A partial answer (here) is, Yes, except it is worded in the opposite direction

That would be incorrect Mr. Lamp.
The correct answer is NO. No one is penalized at all for anything.
Links here and the summary here are to the complete law and the summary.

No, I'm not saying it's GOING in that direction, I am saying that smokers and obese individuals have paid more in insurance costs, already.

From 2006:
Higher Insurance Rates

If you are/were not a smoker, you may not even have noticed, but all the questionaires you fill out when you purchase insurance ask if you smoke, or have smoked, in X# years. And then, how much you smoke. And drink, and BMI, etc. If you check yes to these, your rates are higher than if you say no. It has been this way for years.

(I get to answer NO to all of them, finally!)

You're assuming certain behaviors (i.e. people who have health insurance will go to the doctor instead of using the ER for non-urgent problems), but many people prefer the ER for reasons I'd rather not get into. Unfortunately, costs will go down only if there's a penalty for using the ER when you could have gone to the doctor, and penalizing people for ER use is a tough political sell. More often, the hospital and/or doctors get penalized when people use the ER inappropriately. That saves money (if person A turns up five times in seven days and his/her insurance refuses to pay for more than the first visit) but results in hospitals closing ERs wherever possible.

(The disincentive in Ontario ERs is that in an urban center you'll typically wait 12+ hours or more to be seen. That's good for filtering out those who ought to go to an Urgent Care; not so good for those who are urgently/emergently sick. But I digress.)

There is a penalty for doing that. It's much more expensive. What other penalty would you be talking about?

:D

I had a boss years ago that just that same strategy
(but he used the most up to date references available)

It's not more expensive (to you) if your copay is $3 and you refuse to pay it, and your premiums don't go up no matter how much you use the ER, and there's no limit on the number of ER visits you can make. You still have to be seen. But you're right, people with private insurance and hefty ER co-pays already get penalized for frivolous ER use.

Part of Obamacare is to get more people on private insurance.

If you don't have insurance, and you don't have money, your options may be a $1200 ER visit you can't afford, or a $300 doctor visit you can't afford. You can't afford either, so you might as well go to the one that is set up to accept walk-ins.

If you have insurance, a new option is added - a doctor visit with a $20 copay.

Not everyone will take advantage of it. The people you'd rather not get into, perhaps. But many will. Once the hurdle (sometimes mental as much as financial) of getting enrolled is overcome, it's much easier to do it.

OH, gotcha. Yep, I know all about that. I had poison ivy last spring, lost my job and had to buy individual insurance in the fall. I was rated because I had a "skin condition."

OR ... Dr. visit with a $20 co-pay vs ER with a $20 copay. If the copays are the same, the behavior will likely not change. However if the Dr. visit has a $20 copay and the hospital has a $100 copay, the behavior may change.
Same goes with meds. generic vs name brand where available.

Total aside, I did read an article about some doctors group advocating that birth control should be available over the counter. THAT makes a lot of sense & removes the whole religious "whatever" from that situation. Seems like a win-win idea to me.

ER copay is usually more, and on top of the actual ER cost, instead of in lieu of it.

I'm aware of that HM. With a son like mine the ER staff are not strangers, not by a long shot. Did you get the point I was making though?

The only issue is, I'm not okay with that if it means that low-income/impoverished people do not have access to birth control without paying out-of-pocket. That and the potential for accidental or uninformed misuse, without a doctor making sure the treatment is taken correctly. Birth control - like ALL medical care - should have little or no out-of-pocket cost. the only things that should cost anything at ALL, and even then maybe less than what it costs now, are things to treat mild mild mild ailments not worth seeing a doctor, like a cold or a headache or gas or indigestion.

alls I know is that my rent went down 22 dollars about 2 weeks before he got reelected

Yes, many will (hopefully) take advantage of the chance to get private insurance and will behave as you expect. The mental hurdle you mention, though, is significant. The healthy 20-somethings who choose not to have insurance now, because they feel the odds of needing it are low, will resent paying premiums and copays. They aren't likely to take on that expense unless forced to, when they've been getting along without. (There are quite a few young adults in smalltown who work full-time, decline to enroll in the health insurance their employer offers because it would cost them $20/month although they choose to spend funds on smoking 2 ppd, and still expect to be seen in less than an hour at the local ER while fully intending never to pay for that service. This is very common in the smalltown area.)

