The PPACA - Implementation Phase I

[pirate]

Re: The PPACA - Implementation Phase I

The policies will include those services whether it is on the bill or not. If it makes people feel better, just ignore it.

It's like when I go to a hotel with a pool and a gym. I'm not going to use the pool and the gym, but I don't demand a lower price for my room or get angry with the people at the front desk for offering it.

rationalize much?

 

[joecct]

Re: The PPACA - Implementation Phase I

OK, this is from Newt, which will mean most of you will discount this as the rantings of a deranged man.

Obamacare’s Marriage Penalty and Divorce Incentive

President Obama’s reelection campaign raised the hackles of conservatives last year when it released an interactive web graphic called the Life of Julia. The graphic depicted “Julia’s” cradle-to-grave reliance on government, and many viewers felt it offered a disturbing glimpse of the President’s ideology.

It was particularly striking that Julia seemed to lack any family or friends. At one point she “decides” to have a baby, but she never marries. And now perhaps we know why: under Obamacare, being married would likely have cost Julia thousands of dollars a year.

Many couples buying insurance through the Obamacare exchanges will face huge premium increases if they choose to get married, according to a tool created by the Kaiser Family Foundation. That’s because jointly they’ll lose substantial tax credits or subsidies they were eligible for individually.

The Kaiser calculator reveals that a married couple of 64-year-olds earning a combined $62,081 a year (each earning the same salary) would pay a premium of $15,211 for a “silver” plan under Obamacare. That amounts to more than a quarter of their income (and an even larger portion after taxes). If they chose not to marry (or to get divorced if they were already married), however, they’d pay only $5,360 combined for the same coverage. That’s a marriage penalty (or divorce incentive) of nearly $10,000 a year.

The story isn’t much better for a couple of 40-year-olds, one earning $70,000 a year and the other earning $23,000 a year. If married with two children, they would pay a premium of $9,700. If they chose not to marry (or to get divorced), however, they’d pay only $3,700 combined for the same coverage. That’s a marriage penalty (or divorce incentive) of $6,000 a year. By the time their children were 18, that would add up to well over $100,000 they could have saved to send them to college. (Tom Blumer at PJ Media highlighted similarly troubling scenarios before Kaiser adjusted its calculator.)

It was Robert Rector at the Heritage Foundation who first pointed out the “wedding tax” in Obamacare. That was back in January 2010 before the bill became law. Rector warned that “the bill’s anti-marriage penalties occur because of the income counting and benefit structure rules of the bill. If a two-earner couple is married, the bill counts their income jointly; since the joint income will be higher, a married couple’s health care subsidies would be lower.”

Nearly four years later as Americans log on to the exchange websites to sign up for Obamacare, many couples are discovering this unpleasant consequence for the first time. This week Al Jazeera talked to an Obamacare “navigator” in Colorado who said so far “no one” she’d talked to had signed up for coverage. “Thus far everybody has taken a look at the rates and they've walked out the door,” she said. “There's sticker shock. They just can't afford it.”

It’s a perverse law that would take such a sticker-shocked couple and tell them they could save $5,000, $7,000, even upward of $10,000 a year if they simply got divorced. At a time when nearly two in five children nationwide are born to parents who are not married to each other, this is no small problem.

This anti-marriage, pro-divorce provision needs to be changed before January 1. It should never go into effect.

The law creates a destructive incentive for the poor and their children, especially. As I relate in Chapter 10 of my new book Breakout, we know that children who grow up in single-parent households are far more likely to live in poverty. The poverty rate in 2010 for married couples with children was just 8.8 percent, compared to 40.7 percent for unmarried mothers. Children who grow up in single parent households are seven times more likely to become welfare recipients as adults, according to my friend Peter Ferrara at the Heartland Institute. So in some ways the Obamacare marriage penalty actually feeds the poverty problem.

We already have dozens of welfare programs that create terrible disincentives to marry. Obamacare’s marriage penalty makes this problem even worse, and extends it to many middle class Americans as well. Unfortunately, there are sure to be many more unpleasant surprises like this one ahead.

Your Friend,
Newt

 

[Old Priocless]

Re: The PPACA - Implementation Phase I

The policies will include those services whether it is on the bill or not. If it makes people feel better, just ignore it.

It's like when I go to a hotel with a pool and a gym. I'm not going to use the pool and the gym, but I don't demand a lower price for my room or get angry with the people at the front desk for offering it.

