Obamacare
 

This is the best explanation I've seen about Obamacare, what it is/isn't, what it does/doesn't, and why.

very informative and even-handed

It makes me sad to think how much time, energy, money, and political good will
has been wasted by the GOP and GOP governors fighting Obamacare.

I wonder if Roberts will take much heat on this? His position seems conservative in the sense of not being disruptive of the way society has organized itself to address a difficult problem.

Maybe he listened to these Arizona republicans.

Is there supposed to be some correlation between the employment info and the insurance info?

Of course there is... but the other way.

The GOP has been bullet-pointing Obamacare as a "JOB KILLER"
ever since the ACA was introduced.

So we'd have more jobs without it. OK.

:D

Well we'd have more hiring anyway, as the uninsured workers would be dying faster. :haha:

But big increases next year.
link

Cost transference and cost reduction are different things. Getting those other people to pay for stuff ... never mind.

If the rate increases are justified, then complaining about it is essentially complaining that more sick people are getting treatment than were expected.

If they're not justified, then people will get rebate checks at the end of the year.

I suspect that, as mentioned in the article, the release of pent-up demand pushed much of the increase. Also, I suspect that a lot of people who were used to going to the ER for routine healthcare are still doing so, but now with insurance cards. That's going to hit the insurance companys' bottom lines until they can get their new members educated and paired with GPs.

Plus, as the article also mentioned, the mass of uninsured entering the system were more likely to be sick than those already insured, because being sick was precisely the reason they couldn't get insured under the old system.

Sicker and older... and they are an increasing population ...
But -
"If insurance regulators “do their job, my expectation is that [rates hikes] will come in significantly lower than what’s being requested.” BO

I don't know why I keep reading David Brooks' editorials in the NY Times.
Before I'm half way through one, I'm usually calling him "dumb ass" .
But actually, tho I still think him nuts, he often sets me to explore his references.

Once again, Brooks has played the motivator
Brook's editorial today is a good exploration of
OmabaCare coverage (% population with coverage)

Attachment 54052

and costs ($) given Brooks' 3 potential pathways our economy may take.

Great News! We’re Not Doomed to Soaring Health Care Costs

[*] link
This report also links decreasing Medicare costs to actual improvement in medical treatments,
as prompted by Medicare reducing payments to hospitals on "re-admissions".
That is, patients are getting better care (e.g., reduced hospital-caused infections),
and not needing to be readmitted.

The cynical might question if "re-admissions" were some sort of "profit center".


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Soooo ... For 2016, the NEW Obamacare changes are kicking in -
What are the changes you ask? Well I'll explain.
My premiums are increasing another 21%
My coverage is now ZERO until I meet a $6000- $6400 out of pocket minimum. That includes my prescriptions. So unless I average well over $500 a month in medical expenses, I will pay well over $6000 a year for NOTHING PLUS the increase in premiums!
WTF?
Remember to kick a democrat in the balls for me.

If they're telling you Obamacare forced them to do that, then they're selling you a bill of goods.

My biggest complaint is not with the ACA but the fact that it did not change our model for access to healthcare, your job. No other nation on earth uses this outdated model that is based on a time when companies used health care as a perk for your job and labor unions bargained for it. That was fine when most of the population worked jobs with the same company for many years and then retired which isn't how it is now.

We just got the new information on the NEW plan for next year at my wife's company. Last year we had a plan with BCBS and it was pretty good. The annual per person deductible was $1200 and was the out of pocket expenses. After you reached that you had 100% covered. Our Dr. copays were $35 for a primary and $45 for a specialist. Our prescription copay had 4 tiers, $0, $15, $35, $75.

The new plan sucks. We have a $1500 annual per person deductible, $3800 out of pocket and then an 80-20% payment coverage, they pay 80% and we pay the other 20%. The Dr. payments each went up $10 and the prescriptions went up as well. And while it is still costing about the same we are getting less. My wife pays $1000 per month pre-tax and her employer kicks in an extra $500 per month. Because it is a small company with a mix of ages for the workers they have an age based plan meaning the older workers pay more for insurance than the younger ones. Only about 1/3 of the workers there even get the insurance, the rest get a better deal through their spouses or from former employers who gave them an early retirement package so the pool is small which further increases the costs.

My wife could probably go on Medicare as she is 65 and just get a supplemental policy but I would have to find my own insurance and the costs are even higher that way.