Another part of Obamacare is expanding eligibility for MA. This sounds like a good thing on the surface; however, it will be a serious problem for hospitals. At the moment they can write off non-payment from self-pay patients. If the percent of MA patients they see goes up substantially they will get the MA rates (which are less than overhead for both private practices and hospitals), no copays even at $3, no writeoffs, and they'll go bankrupt. Especially when there are no limits to the number of ER visits on MA - there are individuals, and not just a few, who have 200 ER visits/year in smalltown.

Please understand, this isn't a rant at self-pay or MA patients. One of my sons is on MA and I see the system from his perspective as well as from that of a provider. But people don't always behave as you'd expect, and there are always unexpected results from programs that seem beneficial at first glance.

They are part of the problem.

This group will have no choice but to get health insurance once obamacare is completely implemented. And that's good for the system as a whole.

At first, if they don't get health care, they will look at the penalties and do the math and see that the penalty is the better deal, but the penalties get more and more severe as obamacare is phased in. And when it is fully implemented in 2018, the healthy 20 somethings will have to decide whether they want to pay an arm and a leg for nothing or an arm and a leg for healthcare.

And the policies offered at the exchanges will be subsidized based on need.

It always devilishly amusing to read David Brooks in the NY Times.
He wants so badly to be a leader, a guru, or at least be on the winning team.
He's just not sure which team will win.
Today, he joined the Limbaugh team...

It's going to fail HOORAY ! YEA! YEA! ... I told you so


NY Times
DAVID BROOKS
April 25, 2013
Health Chaos Ahead
But wait a minute, David.
After showing us your width of knowledge... yada, yada, yada
You go on to say:

So which is it, David ... CHAOS ... or just take a while ?

Next month David will be telling us of all the benefits and success
that he predicted for Obamacare.

.

We will all know when Obamacare has succeeded when the first Republicans go back to calling it it The Affordable Care Act. This of course will not work well, since they have spent years attaching Obama's name to it.

You know it's too late when wiki puts in a redirect ....

http://en.wikipedia.org/wiki/Obamacare

If they had tried this bullshit decades ago, Social Security would be called Roosevelt Security.

BTW, Brooks is right about one thing. Obamacare is a sea change. It is not a band-aid. For good or ill is an at least partial overhaul of an entire system. There will be adjustments. We will see the real result in 5-10 years. There will always be detractors, even if there is a consensus that it turns out to be an improvement. But then again, some of the people who disagree with Obamacare still think the Earth is only 10,000 years old.

I got an email today saying Obamacare should be run by walmart. :facepalm:

One of the most efficient delivery systems of goods and services to consumers that exists today, with an almost across the board presence in the U.S. . I can see the pros and cons.

Add in Costco, Sam's Club, B.J.'s, and everyone in the US is probably 30 minutes from a store.

They're the worst thing to happen to the United States since the Vietnam war.

Ummmm. My entry for the worst thing is in three words...

The next time you go to a doctor's office or a hospital or any kind of health center,
check the I.D. badge of the person interviewing you before (?) you are seen by your physician.
That person may then even give you a diagnosis and write a Rx for you,
and you may not ever meet "your" licensed physician (M.D., D.O, etc)
That person was a Certified Medical Assistant

Sounds pretty innocuous, doesn't it ?
At least until you find out that your cute little 20-something's
education only amounted to what would otherwise be called an A.A.
(Community College) degree via an "accelerated program".
And, they are programs being heavily touted now by the
"for profit" colleges, universities, and on-line centers of "education"
Google "Medical Assistant certification" for more info.

OK, so doctors have had assistants and secretaries for years. So what ?
Well, aside from the competence of your CMA, the real rub is when it comes time for your billings.

The physician or hospital can charge for that CMA's time and service at the
same $ rate as "your" physician would have charged for their own
time and service as if they, he/she, had actually provided your service.

Thus, the physician or hospital can have "legal clones" of themselves
seeing patients and practicing medicine, and earning $ at any
number of different locations (offices/clinics) and times (24/7)
and the $-income is at the highest level commensurate with
that physicians "local and customary" charges,
and Medicare/Medicaid must reimburse these charges without question.

If these charges are higher than is covered by your own insurance,
you get the bill for your excess part of this scheme.

So, pay attention to who actually is treating your medical problems.
Maybe you would want to insist on seeing a doctor in person.

these are the same doctors and hospitals that for decades have had a problem with the idea of 'nurse practitioners'?

*shakes*head*

Yes, it's the same idea as was the original concept of a "licensed nurse practitioner",
but there the LNP was a graduate RN, so there was/is a great deal more education and experience.
L.P.N.'s now are setting up their own practices, billings, etc. with only
a modicum of physician medically relevant oversight.