Here here. The bill has been passed, and we're finding out what is in it. "If you like your plan, you can keep it" is hardly a lie. The plan just has to be a real plan, unlike the ridiculously threadbare plans out there that don't cover sh*t. We all know that's what Obama meant in his speeches, despite the protestations of the whiny conservaginas screaming "T3H socialism!1!!1!".

 

[St. Clown]

Re: The PPACA - Implementation Phase I

The policies will include those services whether it is on the bill or not. If it makes people feel better, just ignore it.

It's like when I go to a hotel with a pool and a gym. I'm not going to use the pool and the gym, but I don't demand a lower price for my room or get angry with the people at the front desk for offering it.

You choose whether or not to make use of a hotel at all. We're now mandated to purchase insurance. In the Land of the Free we're compelled to make a purchase regardless of whether or not we want the product.

 

[jerphisch]

Re: The PPACA - Implementation Phase I

You choose whether or not to make use of a hotel at all. We're now mandated to purchase insurance. In the Land of the Free we're compelled to make a purchase regardless of whether or not we want the product.

Of course if you don't pay for the hotel room you can't stay there, but if you don't pay for health insurance you still get healthcare provided on the backs of everyone who does pay.

 

[St. Clown]

Re: The PPACA - Implementation Phase I

Of course if you don't pay for the hotel room you can't stay there, but if you don't pay for health insurance you still get healthcare provided on the backs of everyone who does pay.

Then we should re-examine healthcare as being "a right" afforded to people. IMO, a personal right should not require something of someone else in order to exercise it.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

It appears some people are still tryng to justify the theory to support the intention, while others are describing the effects and results of the actual law.

Where I see the biggest problem coming is in the destruction of the doctor-patient relationship. While subtler, it also appears to have been disguised deliberate intent.

Pre-PPACA, the theory was that the doctor was in charge of how "his/her" patients were treated: the personal physician was aware of all the medical considerations and had a sense of responsibility for how "his/her" patients fared.

One of the more pernicious effects (no matter what the "theory" says, I'm talking practical reality here) is the transformation of the physician from "boss" to "employee." I've seen first-hand what happens when a practitioner moves from private practice to the state payroll, and this process will only become more and more widespread.

No one person is responsible. The patient data is recorded in the chart, and whoever happens to be on duty at the time picks up the chart, reads it, and handles the situation until the end of his/her shift, after which the responsibility transfers over to whomever is next on the schedule. The whole concept of "my" doctor or "my" patients is tossed aside. We can't afford it any more. All must sacrifice to support the greater good.

DrD can probably speak more eloquently than me about how fundamentally transformative this is, and not at all for the better. There are abundant anecdotal stories from Britain about a patient who was ready for surgery at the end of the day who, because the preceding surgery ran long, had to wait for the next day because it was the end of shift and everyone just packed up and left.

This is a separate issue from a doctor shortage, which people can argue theory vs practicality elsewhere. It's the difference between treating "my" patients and making sure they are receiving all the care they need, and "okay, who's next on the list today? and I hope it doesn't take too long because I really have to get out of here by 5 today."

It's the difference between knowing the person, and managing the symptoms. All you blusterers are not going to like it, but by then it will be too late, and no one will take any pleasure in being right.

 

[Priceless]

Re: The PPACA - Implementation Phase I

Of course if you don't pay for the hotel room you can't stay there, but if you don't pay for health insurance you still get healthcare provided on the backs of everyone who does pay.

You already do.

You choose whether or not to make use of a hotel at all. We're now mandated to purchase insurance. In the Land of the Free we're compelled to make a purchase regardless of whether or not we want the product.

I suppose when I go to the Frozen Four I can sleep outside the Wells Fargo Center. I'm sure the locals won't mind.

 

[St. Clown]

Re: The PPACA - Implementation Phase I

You already do.



I suppose when I go to the Frozen Four I can sleep outside the Wells Fargo Center. I'm sure the locals won't mind.

If you don't have the resources for a hotel room, should you really be traveling to Philly and attending the Frozen Four in the first place? Your question is baseless on its face.

 

[Priceless]

Re: The PPACA - Implementation Phase I

If you don't have the resources for a hotel room, should you really be traveling to Philly and attending the Frozen Four in the first place? Your question is baseless on its face.

It's an example. Try not being so literal.

 

[Priceless]

Re: The PPACA - Implementation Phase I

The horror. The horror.

