statements, a bit like these hypothetical 'people that have suffred under ACA'



I have no idea what this means.  Are you attributing that quote to me?


----------



## ace2000

I mentioned several overlaps where government and business compete.  I'm not sure it's best to debate each one and yes, we are going off-topic here.

Here's a good source for my case.

*Here's The Real Reason Why The Postal Service Can't Compete*



> *So why has the USPS gone into the gutter while its biggest competitors -- FedEx and UPS -- pull multi-billion dollar profits despite the rise of email? *Let's take a look.
> 
> The most obvious drain is the unions, and it's the big thing Donahoe has tried to address. He's asking for permission to cut the health and retirement plans for his half million employees and replace them with new programs, and try to impose significant layoffs. *Labor is 80% of the Postal Service's expenses, compared to 53% at UPS and 32% at FedEx, according to the New York Times.*



http://www.businessinsider.com/us-postal-service-congress-2011-9


----------



## ace2000

> But there's a problem that runs deeper than its significant labor woes. The USPS brand is hurting, badly. Its product is just inferior to FedEx and UPS -- at least in consumers' minds.
> 
> Customer satisfaction matters, and the Postal Service doesn't provide the value people demand. The American Customer Satisfaction Index reported in June that UPS topped the mail services industry with an 85, with FedEx falling behind to 83.
> 
> The USPS scored a 79 in express mail and a dismal 74 in regular mail -- and that's actually an all-time high.



http://www.businessinsider.com/us-postal-service-congress-2011-9


----------



## ace2000

SMHarman said:


> Actually the USPS has been in the black since 1982.
> 
> The 2006 Postal Accountability and Enhancement Act mandate causes the accounting and cashflow loss. In that law they required the USPS to prefund it's retiree health care benefits for the next 50 years. Does your employer do that?
> 
> https://answers.yahoo.com/question/index?qid=20100724002941AAvehGg



You're using Yahoo Answers as a source ???  Wow.  

It's probably not fair to compare profits, since the USPS is supposed to set their rates at a break even point and not make a profit.  However, it is fair to measure efficiency and how they manage costs...


----------



## Beefnot

SMHarman said:


> Actually the USPS has been in the black since 1982.
> 
> The 2006 Postal Accountability and Enhancement Act mandate causes the accounting and cashflow loss. In that law they required the USPS to prefund it's retiree health care benefits for the next 50 years. Does your employer do that?
> 
> https://answers.yahoo.com/question/index?qid=20100724002941AAvehGg


 
In full disclosure, that was written by a USPS employee. Fair points though, although in 2012 when the USPS reported a $16 billion loss, much of it was due to the 2006 act. When it reported a $5 billion loss last year, it was all due to the act. At best it breaks even, and at worst it loses money. But based on the articles below, I will recant. USPS is a pretty doggone efficient organization all things considered.

http://www.sacbee.com/2013/04/16/5344613/how-congress-undercuts-the-postal.html
http://www.businessweek.com/article...stal-service-will-not-go-private-anytime-soon


Another question, is Medicare considered efficient?


----------



## SMHarman

ace2000 said:


> I have no idea what this means.  Are you attributing that quote to me?


You have been continually dissing the USPS without providing evidence and even here have not taken any of the stats I provided that shows the USPS is preferred by volume of packages shipped and disputed it.


ace2000 said:


> I mentioned several overlaps where government and business compete.  I'm not sure it's best to debate each one and yes, we are going off-topic here.
> 
> Here's a good source for my case.
> *Here's The Real Reason Why The Postal Service Can't Compete*
> http://www.businessinsider.com/us-postal-service-congress-2011-9





ace2000 said:


> http://www.businessinsider.com/us-postal-service-congress-2011-9





ace2000 said:


> You're using Yahoo Answers as a source ???  Wow.
> It's probably not fair to compare profits, since the USPS is supposed to set their rates at a break even point and not make a profit.  However, it is fair to measure efficiency and how they manage costs...


Taking these together.
The Yahoo Answer was more than adequate.  I do not have the time to dig through the relevant act to cite the specific para of the legislation anymore than you seem to want to take the time to dispute that the USPS ships more parcels than Fed Ex by a factor of 5 and more than UPS (especially as UPS is global and USPS is domestic).

Now you are on to comparing costs.  I am sure that the USPS labor costs are higher, but hey there are lots of middle class americans living the american dream on those wages so don't knock them.

Did you normalize these numbers of labor cost to back out the pension funding requirements that UPS does not have to put on their books and records?  I don't think so.

You then also go on to compare with percentages.  As one is a not for profit and the other is for profit the percentages will never make sense.

So Say UPS has a target profit of 20%  On a $10 shipment $5 is wages, $3 is other overhead $2 is profit.
Lets take the same USPS $8 is wages (and the fully funded pension commitment which is likely to be $2 of that), $2 is overhead.  Profit is 0.

So the real likely difference is that the USPS wages are nearer 60% of costs and UPS 53% with the difference there being higher unionised wages (unless you think we all should earn minimum wage) and the pension mandate.  These employees are also being provided with employee healthcare and not needing government subsidy to get insurance from the exchanges.  Can the same be said for the 'contractors' who own their own FedEx painted van and do deliveries for FedEx??  Seems like a ruse from FedEx to get employees off the books and reduce employee / employee benefit costs.



> http://en.wikipedia.org/wiki/Fedex
> In December 2007, the U.S. Internal Revenue Service "tentatively decided" the FedEx Ground Division might be facing a tax liability of $319 million for 2002, due to misclassification of its operatives as independent contractors. Reversing a 1994 decision which allowed FedEx to classify its operatives that own their own vehicles, the IRS audited the years 2003 to 2006, with a view to assessing whether similar misclassification of operatives had taken place. FedEx denied that any irregularities in classification had occurred, but faced legal action from operatives claiming benefits that would have accrued had they been classified as employees.[7]



As noted in that Yahoo answer the USPS also has the branch mandate which means they cannot close that post office in the middle of nowhere that has $26 a day in revenue.

The post office also provide service for other government agencies.  Passport application, Tax mailing, Money transfer service but is not allowed to add other services that would help drive traffic to the post office.  Operating it from a gas station, or small village convenience store.  The USPS offering basic banking service, savings accounts and checking accounts.

You talk above about satisfaction ratings.  I think that translates into a 74/100 people approve of the USPS First Class Mail, 79 for Express Mail, 83 and 85 for FedEx and UPS respectivly, so the approval rating of all three for express mail / parcels is in the upper quartile.  

I don't know if the US ran the ads back in the 80s for a brand of cat food where the strap line was 8/10 owners said their cats prefer it.  Well the USPS, FedEx and UPS can all say 8/10 customers like our service!  Hardly a resounding thumbs down to the USPS.


----------



## ScoopKona

ace2000 said:


> Can you provide a link to a post where I even used the term "mail" in the broad terms that you keep going on and on about?  The only fair comparison is to look at "services" that overlap.  I have posted several times that I was referring to "package delivery" and even mentioned UPS and FEDEX a couple of times.  Would you like a source on why people prefer those two over the Post Office?



If you wish to keep deflecting, I can roll with that, too....

"People prefer those two over the post office," is a made-up fact. In reality, all major US delivery services have the same customer satisfaction rates. And anyone who mails a LOT of packages will prefer the post office.

Want to make this strictly a package delivery exercise? No problems.

I can send a overnight Priority Mail express box to the following locations for $45 each -- Lahaina, Hawaii; St. John's, USVI; Deadhorse, Alaska; and my neighbor across the street (we're not on speaking terms ever since he dissed the US Postal Service). Grand total, less than $180.

Please get back to me with the cost of mailing a small overnight package to the same locations, using any company or firm that you'd like. Delta Dashmail, Purolator Courier, DHL Express, no restrictions at all.

When you find a company that can do the same thing for $180 or less, please let me know.


----------



## SMHarman

Beefnot said:


> In full disclosure, that was written by a USPS employee. Fair points though, although in 2012 when the USPS reported a $16 billion loss, much of it was due to the 2006 act. When it reported a $5 billion loss last year, it was all due to the act. At best it breaks even, and at worst it loses money. But based on the articles below, I will recant. USPS is a pretty doggone efficient organization all things considered.
> 
> http://www.sacbee.com/2013/04/16/5344613/how-congress-undercuts-the-postal.html
> http://www.businessweek.com/article...stal-service-will-not-go-private-anytime-soon
> 
> 
> Another question, is Medicare considered efficient?


Yes it was but the facts as I understand them are accurate and it allowed you to continue the research and equally conclude that the USPS is not a financial sinkhole, but has a pension mandate like no other.

Medicare efficient.
Premium collection - does not get much more efficient than using payroll tax.  Every employer is an unpaid collection agent (including government employers).
Claim Processing Ratio - I understand that this is in the low single digits.  Some argue that this is due to less dilligence in claim processing and more fraud but the Cignas of the world don't really publish the fraud numbers and spend about 3x more on claim processing.


----------



## ace2000

ScoopLV said:


> If you wish to keep deflecting, I can roll with that, too....
> 
> "People prefer those two over the post office," is a made-up fact. In reality, all major US delivery services have the same customer satisfaction rates. And anyone who mails a LOT of packages will prefer the post office.



LOL on the deflecting.  I'm just glad you're finally on the same page.  

When I say "people prefer those two over the post office", I backed it up with a source.  You're just giving your opinion.  Agree or disagree, at least I've provided something to back up my opinion.



> This year, ACSI expands its treatment of express delivery services to include both consumer senders and receivers. The measure now encompasses packages people pay to have sent to other people and express-delivered merchandise they pay to have shipped from companies. Customer satisfaction for the category inches up for a second straight year, gaining 1.2% to an ACSI score of 84. Double-digit growth in online sales during the first quarter has increased demand for consumer-paid shipping of Internet purchases.
> 
> FedEx led the industry for more than a decade, but this year UPS moves into the number-one position, up 4% to 85. Satisfaction with FedEx dips slightly, falling 2% to 83. UPS has outperformed its rival in the stock market as well, with a 19% share increase over the past year.
> 
> *The United States Postal Service gains 3% for its express delivery services, but its score of 79 keeps the USPS well behind both UPS and FedEx. *



http://www.theacsi.org/index.php?op...acsi-commentary-june-2011&catid=14&Itemid=335


----------



## ace2000

ScoopLV said:


> When you find a company that can do the same thing for $180 or less, please let me know.



I'm willing to grant the fact that the USPS is almost always the cheapest route.  However, UPS has advantages that USPS can't offer.  Cheapest is not always the best option.


----------



## ace2000

Chart on the Ground Shipping Market Share (2007).  The chart shows 2007, UPS still has a current position of a 50% share.