The R.N. is something of an endangered species, particularly
those who graduated out of a 2-year post-graduate program.
The Schools of Nursing are in the process of eliminating the 2-yr programs,
and defining the RN as a 4-yr graduate degree and licensure.

The CMA is a financial gimmick to multiply (literally) the $ earnings of physicans.
This is not a result of a government requirement or Obamacare...
it is strictly the workings of capitalism and physicians efforts to
maintain and/or improve their standard of living.

My friend got her LPN then went back for her RN and was told her credits wouldn't transfer so she basically had to start over.

Do you think that's why some stay at LPN and don't go further?

I'll see the NP for a cold or something. Not been real impressed with them. The PAs, I like, and will see them in a pinch. But if it's for my chronic illness I insist on seeing my D.O.

I may be talking out my...I didn't read EVERYTHING. ;)

Sorry, my senior-moment fingers typed on their own again.

In my post above, I was referring to Licensed Nurse Practitioners,
which should be abbreviated as L.N.P.
But then I typed L.P.N, which (to me) means Licensed Practical Nurse.

I'm not sure, but I think the L.P.N programs have been phased out.
They were also 2-year under-graduate programs, while R.N.'s
were 2- or 4-year post-graduate degrees/licensures.

But I do agree with business about non-transfer of credits.
My daughter has a 4-year R.N. + many years of experience + a Master's of Nursing degree.
She too was told by some Schools of Nursing that her Master's degree credits were not transferable.
To get her L.N.P. license she would essentially have to start over as if she were at the RN level.

She is just finishing her 4-semesters of full-time course work and 600 clinical training hours
... next is the State Boards Exam and she'll be a full-fledged L.N.P. :cheerldr:

I also meant by NP 'nurse practitioner' which really had nothing to do with my question about LPN vs RN. So my comment about NP, PA, and DO were actually irrelevant. :blush:

If they're phasing out LPN what will the proprietary schools do? Those credits don't transfer so certainly they shouldn't also offer RN.

I thought LPNs just did 'lesser' duties (for want of a better word) than an RN, in hospitals and such.

Now, as opposed to years ago, the Licensed Nurse Practitioner, is/can be essentially equal to an M.D.
Legally, I think they still must have some sort of oversight connection to an M.D.,
but beyond that they see patients, make diagnoses, write perscriptions, etc., etc.

Let me try again:

I thought Licensed Practical Nurses (not Nurse Practioners) did 'lesser' duties (for want of a better word) than an RN, in hospitals and such.

Yes, I agree with this.

Sorry, sometimes I can't read straight.

Shit, I hope you two aren't preparing MY medication! ;) :p: :D

Sometimes you just need to go to the doc to get a medical certificate saying, yep, you've got a cold, take a few days off work. DownUnda, a nurse in the Dr's practice can assess this, and sign the forms. They know to be on the lookout for more serious conditions - such as meningitis - but they bloody well better not be charging Doctors rates for it!

My co-pay is the same no matter who I see. Hmmm...

Health Care Exchange application forms: (Under Forms/April 30, 2013)

Probably so, but my rant above was about how much your physician bills
the government (Medicare) or your insurance company when you are seen by a Medical Assistant.

You, yourself, might not see any of this until the billings exceed
the amounts Medicare or your insurance company is willing to pay for that service.

For those of us that are retired and on Medicare, we get a statement
every month from US Social Service showing the dates of medical care,
the amounts billed by the service provider, and the amounts paid by the patient.

Sometimes, the service provider charges are ridiculous
... e.g., $500 for one of our office visits was less than 30 min.
but we had paid only the co-pay of $15.

I was thinking it should be cheaper than 25 bucks when I see the nurse and she barely looks at my throat, though I hadn't thought of that until your posts. It's just the cost for an 'office visit' I guess.

I honestly must take insurance for granted, I never thought about if it actually costs less.

And I certainly won't complain about my insurance: I've made good use of it. Then again, about 13 years ago I was paying the same premium for a 'family' plan (just me and my husband) as the guy whose wife was on baby number 10. I guess it all comes out in the wash, usually, eventually.

(Which makes me wonder what my options will be if I am soonly unemployed!) Dammit.

Your options would be stay healthy or else :neutral:

Hey, we've gone full circle.... your option is: Obama ;) care

I know, then I would have to think about stuff, and stuff. Ugh. I'm not good at doing real life grown up stuff, like planning.

Regardless of the mindless mindset of the GOP to shut down our government,
Obamacare will finally become a reality in people's lives next week.

It is time to truly understand what it is and how to make
it's many facets work for the BEST EFFECT on our own personal lives.