As we try to judge the short-term winners and losers from the Affordable Care Act, you can’t deny that it’s terrible to find out that your insurance plan has been cancelled. It happened all the time before Obamacare when it was a much worse fate, as there was a chance that no insurance might cover you again because of a pre-existing condition.

Still getting that cancellation letter can be disturbing. But what should be more even disturbing is discovering the insurance you were paying for is junk.

This week Diane Barrette was briefly the poster woman for the estimated 3% of America in the private insurance market who will lose their insurance and pay more to get coverage that meets the new minimum standards laid out by the ACA.

It turns out that she was paying $56 a month for a plan that covered — according to Yiddish experts — bubkis.

“She’s paying $650 a year to be uninsured,” Karen Pollitz, an insurance expert at the nonprofit Kaiser Family Foundation, told Consumer Reports. “I have to assume that she never really had to make much of a claim under this policy. She would have lost the house she’s sitting in if something serious had happened. I don’t know if she knows that.”

Still CBS News and Fox News presented her as canary in the Obamacare coal mine, suggesting her fate was indicative of the horrors waiting for millions. But even Fox’s Greta Van Susteren sussed out that Barrette’s story was bunk, Mediaite‘s Tommy Christopher — who has been doing a heroic job of debunking Obamacare “horror” stories — points out. After her appearance on Van Susteren’s show, Barrette’s further Fox News’ appearances were cancelled.

Even though Healthcare.gov is still crap, it was easy to discover that Barrette can get real coverage for under $200 a month. In fact, Consumer Report’s Nancy Metcalf did just that.

“To put these two plans in perspective, let’s imagine that Ms. Barrette’s luck runs out and she receives a diagnosis of breast cancer that will cost $120,000 to treat,” Metcalf wrote. “Under her current junk plan, she would probably receive no more than a few hundred dollars of benefits for doctor visits and drugs. It wouldn’t cover her surgery, her chemotherapy, her many expensive medications, or the repeated diagnostic tests she’d likely require. She would end up with probably $119,000 of unpaid medical bills. With the Humana plan, those bills top out at $6,300 a year, no matter what.”

Also, to the charges that "You can keep it"

Finding out that your health insurance plan has been cancelled is terrible — especially when you have cancer.

This practice, known as recision, was one of the worst and first insurance industry abuses banned by the Affordable Care Act, along with annual caps on coverage and pre-existing conditions for kids.

Discovering that your insurance policy doesn’t cover much of anything after you or a family member has become sick is also unbearable.

The Affordable Care Act also seeks to end this far too common misery for the about 15% of America in the individual insurance market, which is why insurers are sending out millions of notices that inform people that their plans are being discontinued. Most of these policies do not meet the new requirements established by the law.

The good news is that if you earn over 400% of poverty, just over $40,000 for an individual and about $90,000 for a family of four, you can replace this policy with no fear that you or a family member will be denied coverage due to a pre-existing condition. You can do this now through a private insurer. It’s true that you may end up paying more for your coverage. But when you get sick, which you will, you and your family will be covered and able to retain coverage and shop for new coverage, even if you have a chronic ailment. And if your insurance company doesn’t spend enough on care, you’ll get a rebate.

The sort-of bad news is that if you earn under 400% of poverty you have to go to Healthcare.gov to get the subsidies that will help you pay for your new, more comprehensive plan. This is sort-of bad news because the site — depending on the state you live in — often doesn’t work, which is its own kind of misery. You have until December 15th to replace your plan by the beginning of next year and until the end of March to avoid paying the individual mandate.

After years of suggesting Obamacare would spark a Nazi, Communist and Satanic “government takeover” that would set the sky on fire, insurance plans that need to be upgraded and a broken website are what Republicans are stuck complaining about.

Of course, cancellation notices have been sent out by the millions over the last decade by the insurance industry. When these notices came, individuals then had to find insurance in a unregulated marketplace where they could be rejected for any reason whatsoever.

Republicans weren’t upset then.

26,000-45,000 Americans die every year for a lack of insurance. Any outrage from the GOP? Hundreds of thousands more go broke. Not an outrage. Trying to fix the broken system and not doing it seamlessly? Outrage. But outrage only good for 40+ repeals of Obamacare, not enough outrage to pass one plan to replace it.

The fact is America already has a socialized health care system, thanks in part to Ronald Reagan. It’s just socialized in the dumbest possible way, which is why we pay more for health care than any country in the world and don’t get anywhere near the best results. Emergency rooms can’t turn people away, driving up costs for all Americans. And instead of subsidizing the uninsured who are trying to get out of poverty, taxpayers subsidize Ted Cruz’s $40,000 health insurance plan.