Source: http://www.gurufocus.com/news/169552/warren-buffetts-ups-has-an-enviable-durable-market-position


----------



## ace2000

SMHarman said:


> Yes it was but the facts as I understand them are accurate and it allowed you to continue the research and equally conclude that the USPS is not a financial sinkhole, but has a pension mandate like no other.



I thought the source was a good read, and I learned from it.  And I appreciate the other feedback to my comments.  They have a pension mandate like no other, because they have a pension like few others.  Are you saying it's a bad idea to pre-fund their commitment?  I don't believe you are, but you have to factor in those long term costs somehow.  There are several pension funds that are set up to be pre-funded in the same manner.


----------



## ScoopKona

ace2000 said:


> I'm willing to grant the fact that the USPS is almost always the cheapest route.  However, UPS has advantages that USPS can't offer.  Cheapest is not always the best option.



Name these advantages. 

I'm showing apples to apples comparisons of overnight package delivery services to the most far-flung corners of our country. That's what you asked for. That's what you got. Face it, even with the millstone around it's neck of having to maintain post offices in places like Wake Island and Deadhorse, USPS is still the fastest, least expensive, most reliable delivery service. (FedEx will win every time mailing packages from New York to Los Angeles. Sure thing. But in the race to Deadhorse, my money's on the post office.)

No other company offers anything akin to their registered mail service. The US government trusts them to deliver state secrets via registered mail. When lives are at stake, send it USPS.

As for customer satisfaction, this site was already linked before: http://www.theacsi.org/news-and-res...i-press-releases-2013/press-release-june-2013

_"Both FedEx and UPS enjoy high levels of customer satisfaction. FedEx climbs 4% to an ACSI score of 85, just a point above UPS, up 4% to 84. Both carriers beat U.S. Postal Service Express/Priority Mail, which slides 5% to 77. The regular mail services of the U.S. Postal Service edge up by 2.7% to a new ACSI high of 77."_

And that's with the USPS being a conservative whipping post (for whatever bizarro-world reason) for years. If people would learn how to use the USPS's internet label system (so they don't have to wait in line at the post office) I'll bet that number would increase substantially. As it stands, the eight percentage points don't amount to a hill of beans considering the mandate the USPS has to fulfill compared to their competition.

And, for the umpteenth time, you are missing the point that the government service does not cherry pick locations. They keep their offices open in Wake Island and Deadhorse and all the other little rural and far-flung locations; they pay their people well and offer some of the best benefits on the planet; and they're less expensive than their competitors.

People have repeatedly offered up examples of why the system is NOT fraught with waste, fraud and inefficiency. And you simply ignore all of it.


----------



## Patri

I think you should all take your baseball gloves, bats and balls and go home. It is suppertime. Mom is calling.


----------



## ace2000

ScoopLV said:


> Name these advantages.



I can tell you a big one for me on a personal basis. If I go to my local post office to mail something, I end up waiting in line for about 15 minutes... sometimes more, and sometimes less. UPS has always been a quick process for me.

If you want more than that, here's a link to eBay's comparison.

http://www.ebay.com/gds/Shipping-UPS-vs-USPS-/10000000001545951/g.html




ScoopLV said:


> People have repeatedly offered up examples of why the system is NOT fraught with waste, fraud and inefficiency. And you simply ignore all of it.



I don't ignore it. I read it. I choose to comment, if I have something to say, as I did above. Sometimes, there's truth on both sides. This stuff isn't life or death.


----------



## Beefnot

ace2000 said:


> I thought the source was a good read, and I learned from it. And I appreciate the other feedback to my comments. They have a pension mandate like no other, because they have a pension like few others. Are you saying it's a bad idea to pre-fund their commitment? I don't believe you are, but you have to factor in those long term costs somehow. There are several pension funds that are set up to be pre-funded in the same manner.


 
Pre-funding a commitment seems reasonable, but doing so for the next 50 years within a 10 year span? That doesn't seem to make a whole lot of sense. 

As for medicare, IF it is indeed considered efficient, then why is there any reason to believe that universal healthcare would necessarily be any less efficient? Or effective for that matter? Efficiency and efficacy are matters of pragmatism, but when it gets right down to it, I imagine that most folks have an ideological perspective, and they subsequently layer in selective pragmatic arguments as it suits their fancy.


----------



## ace2000

Patri said:


> I think you should all take your baseball gloves, bats and balls and go home. It is suppertime. Mom is calling.



Since I seem to be one of the few people on TUG discussing the ACA from the opposing side, I seem to be the whipping boy on this thread. It's ok, I can deal with it. It's obvious that this is a very emotional issue, and I can understand that.

I've also called out several inaccuracies and rebutted misinformation when I've seen it - that hasn't made me very popular. I've been open minded when others have done the same on my posts. Trust me, I'm not taking it personal, I think it's been a "healthy" debate.


----------



## SMHarman

ace2000 said:


> I thought the source was a good read, and I learned from it.  And I appreciate the other feedback to my comments.  They have a pension mandate like no other, because they have a pension like few others.  Are you saying it's a bad idea to pre-fund their commitment?  I don't believe you are, but you have to factor in those long term costs somehow.  There are several pension funds that are set up to be pre-funded in the same manner.


Most pensions should have some form of pre-funding.  It's a big stretch for any of us to take comfort that our employer today will be around to write us retirement checks in 20-30 years.  The question is how much.  Scoop highlighted that they are making USPS get fully funded in 10 years.  It's a bit like you taking out a 30 year mortgage and then being told a couple of years later to pay it off in 10 years but you can't sell the house.  Just ramp up the capital reapayment.
Actuarially the timing of contribution vs the timing of withdrawal is off.  This will likely mean that the Postal Service pension fund is massivly overfunded in 10 years time (cue the raid of the pension by the government).


ace2000 said:


> I can tell you a big one for me on a personal basis. If I go to my local post office to mail something, I end up waiting in line for about 15 minutes... sometimes more, and sometimes less. UPS has always been a quick process for me.
> 
> If you want more than that, here's a link to eBay's comparison.
> 
> http://www.ebay.com/gds/Shipping-UPS-vs-USPS-/10000000001545951/g.html
> 
> I don't ignore it. I read it. I choose to comment, if I have something to say, as I did above. Sometimes, there's truth on both sides. This stuff isn't life or death.


The USPS now has a set of online tools as competetive as FedEx or UPS.  Most of my parcel mailing does not have me go to the post office, they collect from me or I drop envelopes into the mail box.  


Beefnot said:


> Pre-funding a commitment seems reasonable, but doing so for the next 50 years within a 10 year span? That doesn't seem to make a whole lot of sense.
> 
> As for medicare, IF it is indeed considered efficient, then why is there any reason to believe that universal healthcare would necessarily be any less efficient? Or effective for that matter? Efficiency and efficacy are matters of pragmatism, but when it gets right down to it, I imagine that most folks have an ideological perspective, and they subsequently layer in selective pragmatic arguments as it suits their fancy.


Exactly


----------



## ace2000

Beefnot said:


> Pre-funding a commitment seems reasonable, but doing so for the next 50 years within a 10 year span? That doesn't seem to make a whole lot of sense.



It does seem excessive.  I guess the good news is since it passed in 2006,  the 10-year span is almost over.


----------



## Passepartout

ace2000 said:


> I can tell you a big one for me on a personal basis. If I go to my local post office to mail something, I end up waiting in line for about 15 minutes... sometimes more, and sometimes less. UPS has always been a quick process for me.



I went to UPS on Saturday armed with a tracking number to ask why they shipped a parcel addressed to me back to the shipper. It was addressed perfectly. They have delivered hundreds of parcels to me at the same address.

They were closed on Saturday. And Sunday.

The USPS was open Saturday, and it's lobby is open on Sunday, so if DW wants to check her P.O. Box, she can. UPS doesn't offer that service.

When I ship a package at the UPS store, there IS a line there. Don't tell me UPS is more efficient. Only costlier and less secure.

Now, to re-purchase the Amazon Gold Box item that UPS sent back to the shipper, I can buy it again, Amazon says. For $270 + freight, instead of the $130, shipped free on Amazon Prime.

Don't ask me how I feel about UPS today.:annoyed::annoyed::annoyed:


----------



## Conan

Speaking (when we were) of Fox News, here's today's Fox graphic. What's wrong with this picture?


----------



## Beefnot

Conan said:


> Speaking (when we were) of Fox News, here's today's Fox graphic. What's wrong with this picture?


 

That is classic!


----------



## Ken555

Beefnot said:


> That is classic!




Naw, they're just showing the tip of the iceberg... 

And in all fairness, math isn't Fox News' area of expertise.


Sent from my iPad


----------



## Passepartout

Well, finally. Within the next couple of hours, anyone who wants health insurance this year will have signed up, or decided to pay the penalty for not doing so. I can't imagine that (regardless of what they might say) many can honestly say they were not aware.

Unfortunately, of those who remain uninsured, some will find out the hard way that they cannot buy insurance through ACA until November, and buying it outside ACA will be very expensive. In many cases, there are restrictions of what's covered. A few will go bankrupt because of medical bills. Sad.

My guess is that a large percentage of the uninsured are the same people who drive cars without insurance. We read about those in the newspaper every day.  

Even with the botched roll-out, they came quite close to the goals set for year 1.

Jim


----------



## Ken555

Passepartout said:


> Even with the botched roll-out, they came quite close to the goals set for year 1.




I just saw a news item that they may have hit 7 million. If so...let the spin begin! 


Sent from my iPad


----------



## ScoopKona

Passepartout said:


> The USPS was open Saturday, and it's lobby is open on Sunday, so if DW wants to check her P.O. Box, she can. UPS doesn't offer that service.




Here's the other thing. I'm tight with my USPS delivery dude. I've known him for years. His mother makes the best lumpia on the planet. You can't really build a relationship with the UPS driver or the FedEx driver. They come and go too quickly. Not so with the USPS guy/gal. He's been my mailman since the day we moved in. 

Just two days ago, there was a note in my mailbox from my USPS delivery dude. "Got a package that didn't fit in the mailbox. Looked expensive. It's under the bush by your front door. If you don't pick it up by 4pm, I'll take it back and try again tomorrow."

*That* is government service.


----------



## Beefnot

ScoopLV said:


> Here's the other thing. I'm tight with my USPS delivery dude. I've known him for years. His mother makes the best lumpia on the planet. You can't really build a relationship with the UPS driver or the FedEx driver. They come and go too quickly. Not so with the USPS guy/gal. He's been my mailman since the day we moved in.
> 
> Just two days ago, there was a note in my mailbox from my USPS delivery dude. "Got a package that didn't fit in the mailbox. Looked expensive. It's under the bush by your front door. If you don't pick it up by 4pm, I'll take it back and try again tomorrow."
> 
> *That* is government service.