You are spot on Chris.
Our deductibles are rising as well. This is in part attributable to our so-called Cadillac plan. Ours (we're covered through Pete) is a Cadillac plan because it costs a lot not because it covers a lot. When you have an aging group of computer nerds pulling long hours you will have high health care costs. Since we have an expensive pool of workers to cover ACA taxes the plan 40% on every dollar over $10,200 spent in premiums.

This is why we need a socialized system with the government as a single payer. The pool of employees at my firm is also aging, and our premiums are going up fast too.

I bailed on the standard plan last year and went with the very high deductible, lower premium, HSA plan. It pays for one physical, and then, since I have the family plan, we have a $6k deductible before the plan pays anything. But then it's covered 100% in network and 50% out of network. Basically, we get a free physical, and then pay out of pocket (pre-tax) for everything else, but if we get really sick, we won't go bankrupt. But the premiums are still too high.

Lets see ... looks like everyone agrees.

We are all paying MORE to have govt mandated insurance, but we all have LESS coverage.
Basically what this has turned into is VERY EXPENSIVE catastrophic insurance for all.

I'm $12,000 out of pocket between premiums and deductibles before I get a dime in coverage.
I hate to inform you all, but $12,000 will wipe out most, if not all of the people this was designed to help.
Oh, And I'm talking about the silver plans. I can only imagine how much worse it is with the bronze.

What a bag of shit we were sold. And don't bother blaming those "evil Ins. companies", the D's forced this upon us.
Now that they have created an even larger problem I cannot wait to see their next solution. Fucking idiots.

You know why Pelosi said "we have to pass the bill so you can find out what is in it"?
Because if anyone with 1/10th of a brain read & understood what it was, they would NOT have passed it.

For the 25 years before Obama was elected dogcatcher, we had increased premiums and more highly selective coverage every goddamn year.

ETA That said, I'm sorry that this affects you personally in this way.

Thanks, but from what I see, my actual coverage have fallen off a cliff and my premiums have skyrocketed over the last 5 years. YMMV.

Every year I get a refund from the insurance company because they didn't spend the required amount on claims. It's not a lot, but I LOVE it that Obamacare is making the insurance companies meet minimum standards.

And I have to parrot what UT just said. My insurance premiums have been going up consistently for my entire adult life and after Obamacare was passed, they have not gone up nearly as quickly. I think my increase in healthcare costs is because I am getting older and so are my co-workers. We are not a desirable pool.

I read an article on the uptick in premiums the other day pointing out that it took insurance companies a few years after the passage of the ACA to figure out what the rates should really be, they had to adjust to the fact that now they had to cover more people with pre-exisiting conditions, etc. They found out that Americans as a whole are a lot sicker than was expected. And since they are "for profit" companies they have to raise premiums and cover less in order to make a profit. Furthermore, the ACA has no bargaining power for costs like Medicare does. Even Medicare Part D (the drug part) can not bargain to get lower prices on drugs.

Because they haven't a clue about the people, only actuarial tables and reports. None of those executives have experienced knowing you're sick, but don't have the money, or even know a doctor, to do something about it, until you're taken to the emergency room.

This plan has brought a shitload of those people into the system where they can now get everything at least looked at, so they will. And people who think they're healthy, the I've never been sick a day in my lifers, don't see the need for insurance so will avoid it as long as they can.

Oh, and the medical profession's bosom buddy the drug companies spend billions through the media, making as many people as possible hypochondriacs.
Feel bad? We've a pill for that. Too fat/skinny? We've a pill for that. Raining? We've a pill for that. :rolleyes:

This, plus my kids will continue to be covered. The linkage to work is still a huge problem but more people are being covered.

That sounds more like "Catastrophic Health Insurance" than
what people usually think of as a health care program.

In any case, it's not correct to say you are paying for "...NOTHING PLUS...premiums"

Under ObamaCare...
Also, such insurance plans depend a great lot on whether your
State Governor has elected to expand Medicaid, or not.

If you’re eligible to buy a Catastrophic plan, you’ll see them displayed
when you apply and compare plans in the Marketplace.

.

To get on Medicaid you have to have income of about 400 bucks a year :bolt:

Buster, you may be right about qualifying for all of the benefits associated with Medicare/Medicaid,
but with respect to ObamaCare the eligible income levels are higher …

Determining eligibility for various ObamaCare plans and costs is complicated, and the
entire ObamaCare government website is needed just to work thru the spider web of details.

For example:
* Did your state Governor elect to expand Medicare ?
* What are your state's eligibility requirements ?
* How many members in your family ?
* What is your annual income ?
* What kind of coverage do you wish ?
* Do you qualify to tax credits, and if so how much ?
* Do you qualify for out-of-pocket expense reductions, and if so how much ?
* etc.