Republicans do have a point that President Obama relied on a simplistic, untrue talking point to push his health law: If you like your plan, you can keep it.

He could have have nuanced it in a million ways, possibly by saying: If you like your plan, you’ll keep it or get something stronger. But he didn’t.

The president has no more elections to win. Despite the fact he prevented a depression, saved the auto industry and will end two wars, his legacy is tied to the Affordable Care Act, which is the greatest victory for the middle class since Medicare.

I think that the president should say that he should have been clearer.

He could say this then point out that most Americans will still not even notice a change in their policies, which are now stronger than ever. However, Americans in the individual market may need to find a new policy that meets basic requirements and will cover their family comprehensively. And millions of uninsured Americans, millions of Americans with pre-existing conditions will get affordable coverage, possibly for the first time, as we get Healthcare.gov working as well as it needs to.

If I were him, I would add:

But if you like the broken health care system that Republicans are trying to defend — a system where millions go broke each decade and millions more feel indentured to their employers for their family’s well-being, a system where insurance companies could sell policies that don’t cover enough then don’t spend enough on care, a system where America’s economy falls behind the rest of the world as thousands of Americans die needlessly — I’m sorry, you can’t keep that.

 

[DrDemento]

Re: The PPACA - Implementation Phase I

It appears some people are still tryng to justify the theory to support the intention, while others are describing the effects and results of the actual law.

Where I see the biggest problem coming is in the destruction of the doctor-patient relationship. While subtler, it also appears to have been disguised deliberate intent.

Pre-PPACA, the theory was that the doctor was in charge of how "his/her" patients were treated: the personal physician was aware of all the medical considerations and had a sense of responsibility for how "his/her" patients fared.

One of the more pernicious effects (no matter what the "theory" says, I'm talking practical reality here) is the transformation of the physician from "boss" to "employee." I've seen first-hand what happens when a practitioner moves from private practice to the state payroll, and this process will only become more and more widespread.

No one person is responsible. The patient data is recorded in the chart, and whoever happens to be on duty at the time picks up the chart, reads it, and handles the situation until the end of his/her shift, after which the responsibility transfers over to whomever is next on the schedule. The whole concept of "my" doctor or "my" patients is tossed aside. We can't afford it any more. All must sacrifice to support the greater good.

DrD can probably speak more eloquently than me about how fundamentally transformative this is, and not at all for the better. There are abundant anecdotal stories from Britain about a patient who was ready for surgery at the end of the day who, because the preceding surgery ran long, had to wait for the next day because it was the end of shift and everyone just packed up and left.

This is a separate issue from a doctor shortage, which people can argue theory vs practicality elsewhere. It's the difference between treating "my" patients and making sure they are receiving all the care they need, and "okay, who's next on the list today? and I hope it doesn't take too long because I really have to get out of here by 5 today."

It's the difference between knowing the person, and managing the symptoms. All you blusterers are not going to like it, but by then it will be too late, and no one will take any pleasure in being right.

All stated very well. One of these days when I feel particularly verbose-I will put up a few anecdotes from my own personal history of medical practice. I saw the handwriting on the wall many years ago-i adapted as most have as best i could but i refuse to compromise my treatment, work up, or expertise. i was always(and still am) my patient's advocate. It just got to be too difficult to fight for every single case with medicare and with insurers who demanded I do what is most expedient and what is most economical instead of what is in the best medical interest of my patients. Jenny and i spent 1/2 our day seeing and tending to patients-and 1/2 our day calling and fighting with insurers or the government. Often overlooked by many is the fact that mediclaly untrained individuals make decisions that your provider has to abide by-but they(these decision makers) cannot be held accountable for poor results or even for the death of a patient. The physician is the one who has to bear the legal burden. I am now semi retired-meaning no longer runring an office, I no longer accept government or third party intervention or payment. I choose who and what i treat-virtually all of it without compensation. I love what i was able to do for 40 years and i still love it today. For my own personal care and that of my family-i actively seek out physicians much like myself-who are willing to do their best regardless. But each year it gets more diffiuclt to find them as many retire(or die).

I do not blame all of this on the ACA. That is just the newest wrinkle in the control and invasion of the practice of medicine. I lay as much blame on physicians themselves, who, over the years, stood back and allowed all of the incursions to take place and took the easy way out. Go along with the system, even if it meant patients got substandard care instead of organizing and standing up for practicing what is best for each patient.

 

[geezer]

Re: The PPACA - Implementation Phase I

Starting to hear some rumblings about the latest, maybe the biggest "OOOOOPS" yet out of the incompetent Obama White House. Remember the 7 billion times he chanted "If you like your health care plan. You can keep your health care plan." Yeah... not so much. It turns out millions of people are being kicked off their fully funded insurance rolls onto the "street" of Obamacare, which is proving impossible for most families to buy. Nobody yet knows, and Obama least of all, where this mess is going to lead going forward. Full fledged revolt is growing more and more likely in the "IRS overreach" department. They can't put everyone in jail at once.

 

[St. Clown]

Re: The PPACA - Implementation Phase I

It's an example. Try not being so literal.

I wasn't supposed to continue your metaphor in my reply?

 

[Old Pio]

Re: The PPACA - Implementation Phase I

The horror. The horror.



Also, to the charges that "You can keep it"

"I believe that deck chair looks better over there."

 

[FadeToBlack&Gold]

Re: The PPACA - Implementation Phase I

"...prevented a depression..."

That's a rich statement, which glosses over the fact that we're still in the midst of a long-term recession, with U4 unemployment still north of 7%.

And as I've said a few times before, I voted for Obama the first time around, so don't go lumping me into the angry conservative category. I realize that the President's effect on the national economy is significantly weaker than the James Carvilles of the world would have us believe. But to credit Obama with singlehandedly preventing another depression is a huge stretch.

 

[dxmnkd316]

Re: The PPACA - Implementation Phase I

Found out last week that my premiums are going up something like 10-15%, my deductible is going up 10+%, and my out of pocket max is going up by nearly 50% (over $2,000)

 

[ScoobyDoo]

Re: The PPACA - Implementation Phase I

"...prevented a depression..."

That's a rich statement, which glosses over the fact that we're still in the midst of a long-term recession, with U4 unemployment still north of 7%.

And as I've said a few times before, I voted for Obama the first time around, so don't go lumping me into the angry conservative category. I realize that the President's effect on the national economy is significantly weaker than the James Carvilles of the world would have us believe. But to credit Obama with singlehandedly preventing another depression is a huge stretch.

Wasn't just him. 99% of what Obama did to prevent it Bush was already doing before he left. As for the recession that continues give John Boner a call and ask him about JOBS, JOBS, JOBS. See what he says.

 

[DrDemento]

Re: The PPACA - Implementation Phase I

Found out last week that my premiums are going up something like 10-15%, my deductible is going up 10+%, and my out of pocket max is going up by nearly 50% (over $2,000)

You are still relatively fortunate. My wife renewed her policy with horizon B/C in NJ and the increase was 19%. Deductible stayed the same($5000) and out of pocket cost is now maxed out at $10,000. Drug coverage is abyssmal-50/50 copay but only of the price that horizon deems appropriate for the drug-and ti had better be a generic or the reimbursement is a pittance of the cost. She was forced to make an ER visit 2 weeks ago and we bore the entire cost since the first $100 went to her ER copay and the remainder of the bill all to her deductilbe. Unfortunately for us-this is october-so a completely new deductible starts on 1/1/14 so we will be on the hook again for most bills. after all of this-Horizon sends her a letter that this will be the last renewal due to the fact that this policy does not meet ACA standards. They assure us they will offer her acceptable coverage when this policy is cancelled-but they have no idea as yet what the deductible, copay, premium or even the drug coverage will be. I did manage to ask why she will need obstetrical coverage-after all she had a hysterectomy years ago and there is no possibility of a preganancy. The representative actually just got very quiet. Let me see the fervent supporters blame this one on GW Bush(and he was not one of my favorites either).

 

[dxmnkd316]

Re: The PPACA - Implementation Phase I

Yeah, the generic/brand thing is an absolute scam. I have recently come to find out the medication I take had a "generic equivalent" approved. It hardly worked. I could actually feel the difference between the two. It was incredible. The off was sudden and dramatic. It lasted a few hours less than the brand I had been taking.

I came to find out the actual medication was therapeutically equivalent but the delivery mechanism wasn't. And it wasn't even close. The generics available for this medication are simply not equivalent and after months of suffering through the lower cost but relatively ineffective medicine, I've decided to pay the penalties. It's not worth having my daily life impacted despite doubling my costs.

All because the FDA and insurance companies, people who have no personal experience and no medical understanding of the drug have made a decision (and an incorrect one at that) with a great financial impact to me.