Then they get paid way too much.


----------



## Ken555

ScoopLV said:


> Here's the other thing. I'm tight with my USPS delivery dude. I've known him for years. His mother makes the best lumpia on the planet. You can't really build a relationship with the UPS driver or the FedEx driver. They come and go too quickly. Not so with the USPS guy/gal. He's been my mailman since the day we moved in.
> 
> 
> 
> Just two days ago, there was a note in my mailbox from my USPS delivery dude. "Got a package that didn't fit in the mailbox. Looked expensive. It's under the bush by your front door. If you don't pick it up by 4pm, I'll take it back and try again tomorrow."
> 
> 
> 
> *That* is government service.




Unfortunately, your experience is not universally shared as far as USPS is concerned. My local post office has management that likes to yell at customers, and I have regular issue with incorrect delivery of items (at least once per week or so I get a letter that was intended for another address and I return it...). I tell all vendors now that if they can't email me billing or other critical info I won't do business with them. Packages...fine...but UPS and Fedex are great and USPS is so-so. 

It's time to take the delivery service discussion and put it in its own thread. It doesn't belong in the health care thread.


Sent from my iPad


----------



## Tia

Ken555 said:


> It's time to take the delivery service discussion and put it in its own thread. It doesn't belong in the health care thread.
> 
> 
> Sent from my iPad





YES too confusing


----------



## ace2000

I'm on board with leaving the post office discussion as is.  I will say I've got a new appreciation for the USPS.  Haven't changed my mind, but I have a deeper respect for the other side.   

I'm firmly convinced that the current healthcare debate and it's future is a question of how are we best served - government run health care vs. private run health care.  

The ACA tries to do both and that's one of the reasons I don't like it.  My main concerns though are budget issues, which I've had the opportunity to express here several times.  

The solution in my mind IS complete government health care.  I'll say it again, it is a choice and tradeoff between the greedy corporate profit making insurance companies vs. the inefficient government bureaucracy and red tape.  But, in the end I've concluded that health care is better served by our government.

I also know that I seem to be the only one on this thread that thinks that the government is less efficient than our corporations - or at least that chose to express it verbally.  It appears that I'm far outnumbered, which is ok, at least we have learned who we are.


----------



## ace2000

Ken555 said:


> I just saw a news item that they may have hit 7 million. If so...let the spin begin!



No spin here.  The 7 million is significant because it's the number the original estimates were built off of.  Other significant numbers are how many are actually enrolled and paid, how many were previously uninsured, and how many of the young population are in the mix.  

To it's credit, the Obama administration did an incredible job marketing the program.


----------



## Beefnot

ace2000 said:


> I also know that I seem to be the only one on this thread that thinks that the government is less efficient than our corporations - or at least that chose to express it verbally.



Wrong answer.



Beefnot said:


> I don't necessarily believe the government is efficient at anything, even the post office (USPS is losing money hand over fist). But they are highly effective. There is a difference. Police, fire, military, mail, motor vehicles, etc. Local, state, and federal government provide generally very effective services, even if the are operated inefficiently.


----------



## ace2000

Beefnot said:


> But based on the articles below, *I will recant*. USPS is a pretty doggone efficient organization all things considered.



Yea, perhaps so.  But, then you recanted, so it's hard to really tell where you stand.  I'm not sure what statement you were recanting then.  I guess you meant only the post office.  But, it really doesn't matter.  I think people understood where I was coming from.


----------



## bogey21

ace2000 said:


> Other significant numbers are how many are actually enrolled and paid, how many were previously uninsured, and how many of the young population are in the mix.



Other numbers we need before we can make a reasonable judgment as to the success of the ACA are premium increases or decreases the second year and the amount (if any) the taxpayer has to chip in to cover Insurance Company losses.

George


----------



## Passepartout

ace2000 said:


> The *solution in my mind IS complete government health care*.  I'll say it again, it is a choice and tradeoff between the greedy corporate profit making insurance companies vs. the inefficient government bureaucracy and red tape.  But, in the end I've concluded that health care is better served by our government.
> 
> I also know that I seem to be the only one on this thread that thinks that *the government is less efficient than our corporations* - or at least that chose to express it verbally.  *It appears that I'm far outnumbered*, which is ok, at least we have learned who we are.



I am confused, but not as confused as you seem to be. On the one hand you say that government bureaucracy and red tape and 'waste, fraud, and abuse' are a bad thing, yet a sentence or two later you espouse 'complete government healthcare'? This position seems different than where you began posting in this thread nearly a thousand posts ago. Back then (iirc) you wanted nothing short of 'repeal and re-do' Obamacare. We seem to have made some progress toward consensus.

In the last couple of pages here, you've tried to make a case for private enterprise doing a better job than government agencies. I am not disagreeing with you. You are just using the wrong examples. Try some others. Like Space-X vs. NASA. It may well be that the private rocket company will end up doing a better job of hauling stuff to orbit and maybe to Mars. We just don't know yet.

Yes, you DO seem to be nearly the only naysayer in the thread. I'm sure you have some kindred spirits here, just not so vocal. Surely you've received PM's with 'attaboy' messages. As you said, we know on which side of the issue we stand, and I suppose it defines us on some level. I noticed that we didn't exactly see eye-to-eye when we sat together over a Mai-Tai in Maui a few years back. After cocktails we went in different directions for dinner with more agreeable companions. Nonetheless, I'm glad we met.

Now, the time for argument is over. Those who want insurance this year have signed up. The political lines are drawn, to be taken back up in the Fall. 

Step back, take a deep breath. Go on a vacation- or at least plan some.

Have a great Spring and Summer.

Jim


----------



## ace2000

Jim, let me clear it up for you on how it went down this path. Hopefully it will clear up your fog. 

After this chain, I listed several government programs that I believe were not run efficiently (I don't want to list them again because I don't think we need to hash them out individually.) Then one program on my list became the focal point of yesterday's discussion. The strange thing is I never got a direct response to my question to SMHarman, only his post describing my question as a "straw man" when I quoted his exact post. 



geekette said:


> I personally think there should not be profit motive in health care, but that's where we are, ins execs can pocket millions in bonuses.


 


ace2000 said:


> It's the evil profit motive vs. the inefficiencies and costs of another government program. *I'm not taking a side on this, just saying there's advantages and disadvantages for both*.


 


SMHarman said:


> Please list these inefficient government programs. Most government programs operate more efficiently than similar private programs.


 


ace2000 said:


> Maybe we need to understand where you're coming from. Can you provide a government program that DOES operate more efficiently as you have chosen to claim here ???


----------



## ace2000

Passepartout said:


> I noticed that we didn't exactly see eye-to-eye when we sat together over a Mai-Tai in Maui a few years back. After cocktails we went in different directions for dinner with more agreeable companions. Nonetheless, I'm glad we met.


 
LOL - more fog and confusion. This one is more bizarre, and you're telling me to take a deep breath?  What makes you think we met in Maui? I can promise you that wasn't me. 



Passepartout said:


> Now, the time for argument is over. Those who want insurance this year have signed up. The political lines are drawn, to be taken back up in the Fall.
> 
> Step back, take a deep breath. Go on a vacation- or at least plan some.
> 
> Have a great Spring and Summer.
> 
> Jim


 
Naw, it's far from over. One of my concerns about the ACA is that the plan is so poorly designed that we will have moved further away from a single payer plan.


----------



## ace2000

Passepartout said:


> Back then (iirc) you wanted nothing short of 'repeal and re-do' Obamacare. We seem to have made some progress toward consensus.


 
I don't know what the reference to "iirc" is here. I have never called for "repeal" of the ACA, and I believe I've been consistent in this thread. My feelings haven't changed at all as you've described. Please provide any of my quotes to back your claim. I'll be willing to admit it if I'm wrong.

I do feel strongly that the ACA is going to have to be "re-done" in the future. I hope the under-26, the caps, and the pre-existing remain. I have no reason to think that those will ever go away, especially now that they're entrenched. 

A big test will be the 2014 Fall elections. If the politicians see this as a losing issue, they'll run from the ACA faster than anything you've ever seen.


----------



## Passepartout

ace2000 said:


> Seriously ???  Go down the list...* Post Office, Medicare, Medicaid, Disability, Social Security.  *They all are notorious for being inefficient with fraud, waste, and abuse.  Things happen in those programs that just don't happen in private enterprise.
> 
> Are you saying otherwise?



Just to refresh your memory. There ARE no equivalent civilian, private enterprises that do what these (yes) bureaucracies do. Period. 

I did say that I don't disagree that there are some inefficiencies, but since these happen to be the only programs that do what these programs do, either *offer some private outfits that overlap ALL the government services YOU cite, or find  different examples.* I cited one, Space-X vs NASA. 

Oh, and again using your examples: USPS is a private corporation operation under federal mandate. At a profit. Medicaid is a federal program, overseen by the various states. And Disability and Social Security are insurance. Funded by that little FICA tax that comes out of either your paycheck (if you are self employed) or a 50/50% payment by you and your employer.

Could they be be more efficiently run? Probably, but how would you do that? Start another oversight agency? I doubt that's the answer. 

You?


----------



## ace2000

Passepartout said:


> Just to refresh your memory. There ARE no equivalent civilian, private enterprises that do what these (yes) bureaucracies do. Period.


 
I think we just talked about one example yesterday.  I also provided another list in a different post. I purposely left that list out in my previous post and you chose to bring it up again - and I even described why. I'm ready to move on to the next topic, I think almost everyone else is too.


----------



## Passepartout

ace2000 said:


> I don't know what the reference to "iirc" is here. *I have never called for "repeal" of the ACA,* and I believe I've been consistent in this thread. My feelings haven't changed at all as you've described.  Please provide any of my quotes to back your claim.  I'll be willing to admit it if I'm wrong.
> 
> I do feel strongly that the ACA is going to have to be *"re-done"* in the future. I hope the under-26, the caps, and the pre-existing remain. I have no reason to think that those will ever go away, especially now that they're entrenched.
> 
> A big test will be the 2014 Fall elections. If the Democrats see this as a losing issue, they'll run from the ACA faster than anything you've ever seen.



We may be parsing words here, but I construe "re-done" as being, if not the same, darn close to "repeal". But I am willing to give you the Mulligan on this. 

We all (supporters of ACA) know there will be changes, adjustments, tweaks, re-do's, call them whatever you want, to get more people covered, at lower cost. Maybe it will be through increased penalties for the non-insured. Maybe it will be through advertising in more direct and creative ways to attract the 'young, invincibles' to prioritize healthcare into their budgets. It might be with targeted programs to recruit people whose English may be a second- or unknown- language. Underinsured segments will be identified, and targeted to be covered.

As to your comment re: the mid-term elections. Democrats will turn their backs on the hard-won ACA at their peril. Republicans made Obamacare the centerpiece of their efforts in the General Election year of 2012. It cost them plenty. Customarily, mid-terms give the opposite party (of the White House holder) gains. It may and probably will happen again. The number of paths for Republicans to take the Senate are greater than the number of paths the Dems have to re-take the House. The larger problem Republicans face is the splintering of that party. A divided Republican Party doesn't have a chance against it's own factions, let alone a united opposition.

But this is not an argument that belongs on TUG. I wouldn't be surprised to see that last paragraph disappear.


----------



## Passepartout

ace2000 said:


> What makes you think we met in Maui?



Oops. We were joined by another TUGger with a very similar username to yours. I just searched and darn it, it wasn't you. Pleasant get together and perhaps more pleasant dinner overlooking Lahaina harbor afterwards. Sorry you missed it.


----------



## Beefnot

Beefnot said:


> In full disclosure, that was written by a USPS employee. Fair points though I will recant. *USPS* is a pretty doggone efficient organization all things considered.


 


ace2000 said:


> Yea, perhaps so. But, then you recanted, so it's hard to really tell where you stand. I'm not sure what statement you were recanting then. I guess you meant only the post office. But, it really doesn't matter. I think people understood where I was coming from.


 
I recanted USPS only, which is why I had stricken it out in my repost.


----------



## Ken555

ace2000 said:


> No spin here.  The 7 million is significant because it's the number the original estimates were built off of.  Other significant numbers are how many are actually enrolled and paid, how many were previously uninsured, and how many of the young population are in the mix.
> 
> 
> 
> To it's credit, the Obama administration did an incredible job marketing the program.




Yes, this is significant. Imagine how many might have signed up had the website and everyone advocated signup by those who have been marginalized by existing policies. I suspect many more will be helped by this new law next year.

And, don't forget the numbers for those who couldn't change policies due to pre-existing conditions and now are able to and save a considerable amount each month. I count this category as significant a change as those who weren't insured.


Sent from my iPad


----------



## SMHarman

ace2000 said:


> It's the evil profit motive vs. the *inefficiencies and costs of another government program.*  I'm not taking a side on this, just saying there's advantages and disadvantages for both.





SMHarman said:


> *Please list these inefficient government programs.*  Most government programs operate more efficiently than similar private programs.





ace2000 said:


> Seriously ???  Go down the list... Post Office, Medicare, Medicaid, Disability, Social Security.  *They all are notorious for being inefficient with fraud, waste, and abuse.*  Things happen in those programs that just don't happen in private enterprise.
> 
> Are you saying otherwise?





SMHarman said:


> Huh I'm being challenged to provide efficient government programs because *I'm challenging the prior assertion that government is inefficient.* Nothing like a straw man!!!
> 
> Sent from my LT26i using Tapatalk





ace2000 said:


> Jim, let me clear it up for you on how it went down this path. Hopefully it will clear up your fog.
> 
> After this chain, I listed several government programs that I believe were not run efficiently (I don't want to list them again because I don't think we need to hash them out individually.) Then one program on my list became the focal point of yesterday's discussion. *The strange thing is I never got a direct response to my question to SMHarman, only his post describing my question as a "straw man" when I quoted his exact post.*



I was quoting you...  I know it got lost in the mix.  A generallization of the inefficiencies of government programs.

We then took apart the efficient USPS as an example were we could pull apart the government directed USPS and the private FedEx/UPS


----------



## ace2000

SMHarman said:


> I was quoting you...  I know it got lost in the mix.  A generallization of the inefficiencies of government programs.



No problem.  Nobody else cares and if they do they can look at the posts (#940 and #959).  I think it's pretty well laid out.  

I've moved on.  If I'm falsely accused of using a "straw man" (#959) and playing "games" by Ken (#960), I'm probably going to defend myself.  I'm willing to leave it at that.


----------



## ace2000

Ken555 said:


> And, don't forget the numbers for those who couldn't change policies due to pre-existing conditions and now are able to and save a considerable amount each month. I count this category as significant a change as those who weren't insured.



I'll add one more significant number - how many uninsured have signed up through the Medicaid expansion?  That number has probably made the biggest dent in the uninsured.


----------



## Passepartout

ace2000 said:


> I'll add one more significant number - how many uninsured have signed up through the Medicaid expansion?  That number has probably made the biggest dent in the uninsured.



I heard on the (NPR) radio this morning that an additional *9 million* were signed up for Medicaid on top of those* 7.1 Million* who signed up for ACA. That number doesn't count the *3.1 million* young people who are covered on their parent's policies. They are different entities. Whether that number were new enrollees to Medicaid or if that number included those who were on Medicaid before it's (optional by state) expansion was not made clear. 

Indeed, the expansion of Medicaid to those too poor to qualify for ACA, may be the 'back door' into 'single payer' healthcare. Like in Great Britain, Canada, France, Germany, Japan and the other countries with single payer, The Gov't Health Service- or whatever they call it- is very basic- a safety net. People in those societies who want 'elective' procedures, dentistry, eyeglasses, or any but the most basic services pay extra for coverage for that.


----------



## SMHarman

Passepartout said:


> Indeed, the expansion of Medicaid to those too poor to qualify for ACA, may be the 'back door' into 'single payer' healthcare. Like in Great Britain, Canada, France, Germany, Japan and the other countries with single payer, The Gov't Health Service- or whatever they call it- is very basic- a safety net. People in those societies who want 'elective' procedures, dentistry, eyeglasses, or any but the most basic services pay extra for coverage for that.


In the UK the NHS does not cover adult dental or vision, but does cover pediatric vision and dental and dental during pregnancy.
Basically NHS is your healthcare, not your dental or vision plan.
NHS covers everything cradle to grave but at times for non urgent elective surgery you will wait.  The result of a system using 90+% of resources rather than having hundreds of MRI machines sitting around idle most of the day or etc.
What the middle and upper classes then buy is a top up cover.  In many respects it is quite a limited policy, like an HMO here, you will still first see your general practicioner.  Many of the more affordable ones require that if the procedure can be done timely on the NHS they perform it, however if there is a waiting list for the NHS you can elect private and that treatment is covered on your insurance.
The insurance excludes whole classes of treatment as the private system is not set up to cover them including delivering babies and dialasis as a couple that come to mind.
This kind of insurance also has the added social benefit that if you are having the work done privately then you are not taking the place of someone else without the insurance in the NHS system.

But the NHS also trains the doctors, largely at its own expense with (i think) a requiring a commitment from the doctor at the back end to continue to provide service to the NHS.

http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/

This means doctors are not as highly paid in the UK in cash terms, but with liability coverage taken care of by the NHS and training costs also taken care of by the NHS they are also not hundreds of thousands of dollars in debt resulting in not needing quite as many $$ to service that debt and pay for liability coverage.

http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/

There are many pieces of the healthcare puzzle to fix in the US.  For example, treatment costs can be reduced by reducing doctor training costs as detailed above.


----------



## Passepartout

Sounds like a perfectly sensible system the Brits have there. I hope I live long enough to see something similar here.

Jim


----------



## bogey21

Passepartout said:


> I heard on the (NPR) radio this morning that an additional *9 million* were signed up for Medicaid on top of those* 7.1 Million* who signed up for ACA. That number doesn't count the *3.1 million* young people who are covered on their parent's policies. They are different entities. Whether that number were new enrollees to Medicaid or if that number included those who were on Medicaid before it's (optional by state) expansion was not made clear.



The numbers have me confused.  I think I remember hearing that the ACA was enacted to provide coverage to some of the 35 million who were uninsured  when it was enacted.  Now I hear there are 40 million uninsured notwithstanding the 7 million who have signed up for the ACA and the 9 million who signed up for Medicaid.  I must have something wrong as this doesn't make sense to me.

George


----------



## Passepartout

bogey21 said:


> The numbers have me confused.  I think I remember hearing that the ACA was enacted to provide coverage to some of the 35 million who were uninsured  when it was enacted.  Now I hear there are 40 million uninsured notwithstanding the 7 million who have signed up for the ACA and the 9 million who signed up for Medicaid.  I must have something wrong as this doesn't make sense to me.
> 
> George



Does it really matter whether the number is 35 million or 40 million? The number is squishy. People are born. People die. People go to work and get insurance, people drop out. Whatever the number was this morning, or yesterday, or last week, it's a different number tonight.

The important number is the many many people who didn't have insurance last November and December before ACA took effect, and have coverage now.


----------



## Conan

Here's an interesting take on the numbers covered and not covered:


> Even with millions of Americans gaining access to health care thanks to  Obamacare—seven million have signed up, but 9.5 million are now covered  thanks to Obamacare (Medicare expansion, kids who can stay on their  parents health care plans until they're 26)—the Congressional Budget  Office estimates that 30,000,000 Americans will remain uninsured in 2017  despite Obamacare. That number is not expected to budge. There were  60,000,000 uninsured Americans before the passage and implementation of  the Affordable Care Act and halving the number of uninsured Americans is  a huge achievement and a hard-won victory. But... again... still: *30,000,000 uninsured Americans*. So the hardships, bankruptcies, and deaths due to lack of access to health care will continue. But instead of 45,000 Americans dying every year  because they lack health coverage, after 2017 we can look forward to  "only" 22,500 Americans dying annually because they lack access to  health coverage. That's "just" 7.5 9/11s. Every year. Forever.
> http://slog.thestranger.com/slog/archives/2014/04/01/obamacare-enrollment-hits-7000000-number


He goes on to say that this will be the case unless/until "we" win the fight for a single-payer system that covers all American citizens.


----------



## ScoopKona

Passepartout said:


> The Gov't Health Service- or whatever they call it- is very basic- a safety net. People in those societies who want 'elective' procedures, dentistry, eyeglasses, or any but the most basic services pay extra for coverage for that.



One of the things that drives me loopers about living in America (and yes, I was born here -- I can trace it back to well before the revolution), is that those "elective" procedures like eyeglasses cost pennies on the dollar compared with the horrible consequences of people on the freeway who need a new prescription.

It is simply stupid that some people have to choose between new glasses/contacts/surgery and food/rent/utilities. How much would it cost each of us to insure that we aren't driving on I-95 with someone who hasn't had an eye exam in 20 years? A sawbuck? 20 bucks? Freakin pennies on the dollar if you ask me.

I wish to [not allowed to say] that we would ALWAYS institute the "pennies on the dollar" plan, in all cases all the time.