If someone is lazy and puts it off until after March 31, 2014,
they will have only themselves to blame if things don't go the way they hope/expect.

Here is an very good article that can be a gateway into understanding
the "whats-in -it-for-me" and "what-should-I-do"...

NY Times
ARA SIEGEL BERNARD
9/27/13
A Guide to the New Exchanges for Health Insurance

Some interesting questions about Obamacare.

A problem is that the underlying assumption within that link (Bloomberg) is not valid,
or at least it was not the primary raison-d'etre for the Affordable Care Act.
Most the issues in that link are based on a thesis of "saving $". For example:
But the primary basis of the ACA / Obamacare primarily was to insure
the (15 ?) millions of people who did not have their own health insurance,
and then to support these newly "insured" by inducing larger numbers
of relatively healthy (working younger people) to buy into their own
health insurance instead of going without.

It's a matter of POV.

AFFORDABLE Care Act.
No, the idea was to get skyrocketing medical costs under control by getting everyone covered and having more efficiency. That should have been single payer instead of the hodge-podge we got. But as I said before, it can be fixed as we go.

I agree that getting "skyrocketing medical costs under control" is part of the ACA,
but that was proceeding under Medicare even before the ACA was passed.
My issue was with the premise of the various "observations" in the link.

We are probably in agreement also on "should have been single payer
instead of the hodge-podge we got."

But that was just one of the options being considered, but that obviously
would have been far more of a upheaval in the US economy
than the more limited transformations of the current form of the ACA.

This editorial is from Forbes...

Forbes
Todd Essig
9/29/13

Let's Get Personal: Obamacare Really Is Good For The Young And Healthy
It is left to the reader to explore this man's calmly stated
and sensible approach to health insurance...
.
.

Just heard on the radio that Aetna (CA's biggest medical insurer with 48% of the market), has dropped out of the exchange for ObamaCare.

This is going on in many states: Iowa (lost their largest insurer), New Hampshire and West Virginia have no health care provider, at all.

The larger health insurers are reluctant to get into this because it's unknown territory for them. On the one hand, the law prevents them from raising the rates above a certain level, but on the other hand, they have to provide a certain level of care to those that they cover.

To top it off, if the healthy people don't need to buy it (maybe paying the IRS penalty will be a better alternative for them), then the whole insurance plan idea, goes out the window. Insurance can't work that way. The risk has to be spread around an adequate base of subscribers.

The national health care plan is a good one, but I wish they would have done more planning and studying, before they decided to pass it into law. So many things - like all these exemptions, etc., they make for a very poor start for it.

The way this is being phased in, the penalties for not buying insurance in the first year are relatively small. (At least the last time I looked into it several months ago.) So it's probably wise from a financial point of view to sit on the sidelines until next year when the penalties become real, and health care will be cheaper than the fine. Of course, if you pay for the health care, then you can use the health care. If you opt for the fine, you get nothing in return.

Debating Obamacare is kind of funny that way, because it's only being phased in slowly, so it will be a few years before we know exactly how it's going to pan out.

So why are so many easily brainwashed Limbaugh disciples telling me ObamaCare has damaged the economy? You mean these "hate all Americans" Americans do not think for themselves?

Bill King, a health care insurance broker (sells plans for scads of companies), was doing a commercial today (first time I've heard this), saying that EVERY health care plan premium is going up by 30% to 100%.

You can avoid that, by re-upping your plan for another year, before 2014, with one insurer only, allowing the old rates until 2015.

There's your Affordable Health Care Act in Action.

A local DJ (not a conservative), was saying he will have a 99% increase in his health care premium, and his fiance will have a 66% increase (she earns considerably less than him). The people who really do well with Obama Care, are the very low income wage earners.

The middle class and up, will get soaked, as they are finding out. Thus their dissatisfaction with it.

Sounds like BS to me. They are required by law to spend 85% of premium money on providing patient care. So raising the rates would just result in them having to give more refunds.

It would be better if you called Bill King's office, directly at this (toll free) number:

Call Bill King - 800.442.5464.

Or swing by his office in Carlsbad if you're close by in So. CA.

His website: http://kingbenefits.com/

I'm not sure how the medical insurance companies will structure their premiums, under Obama Care.

glatt doesn't have to call anyone, since that part of the law went into effect last year. He's not just listening to some asshole on the radio, he has already experienced the refund.

People who do this stuff professionally recently discovered costs were not only reduced. But were reduced by more than originally predicted. Informed posters quote from people who actually learn facts. The naive so hate America as to routinely recite claims from a least informed and wacko extremists.

