If you're not buying Obamacare, stop saying you are. OK?

[riqster]

http://bluntandcranky.wordpress.com/2013/10/07/if-youre-not-buying-obamacare-stop-saying-you-are-ok/

I have seen a fair few people (here and elsewhere) who are holding up increased employer-based health plan costs and saying that their “ACA” or “Obamacare” costs more than their “old plan". Let’s clear this up:

Number A: The only people buying “Obamacare” are those who are shopping on the exchanges. If you’re getting any other benefits due to the ACA (lifetime caps, kids on your plan till 26, etc.) but are not buying insurance from the exchanges, you are not buying Obamacare.

Letter 2: Most of us (80% or better) aren’t able to buy Obamacare. So blame any and all increases on your greedhead employer or scum-sucking insurance company, because that’s what you had before, and that’s what you still have.

More at the link.

[Journeyman]

1. Because I can buy insurance on the open market & not be restricted by "pre-existing condition". . .

I may be able to cut our premiums by 66%.

So though I'm not getting insurance through the Exchange, my insurance situation will be infinitely better because of the ACA.

[riqster]

3. Granted. and there are lots of benefits that the ACA gives us

Transparency, competition, consumer protections, etc. I am personally benefitting from them.

But people are running about, blaming Obamacare for the fact that their employers are screwing them. That's the bullshit I am calling.

I am glad you are benefitting. too.

[notadmblnd]

29. I'm blaming Obamacare...

Because of Obamacare, my son (20) who sliced his forearm wide open on a wire saw yesterday, was able go to the ER for stitches. It's Obama's fault that he was able to go and I am grateful to him for it.

[TBF]

65. If you slice your arm open and go to ER that is not "Obamacare" -

that is you (or your son in this case) making a much needed trip to the ER.

That is nothing new.

We've all had to use ER at one time or another ... the only question is who pays the bill (or if it gets paid).

[notadmblnd]

72. He is able to be covered on my policy till he is 26 because of the ACA

Otherwise he would have had to play John Rambo and sew it up himself.

[TBF]

73. Cool - thanks for clarifying!

It is true that many won't even go to the ER because they fear the bills that will arrive if they don't have insurance.

[brush]

76. Well why did you write that you are blaming Obamacare?

I think I read you post title correctly. Please be clear so people don't misunderstand. Maybe you should praise Obamacare because your son can stay on your policy and your insurance company can pay for the trip to the ER and not the taxpayers.

[notadmblnd]

78. Apparently it was a poor attempt at humor.

I don't know if you have noticed, but there has been a lot of whining and complaining about how awful the ACA is here and I was just joining in. Sorry you misunderstood

[brush]

79. Oops! Sorry I missed the joke

[pnwmom]

6. Are you saying that even non-exchange insurance policies

will not be able to bar preexisting conditions? Will they have to offer the Essential benefits, too, and comply with other features of the law?

[riqster]

8. The answer to the first part of your question is yes. The second part, partly.

There are regulations on what insurers can and cannot do under the ACA.

[Journeyman]

10. Everyone I've spoken with so far (Kaiser, HealthNet, Blue Shield) say preexisting conditions are...

no bar to their providing insurance. My daughter (25 years old) has been on our existing, "grandfathered" policy since the ACA passed. So I'm not certain what benefits and compliance they must offer and adhere to, but here at the outset it looks very good for all of it.

[pnwmom]

18. Thanks!

[JDPriestly]

26. But I can assure you that pre-existing conditions were a big problem before the ACA.

I was older and of course had a number of minor pre-existing conditions when I shopped for insurance. It was a real problem, and insurance companies use some minor problem to raise your rates to unaffordability. It was very difficult, but I found a way.

I firmly believe that no one should be without health insurance. Why should I shift any major health costs I might incur onto my neighbors and their insurance policies? And why should I go to an emergency room when what I need is the care of a general practitioner on an out-patient basis? I don't think they give you prescriptions for things like ongoing blood pressure medications in the emergency care. But it is that sort of thing that most people need.

The ACA responds to a need that is widespread. It may have a few glitches, but it will succeed. And maybe we will get single payer once people realize that the concept that everyone needs insurance makes sense.

[Journeyman]

42. Well understood. My "pre-existing" condition was "non-existent," but it cost me nonetheless. . .

A false positive on an in-office finger-prick test for diabetes has consigned me to seven years of ever-increasing premiums. No other test has ever shown me to have even a "pre-diabetic" condition, yet the insurance company I'm with insists I'm diabetic. And as a self-insured individual, with a wife who does have an active condition, it's been a devastating "diagnosis" -- our premiums have gone up a minimum of 20 to 40% every year since then.

So, yeah, I heartily agree with you about the need for single payer. For me, however, it's partly fueled by a desire to see these rapacious corporate insurance vampires put out of our misery.

[dipsydoodle]

2. Does this explain that ?

http://obamacarefacts.com/obamacares-medicaid-expansion.php

[riqster]

5. That's covered at the link in the OP.

Lots of people are getting insurance via Medicaid expansion, mostly in blue or purple states. They aren't "buying" Obamacare either - they are getting access to the system, most of them for the first time.

[uppityperson]

4. k&r though there are provisions of Obamacare that affect those with employer based insurance

My employer based insurance rates and deductible increased every year and the benefits decreased, back several years ago when I had it. I expect it will continue to do so for those who have it now. BUT, ACA does have provisions that even those employer-based insurance plans must follow which are good.

I am agreeing with you, just adding on.

[riqster]

7. Yep. Thanks.

Pre-existing conditions and kids on policies to name but a few.

[Kber]

9. And premium rebates

I will get one of those this year - a very small one, but more that i would have gotten without ACA.

[riqster]

12. Good point.

[robinlynne]

11. not so fast. I support the ACA. I am currentlunder poverty level. I pay for health insurance. A lot.

To get similar coverage through the exchange would cost me 80.00 more per month.

The math is not the same for everyone. I smoke. We are in a separate class under the ACA. for example. no help to pay premiums.
And no, don't tell me that is ok. I'm only quiet about it because there are bigger, more important things happening in this country than my personal health care. but I'm sure there are a lot of us in a donut hole. It happens.

[riqster]

14. It sounds like you are saying you COULD buy under an exchange, but it's not a good deal for you.

So Obamacare isn't jacking up your costs. Unless there are other details that I'm missing here.

[robinlynne]

15. correct.

Now, I have not yet taken the time to do a full analysis, and find out the price if I had not checked smoker. But I will.

[Marrah_G]

37. Where do you live?

Wouldn't you be covered by medicaid if you are below the poverty level?

[robinlynne]

55. no because I have money saved in the bank. My income is below poverty level.

California. I believe the high charge is for smoking. not income. Per my income, it should be partially subsidized.

[Skittles]

59. quit smoking, robinlynne

Last edited Tue Oct 8, 2013, 05:29 AM - Edit history (1)

seriously, it can be done and it will save you so much money - if you try and fail, keep on trying - I know - it took me several attempts for it to stick but it is SOOOO worth it

I recommend reading / listening to Joel Spitzer

http://www.whyquit.com/joel/dayzero.htm

[pscot]

71. Kicking's a bitch

But it is sooo worth it. And the craving does go away after 3 or 4 years,

[Kber]

13. Very good point

Look, our company's insurance premium went up 12% last year, 8% the year before, 14% the year before that, 22% the year before that and 9% the year before that.

It will go up 6 - 9% this year as well.

All that time our co-pays went from $10 to $15 to $25 to $30 and our deductibles went from $500 / family to $2000.

That has nothing to do with the ACA, unless you consider that the relentless increase in cost coupled with a decrease in benefits was one of the motivators for the ACA in the first place. Healthcare and health insurance costs have been increasing steadily for years and years. The ACA won't begin to bend the curve for a while yet.

[HockeyMom]

16. What are copays?

Self-Insured public school district in Florida for $160/month for employee. Cheap???? No co-pays until you exceeded $3,500 a year deductible, before which you paid 100% yourself. After that? 50% of the charges. Good deal?????

[Kber]

19. We have three plans

one HMO and two PPO's which have some "out of network" coverage

For the HMO, the employee only premium is $84.00 per month.

There is no out of network coverage.

In network, there is an individual deductible of $750 that applies to diagnostic tests, out patient surgery and hospital care. Doctor visits are not subject to the deductible.

Co-pay is $30 for primary and $40 for a specialist and $100 for emergency room visits.

As required by law, all preventative care is covered at 100% with no co-pay and no deductible.

The lower priced PPO is $165 / month for employee only.

There is no deductible if you stay in network and a &750 deductible for of network stuff. Out of network is covered at 70%. In network is covered 100% after your copay of $25 for primary and $35 for a specialist. Emergency room visits have a $100 co-pay, waived if you are admitted.

My company picks up 80% of the premiums cost so it's generally a better deal than the ACA and we don't have any employees who would qualify for subsidies based on the research I've done (I'm in HR)

[robinlynne]

57. What if you need major medical care, like surgery? Do you pay 50%?

yes 160 is very very cheap, but 50% can bankrupt anyone, I would think, in case of a disaster.

[HockeyMom]

69. Yes, 50%

That deductible wasn't just for doctor visits, but also for hospitalization. So if you had $300,000 worth of hospital bills, you would have to pay $150,000. Good?????

If I was still working there, you bet I would be on that ACA site looking for better.

[Wounded Bear]

17. Also, since the passage of the law....

ins co's have had incentives to jack up rates before some of the ACA provisions kick in and prevent that.

Corollary to the law, maybe, but not caused by it.

[riqster]

20. S'truth.

The fun part will be when they post rates on the exchanges that are cheaper than what they've been charging their existing customer base (employers) and some bright spark decides to go check.

Watch those rates go down.

[Rebl]

36. Exactly

Our insurance has gone up every year for many years-long before the ACA came along. Our co-pays and deductibles have gone up as well-again, long before ACA.

[robinlynne]

58. yes.

[MANative]

21. Employers are doing other things that relate to ACA...

For example, my husband works for a subsidiary of Walgreens and we've just been notified that he will be getting a "shopping allowance" that we will apply to a "corporate exchange." We won't have the details until 10/28, but the high-level sketch is that there are about a half-dozen insurers participating, all offering the five levels of care as outlined in the ACA - Bronze through Platinum - so we'll have a "choice" of about 30 options. We don't know how much the "allowance" is yet. We do know that our premiums, co-pays, and deductibles have sky-rocketed over the past five years. I'm hoping that whatever they allow us will be more than a pittance, but we're pretty much in the dark until the end of this month. I must admit, I'm a bit nervous.

[riqster]

23. Yep. They are tying to screw us any way they can.

And as always, they always blame somebody else. Bastards.

[MANative]

30. Well, the truth is, we have no idea if that's the case.

There are supposedly at least a half-dozen corporations in addition to Walgreens taking part in this program, and Walgreens alone brings over 120,000 subscribers. We've been told nothing other than there will be millions of participants and that we will get a "shopping allowance." I suppose it could be an okay deal if the subscriber base is large enough. We just don't know, and that's frustrating.

[Rebl]

38. Your

Right about the more people in maybe the premium might be okay. Like you, I'd be anxious and frustrated by what they are doing though.

[cigsandcoffee]

22. Don't know if I'm buying it or not - still can't log on. n/t

[Leopolds Ghost]

24. Are people that dense? Economics 101.

I spoke to a relative who works in medical field and is a big supporter of the individual mandate despite claiming to be an old-fashioned liberal.

I.e. a supporter of Clinton / Gingrich economics.

I asked them if they understood the basic economic principle that if you turn a commercial good into an non-price-fixed utility, the prices will skyrocket because demand is inflexible by law. The captive market principle.

They said they had not heard of it and did not believe it.

I asked them (they are a highly educated person) if they had taken economics in college. They had not.

[riqster]

25. Yep, people are that dense.

Conflating and concatenating away, all the while misapplying simplicity to the complex.

[Leopolds Ghost]

27. Your sesquipedalian loquaciousness fails to address the underlying issue.

The vast majority of people who are Democratic activists already have health insurance through a group plan, or have a pre-existing condition that prevented them from getting health insurance. They have little sympathy for anyone who calls an insurance rep and is told that they had better buy health insurance now, because they have no right to back out of the marketplace. It is no different than going to Best Buy and being told to fuck off if they don't like the product because there is no competing electronics store in town.

[Pretzel_Warrior]

35. the insurance companies are still competing with each other

so it's not like a monopoly on a necessary good where the one company can charge whatever they want and you are screwed.

And for those truly in economics, there are a large number who could decide in purely economic terms they would rather pay the penalty than get an overpriced shitty-ass plan.

[Leopolds Ghost]

41. Or not pay the penalty

And wait for the price to drop. Chances are I'll be waiting a long, long time.

It's sort of like restaurant economics in "liberal" neighborhoods. (I tend to put the word liberal in scare-quotes more often than not these days given the number of fake liberals I run into who equate liberalism with a sort of shallow, upscale social libertarianism.)

Have you ever noticed that whenever "liberal" planners and house-hunters redevelop a neighborhood, the restaurants and shops that come in (even the crunchy-granola ones) are always more upscale than what preceded it? And if you ask them they say stuff like a person just said to me when I asked, lighthearted fashion (their store had not opened yet) "so will you have any food that normal people can afford":

Person #1 (obnoxious twentysomething) -- "Oh lord, one of those people." Brushes past me

Person #2 (polite and considerate twentysomething) --"What do you consider normal?"

"Different people are willing to pay different amounts of money for what they consider good food. Our customers are simply willing to pay more. Other people aren't. I'm sure there are other places that cater more to their taste."

See, it's about willingness to do the right thing.

by being willing to pay more for a better product. /)~_~

[Pretzel_Warrior]

43. or do like Portland--FOOD CARTS!

Terrific variety of food for low price and excellent quality. Portland "liberal" neighborhoods even have food cart pods where you can sit down at covered seating to enjoy your items with friends.

[Leopolds Ghost]

49. Here in the glorious capital of (fill-in-the-blank), they just apssed a law to limit food carts

So as not to discourage all the upscale dining they want to bring in.

Also my impression of Portland is that it is one of the few remaining (non-scare quotes) liberal cities.

Of course it's been a long time since I was there...

http://tinyurl.com/90s-portlandia-song

[TheKentuckian]

75. They are a cartel with an anti-trust exemption, they are not competitive in the way you pretend.

[Pretzel_Warrior]

77. yes they are.

there may not have been enough market forces to drive prices downward, but it is here.

[riqster]

53. Fun word choice.

But I am not ignoring any issues. I am selecting a part of a very complex whole to address here, since it was a blog post quoted on a message board, and not TNT academic treatise.

There are many more facets to health finance than whether consumers therof identify causes, effects, agents and agencies correctly. And having worked in the financial side of the industry, I am reasonably well-versed in the breadth and complexity thereof.

I just focused on this one aspect: know what you are talking about before you post,

[LynnTTT]

45. What does that mean?

where in economics is a "commercial good"

[Leopolds Ghost]

46. I'm assuming you know exactly what I'm talking about

And are just being silly because you disagree with me...

[DesMoinesDem]

28. There's a lot more to Obamacare than the exchanges

and yes, it does affect employer provided health insurance plans. To deny that is to deny reality.

[seveneyes]

31. Why does the ACA not have provisions and laws to prevent such damage?

The people writing this thing would have known all of the potential outcomes. There should be some teeth in it to stop any existing clients from having their rates raised.

[Pretzel_Warrior]

44. nope. this law doesn't address the amount and cost of actual health care. THAT is one of the things

driving up costs of health insurance. There are things which will kick in to slow the rate of growth, and it has already started to take effect according to a number of reports I'v read.

[LynnTTT]

47. It does

ACA does have regs that apply to all inurers, noy just the exchanges.
I especially like the Medical Loss ratio. Companies must spend at least 85% of collecetd premiums on actual patient care. Last year my daughter got $ 250 back. Florida residents got $54 million. many individuals don't see it, because in company paid plans it does go to the company, but hopefully the employees are notified and either get the money or it goes to reduce premiums in the future.

[Humanist_Activist]

32. What is bullshit is the convoluted requirements, I don't know if I can go on the exchanges or not...

my employer provides health insurance, at about 168 dollars a month for my contribution to it, according to Kaiser, I would be eligible for at least a 30% decrease in premiums through subsidies at my income level, but I don't know if I qualify, my gross pay a paycheck would be around 850, so 1600 to 1700 a month, give or take. I'm hourly so it varies, and since I'm so close to the "wire" so to speak, from month to month I would qualify and then get disqualified for the exchanges, or maybe it averages out every year, but, again, that will vary as well, even though I haven't had a raise in over a year, I may have more hours.

As of right now, based on my 2012 W-2, I would pay, on average, 8.9% of my income on premiums alone for my employer's insurance, and I get confusing info on that too, do I qualify for the exchanges if its above 8% or above 9.5%, that could make all the difference in the world.

[Rebl]

40. I think

That if your employer offers health insurance, you cannot go through the exchange and buy your insurance. Personally I don't think that is fair.

[Humanist_Activist]

48. That's not the issue, I already know that, I'm asking if I can apply for an exemption. n/t

[TheKentuckian]

54. You can buy but the purchase is unsubsidized and your employer contribution is not portable.

If the plan offered doesn't meet minimum requirements or is something like 9.5% of income or more then an exemption on the exchange restriction is possible as long as you earn enough to get a subsidy.

Odds are that you will have to take whatever your employer offers or see what can be had off the exchange.

Pitching this as broad reform was a bad idea, the gist is really about sanding off the rough edges of the individual market using the group market as a template along with a hodgepodge of efforts to increase coverage.
If it was pitched as such it would have greatly reduced both disappointment and opposition, I really do believe.

[Humanist_Activist]

62. See, this is the confusing part, according to the paperwork I got from work, its 8% of income...

then I can get subsidized premiums and cost sharing on the exchanges, being exempt from work's health insurance plan.

They did also say they do meet minimum requirements for coverage.

[TheKentuckian]

74. I've never heard the 8% before, I guess if you are there then it will be time to push back

and explore the options. I'm betting you're stuck like Chuck but this is important and if I was close I'd apply and see what happens.

No sense worrying about it at all if you aren't even at the eight points that no one else is mentioning but if it is close then you'll have to take a chance on wasting your time.

[Yo_Mama]

60. 9.5%

8% is the penalty limit. The limit to tell whether your employer-provided insurance disqualifies you from exchange subsidies is 9.5%, but that's just for the employee, not for their family/dependents (if any).

So yeah, you are right on the line, but that makes it difficult. If the premiums go up you'll be over and should be able to buy on the exchange, but using last year's metric you don't.

I'd wait until November and then call the help line.

[Humanist_Activist]

63. I looked at my latest year to date, just got paid, its 15,000 dollars(gross)...

give or take. Whether I can make 7 grand before the end of the year is unlikely.

I think I'm going to end up making less this year, mostly because of some...difficulties in January and February that caused me to miss quite a bit of work, which would drastically affect my pay. Not to mention last year I had damn near perfect attendance, and worked a bit of overtime.

But honestly, what I do know is that I can't afford what work offers now without some type of assistance, their contribution simply isn't enough. Not to mention cost sharing, particularly since next year I'm going to be marrying someone with chronic health issues, and even with my work insurance, paying at least 10 dollars per prescription a month will be over 100 dollars, on top of premiums for us to pay, and that's the minimum. If we get married that is, right now she's on Medicaid, if we get married, she may get kicked off it, so we may end up delaying it, we don't know yet.

[Yo_Mama]

70. If you wind up making 19K

Your max premium under the 9.5% standard would be $150 monthly.

I think you should shop on the exchange. If your income goes down there you will get an increased subsidy.

Don't get married if she loses Medicaid because of it. The higher copays and deductibles alone would kill you guys financially if you had to buy family insurance on the exchange. Way too much of a risk.

Also, if you get married and you get a higher income, you will lose the ability to even buy subsidized insurance for her on the exchange because then your employer premium would be within the limits.

So don't take any chances on that.

[Rebellious Republican]

33. I have health care through my employer, and I have the VA when needed.

I have had no such increase and fully support ACA for those that need it. Lets stop calling it Obamacare, That is simply a right wing mime to confuse the the less enlightened. Numerous polls show that when asked (regardless of party affiliation) would they prefer the ACA or Obamacare. A majority of respondents would prefer and accept the ACA.



http://www.huffingtonpost.com/charlene-obernauer/obamacare-vs-affordable-care-act_b_4044579.html

http://news.yahoo.com/blogs/sideshow/all-in-a-name--jimmy-kimmel-quizzes-americans-on-%E2%80%98obamacare%E2%80%99-vs--%E2%80%9Caffordable-care-act%E2%80%99-214544505.html

[Puzzledtraveller]

34. No O care here

The plans the Commonwealth of Kentucky offers me are still better and cheaper.

[HereSince1628]

39. Actually, I'm not employed, I don't earn 100% of poverty level so I CAN'T buy off the ACA Exchange.

I CANNOT blame a greedhead or scum-sucking insurance company.

Check out options for living in WI, age 60, annual income 20% of poverty level.

The problem is my Koch-headed state government. And MANY Americans who live in poverty, live in states which have NOT expanded medicare.

[riqster]

51. The Supremes really screwed the pooch

When they allowed states to opt out.

[Laelth]

50. k&r for exposure. n/t

-Laelth

[riqster]

52. Thanks.

:Hi:

[Yo_Mama_Been_Loggin]

56. Already have health insurance

However I do know others who are able to buy it for the first time.

[B Calm]

61. Right now I have insurance through my wife's employer. When she

retires at age 62 next year, we will be on ACA.

[ileus]

64. I'm just holding my breath hoping my wife doesn't get kicked off

my insurance.

It will cost us 1200 upfront, not counting increased co-pays and deducts compared to her being on my plan.

[LWolf]

66. I don't have to stop.

I never said that.

I HAVE said, since the beginning, that the ACA would not provide me with affordable care. That's true. It's also true for "most of us." I don't know that the 20% you reference who actually "buy" insurance through the ACA have any better access to affordable care than the rest of us. My sons don't.

You said, "So blame any and all increases on your greedhead employer or scum-sucking insurance company, because that’s what you had before, and that’s what you still have."

That's exactly the point. Nobody should have to pay extortion to a for-profit insurance company to get access to the care they need, and that care should not bankrupt us.

[riqster]

67. There's SHOULD, and there's IS.

I agree completely. We need single-payer. Perpetuating the for-profit paradigm is just prolonging the inequities of that system.

But I will not pretend that the ACA is all bad. It is a big first step towards single-payer, and is already saving lives.

[Doctor_J]

68. The problem with the ACA is that the greedhead scum-sucking insurance companies locked up

their access to our money. We will never get them out now, since the president and congressional Dems refused to insist on a public option.