----------



## ace2000

bogey21 said:


> The numbers have me confused.  I think I remember hearing that the ACA was enacted to provide coverage *to some of the 35 million who were uninsured  when it was enacted.*  Now I hear there are 40 million uninsured notwithstanding the 7 million who have signed up for the ACA and the 9 million who signed up for Medicaid.  I must have something wrong as this doesn't make sense to me.



The numbers are a continuous moving target and the graph below shows why.  The amount of uninsured when the law was enacted was closer to about 55 million.


----------



## ace2000

Please note the asterisked item below the graph.  There are several states that have decided to not play along with the Medicaid expansion.  The bottom level of the blue line may be overestimated because of that.


----------



## ace2000

Passepartout said:


> I heard on the (NPR) radio this morning that an additional *9 million* were signed up for Medicaid on top of those* 7.1 Million* who signed up for ACA.



There have been several sources quoting the LA Times research over the last few days.  I'll provide a link to the source below.

My summary:

- 6 million have signed up on the new marketplace (we now know that number has been shifted upwards to 7 million).

- About one third of whom were previously uninsured (7M * .33 = 2.3 million)

- 4.5 million previously uninsured have signed up through Medicaid

- 3 million have gained coverage under the "under 26" provision.

*Net gain in uninsured: about 9.5 million - 10 million*


http://www.latimes.com/nation/la-na...l-20140331,0,6550360,full.story#axzz2xYx7CcJb


----------



## ace2000

Passepartout said:


> Does it really matter whether the number is 35 million or 40 million?



I think this is a fair point.  Do any of these numbers matter?  Of course they do, because that's what future premiums are based off of... actual numbers.

However, I'm with Jim - do they really matter to the average "Joe"?  If I was a politician on the "anti-ACA" side, I'd be staying away from talking about the numbers and focus on other arguments.


----------



## bogey21

ace2000 said:


>


 
Definitely progress.  Was it worth the cost to taxpayers and the impact on those who lost their doctors, hospitals and insurance they liked?  Only time will tell.

George


----------



## ace2000

bogey21 said:


> Definitely progress.  Was it worth the cost to taxpayers and the impact on those who lost their doctors, hospitals and insurance they liked?  Only time will tell.
> 
> George



George - don't ruin the party.  Those costs are being passed on to future generations.  We all say we care about our national debt, but nobody else besides you and I feel it's showstopper.


----------



## Passepartout

bogey21 said:


> Definitely progress.  Was it worth the cost to taxpayers and the impact on those who lost their doctors, hospitals and insurance they liked?  Only time will tell.



Who has lost doctors or hospitals or insurance they liked? People get to choose the insurance that is accepted by their doc/hospital before they buy it. Only an idiot would buy insurance that is not accepted by their provider. As to 'insurance they liked', Insurance companies were freed to re-issue any plans they offered. As you know, insurers review their plans and change their policies every year anyway. This year they were simply required to have minimum standards on their offerings.

Over time, it will be easier when one can go online or walk into an 'insurance center' and see a simple menu. Maybe like this:

Bronze plan: $4000 deductible- 50% pay after met at $X price
Copper plan: $3,000       "      - 60%  "             at a little more
Silver plan  : $2,000      "       - 70%  "            at a little more
Gold  plan   : $1,000      "       - 80%  "            at even more

All plans have X number of visits & all diagnostics paid with no deductible or co-pay. Choose your plan and insurance company based on the doc/hospital in it's plans.

As has been said time and again over the 4+ months we've managed to keep this thread going without it being closed (THANK YOU, MODERATORS) the ACA is just a start. It's a work in progress. Much modification remains to get more people insured, lower costs, make coverage more universal. As you said, George, Time will tell.


----------



## geekette

Passepartout said:


> Who has lost doctors or hospitals or insurance they liked? People get to choose the insurance that is accepted by their doc/hospital before they buy it. Only an idiot would buy insurance that is not accepted by their provider. As to 'insurance they liked', Insurance companies were freed to re-issue any plans they offered. As you know, insurers review their plans and change their policies every year anyway. This year they were simply required to have minimum standards on their offerings.
> 
> Over time, it will be easier when one can go online or walk into an 'insurance center' and see a simple menu. Maybe like this:
> 
> Bronze plan: $4000 deductible- 50% pay after met at $X price
> Copper plan: $3,000       "      - 60%  "             at a little more
> Silver plan  : $2,000      "       - 70%  "            at a little more
> Gold  plan   : $1,000      "       - 80%  "            at even more
> 
> All plans have X number of visits & all diagnostics paid with no deductible or co-pay. Choose your plan and insurance company based on the doc/hospital in it's plans.
> 
> As has been said time and again over the 4+ months we've managed to keep this thread going without it being closed (THANK YOU, MODERATORS) the ACA is just a start. It's a work in progress. Much modification remains to get more people insured, lower costs, make coverage more universal. As you said, George, Time will tell.


Right, if one lost anything, they chose to.  No one was required to buy via exchange, a person could certainly select a policy from the ins co they already had.  If people swapped to cheaper plans that did not contain the providers/facilities they wanted, then they made the compromise based on price.

My primary doctor has always made a point of accepting whatever ins a patient had so one need not stop at "well, they aren't on the list, I just won't ever go to that doctor again".  everything is negotiable, why wouldn't one attempt to get the provider and ins co to make it happen?  OR, go to whomever you like, it's really only a question of Who Pays, you or ins co.  Another choice...


----------



## Beefnot

Passepartout said:


> Who has lost doctors or hospitals or insurance they liked? ..... Insurance companies were freed to re-issue any plans they offered......This year they were simply required to have minimum standards on their offerings.


 
Theoretically speaking, I would imagine that the required minimum standards can cause insurers to drop certain plans or raise the pricing on similar plans such that an individual may need to opt into a different plan that does not reflect the risk that s/he was willing to accept and which contains a different network of doctors that does not include their preferred provider.


----------



## Passepartout

ace2000 said:


> We all say we care about our national debt, but nobody else besides you and I feel it's showstopper.



I think we agree more than you think. However we feel there are different ways to deal with it. There are those that feel that the pickle we got ourselves into has been brought about by unwise and un-thought-through wars (Iraq and Afghanistan and Panama and Granada come to mind), corporate welfare (Wall Street and GM bailouts), farm subsidies to conglomerates like Cargill and ADM. Military contracts to states with powerful politicians, (don't dare consider closing an airbase or shipyard or cancelling a billion dollar EACH! jet fighter) and such items as the famous $600 toilet seats. Millions of research dollars to develop pens that write in zero gravity for astronauts. Russia gives their cosmonauts pencils. The list goes on and on. 

Meanwhile Americans go without healthcare in the wealthiest country in the world. People go bankrupt while their doctors have to flip a coin to decide which of their Mercedes or Tesla's or Porsche's to take to work. It's a matter of priorities. You have yours and I have mine.

In the Reagan Years, top tax rate was 92%, now it's 39%. I don't think we need to go back to the pre-Reagan rates, but some compromise might be in order.

Jim


----------



## SMHarman

geekette said:


> Right, if one lost anything, they chose to.  No one was required to buy via exchange, a person could certainly select a policy from the ins co they already had.  If people swapped to cheaper plans that did not contain the providers/facilities they wanted, then they made the compromise based on price.
> 
> My primary doctor has always made a point of accepting whatever ins a patient had so one need not stop at "well, they aren't on the list, I just won't ever go to that doctor again".  everything is negotiable, why wouldn't one attempt to get the provider and ins co to make it happen?  OR, go to whomever you like, it's really only a question of Who Pays, you or ins co.  Another choice...


Thats nice of them. At my employers renewal this year I made a list of key doctors.  Mrs SMHarmans, Miss SMHarmans etc and called them with the list of coverage options (7 different options) I had, put ticks in boxes and then when all done had to stick with Cigna otherwise someone was switching doctors.
The illusion of choice is a wonderous thing!


----------



## ScoopKona

Passepartout said:


> In the Reagan Years, top tax rate was 92%, now it's 39%. I don't think we need to go back to the pre-Reagan rates, but some compromise might be in order.



Actually, in the Reagan years it topped out at 50% You have to go back to the Eisenhower years for the 90+% rates.  http://www.ntu.org/tax-basics/history-of-federal-individual-1.html

I am ALL for raising taxes. The very wealthy 1% controls 90% of the wealth in this country but pay only 70% of the taxes. That shifts the tax burden to the middle class (because the poor can't pay it).

Control 90% of the wealth? Then pay 90% of the taxes. Fair is fair.


----------



## bogey21

ScoopLV said:


> The very wealthy 1% controls 90% of the wealth in this country but pay only 70% of the taxes. That shifts the tax burden to the middle class (because the poor can't pay it).



There is a difference between wealth and income.  In many cases the wealthy paid Federal Income Tax on their "wealth" back when they earned it.  If they inherited it, there is a good chance there were inheritance taxes paid in addition to the income taxes paid back when it was earned.

George


----------



## geekette

SMHarman said:


> Thats nice of them. At my employers renewal this year I made a list of key doctors.  Mrs SMHarmans, Miss SMHarmans etc and called them with the list of coverage options (7 different options) I had, put ticks in boxes and then when all done had to stick with Cigna otherwise someone was switching doctors.
> The illusion of choice is a wonderous thing!



you had 7 options if you stuck with employer ins, you opted to stick with employer and pick an option from the 7 choices you limited yourself to.  where's the illusion part?


----------



## vacationhopeful

*On my medical insurance premium LAST MONTH *was the little notice that MY current policy would NOT be renewed as it did NOT comply with ACH. So, I decided that my choices were: wait til OCTOBER when my current policy expires or do the ACH during this Open enrollment (by Mar 31st) or have bigger issues come October (like no insurance or accept whatever plan offered at whatever rate while waiting for Jan 1st Open enrollment).

*This month's fine print on the Medical Insurance invoice *is an email address to send "Notice of Intent to Cancel" ... I think I chose wisely. 

PS Checked with my Druggist over the weekend what she has been hearing about the NEW policies...*basicly, the premiums are $300 per individual HIGHER on the ACH. *No one is happy. My pharmacy is in located in an area of $425K-800K+ homes. My monthly premiums saw that rate increase - so NOW, it is $997 per month with $5000 co-insurance still - the $300 monthly increase. And no better benefits; more expensive co-pays.

Of course, if I had LESS INCOME, I would be subsidized ... but I would have either had NO INSURANCE or a more basic policy in prior years. And I am still paying off the LAST 2 years of co-insurance payments to the hospitals ($9000 of existing co-insurance fees for the last 2 years). 

Doing the math, I had $375 per month of co-insurance "premiums" for the past 24 months. Now, I will have a mandatory premium increase of $300 AND the possibilities of MORE co-insurance charges in the future .... while still paying on the OLDER coinsurance fees.

I HATE the inventor of *co-insurance - it is a sick tax - use tax on medical services - smoke & mirrors in marketing *- a victim fee.


----------



## ace2000

vacationhopeful said:


> PS Checked with my Druggist over the weekend what she has been hearing about the NEW policies...*basicly, the premiums are $300 per individual HIGHER on the ACH. *No one is happy. My pharmacy is in located in an area of $425K-800K+ homes. My monthly premiums saw that rate increase - so NOW, it is $997 per month with $5000 co-insurance still - the $300 monthly increase. And no better benefits; more expensive co-pays.



You can check the record, I've mentioned it at least a handful of times...  the next layer of this onion will be increasing premiums.  Coming real soon.


----------



## Blues

ace2000 said:


>



Ace, you've printed that graph from the CBO at least twice that I can recall.  But you seem to have forgotten to include the rest of their estimate.  Quoting from the very same document:

"Those amounts do not reflect the total budgetary impact of the ACA. That legislation includes many other provisions that, on net, will reduce budget deficits. Taking the coverage provisions and other provisions together, CBO and JCT have estimated that *the ACA will reduce deficits over the next 10 years* and in the subsequent decade. (We have not updated our estimate of the total budgetary impact of the ACA since last summer; for that most recent estimate, see Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act.) "

[Emphasis mine]


----------



## Luanne

vacationhopeful said:


> *On my medical insurance premium LAST MONTH *was the little notice that MY current policy would NOT be renewed as it did NOT comply with ACH. So, I decided that my choices were: wait til OCTOBER when my current policy expires or do the ACH during this Open enrollment (by Mar 31st) or have bigger issues come October (like no insurance or accept whatever plan offered at whatever rate while waiting for Jan 1st Open enrollment).



My understanding is that if you lose your insurance at some point during the year, prior to the next open enrollment, you CAN still sign up for ACA.


----------



## ace2000

Blues said:


> Ace, you've printed that graph from the CBO at least twice that I can recall.  But you seem to have forgotten to include the rest of their estimate.  Quoting from the very same document:
> 
> "Those amounts do not reflect the total budgetary impact of the ACA. That legislation includes many other provisions that, on net, will reduce budget deficits. Taking the coverage provisions and other provisions together, CBO and JCT have estimated that *the ACA will reduce deficits over the next 10 years* and in the subsequent decade. (We have not updated our estimate of the total budgetary impact of the ACA since last summer; for that most recent estimate, see Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act.) "
> 
> [Emphasis mine]



Blues, it sounds like a good discussion.  The graph is labeled "Net" impact.  I'm not sure how the paragraph you quoted squares with the graph I posted.  I think it gives us all something to talk about.  

If the ACA in it's entirety (including the Medicare expansion) does reduce deficits,* I would be more inclined to support it.*  I'll make that statement right here.


----------



## Blues

ace2000 said:


> Blues, it sounds like a good discussion.  The graph is labeled "Net" impact.  I'm not sure how the paragraph you quoted squares with the graph I posted.  I think it gives us all something to talk about.
> 
> If the ACA in it's entirety does reduce deficits, I would be more inclined to support it.  I'll make that statement right here.



Sounds good, Ace.  I believe that the disconnect is right there in the title of that graph: "Comparison of CBO's Estimates of the Net Budgetary Impact of *the Coverage Provisions* Contained in the Affordable Care Act".  [Again, emphasis mine].

In other words, that graph covers the impact of just one of the many provisions of the ACA.  In effect, you're looking at the costs without looking at the provisions that provide net reductions.

-Bob


----------



## vacationhopeful

*I can see my monthly budget deficient GROWING with ACH* ... by $300 monthly with NO INCREASE in benefits nor a decrease with co-insurance. I had major surgery in 2013 and a 2 night hospital stay in 2012.

I have been paying $100 per month for the 2012 stay and have $800 MORE to pay due to CO-INSURANCE ... to the hospital.

I had a $5000 CO-INSURANCE bill due to the 2013 major surgery - am paying $75 a month for the last 7 months ... to the surgeon & a (different)hospital.

Starting May, 2014, I will have a $1000 per month Health Insurance premium (over the $697 individual policy premium for the last several years).

I am over 60 ... basicly, I am healthy. Do you think I give a rat's ass about the Federal Government deficient being reduced via ACH? (which personally I feel is impossible). There are MANY, MANY areas of the Federal Budget which seriously need to be review for MUCH BIGGER reductions .... duplication of programs .... multiple federal health care services .... luxuries for the few senior government officials .... handouts to big business.


----------



## Blues

[withdrawn]


----------



## SMHarman

geekette said:


> you had 7 options if you stuck with employer ins, you opted to stick with employer and pick an option from the 7 choices you limited yourself to.  where's the illusion part?



My employer (who is large) offered about 7 healthcare options e.g. 
Cigna PPO
Cigna HMO - No out of network
Cigna - High Deductible
Athem PPO
Anthem HMO
BXBS PPO
BXBS HMO 
and so on.

But realistically as not all the 'line in the sand' doctors we wanted to keep were in BXBS, Anthem etc we were down to choosing a Cigna Plan.  Then the exonomics of the three Cigna plans come into play.  High deductible works for the very wealthy and the very healthy (whole other tax code debate about what I think of HDHP with HSA).  HMO had no out of network so that took the choice back to one, an illusion of choice.

Now I prefer the customer service of BXBS, hate Cigna Customer Service and claims processing, the way out of network checks are neatly cut exactly 30 BUSINESS days after the claim is submitted.  The errors in processing (I just had a claim rejected as they decided the date of service was 1/14/11 not 1/14/14 - seriously, you could not take a second look at the doc.  Of course they wait 30 BUSINESS days to reject the claim and then another 30 BUSINESS days to reprocess the claim!

Clearly we could have sourced new doctors but decided that was something we did not want to do.

#FirstWorldProblems


----------



## Ken555

SMHarman said:


> Clearly we could have sourced new doctors but decided that was something we did not want to do.



This is your choice. There's no illusion; it's obvious. If you don't accept the choices given, then you may perceive them as not having a choice, but the choice is there for those who want to change. 

Personally, I also felt this impact on doctor selection. My primary physician doesn't accept any insurance any longer. I scheduled an annual checkup after discussing it with her billing office as my new plan won't cover *any* of an out-of-network annual physical, and discussed cash discounts etc. I'm sure we'll figure it out and it won't cost much (esp since it seems every annual physical also includes other stuff, which inevitably gets classified as a regular visit). But, it's yet another hurdle to navigate. That said, this should be *no surprise* to anyone - change is inevitable.


----------



## Luanne

We've had to change doctors several times over the years due to changes in providers.  This was well before ACA.


----------



## SMHarman

Ken555 said:


> This is your choice. There's no illusion; it's obvious. If you don't accept the choices given, then you may perceive them as not having a choice, but the choice is there for those who want to change.
> 
> Personally, I also felt this impact on doctor selection. My primary physician doesn't accept any insurance any longer. I scheduled an annual checkup after discussing it with her billing office as my new plan won't cover *any* of an out-of-network annual physical, and discussed cash discounts etc. I'm sure we'll figure it out and it won't cost much (esp since it seems every annual physical also includes other stuff, which inevitably gets classified as a regular visit). But, it's yet another hurdle to navigate. That said, this should be *no surprise* to anyone - change is inevitable.



For the healthy changing doctors is less of a headache than for those with chronic disease.  The education process of a new primary care physician, what has been tried, what works what does not is all new to them and they don't read the tens of pages of case notes sent over from the prior doctor at $1 page or something silly like that.


----------



## ScoopKona

SMHarman said:


> #FirstWorldProblems




I could not disagree more, or more strongly with this. The rest of the first world doesn't even THINK about this nonsense because they sorted out healthcare decades ago.

This is 100% absolutely and completely #AmericaBehindtheTimes not #FirstWorldProblems. (First world problems are things like, "Honey, do we really have to eat Kobe beef Hamburger Helper _again_???"


----------



## ace2000

Blues said:


> Sounds good, Ace.  I believe that the disconnect is right there in the title of that graph: "Comparison of CBO's Estimates of the Net Budgetary Impact of *the Coverage Provisions* Contained in the Affordable Care Act".  [Again, emphasis mine].
> 
> In other words, that graph covers the impact of just one of the many provisions of the ACA.  In effect, you're looking at the costs without looking at the provisions that provide net reductions.
> 
> -Bob



Possibly.  I'll have time to look at it more this evening.  I seem to recall some data or a chart that showed how the future deficits will increase in the next 7 or 8 years, and the primary cause was the Medicaid expansion (I'm estimating the timeframe).  I did a brief search and can't find anything like that now.  Could I have seen it on Fox News?  

I've heard the President say that "Obamacare will not add one dime to the deficits", and I've seen similar quotes in other sources.  I'll be honest with you, I always thought they were referring to the exchanges or a partial view of the ACA.  It really is big deal to me to know the answers about this question.


----------



## ace2000

Blues said:


> In other words, that graph covers the impact of just one of the many provisions of the ACA.



Blues, how do you come to the conclusion that it covers "one of many provisions"?  I'm just curious if you read something and know for sure.


----------



## Ken555

SMHarman said:


> For the healthy changing doctors is less of a headache than for those with chronic disease.  The education process of a new primary care physician, what has been tried, what works what does not is all new to them and they don't read the tens of pages of case notes sent over from the prior doctor at $1 page or something silly like that.




True, but this is a performance issue with the business of medical practices and the practical preference of choosing your own doctor. While I appreciate the distinction and agree that I want to keep those doctors I am most comfortable with (for whatever reasons) I still am not prevented from changing and most assuredly have choice. Remember it is up to the doctor to determine which insurance the practice accepts, so don't confuse that with insurance, group/company offerings or ACA options. 




Sent from my iPad


----------



## ace2000

After reading vacationhopeful's post, I have a general question for anyone.  Does previous health history have an impact on the rates you pay on the ACA?

For me, I've always been covered by government or employee plans in the past, so I don't know.


----------



## SMHarman

ScoopLV said:


> I could not disagree more, or more strongly with this. The rest of the first world doesn't even THINK about this nonsense because they sorted out healthcare decades ago.
> 
> This is 100% absolutely and completely #AmericaBehindtheTimes not #FirstWorldProblems. (First world problems are things like, "Honey, do we really have to eat Kobe beef Hamburger Helper _again_???"



Actually, you are bang on right and this is where the crazy of doctor restriction by network comes back to my illusion of choice point.

Coming from the UK NHS you don't have to go looking around each year to find out what network what doctors are in etc.

#AnywareButAmerica

I think my FWP comment was more related to my situation than others in this thread.  My medical coverage premiums for my family with my group plan and employer subsidy are within what I can manage on my income.

Which brings me onto the thought that I regularly share, if you take my city, state, federal taxes, medical premiums, copays and deductibles and add it all up it pretty much comes to the 40% higher marginal rate tax band that I paid in England (income over £31,866 ~ $50k)

http://en.wikipedia.org/wiki/Taxation_in_the_United_Kingdom#Income_tax

Medical should be free at the point of use.  It does not mean that you are not paying for it, just not paying for it when you may not have the means to pay.


----------



## geekette

Ken555 said:


> True, but this is a performance issue with the business of medical practices and the practical preference of choosing your own doctor. While I appreciate the distinction and agree that I want to keep those doctors I am most comfortable with (for whatever reasons) I still am not prevented from changing and most assuredly have choice. Remember it is up to the doctor to determine which insurance the practice accepts, so don't confuse that with insurance, group/company offerings or ACA options. Sent from my iPad



Right, if you change doctors and are unhappy with the new one, try try again.  I would do that with any service provider that refused to pay attention to their customer.  

What if your preferred doctor retired, moved, etc?  Wouldn't you have to go thru the same thing?  

Some people change doctors when they move, altho I would not do so if the move was in same city/area (same primary doc for as long as I've been in this city).


----------



## vacationhopeful

The problem with the OLD STYLE health insurance, YES  ... prior medical issues would cause a NEW POLICY to be rated as AT A HIGHER RISK FACTOR (higher rate).  As I did NOT change policies in the past 2 years, I did not change my risk factor rating. And think if your were in a large group, it was the large "group's" combined Risk Factor. Individual, small or family policy holders got zap.

For ACH, there is NOT PRIOR risk factor or future risk factor -- you pay for WHAT you can afford in a policy as for options. You can not be denied  - I did the applications and it DID NOT ask me for my prior health history or prior (or if I even had a) health insurance policy in effect now.


----------



## Ken555

ace2000 said:


> After reading vacationhopeful's post, I have a general question for anyone.  Does previous health history have an impact on the rates you pay on the ACA?
> 
> 
> 
> For me, I've always been covered by government or employee plans in the past, so I don't know.




Nope. They must accept everyone and cost is determined by age and plan.


Sent from my iPad


----------



## Ken555

SMHarman said:


> Actually, you are bang on right and this is where the crazy of doctor restriction by network comes back to my illusion of choice point.
> 
> 
> 
> Coming from the UK NHS you don't have to go looking around each year to find out what network what doctors are in etc.
> 
> 
> 
> #AnywareButAmerica




Welcome to America! 

#USA4DocMartin


Sent from my iPad


----------



## geekette

ace2000 said:


> After reading vacationhopeful's post, I have a general question for anyone.  Does previous health history have an impact on the rates you pay on the ACA?
> 
> For me, I've always been covered by government or employee plans in the past, so I don't know.



No.  To my knowledge there is no health questionaire, it's age-based.  There are no pre-existing condition blocks so no disclosure necessary.

Since males and females now get charged same rate, probably don't even have to disclose that.


----------



## ace2000

vacationhopeful said:


> The problem with the OLD STYLE health insurance, YES  ... prior medical issues would cause a NEW POLICY to be rated as AT A HIGHER RISK FACTOR (higher rate).  As I did NOT change policies in the past 2 years, I did not change my risk factor rating. And think if your were in a large group, it was the large "group's" combined Risk Factor. Individual, small or family policy holders got zap.
> 
> For ACH, there is NOT PRIOR risk factor or future risk factor -- you pay for WHAT you can afford in a policy as for options. You can not be denied  - I did the applications and it DID NOT ask me for my prior health history or prior (or if I even had a) health insurance policy in effect now.



Good to know... thanks to you, Ken, and geekette for the quick response.


----------



## Blues

ace2000 said:


> Possibly.  I'll have time to look at it more this evening.  I seem to recall some data or a chart that showed how the future deficits will increase in the next 7 or 8 years, and the primary cause was the Medicaid expansion (I'm estimating the timeframe).  I did a brief search and can't find anything like that now.  Could I have seen it on Fox News?
> 
> I've heard the President say that "Obamacare will not add one dime to the deficits", and I've seen similar quotes in other sources.  I'll be honest with you, I always thought they were referring to the exchanges or a partial view of the ACA.  It really is big deal to me to know the answers about this question.



I had always heard the conservative pundits making the claim of increased budget deficits, and every time, the answer, not only from the dems but also from the mainstream press, was "but the CBO's own estimates show that ACA will actually *reduce* the deficits."  So when I saw your graph from the CBO, something didn't click.  That's why I looked it up and read carefully.  It's all a matter of presenting the full picture rather than cherry-picking parts.



ace2000 said:


> Blues, how do you come to the conclusion that it covers "one of many provisions"?  I'm just curious if you read something and know for sure.



From exactly the quote that I provided.  The CBO presents that graph as part of the estimate of the coverage provisions, then goes on to state that "those amounts do not reflect the total budgetary impact of the ACA. That legislation includes many other provisions that, on net, will reduce budget deficits."

I believe I'm reading that right, that just the coverage provisions cost money, but the sum-total of all provisions result in a net deficit reduction.  But if you read it differently, I'd love to know a different interpretation.

Also, I'm taking it on faith that that statement includes all provisions, including Medicaid expansion.  But truthfully I don't know; would love a confirmation one way or the other.

-Bob


----------



## Blues

Follow-up:
The quote I provided came from the CBO publication on this web page:
http://www.cbo.gov/publication/44176

By following the link referencing the letter to John Boehner, you get here:
http://www.cbo.gov/publication/43471

The first bulletted point on that page states:
"The ACA contains a set of provisions designed to expand health insurance coverage, which, on net, are projected to cost the government money. The costs of those coverage expansions—which include the cost of the subsidies to be provided through the exchanges, *increased outlays for Medicaid* and the Children’s Health Insurance Program (CHIP), and tax credits for certain small employers—will be partially offset by penalty payments from employers and uninsured individuals, revenues from the excise tax on high-premium insurance plans, and net savings from other coverage-related effects." 
[emphasis mine]

So, as I read it, they are taking into account increased costs, including Medicaid expansion, and still come to the conclusion that the new revenues and cost reductions more than make up for it, resulting in a net reduction in the deficit.

That's my interpretation.  I'd love to hear other interpretations.

-Bob


----------



## ace2000

Blues said:


> I had always heard the conservative pundits making the claim of increased budget deficits, and every time, the answer, not only from the dems but also from the mainstream press, was "but the CBO's own estimates show that ACA will actually *reduce* the deficits."  So when I saw your graph from the CBO, something didn't click.  That's why I looked it up and read carefully.  It's all a matter of presenting the full picture rather than cherry-picking parts.
> 
> 
> 
> From exactly the quote that I provided.  The CBO presents that graph as part of the estimate of the coverage provisions, then goes on to state that "those amounts do not reflect the total budgetary impact of the ACA. That legislation includes many other provisions that, on net, will reduce budget deficits."
> 
> I believe I'm reading that right, that just the coverage provisions cost money, but the sum-total of all provisions result in a net deficit reduction.  But if you read it differently, I'd love to know a different interpretation.
> 
> Also, I'm taking it on faith that that statement includes all provisions, including Medicaid expansion.  But truthfully I don't know; would love a confirmation one way or the other.
> 
> -Bob



Thanks Bob.  That does help and hopefully it'll save me some time this evening.  

Also, I didn't "forget" or "cherry-pick" the information I provided.  When I posted the original chart to Ken's general question about budget impact, that was a graph that I had remembered seeing previously and so I posted that and mentioned it as a starting point for the discussion.  It looked pretty complete to me.  I expected a lot more overall discussion and feedback on Ken's question than what was given.  I believe if you go back to the post, hopefully you can see that point.  

For some reason, it's pretty customary for people to not post their entire articles into their posts on TUG.   I posted the graph because I thought it was pertinent.  I appreciate the clarification if you're right about what you're saying.


----------



## Blues

ace2000 said:


> Thanks Bob.  That does help and hopefully it'll save me some time this evening.
> 
> Also, I didn't "forget" or "cherry-pick" the information I provided.



You're welcome.  I've learned a lot from this discussion.

And I'm sorry that my poor wording made it appear that I was accusing you of cherry picking.  I had no such intention.  I meant to say that the conservative pundits and Fox News tend to cherry pick what they present.  Many apologies if my poor wording left a wrong impression.

And BTW, the latter page that I referenced, the letter from CBO to John Boehner, quantifies the deficit reduction they expect.  It says that the repub's bill to repeal the ACA would add $109 billion to the deficit between 2013 and 2022.  IOW, that's the amount that the enacting of ACA is expected to save over that period.

Thanks for the spirited discussion.

-Bob


----------



## Ken555

Blues said:


> It says that the repub's bill to repeal the ACA would add $109 billion to the deficit between 2013 and 2022.  IOW, that's the amount that the enacting of ACA is expected to save over that period.




Wow. If accurate, how could any politician anywhere even think of advocating repeal, or drastically change, the ACA without a new plan ready to go on day one to prevent our deficit from increasing?


Sent from my iPad


----------



## ace2000

Blues said:


> I believe I'm reading that right, that just the coverage provisions cost money, but the sum-total of all provisions result in a net deficit reduction.  But if you read it differently, I'd love to know a different interpretation.



Blues (Bob), I believe you're reading it right also.  I've spent 2 hours researching the Internet for the real impact of ACA on the budget and I've seen nothing that has firmly convinced me otherwise.

I am even ready to concede further that I cannot even find any definite evidence that suggests that the ACA will end up adding to the deficits at all.  I did see some opinions and some credible possible negative scenarios that might happen, but it's speculative. 

Bottom line for me: the graph I presented is very misleading and I apologize to everyone for submitting it to the thread.


----------



## ace2000

Bob, you've caused me re-evaluate some things here and I really appreciate that aspect.  I hope you choose to contribute even more to the thread in the future.

Thanks!


----------



## ace2000

ace2000 said:


> I am even ready to concede further that I cannot even find any definite evidence that suggests that the ACA will end up adding to the deficits at all.  I did see some opinions and some credible possible negative scenarios that might happen, but it's speculative.



One last comment about the subject of the ACA's impact on the budget.  I do still believe that the overall financial impact will be negative in the end, but unless I firmly believe that I have some facts to back up that opinion, you won't be hearing those words from me again on this thread.


----------



## Passepartout

ace2000 said:


> Bottom line for me: the graph I presented is very misleading and I apologize to everyone for submitting it to the thread.



Glad Bob read the rest of the article from CBO and posted his findings here. Sometimes the taste of crow kinda puts it all in perspective. We've all had our share. It tastes like chicken.


----------



## Conan

*We're [Not] Number One*

https://www.youtube.com/watch?v=UsQkAjR4P_0#t=233

In the Social Progress Index,  the United States excels in access to advanced education but ranks 70th  in health, 69th in ecosystem sustainability, 39th in basic education,  34th in access to water and sanitation and 31st in personal safety. Even  in access to cellphones and the Internet, the United States ranks a  disappointing 23rd, partly because one American in five lacks Internet access.
....
This Social Progress Index ranks New Zealand No. 1, followed by  Switzerland, Iceland and the Netherlands. All are somewhat poorer than  America per capita, yet they appear to do a better job of meeting the  needs of their people.
....
Many who back proposed Republican cuts in Medicaid, food stamps and public services believe that such trims would boost America’s competitiveness. Looking at this report, it seems that the opposite is true.

Ireland,  from which so many people fled in the 19th century to find opportunity  in the United States, now ranks 15th. That’s a notch ahead of the United  States, and Ireland is also ahead of America in the category of  “opportunity.”

Canada came in seventh, the best among the nations in the G-7. Germany is 12th, Britain 13th and Japan 14th.

http://www.nytimes.com/2014/04/03/opinion/were-not-no-1-were-not-no-1.html?smid=tw-share&_r=0


----------



## geekette

SMHarman said:


> ...
> 
> Which brings me onto the thought that I regularly share, if you take my city, state, federal taxes, medical premiums, copays and deductibles and add it all up it pretty much comes to the 40% higher marginal rate tax band that I paid in England (income over £31,866 ~ $50k)
> ...
> Medical should be free at the point of use.  It does not mean that you are not paying for it, just not paying for it when you may not have the means to pay.



What's bothersome to me is that poverty levels, etc., are federal, but cost of living is local.  What might afford living in a studio apt in a bad part of town here at poverty level might get a van down by the river in a larger city or a 2 bd apt in a small town.  

400% of poverty to qualify for subsidy is either ridiculously generous or screwing folks over.  I forget the figure beneath which it's Medicaid, but the gap between medicaid and subsidy is pretty large in some areas.  Those folks are the big question marks for me, as to whether they can actually afford to be insured (let alone be sick and actually use the insurance), and whether or not their penalty is waived because they truly cannot afford it.  

While we may now have lifetime caps lifted, I don't think we'll see the end of personal bk over med bills yet.  Some of the annual out of pocket amounts could indeed wreck a persons financial life.  Coming up with thousands, even if the provider will float payments for a year, could be devastating to someone barely making ends meet before getting sick and becoming unemployed.  

I agree with you completely - point of service should be free, everyone should pay something (but there will always be folks that really Cannot and also some Cheats).  

I also can afford my med stuff (you know, so far) but like Linda, have had to finance bills before.  What alarms me is when I hear about 'prepay' before ever going for treatment.  I'm not sure how prevalent this is, but it is very troubling to me.


----------



## geekette

ace2000 said:


> Blues (Bob), I believe you're reading it right also.  I've spent 2 hours researching the Internet for the real impact of ACA on the budget and I've seen nothing that has firmly convinced me otherwise.
> 
> I am even ready to concede further that I cannot even find any definite evidence that suggests that the ACA will end up adding to the deficits at all.  I did see some opinions and some credible possible negative scenarios that might happen, but it's speculative.


I think that since Medicaid is not expanding as far as originally expected, there is even less to 'pay for'.  

I don't know if your latest analysis went by original estimate or revised, and what the difference is.

Just curious.  but not curious enough to go look it up myself


----------



## Conan

A useful illustration from the Wall Street Journal
(But it would be good to see a similar illustration for a married couple age 35 with a couple of young children.)

Edited to add:
I checked and the young family's premium is about 2/3 (per adult) of what the 55 year old pays:  $722/month combined before subsidies. 
Of course the children are also included at that price.


----------



## ace2000

geekette said:


> I think that since Medicaid is not expanding as far as originally expected, there is even less to 'pay for'.
> 
> I don't know if your latest analysis went by original estimate or revised, and what the difference is.
> 
> Just curious. but not curious enough to go look it up myself



After researching the question, I just don't see how anyone else can provide a better budget impact analysis than the CBO right now. Definitely not a guarantee that they'll be right in their predictions, but who has the resources to do a better job? There are going to be so many variables though. One of the keys is going to be enforcement of the ACA provisions. There is no way to figure that out right now.

I got lost because the title of the chart had the words "Net Budgetary Impact", and I was very confident it meant the real net impact to the budget. Plus I had actually seen that chart in a few other news articles, so I felt good about it. After Bob referenced the paragraph in the source, I'm convinced he's right.

The impact on my beliefs is significant because the budgetary issues are my number one concern. The rest of my concerns are relatively minor, and I've always supported helping the ones that need it, even if I have to pay more.

On your specific question about original or revised, if you look at the chart there are several lines each offering a different revision date. The analysis that contained the chart was published in May 2013, so I don't know.

Additional Edit:  A lot of the numbers are labeled as "original".  I assume they're almost always referring to the point in time when the ACA was enacted into law.  I ran into a few articles that mentioned the "30 million" uninsured that George referenced yesterday.  I have no idea where they came up with that number.


----------



## ace2000

Passepartout said:


> Sometimes the taste of crow kinda puts it all in perspective. We've all had our share. It tastes like chicken.



Ha!  Yea maybe so, but next time can you all serve it with some ketchup or something ???  It tasted kinda lousy.


----------



## ace2000

Ken555 said:


> Wow. If accurate, how could any politician anywhere even think of advocating repeal, or drastically change, the ACA without a new plan ready to go on day one to prevent our deficit from increasing?



Yes, it's a good question.  One side was completely shut out of the original negotiations though, so that may have something to do with it.  Plus the fact that the current law happens to have the President's name labeled on it.  

In the past week, there was a budget submitted for debate by one side.  Of course, it called for repeal of the ACA with no suggested plan to take its place.  Do I really believe they actually want to repeal it?  No, but it feeds their base.


----------



## Passepartout

ace2000 said:


> One side was completely shut out of the original negotiations though, so that may have something to do with it.  Plus the fact that the current law happens to have the President's name labeled on it.
> 
> Do I really believe they actually want to repeal it?  No, but it feeds their base.



Let's not re-write history here. If you'll recall, The President and congressional leaders asked, no, begged the Republicans for their plans that would accomplish the following: Lower costs, insure the uninsured, end pre-existing condition exclusions (you know the rest of the minimum standards) and no plan was brought forth. There STILL is no competing plan. 

Then to address the 'name of the President' on it. Again, that name was put on it by the Republicans as a 'dig'. It was only after he embraced the name by saying "Obama DOES Care!" that the name stuck. Do I wish it was still known as Affordable Care? Sure. But after a new administration takes over, and 30-40 million are signed up for it, a new name will surface.

Can it still be repealed? Maybe. I don't find it likely, especially with this President still sitting through 3 more open enrollment periods. Americans got a taste of what 'insurance for all' might look like, and the major tenets won't go away.


----------



## ace2000

Passepartout said:


> Let's not re-write history here.



Let's not re-write my "post" here.

I mentioned negotiations.  This was not a bi-partisan solution and it was not a compromised solution, nor one attempted.  I think I understand where you're coming from though.  The last two presidential candidates both had solutions to health care, though nowhere near the scope of the ACA.  

Again, I am strongly suggesting that this will not be repealed and rolled back to square one.  There's absolutely no way.  Repealed, or replaced, or enhanced, or whatever all become a matter of semantics.


----------



## Ken555

ace2000 said:


> This was not a bi-partisan solution and it was not a compromised solution, nor one attempted.  I think I understand where you're coming from though.



Ace, you're slipping into no mans land for TUG. And some of us won't be able to hold back and not respond when we see partisan statements that are, perhaps, heavily influenced by biased "news" sources (which are themselves heavily influenced by those with a cause). History should not be rewritten, so be careful what you post here.



> The last two presidential candidates both had solutions to health care, though nowhere near the scope of the ACA.




Really? Something more than a campaign promise without details? The kind we have had for decades that turn out to be meaningless? I wonder which candidates you have in mind...as "last two" would strictly be defined as Obama and Romney, and Romney only had campaign promises... 

FWIW, I humbly suggest you not bother responding to this post, or else we may likely finally have this thread locked.


Sent from my iPad


----------



## Ken555

ace2000 said:


> Yes, it's a good question.  One side was completely shut out of the original negotiations though, so that may have something to do with it.



Oh, please. Utter nonsense. "One side" removed themselves unilaterally from discussions. That's not the same as being "shut out".



> In the past week, there was a budget submitted for debate by one side.  Of course, it called for repeal of the ACA with no suggested plan to take its place.  Do I really believe they actually want to repeal it?  No, but it feeds their base.




I really wish we could have a civil debate here on this topic, as I think it would be interesting. I think we need competing ideas for our national budget and direction as it keeps everyone continually pushing for the best solution (as it should in commerce, etc). I define it like this: one side wants those who earn the vast majority of money to pay the vast majority of taxes, and the other side doesn't. Guess which side is going to benefit most from this weeks Supreme Court decision on removing campaign donation limits and how influential that will be on twisting the election? No, don't answer... 


Sent from my iPad


----------



## ace2000

Ken555 said:


> FWIW, I humbly suggest you not bother responding to this post, or else we may likely finally have this thread locked.



This is hilarious.  You make your initial political post and then suggest to me not to respond to your political post.  

There's two sides to the story, if you can't handle hearing an opposing view, don't make the first political post in the first place.  Because right now, you've given your "opinion" and I gave mine.  I'm willing to leave it alone, but please stop your "games".


----------



## ace2000

Ken555 said:


> Guess which side is going to benefit most from this weeks Supreme Court decision on removing campaign donation limits and how influential that will be on twisting the election? No, don't answer...



More of the same...


----------



## Ken555

ace2000 said:


> This is hilarious.  You make your initial political post and then suggest to me not to respond to your political post.
> 
> There's two sides to the story, if you can't handle hearing an opposing view, don't make the first political post in the first place.  Because right now, you've given your "opinion" and I gave mine.  I'm willing to leave it alone, but please stop your "games".




Ace, I'm done letting you have the last word when you slip in political statements - it was you who just referenced the last "two" candidates first, not me. Then you think it's hilarious that I'm making a political post first. I think we all get the picture here - you really don't want to discuss this issue, as you know it's not allowed here, but still you want to slip in your own biased viewpoint of history...well, some of us won't allow that anymore, and if it requires locking this thread to stop it, so be it.


Sent from my iPad


----------



## SueDonJ

I think we're done.


----------

