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

[bogey21]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

#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]

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]

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]

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]

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]

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]

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]

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]

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.