But, qualifying for the advantages of and cost reductions of Medicaid coverage,
the following annual income levels apply:

Below $21,983
You'll qualify for free or low-cost coverage through Medicaid based on income alone.

$21,983 - $39,825 You'll qualify for a Marketplace health plan with lower monthly premiums
plus savings on out-of-pocket costs, like deductibles and copayments.

$39,826 - $63,720 You'll qualify for a Marketplace health plan with lower monthly premiums.

Above $63,720 You won't qualify for savings on a Marketplace insurance plan.
You can buy insurance through the Marketplace at full price, or buy from other sources.

,

all i know is...
 

...before the ACA, I had perfectly servicable, affordable, insurance policy as a self-employed guy, and, after the ACA, that insurance was deemed substandard and cancelled. Now, I can't afford a policy without takin' a subsidy, which I won't do.

Not seein' the upside of Obamacare at all, not for me, anyway.

I don't understand this. If you are eligible for a subsidy, why wouldn't you take one?

Do you take the deductions the IRS offers you when you file your income taxes?

"I don't understand this. If you are eligible for a subsidy, why wouldn't you take one?"

Call me weird, but I don't want other folks payin' my way...I like doin' for myself...before the ACA, that's what I did with my little policy...now, if I want insurance, I gotta take a handout...unappealing idea.

#

"Do you take the deductions the IRS offers you when you file your income taxes?"

What dee-ductions? I got no steekin' dee-ductions....probably could find some but it's easier to give Shylock his pound and be done with it...no one can come to me later and lay claim to me if I'm paid in full.

Now days: I render unto Caesar what's due, in full, and expect to be left alone for my trouble.

You're quirky, henry quirk.

I, and I have the gut feeling that most people, take advantage of what the rules allow. If the government is saying "you have to pay A, but not B, or C" then I'm only going to pay A. I view the subsidies for Obamacare in the same light.

But I can see your point.

I don't like debt or indebtedness...got too much of it now as is (that I can't pay off)...can't see takin' on more, and that - to me - is what subsidies are: debt (and linkage and unnatural ties).

As for taxes: there was a time I took great pleasure evading and avoiding and minimizing...got older and less bolder and it just made/makes more sense to give over that pound and be done with it...as I say, if I'm paid up then I should be left alone.

But, if my combined tax bill gets much beyond fifty percent, I may have to revist my old ways...livin' close to the bone now...not givin' 'em my marrow too.

So, as it stands, you'll get appendicitis, go to the ER, have it taken care of, and either face a shitload of debt and indebtedness you don't like, or declare bankruptcy and foist the bill for it all on the taxpayers.

Because you drew an imaginary line in the sand according to whim.

Whether you're considered quirky or not, the bottom line is it's your money so you're entitled to do what you want with it. I don't agree with your positions on many things, but will defend till it hurts a little, your right to hold them. ;)

That pound will include a charge for not having insurance.

Toad,

I always pay my bills...I never default. An honestly acquired bill is not the same as takin' a subsidy.

'But, Henry you said, "got too much of it now as is (that I can't pay off)".

Sure, in one lump sum...I'm payin', just not as quickly or largely as I or the debt-holder would like...but I pay, so, don't worry, none of your tax dollars are coverin', or will cover, my ass.

#

"whim"

Go fuck yourself.

##

Bruce,

HA!

And: don't go fuck yourself.

##

Monkey,

As of now: no fine has been levied, and I'm not the habit of worrying about what 'might' happen. If and when: I'll deal with it then.

And: don't go fuck yourself.

Hmmmm.... HQ, you may have to deal with it sooner than you expect - next come the ides of April !

From the ACA website:
... this is only a small portion of all the if/then details

.

Lamp,

"You pay the fee when you file your federal tax return for the year you don’t have coverage."

As I say: 'I'll deal with it then'. I always pay my honest bills but there are 'options' when a bill is inflated or outright dishonest. We'll see.

And: don't go fuck yourself.









And, Toad: go fuck yourself.

Whole lotta fucking going on.

Obviously it's the heart of the matter.

You could pick any line in the sand to draw and how deep you draw it. It's just what you like.

Drawing a line in the sand based on consideration of one's self in the world is not the same as whim (buying tic-tacs on impulse). You disagree with me: well and fine, many do, but only you, in this thread, tried to reduce me, to reduce my thinking. You're a crapsack and can go fuck yourself.

Yes but being "reduced" doesn't really merit this severe triple over-reaction, so obviously it's the heart of the matter.

"doesn't really merit"

Sez you.

I'll decide what merits what for myself, thank you very much

And, in case you forgot: go fuck yourself.

OK, it's time to put the boys away.

.

You're right...sorry for hijacking the thread even slightly.

I can only say, as explanation, Toad gets up my nose in a big way and, while I mostly can *shrug* and be a duck, sometimes I can't (or won't).

Anyway: I'm done with it.

You are incorrect. I am now paying OUT OF POCKET for the first $6000-6400 of medical expenses AND the premiums which are now about $513 a month. So some quick math shows that I am getting NOTHING for the first $12,000 out of MY POCKET - all after tax $$ as well.

As for the State Gov - thats a shiny distraction as well. Medicaid has no bearing on my situation.

Last year I was financially forced to opt for a lesser policy. It was $434 a month. The rest stayed about the same. Since I cannot afford to get sick or injured, the massive OOP number doesn't matter.

Sadly next year (2017) my premiums are going up 32% this year alone to $638 a month. I literally cannot afford that. 4 years ago I was payin about $250.
I have begun to seriously consider not being insured and just paying the penalty. This is totally fucked up.

I'm guessing that the vast majority of you all have plans through work and this isn't affecting you as much as the rest of us.

Preventative care is free, and one major hospital visit can blow past $14,000 easily.

You ought to be able to set up a HSA to use pre-tax money for most of the non-premium costs, if you expect to spend thousands of dollars a year, or want to build up a tax-free nest egg in case you do in the future. I expect you can do this even if you plan to go without insurance.

You may be able to deduct your premiums as well, if they exceed 10% of your adjusted gross income; ie if your AGI is less than $76,560 for a $638/month plan.

"Not being insured" was the ONLY option for many, and will be again if the law is repealed. Any cost savings you realize in that system will be at the expense of people who actually need medical coverage (who may be a future you), and are therefore dropped.

Also note that the out of pocket costs are a MAXIMUM, not a minimum. Even if you're correct that the plan does nothing for you up until that limit*, it covers you 100% after you reach it. This was not the case before the ACA.

*And the plan probably does do something - free preventative care and negotiated prices.

1) Preventative care is NOT free.
2) Please don't lecture me on medical costs.
3) Shouldn't have to set one up.
4) Well aware what OOP cost are.
Thanks for the effort though. Still doesn't change the reality of my budget not allowing for the cost. As I said - 4 years ago I was only paying about $250 for a far better plan ie:$2500 OOP and $20 co-pays. I have no dental now either - can't justify the expense.

1) The entire visit may not be, but a large portion of the tests should be, unless your plan is grandfathered in, which seems unlikely if you just switched.

3) You don't have to; if your total medical expenses (including dental) are over 10% of your AGI, you can deduct all of them (minus any that you used HSA for, if you have one). If the premiums alone don't push you over that threshold, you probably shouldn't have the HSA (so you can use those costs to push you over), but if they do, it may make sense to have one for convenience and to simplify bookkeeping, and to bank pre-tax money for the future.

4) Re OOP, I just wanted to note that for most pre-ACA plans, the OOP maximum wasn't a hard maximum, it was the point at which the higher level of coverage kicked in. Under the ACA, it is actually a maximum.

Pete who actually supports ACA got burned for $500 in blood tests and urinalysis last time she went in, so no all preventative care is not free. I feel like our adherence to talking points on this issue is counter-productive. I'd almost rather single-payer so we wouldn't have to research who is in network, only to get burned by the odd anesthesiologist, or spend our days searching out which tests aren't covered because our in network doctors don't know what's covered but do know what tests they want etc...

Congress could fix all this shit, but the money doesn't want it fixed, they want it dumped.

Yes, I added a clarifying link in my next post; apologies for oversimplifying.Absolutely. Ditto for me minus the "almost".

Single payer seems to work just fine for all of Europe.

Our mostly employer provided system is totally insane. It's like a drunk monkey invented it. Our system is great only if you are rich. I think Obamacare is a step in the right direction, but it can't turn a sow's ear into a silk purse.

Western Europe seems to have mostly functioning representative government. Ours seems to be good at representing the interests of oil companies, banks, and nutters. We've been told so long that government can't do stuff and the GOP works hard at proving it, that I don't single-payer happening without a huge movement and a popular change agent. Watching the manipulations and smear campaigns this election cycle makes me doubt we have the tools to build a sensible system rather than a special interest feed trough.