He quotes hearsay from a DJ. After all, when something comes from a voice on a radio, it must have more credibility. It must be true. It came from a magic box.

A friend loved promoting scams to the most religious. The most naive automatically believe what they are told rather than learn how to become a patriotic American - an informed moderate.

Limbaugh said, "We want America to fail." Adak still believes it.

Remember a TV show called "Threes Company"? Wacko extremists told their disciples that ABC was corrupting American morals. So their disciples called ABC in mass numbers complaining about how much they hated that show they just saw. One small problem. The first episode of "Threes Company" had not aired yet. Would not air until the next day. Amazing how disciples of wacko extremists could view a TV show a day before it aired.

Brainwashing the most naive is that easy. The law has not even taken effect. But the most dumb and naive claim ObamaCare has done major damage to the economy BEFORE it even started. Same naive also know ObamaCare has raised costs before it even started.

This is Saddam's WMDs all over again. With the most anti-Americans (dumb and uneducated manipulated by hearsay) claiming a disaster has done harm BEFORE anything even started.

His expert is a radio DJ. No wonder he believes "We want America to fail."

This ASSHOLE is a professional medical insurance broker. He deals with many of the major insurers, in this state.

Why don't you call the toll free number and see what the FACTS are about NOW, in THIS area?

It's free, and then you might be a more tolerant fellow, when people state something you don't want to believe in.

If glatt is in the lower middle class income range, or below, he should receive a nice reduction in his premium costs, under Obamacare. Those rates will vary widely from state to state. Tennessee for instance, has rates that are about half the rate for Wyoming, according to that "asshole" Dr. Gupta on the TV.

So sure, some people will pay less. Others will pay more. If you are in So. CA, and earn above average, you will pay a lot more.

Yeah, a lot of insurance companies and agents are trying to get people to renew their plans under the old rates. Probably not out of the goodness of their hearts. Bill King is paid on commission.

Duh, he's a fucking salesman.

Buy a policy and get a second policy free,
just pay an second shipping and handing.

As seen on TV.

Call within 10 minutes and we may use some lube.

Fox News themselves found THAT REPUBLICAN voters were MORE THAN fifty percent MORE FAVORABLE to factual evidence, like the Affordable Care Act, than they were to made-up things, like Obamacare.

I understand why the references to job and perhaps, to character, but I don't understand why the continual return to sexual innuendos. Can't you argue a point of view without them?

Yes, Bill King is a broker - so a glorified salesman. Let's look at that. He 's paid on a commission - I don't know that, but it's very likely how he's paid. So, why would a salesman who's paid on commission, want you to buy the cheaper policy?

With the higher priced policy, he would make more commission, yet he's not trying to get us to buy the higher priced policy.

It sounds like he's trying to increase his market share, by giving us a valuable heads up on a future increase in policies, that has been announced by some companies.

In the ad, he names the companies - by name. Which one's will be increasing their rates this year in January, and which one will be increasing it's rate next year.

You could check that out and see if it was true or not, with a free phone call, but you're not interested.

When the facts conflict with your desired beliefs, the facts get ignored, and swept out of sight, and out of mind. It must be that tension it builds, that brings out the sexual innuendos.

Obviously, the facts can't be correct - of course not.:rolleyes:

No wonder you fall for this shit, you can't tell the difference between sex and rape.

You're concerned insurance rates are going up? Well duh, they've been going up way faster than the inflation rate for years. They've been driving the inflation. That's why the AFFORDABLE Care Act was passed. Now they will fall or at least level off across the country. I'm sorry they aren't in your neighborhood yet, like they have in glatt's.

Wait, no, I'm not sorry... you deserve it for your spreading half-truths and lies.

Yes! I have been working for the same company for 7 years (through this recession). Included in that time are a couple of raises and a promotion (totaling 22%-average of 3.14%/year). And yet, I take home less today than I did 7 years ago, thanks in large part to my insurance costs (which have more than doubled!).

I suspect many employers have been reducing or holding flat
their contributions to their employee's health care programs.
Certainly the counter-balance of unions during labor negotiations has declined.

I happen to get my family's health insurance through the same non-profit
agency as retired State employees, some teachers unions, etc.
Our premiums have gone up, but not nearly the % that you have experienced.

Also, policies do change (both more and less benefits) what
they offer and what they cover, along with co-pays, fees, etc.

Until the ACA came along, it was either take what your employer gives you,
or go back to college to get an MBA so you can compare the policies of different companies.
At least now there is a bit of common ground (the metal ratings) to compare one to another.
:rolleyes: