General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsSo let me see if I've got this straight...
The signature piece of legislation offered by the President of the United States - the one he chose to pursue in all-out fashion - says that no one with a pre-existing condition can be denied coverage. This new requirement inspired millions of people with pre-existing conditions to barnstorm the ACA website to get that guaranteed coverage. But the entire process remains - deliberately and by design - under the complete control of the insurance companies, who will happily take your money and offer "coverage" for your pre-existing condition, but deny coverage for the deadly-necessary medication needed to treat your disease. You can get a cheap doctor visit and a cheap scan to see how your disease is progressing, but you can't have the medicine needed to treat it, and that's called "coverage."
But this isn't the president's fault.
His plan, his legislation, his advocacy, his "signature achievement."
Not his fault?
Gotcha. The buck stops over there. Or something.
Being really angry about it? Definitely my fault. Do I feel bad about that? Nope.
P.S. some of you folks have holes in your hearts. I wish there was medication for that, but even if there was, you probably can't get coverage for it.
Thank you for your patience, your call is important to us, please continue to hold.
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djean111
(14,255 posts)except for the bad parts.
Reminds me of when we say corporations socialize losses but privatize profits.
People SHOULD feel strongly about this sort of thing.
polichick
(37,152 posts)Even war profits are privatized while the losses belong to the taxpayers and to the pawns who are sent to fight.
woo me with science
(32,139 posts)I think it should be used politically.
It's short, clear, and perfect for helping people understand what's being done to them.
Fantastic Anarchist
(7,309 posts)
bvar22
(39,909 posts)President Obama called it "The Uniquely American Solution"!
He is correct about that.
ALL other civilized countries view access to health Care as a fundamental Human Right that is protected by the government
and administered in an open, egalitarian process.
FDR and LBJ also view health care as a fundamental Human Right.
But Republicans, and their friends, 3rd Way Centrists "Democrats", see Health care as just another Commodity to be SOLD to Americans by For Profit Corporations.
"And everyone has a Share!" shouted Milo
as the American Bombers began their bombing run on their own base.
Fantastic Anarchist
(7,309 posts)... that as part of these new trade agreements, that American officials are strong-arming other governments to "reform" their health care models. You know, in the interest of being "competitive."
For shame, for shame.
truedelphi
(32,324 posts)
cui bono
(19,926 posts)And people should be ashamed when they post a mocking thread in response to Pitt's angry and completely disregard the reality that his wife cannot get treatment. As should anyone who rec'd it.
No compassion, just knee jerk attacks on anyone who dares criticize their hero.
840high
(17,196 posts)
pscot
(21,024 posts)First one in the back door of the Whitehouse after the President announced his plan. He left with a big grin on his face.
polichick
(37,152 posts)Fantastic Anarchist
(7,309 posts)Tell me, who runs this country again?
Enthusiast
(50,983 posts)The advantages of single payer are to remain a secret and kept from the American people. But still, the public favors single payer. Properly informed, the public would insist on single payer.
Fantastic Anarchist
(7,309 posts)Yet, congressmen, and if I remember correctly, a Democratic congressmen, had single-payer advocates detained (arrested).
So much for the party of the common guy, right?
Enthusiast
(50,983 posts)Third Way blue dog, a Republican by any other name.
It was a complete scam, a betrayal.
840high
(17,196 posts)
jsr
(7,712 posts)Tauzin’s $11.6 Million Made Him Highest-Paid Health-Law Lobbyist
By Alex Wayne and Drew Armstrong | Nov 28, 2011 11:01 PM CT
Billy Tauzin, the former congressman turned pharmaceutical industry lobbyist, was paid $11.6 million in 2010, the year he brokered a deal with President Barack Obama that helped pass the health-care overhaul.
pscot
(21,024 posts)
ReRe
(10,597 posts).... he's the one that came up with the unpaid medicare prescription drug program that was passed in the middle of the night in the House and signed into law by GWB. I stayed up all night with my Mother and watched it all unfold. He didn't run for office again, and went directly to work with a mega million lobbying contract for one of the big pharmaceutical companies. I had no idea Tauzin had anything to do with the ACA. Not a good omen, right there. 
geek tragedy
(68,868 posts)Many of us have had traumatic fights with insurance companies for ourselves and loved ones. My wife has had her life-saving medicine jerked out of coverage several times, and she and her doctor have had to fight to get it restored. But we didn't blame Bush, or Obama for it when it happened each time.
The ACA made that better for some, but it certainly was never going to make that go away. But, the answer is to fight with the insurance companies, not audition for a Koch Brothers commercial.
mountain grammy
(26,601 posts)
sabrina 1
(62,325 posts)are and should be beyond politics.
Your wife should NOT have to fight for her life in this country. Certainly not with for-profit Corporations. And no one should ever be willing to just accept such a horrible situation or they will continue to be victimized by it.
daleanime
(17,796 posts)VanillaRhapsody
(21,115 posts)My grandmother always said "wish in one hand...."
Erich Bloodaxe BSN
(14,733 posts)until you start trying to do it.
VanillaRhapsody
(21,115 posts)if you think Pres. Obama could have gotten more than the ACA passed....then I have a bridge I want to sell you!
Fantastic Anarchist
(7,309 posts)I guess no one should have ever tried to do anything about it ... oh, wait.
And your argument is disingenuous. Obama didn't consider single-payer, and took the compromise (Public Option) off the table. That coupled with who had his ear doesn't tell me he was interested in much of anything except placating the parasitic insurance cartel.
VanillaRhapsody
(21,115 posts)do we go to war for the public option now too?
5 Million who just got insured through the ACA would call your post disingenuous!
Fantastic Anarchist
(7,309 posts)Or are you just ready to concede that which is a fundamental right to the parasitic insurance cartel?
My post is not disingenuous, in the least. Yours, however, is, since you are the one asserting that it was impossible to pass. Well, yes, it was impossible to pass if you take what you're trying to pass off the table. That tautology may benefit you, but it doesn't benefit me.
VanillaRhapsody
(21,115 posts)I never said we don't work to fix it...just like FDR and LBJ had to do....
Fantastic Anarchist
(7,309 posts)And you said no such thing.
But I didn't expect anything else from you.
Edit: Here's what you said ... just because I'm feeling generous:
if you think Pres. Obama could have gotten more than the ACA passed....then I have a bridge I want to sell you!
VanillaRhapsody
(21,115 posts)but you can twist my words to your hearts content....
Fantastic Anarchist
(7,309 posts)if you think Pres. Obama could have gotten more than the ACA passed....then I have a bridge I want to sell you!
Must be another VanillaRhapsody in this thread. Please don't accept my apologies.
Edit: No twisting is need with you, VanillaRhapsody. You can't even keep your argument straight as is.
VanillaRhapsody
(21,115 posts)That was about the Public Option....
So twist and shout man....
Fantastic Anarchist
(7,309 posts)It's nigh impossible.
VanillaRhapsody
(21,115 posts)Fantastic Anarchist
(7,309 posts)You've indicated that you don't understand even your own argument, much less the position I was taking. A nice lovely two day backpeddle for you, I see.
This is what you said:
if you think Pres. Obama could have gotten more than the ACA passed....then I have a bridge I want to sell you!
Now, if you would kindly re-read my posts, maybe you'll get it. Or not. It's not my concern anymore.
VanillaRhapsody
(21,115 posts)you should have just replied...
"oops"
Fantastic Anarchist
(7,309 posts)VanillaRhapsody
(21,115 posts)Fantastic Anarchist
(7,309 posts)Let me know when you have grasped it.
VanillaRhapsody
(21,115 posts)(stalking or trolling I should say) to try and interject something totally unrelated to the conversation.
My reading skills are not the one at question.
cui bono
(19,926 posts)
Amonester
(11,541 posts)So he tried something else that could pass in Congre$$, and did.
That is all not being a Dictator could do at the time.
But he gets the blame! Thanks, O-bah-mah!!
Fantastic Anarchist
(7,309 posts)And your non sequitur and straw man don't help your position.
Why would Obama come to the negotiations without all of his options? He took two, single-payer, and what I would consider the compromise, Public Option, off the table. Not a great tactic, to say the least.
cui bono
(19,926 posts)What is so hard to understand that in negotiations you start with what you hope to get? Obama consistently starts with what they will allow him to get.
Sad.
Fantastic Anarchist
(7,309 posts)... never address that?
They always seem to assert that "We can't have everything" or "Obama got what he could get." These are red herrings. Our argument (yours and mine) are not that he got what he could get. Our argument isn't that he didn't even bother to ask in the first place!
You don't get what you don't ask for. Either by design or stupidity. That's an argument for others to have. I have a sneaking suspicion, based on other negotiating tactics that he displays, that it's the former. Obama is a very intelligent president, so I really don't think it's stupidity.
Lars39
(26,107 posts)to what you want. 
cui bono
(19,926 posts)Reminds me of a Maher New Rules where he said the left has to start making demands as crazy as the rights and one of the things he mentioned was that we should demand abortions be available at McDonald's drive thrus. 
That was the funniest New Rules I ever heard. I was laughing sooooo hard.
Fantastic Anarchist
(7,309 posts)Wish I would have caught that!
cui bono
(19,926 posts)So hilarious!
Fantastic Anarchist
(7,309 posts)Especially the "Donner Party."
Let's you and me start it. I'll be barking at a pine cone for nine hours.
cui bono
(19,926 posts)He shunned single-payer advocates and had secret (until he had to admit he was having them) back room deals with insurance companies.
Dropped the public option like a hot potato without fighting for it.
Failed to message health insurance reform properly and didn't even fight back much when the R's flat out lied about what was going to be in the bill.
Failed to use the bully pulpit, preferring to try to deal with the unreasonable liars from the other party.
Now had he tried... we then we might know if he could have gotten more passed. I think he could have had he taken the steps to get the public informed. The entire Dem Party missed its mark on messaging. It's sad really. Makes you wonder if they even wanted a better plan.
Aerows
(39,961 posts)Welcome to DU!
sabrina 1
(62,325 posts)what you deserve'. She was right, Health Ins Corps fought for what they wanted and they got it.
Funny no one ever tells THEM that their insane ideas are impossible?? Why is that? Espectially since they really ARE insane?
VanillaRhapsody
(21,115 posts)My grandmother also said..."Don't let the good be the enemy of the perfect..." If you think the "insane" would have allowed more than the ACA to happen...you have another think coming....
Now stop wasting all that "fight" worrying about the past...it doesn't change a damn thing about it...my grandmother would approve that statement.
sabrina 1
(62,325 posts)What I get from never allowing the bad to dominate me is the satisfaction of knowing that is only a matter of time before the good prevails, and the bad, already so scared as they should be, that they are desperately trying to silence the good. I can sleep at night, they can't.
Whisp
(24,096 posts)If there was one sentence to offset the diarrhea post from yesterday, This Is It.
kelliekat44
(7,759 posts)both are using alternative approaches to the so-called choice formal medical approaches with pretty good results.
And one had been using the a preferred medication and found out that is caused severe kidney damage.
Cha
(296,893 posts)disagrees with that.. "holes in heart". Because he's purposely obtuse about what's causing his problems. Facts be damned.. he will get his whine on about the President.
geek tragedy
(68,868 posts)of a wounded soldier, maybe this would seem like it came out of the blue.
Cha
(296,893 posts)Hekate
(90,565 posts)... which makes what's happening now that much more unacceptable. Or something.
We've had our share of run-ins with Blue Cross, too, geek t, and thankfully have prevailed so far. Glad you and Mrs Geek have, too. Hopefully all those currently experiencing difficulties will prevail in the end, but it's a job getting there.
geek tragedy
(68,868 posts)her employer switches health plans end of this month--doctor is covered, looks like the medication is, but . . . here we go again
snooper2
(30,151 posts)and did he/she learn anything?
WilliamPitt
(58,179 posts)That's how you interpreted that?
He said it was a waste of time to try and get coverage with other companies outside the holy and sainted exchange.
Your skills are impressive.
snooper2
(30,151 posts)I learned something reading through that thread I was hoping you did too
No matter how smart you are, there is always somebody smarter-
pnwmom
(108,960 posts)And your wife's preexisting condition does not allow an insurer outside the exchange to deny her application. So it is not a waste of time to see what your other options are . . . other than the policy your friend wants you to take.
I had a similar experience with a broker who basically wanted to sell me his product. So I gave up on him and did my own research. You need to do this, too.
ProSense
(116,464 posts)But this isn't the president's fault.
His plan, his legislation, his advocacy, his "signature achievement."
Not his fault?
Gotcha. The buck stops over there. Or something.
...doubling down to justify an uninformed and vile attack on the President.
Let's say someone truly doesn't know that the President has nothing to do with formularies. After learning the facts, that person would remove the vile attack. That was not the case. The attacks continued, and were clearly personal and intentional as this OP proves.
Drug formularies are not the President's decision. They existed before the ACA. They exist in Medicare Part D.
The one thing the ACA did do is introduce a new rule applicable to appeals.
The Affordable Care Act ensures your right to appeal health insurance plan decisions--to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”
http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html
Yes, Obamacare is Obama's fault. Your being uninformed is not. ACA is saving lives.
Sanders: “How many people will die if the Affordable Care Act is repealed?”
http://www.democraticunderground.com/10024689831#post3
polichick
(37,152 posts)into the WH over and over again while the bill was written.
He also had everything to do with NOT inviting public option advocates in to the WH.
ProSense
(116,464 posts)"Pres. Obama had everything to do with inviting Billy Tauzin and other lobbyists..."
...improved the Medicaid drug rebate program, which is one of the best.
<...>
The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.
The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drug’s coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html
The ACA increased the Medicaid rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html
<...>
Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drug’s price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).
- more -
http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates
The President has proposed the same rate for Medicare (http://www.democraticunderground.com/10022670043 ), which would save even more than the Senate proposal (http://www.democraticunderground.com/10022725266), $164 billion to $141 billion, respectively.
polichick
(37,152 posts)Give me a break!
ProSense
(116,464 posts)is that it's helping millions of people: http://www.democraticunderground.com/10024689326
polichick
(37,152 posts)and voters are supposed to be thrilled to get crumbs when it's OUR country and OUR money.
FUCK THAT!
ProSense
(116,464 posts)"I'm sick of all the bullshit. Dem Party leaders serve corporations and the 1%..."
...aren't considering other people's opinions of "the 1%," which is completely irrelevant to Obamacare.
polichick
(37,152 posts)Stop the commercial already.
ProSense
(116,464 posts)polichick
(37,152 posts)ProSense
(116,464 posts)polichick
(37,152 posts)ConservativeDemocrat
(2,720 posts)There's a difference.
- C.D. Proud Member of the Reality Based Community
polichick
(37,152 posts)That's fine - but it is what it is.
The Masked Shrike
(14 posts)She's just "catapulting the propaganda".
Jakes Progress
(11,122 posts)How very droll.
Veilex
(1,555 posts)You are both right. It is helping people and it is also driving inordinate amounts of cash to the 1%. We definitely need to push for single payer. There is way too much profit in healthcare and health insurance. Particularly when "insurance" rarely is.
The ACA is far from perfect... the fact that the two of you are bickering over it (along with so many others) is a testament to that fact. I am hopeful that at some point we'll have the political will to get single payer up and running.
sufrommich
(22,871 posts)What a ridiculously insulting thing to say to two women having a political debate.
Veilex
(1,555 posts)One: I don't assume anyone on any blog, regardless of naming convention, is female (or male for that matter).
Two: It was a quote from the movie Megamind, and was intended to diffuse rather than escalate.
That said, there's been enough negative responses that I've changed it.
stevenleser
(32,886 posts)"...you're both pretty" - way to trivialize the positions of two individual human beings, just becasue they're female.
You should be embarrassed .
Veilex
(1,555 posts)but I'm not. It was a movie quote... and was intended to diffuse an argument. The only thing it trivialized was the argument itself. I continued on to affirm both respective positions.
You will be happy to know, however, that I have altered the title so as to be less offensive to you and any other who might object.
cyberswede
(26,117 posts)
Veilex
(1,555 posts)I'm here to be part of the community and hopefully part of the solution...
not part of the problem
bluesbassman
(19,361 posts)That has no place in DU discussion.
Veilex
(1,555 posts)I thought the movie quote was an appropriate way to diffuse the argument. However, others have taken umbrage, so the title has been altered.
bluesbassman
(19,361 posts)I also like to use dialog quotes to emphasize my thoughts in a post. Sometimes they work, sometimes they don't. Thanks for your willingness to make the correction. 
cui bono
(19,926 posts)What's with your blatant sexism? Are you from the stone ages? I don't think you could be more condescending if you tried.
Ladies, ladies... you're both pretty...
You should apologize to both of them as well as all the women on DU for that disgusting remark.
And the jury members who voted to leave it need to get a clue.
Someone else already alerted on this post before you alerted on it, and only the first alert was sent to a Jury. A randomly-selected Jury of DU members completed their review of the post on Wed Mar 19, 2014, 09:47 AM, and voted 2-4 to keep IT. Please note that even though your alert was not sent to a Jury, it has been forwarded to the Administrators who review all alerts.
Thank you.
But yeah, there's no sexism on DU. Um-hm... sure.
Veilex
(1,555 posts)Just a movie quote in an attempt to diffuse an argument.
However, I've self-moderated and removed the movie quote.
cui bono
(19,926 posts)I don't know that movie - and apparently others don't either - but out of context it's really just a sexist remark, hopefully in the movie it's making fum of the sexism of it.
I appreciate you removing it.
Veilex
(1,555 posts)Here to aggravate and agitate the nonsensical GOP... not fellow DUers
brush
(53,745 posts)who have signed up and are benefiting from the ACA.
You can get mad and deny it all you want but the ACA is a law now and is helping people who weren't able to afford health insurance before.
Of course it's not perfect. Pls consider re-directing your anger into energy for the 2014 campaign and work to get candidates elected who will help to take health insurance reform to the next level.
Remember, presidents since Roosevelt — Teddy, not just FDR — have tried to get health care reform passed. Obama got passed what all those other presidents couldn't. And he got passed through the repugs and their allies the bluedog democrats what would pass. You have to know that single payer was not getting through the repugs and bluedogs in 2009.
As Joe Biden said, "IT'S A BIG FUCKIN' DEAL".
Now it's up to us to pick up the ball and work toward improving it, or better yet, getting single payer passed.
Hell, it might be 2019 before we can even get a bill put before the Congress for single payer. It might be more years than that before it passes into law but we have to keep trying. Teddy Roosevelt was president in the first decade of the 20th Century (1901 to 1908 I believe), so it took just about 100 years for a health care reform bill to be passed.
It ain't gonna be easy. This is America. Capitalism reigns. Profit motives reign. Insurance companies are not going just voluntarily roll over and not try to make huge profits. They make less profit with the ACA then before but they still make something, which is the only way the ACA was going to pass.
Once people see that the ACA is not the end of the world, and maybe big insurance should not be profiting off of people's misery, we'll be able to move towards single payer (WOOHOO!).
The ACA is better than what we had but clearly it's just a stepping stone.
polichick
(37,152 posts)Oh yeah, we tried that. The Dem WH went after the activists who paid for the ads.
Maybe we can elect a hope and change candidate who would never allow industry lobbyists to write a healthcare bill.
Oh yeah, we tried that.
Maybe the next wave of corporate Dems will have our backs...
brush
(53,745 posts)Or do you intend to do more?
I'm all for outing blue dog dems with ads who vote with repugs. I agree with you on identifying the traitor dems but I also am not just falling back on cynicism.
I will be working on the 2014 and 2016 campaigns to get Democrats from the democratic wing of the Democratic Party elected.
GO WARREN!
polichick
(37,152 posts)from the democratic wing of the party?
If you're not cynical about our corporate parties at this point, you haven't been paying attention. It's sane to be cynical.
"The power of accurate observation is commonly called cynicism by those who have not got it." George Bernard Shaw
brush
(53,745 posts)"The power of accurate observation is commonly called cynicism by those who have not got it." George Bernard Shaw
Nice quote, but it doesn't quite apply now, because as we now know, those 2007 cynics who poop pooped the chances of a black man becoming President of the United States, now have way more than egg on their faces.
So I still say, "Go Warren, woohoo!
polichick
(37,152 posts)have egg on our faces.
I'm watching to see what Bernie Sanders does - he's pretty much said he's running, but hasn't decided to go Dem or not.
brush
(53,745 posts)Guess we all better fasten our seat belts because with Hillary in it also, the 2016 dem race is going to be a bumpy night.
And you kinda have to admit Obama did change some things — maybe not a much as we wanted, but he had UNPRECEDENTED REPUG AND BLUE DOG OBSTRUCTIONISM that he is still up against. Check this list from Mother Jones:
1. Passed Health Care Reform (not perfect by any means)
2. Passed the Stimulus
3. Passed Wall Street Reform
4. Ended the War in Iraq
6. Eliminated Osama bin Laden
7. Turned Around US Auto Industry
9. Repealed "Don't Ask, Don't Tell"
12. Reversed Bush Torture Policies
14. Kicked Banks Out of Federal Student Loan Program
16. Boosted Fuel Efficiency Standards
18. Passed Mini Stimuli (July 22, 2010; December 17, 2010; December 23, 2011)
22. Created Conditions to Begin Closing Dirtiest Power Plants
27. Achieved New START Treaty
http://www.motherjones.com/kevin-drum/2012/03/barack-obamas-had-pretty-damn-good-presidency
We need to point out blame (he's not a progressive as we all hoped) but also give credit where credit is do.
Wait Wut
(8,492 posts)I really do try not to make this about me, but I'm the closest example I have. I haven't gone, yet, but I will be able to see a doctor for the first time in 13 years, except for my emergency room visit for a miscarriage that left me $15000 in debt.
I have a history of cancer, stroke, hypotension (extreme low blood pressure), heart attack and a few that I've probably forgotten. 13 years is a long time for someone like me not to be able to afford to see a doctor.
But, there are much more heart warming stories out there. The young mother who will be able to live to see her daughter get married someday. The young boy that won't be yanked off his parents insurance because he reached his lifetime cap at 9 years old, will have the chance to go to college. The college kid that wasn't feeling well and was able to see a doctor to find out that he's got a very treatable illness that could have otherwise jeopardized his future. The dad that won't have to sell his families home to pay medical bills after a heart attack.
Prescription meds? Yeah. We need to revisit that nightmare. But, to 'blame' our President for something that will save the lives of people that had no hope, okay...blame him. I'll blame him for the absolute terror that I will experience when I get to step into a doctor's office for the first time in 13 years.
VanillaRhapsody
(21,115 posts)in fact is it exactly the same!
polichick
(37,152 posts)you're getting crumbs - with a bill.
JoePhilly
(27,787 posts)According to you.
There are millions like her. Kids who had cancer and survived.
Kids who were going to carry that around as a preexisting condition, preventing them from getting care for anything more serious than common colds or sports injuries.
polichick
(37,152 posts)or maybe you just twist things on purpose.
JoePhilly
(27,787 posts)polichick
(37,152 posts)JoePhilly
(27,787 posts)lumpy
(13,704 posts)Lars39
(26,107 posts)will not solve the problem.
"Ignoring feedback from people that are not being helped or who are being economically hurt will not solve the problem."
...how exactly does inaccurately attributing something to the law and saying, "Fuck you, Mr. President, you piece of shit used-car salesman," solve any "problem"?
I mean, the RW scream a lot of unsubstantiated crap about the law, and the solution is to call them on it and debunk those claims.
Lars39
(26,107 posts)before the negotiations even started is one reason.
ProSense
(116,464 posts)"Obama taking single payer off the table before the negotiations even started is one reason."
Every health care system uses formularies.
Lars39
(26,107 posts)ProSense
(116,464 posts)Lars39
(26,107 posts)
Mojorabbit
(16,020 posts)ProSense
(116,464 posts)Mojorabbit
(16,020 posts)brooklynboy49
(287 posts)Notice how non-responsive his head cheerleader's "response" was
Bobbie Jo
(14,341 posts)Welcome to DU.
uppityperson
(115,677 posts)brooklynboy49
(287 posts)I did the unthinkable -- I stayed home in 2012.
uppityperson
(115,677 posts)brush
(53,745 posts)Hope it wasn't Romney.
brooklynboy49
(287 posts)I stayed home.
brush
(53,745 posts)Pls vote in 2014 though, we need to try to keep the Senate and maybe pick up a couple of seats in the House.
one_voice
(20,043 posts)
brooklynboy49
(287 posts)I didn't take staying home lightly and didn't do it cavalierly. I take voting very seriously and, except for 2000, when I voted for Nader, I have always voted the straight Democratic ticket.
I had my misgivings about Obama early on. WilliamPitt has cursed the president and called him a used car salesman. Knowing what I know of his situation (only what I've read on thus forum), I can understand why he has lashed out as he has.
During the 08 primaries, I came to call Obama a snake oil salesman. A great speaker selling an elixir that would solve all of our problems. His qualifications for the office were his oratory skills, if you can call that experience qualifying you to hold the office of President of the United States. Frankly, I didn't think he had the necessary experience and was capitalizing on his celebrity status. He was the biggest thing to hit since The Beatles. And as much as I loved John Lennon, I don't think he would have made a very good president, either.
Despite my misgivings, I held my nose and voted for Obama. As I had done for Clinton, Dukakis and Carter before him. I have only pulled the lever for a presidential candidate enthusiastically twice -- the first time I voted, in 1972, for McGovern; and in 1984, for Mondale. Well, three times if you include 2000, when I voted for Nader.
My problem with Obama was simply this -- Here's a guy, I thought, who wants to implement real, fundamental reform. Reform that would transform government into an institution which would do the peoples' work, not the PTB's. But I just felt that as wonderful as it would be to live in a society envisioned by Obama, he wasn't being straight with us. He's an exceptionally smart guy, he knew full well there was no way in hell he could accomplish anything remotely approaching the "change" he was running on because of the obstacles which would have to be overcome to implement those changes, and he knew he about a snowball's chance in hell of overcoming those obstacles.
I voted for him anyway. And I was wrong. He wasn't tilting at windmills, he was just another politician, no different than the rest. Health care "reform" was a debacle. He was clearly in over his head. And that scenario played out again and again.
Worst of all, he gives the opposition gifts they haven't even asked for. Like not even putting single payer on the table so you can negotiate down to a public option.
Then unnecessarily putting Social Security on the table.
I am convinced that Obama suffers from having a huge ego. And believing in his heart that if he does the "right" thing (as he sees it), the Republicans will say, yeah, let's get that grand bargain done! In this respect he is stupid. He doesn't get it that they hate his fucking guts with a passion, and we all know why. They would rather let the country implode than do anything to help him govern in the best interests of the people they ostensibly represent.
So, yeah, I stayed home for the first time in my life. Which was unthinkable for me. I think, eat and breathe politics. And I just got sick of voting for a guy I had to hold my nose to vote for.
And I will do it again, if necessary. If Hillary is our nominee, I will not support her candidacy. I am hoping that before I die, I will get one more chance to vote for a candidate I truly support, a candidate I truly believe will shake things up and make Washington work for us. A Bernie Sanders. Or an Elizabeth Warren. Or a Dick Grayson. Or even a Sherrod Brown.
Don't dismiss me because I stayed home. I voted in 2012. I voted for none of the above.
VanillaRhapsody
(21,115 posts)it is what it is...we cannot keep beating THAT dead horse now can we?
Lars39
(26,107 posts)Sweeping unpopular feedback under the rug will not solve these very real problems with ACA.
VanillaRhapsody
(21,115 posts)beating him doesn't bring him back to life....
We have to move forward from where we are....not where we were.
Lars39
(26,107 posts)VanillaRhapsody
(21,115 posts)How does going over and over how we got the ACA passed change people's problems with the ACA? Unless of course they only hate the ACA because they hate the President who got it for us...talk about looking gift horses in the mouth....but instead you want to beat the dead one!
Will's problem HAS been addressed.....he just didn't like having HIS mistakes pointed out....he WANTED to trash the President. Per usual. That is all.
Lars39
(26,107 posts)Doesn't appear that WillPitt did anything wrong, he did all that the ins co asked him to do, according to this post: http://sync.democraticunderground.com/?com=view_post&forum=1002&pid=4690867
"Wife went to part-time in November, but her coverage lasted through December. COBRA in January, Anthem in February.
When we signed up, the very first question we asked was about getting coverage for this medication. They told us all we needed for medication approval was to have her doctor call them and peer-approve it. He did that two months ago. When we tried to get a refill, they said we couldn't because her doctor needed to peer-approve it first, which he had done. Her doctor called them again. We heard nothing from them. Then they said it needed to go before a review board. Then they denied coverage.
It has been a bullshit runaround. They told us what we needed to do to get the meds. We did that. Then they said that wasn't what we needed to do. They basically lied to us. If they had said flat-out, "No this medicine will never be covered," we would have pursued other options and other meds weeks and weeks ago."
questionseverything
(9,645 posts)paid for coverage under the aca and now has to beg and fight with the insurance companies to get the treatment they need
I am pretty sure will will win his fight ( in no small part due to his visibility)
but where does that leave the rest of us?
I have written many times on this board that at 75 grand a year the aca wants from 26% to 33% of our pre tax income to pay for premiums and out of pocket
I have been told to die, not be selfish, blah blah blah....
my fear has been that even if I could somehow rebudget to find 33% of income to pay for healthcare my spouse would STILL not have his specialty drug covered.....will's experience seems to mirror that (except I have no idea what his premiums are)
even if we were going to have ins reform instead of healthcare reform the place to start should of been cost containment of providers (putting some limit on what drug companies can charge)
as someone who pays income taxes I also get the added insult of subsidizing others plans...while my family will go without
the aca has some huge holes in it, thank you for taking time to debate the "cheerleaders"
theboss
(10,491 posts)There are major gaps regarding affordability.
Question: How were you getting these specialty drugs before?
questionseverything
(9,645 posts)the cost is the REASON for the formulary
we both know the formulary exists to help insurance companies manage costs and for no other reason
Hekate
(90,565 posts)... cost-control measure. Without cost-control measures, everything goes belly-up.
The question is: Which cost-control measures and how flexible, because one size does not fit all. That's why review boards exist EVEN IN SINGLE PAYER SYSTEMS.
Having read a few of the poster's other replies in this unwieldy thread, I don't think he's being dishonest, just mistaken or misspoken in this one thing.
naturallyselected
(84 posts)In the single payer systems in both Canada and Great Britain, there are formularies of covered medications, and many medications are not covered. There are medications that must be paid for by the individual, and insurance plans exist (at least in Canada) for the express purpose of paying for drugs not covered in the national formulary. This is by no means unique to the ACA or the private insurance model in the US.
As an example, here is a link detailing the story (now a couple of years old, maybe the policy has since improved) of a young woman in Canada trying to pay for her Hodgkins lymphoma medication.
http://www.theglobeandmail.com/news/national/time-to-lead/the-cost-of-drugs-breaking-the-bank-to-stay-alive/article4263623/?page=all
Should this problem exist anywhere? That's different question - but it is not a problem unique to the American system.
For the record, I think single payer is the way to go, and I am very dissatisfied with the timid solutions in the ACA. But even a single payer answer won't necessarily solve this specific aspect.
Hoyt
(54,770 posts)shouldn't get cancer, have heart attacks, etc.
But, even those countries with lots of experience with single payer do not cover every drug and every treatment. They exclude things that cost too much, with suspect efficacy, for which there are other alternatives even if not quite as good, etc. If you get caught in the exclusion -- as the OP apparently has -- it is awful and anger is understandable. At least ACA has a process for appeals and it is possible to change insurers without being excluded outright for pre-existing condition. But, I realize that doesn't solve all the problems.
I wish the OP would tell us what drug is involved, although I can understand why he might not want to do that. Then, we could see what other countries do, etc.
Fact is, ACA is helping a lot of people, is much better than what we had before, is a first step toward a better system, and avoided the 20 year lapse of any meaningful health care legislation (other than Medicare prescription drug coverage) that occurred after Hillarycare was defeated.
Personally, I'm OK with insurance companies taking on the risk of covering more people in the short-run. There is no way our Congress would have passed a risky Medicare-for-all at this time if the government had to shoulder the total risk. And quite truthfully, folks would still be griping if that had happened when they find that traditional Medicare is expensive; has no out-of-pocket limit; is still run by insurance companies on local level and for drugs; has drug formularies; does not cover a lot of things; etc.
In any event, I hope things workout quickly for the OP and his family.
Mojorabbit
(16,020 posts)Hekate
(90,565 posts)Formularies are a cost control device. Start with that. We need to IMPROVE the freaking things, for gods' sake, so they are more flexible. I don't think we can get rid of them.
ChiciB1
(15,435 posts)At least not that I can recall. BUT, I do have to agree with this. It's NOT because of ACA! I don't have ACA Insurance, I have an employer based Medicare Retiree Humana PPO. My coverage has been very good, I only pay the monthly Medicare cost and it includes drug coverage with my plan. I actually use mail order and my husband & I get many meds free.
BUT, this is happening to me too. All of a sudden I'm being denied insurance coverage on medications that I've taken for a very long time, month after month. Insurance company has never had to cover ANY adverse reaction these medications caused, and they call me all the time regarding Wellness Check-ups! Now, if they won't cover the meds anymore I will have to buy my meds by telling pharmacist I don't want them to go through my insurance. AND even though MY doctor already told insurance it's "medically necessary" they still denied the coverage! But what IF I can't afford the cost of the medication without my insurance covering it??? I DO WITHOUT!
So, now I'm faced with the prospect of paying extra out of pocket costs OR risk not having the medication that may THEN really cause a reverse reaction that I WILL have to seek OTHER medical attention due to the fact that I had medication denied! AND the adverse reaction very well could cause the insurance company to pay extra/more $$$$ because the medication actually WAS needed in the first place!!
THIS IS CRAZY and so wrong-headed! But it is THE MEDICARE FORMULARY rules that have been put in place, NOT ACA! A one-size fits all formula that seems to have more negatives than pluses!
CJCRANE
(18,184 posts)However all healthcare systems, even socialized ones, have shortfalls and loopholes and areas where they don't measure up.
But..you have hundreds, if not thousands, of people rooting for you here on DU, so please go and use that energy and expertise to resolve the issue!
steve2470
(37,457 posts)I think we can all empathize with Pitt's anger and frustration. Medicare for All or anything even close to that was not a realistic option in 2009, so we keep fighting for it. Until then, we deal with the crapheap we have.
My insurance plan doesn't cover some drugs either, and it's a platinum level plan. It sucks.
Scuba
(53,475 posts)Remember, the ACA passed with exactly zero Republican votes.
steve2470
(37,457 posts)I think all the Blue Dog Dems would have defected to the dark side. It was hard enough just passing the ACA, which was a Republican plan. NOW...I think Medicare for All is realistic.
ProSense
(116,464 posts)Scuba
(53,475 posts)ProSense
(116,464 posts)Scuba
(53,475 posts)VanillaRhapsody
(21,115 posts)
blue neen
(12,319 posts)My husband's anti-depressant is very expensive. It's the only one that works for him---we had to shop around for Part D coverage that will at least cover part of it.
Also, the psychiatrist does not accept Medicare (reimbursement probably not sufficient). We have to pay him completely out of pocket. This doctor is the best around, in a specialty that is truly lacking in doctors. We choose to pay him and are lucky enough that we are able to.
So, does all of this mean we should damn Lyndon Johnson to eternal hell? I mean, after all, Medicare was his signature piece of legislation, was it not? It's HIS fault, from the grave, that my husband's medication is not covered. 
In all seriousness, I sympathize with anyone who is fighting for good care for their loved ones. Big Pharma and Big Insurance still do suck. We shouldn't be spending time on a message board saying hideously disrespectul things about a President who did something not perfect, but very good and very valuable. It would be great if we could use our talents and resources in a more productive way.
lumpy
(13,704 posts)blue neen
(12,319 posts) Nay
(12,051 posts)If so, then yes, the ACA is wrong, wrong, wrong, and that should be changed. All drugs that Medicare covers should be covered by every ACA insurance provider. If the providers can just pick and choose what drugs to cover, then it is worse than useless.
brush
(53,745 posts)who had to be brought kicking and screaming to support the bill. And of course we all know that they insisted on the watering it down significantly before they voted for it.
They are just repugs in blue dog clothing. And we can blame Rahm Emanuel for ramrodding their right-leaning candidacy through — remember that fight — Howard Dean saying he wanted candidates from the democratic wing of the Democratic Party (of course I'm paraphrasing)? That did happen.
pnwmom
(108,960 posts)Medicare would have solved Will's problem?
It all depends on the drugs listed on any formulary. Will needs to check with the other plans in his state to see if any cover the drug his wife needs. He was given very poor advice by a "friend"" not to bother, that checking would be a waste of time.
pnwmom
(108,960 posts)
leftstreet
(36,101 posts)CJCRANE
(18,184 posts)I don't remember him being interested in healthcare reform.
Nye Bevan
(25,406 posts)Hoyt
(54,770 posts)did without, cut pills in half or thirds, took much less effective alternatives, lost everything they had before becoming eligible for Medicaid, etc. I give bush credit for doing that. Yet, people still gripe about that, saying things like it wasn't funded, it was designed for insurance companies, etc.
Puzzledtraveller
(5,937 posts)It would have been fast labelled as a health insurance industry bailout.
Drunken Irishman
(34,857 posts)What a dumb point. Bush never tried to reform the healthcare system. The closest he came was Medicare Part D and even that had to be fixed by the ACA.
uponit7771
(90,304 posts)phleshdef
(11,936 posts)
Zorra
(27,670 posts)bitter, bitter
“Our strategy should be not only to confront empire, but to lay siege to it. To deprive it of oxygen. To shame it. To mock it. With our art, our music, our literature, our stubbornness, our joy, our brilliance, our sheer relentlessness – and our ability to tell our own stories. Stories that are different from the ones we’re being brainwashed to believe.
The corporate revolution will collapse if we refuse to buy what they are selling – their ideas, their version of history, their wars, their weapons, their notion of inevitability.
Remember this: We be many and they be few. They need us more than we need them.
Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing.”
― Arundhati Roy
To Another, Kinder world, soon.
oldandhappy
(6,719 posts)so we can have people in place to make necessary changes. 2014 is an important election even if people are saying, what is there to be interested in for 2014? Lots! This stream is the perfect example. VOTE Thank you!
MH1
(17,573 posts)However, that post got many fewer recs than the "Obama is a piece of shit" post.
(I sympathize with Will's anger and won't attack him for it, but I do feel it is misdirected in the heat of the moment. There are many to fault in this situation and Obama not wringing a better health care plan out of this effed up Congress is just one piece of it.)
polichick
(37,152 posts)the WH with lobbyists as the bill was written. HE'S the one who called the left off when we ran ads against the Blue Dogs about this. Obama got what he wanted - it's just not what WE wanted.
VanillaRhapsody
(21,115 posts)lest you forget EVERY Democratic President wanted to be able to do what he did...
Stop looking gift horses in the mouth and lets move on and make it better....just like FDR and LBJ had to do!
polichick
(37,152 posts)woo-hoo, what a "gift horse."
VanillaRhapsody
(21,115 posts)
5 million who are recently insured think its a gift...you can bet on THAT
Hell Hath No Fury
(16,327 posts)when you bogart a Republican approach to "healthcare". There's no polishing a turd. 
I remember watching one of the original debates with friends. For the first time ever, I heard him say "access to health insurance" vs. his usual "access to healthcare". He kinda slipped that in, hoping no one would notice. I sure as heck did, and I even asked my host to rewind the DVR to makes sure my ears weren't deceiving me. Yup, that's what he said. It kind put a damper on our evening because we knew what it meant. 
As long as the insurance industry involved, they will ALWAYS be working against their patients.
area51
(11,897 posts)The current ACA was originally created by the Heritage Foundation and promoted by Newt Gingrich. Why the hell did the democrats latch onto and promote a completely republican answer to our health care system?
TorchTheWitch
(11,065 posts)Big Pharma and Big Insurance is who gives billions of dollars to Dems to get them elected. And whenever that happens regardless of the party taking that money the deal is sealed. The political system in this country is and has been so broken that EVERYTHING revolves around who paid you to put your ass in the seat you won. Lobbyists are nothing but the bribery middlemen. And that's exactly what our whole political system is - bribery.
Until private money is taken out of the system this is how it will be, and with only two parties both of which give back in favorable legislation them that put them in their seats us regular folk are fucked. Doesn't make one shit's bit of difference who you vote for, the results are ALWAYS going to be the same solely because of that money.
Once Reagan killed the unions the Dems had nowhere to go for the campaign treasure chest other than the exact same places that Repubs always have - Big Corporate. Since then Dems have had exactly ZERO incentive to do jack shit for Joe and Jane Average.
jeff47
(26,549 posts)One is to call the president a "fucking piece of shit used car salesman".
Your other option was to ask people how they fixed problems like yours. And you'd have discovered how to get the insurance to pay for the drug despite their initial denial. Because Formularies are not new, and drugs not being on them is not new.
You picked the first one. Did rage actually solve your problem? Nope. Can you actually get the drug covered? Yep. Too bad you didn't bother with the second. You might have found out how.
polichick
(37,152 posts)over the crumbs and scraps we are tossed when it's OUR country and OUR money.
Anger inspires action beyond this one necessary solution, which will also come.
jeff47
(26,549 posts)And his blind rage means he isn't finding out how to get the drug his wife needs. A few people told him how in his blind rage thread, but they're few and far between, thanks to the blind rage.
polichick
(37,152 posts)if the people are ever going to take what's left back.
jeff47
(26,549 posts)And those people don't reside in the white house.
Also, that anger would realize single-payer plans still have formularies. So this problem would still exist if he was on Medicare D or lived in Canada, despite being single-payer plans.
polichick
(37,152 posts)from Day One. Tauzin was actually one of the most frequent visitors to the WH - that doesn't happen without the president's invite, and the ACA couldn't have happened without the president's signature.
jeff47
(26,549 posts)You're so desperate to bash Obama you are ignoring the fact that single payer does not solve the problem. They have formularies in Canada, the UK and every other single-payer country.
Waking up would also require understanding we have 3 branches of government. The one that killed single-payer is Congress. Single-payer would have never passed the Senate, and probably couldn't get past the House.
polichick
(37,152 posts)Perhaps you could address that.
jeff47
(26,549 posts)Perhaps you could explain how you get Lieberman to vote for single payer. The "Senator from Aetna" who knew he could not win reelection. You either need his vote for the bill, or you need his vote to change the rules.
polichick
(37,152 posts)and the WH attacked those activists.
Don't kid yourself about where the players stood.
The big problem Dem voters have is not knowing who actually stands with them - and who stands with corporations against the people.
jeff47
(26,549 posts)Lieberman knew he would not be running for reelection. He knew he could not win. So run all the ads you want, Lieberman is not in the race.
So how, specifically, do you get his vote?
polichick
(37,152 posts)who stands with the people and who puts corporate profits first. It's not enough to see a D behind a name - and no politician should get a free pass when it comes to the health and safety of the people and the planet.
jeff47
(26,549 posts)The bill does not pass without his vote, or you need his vote to change the rules in order to pass the bill.
So how do you get Lieberman's vote for single-payer? It does not happen in the 2009-2010 Congress without Lieberman's vote. And there's no fucking way in hell it passes after 2010 with the Republican House.
Single-payer does not happen in 2009-2010 without Lieberman. How do you get him?
You had 3 options:
1-Pass the ACA. It helps a lot of people in the short run, and moves the single-payer battle to the blue states. Where we will win. And where we can use those victories to spread it to the rest of the country.
2-Fail to pass single-payer. And health insurance reform goes nowhere for another 16 years, just like after 1993.
3-Do nothing, hoping we win more seats in 2010. And be screwed when we lost seats.
You are arguing for #2 or #3. How well did that work in 1993?
polichick
(37,152 posts)before anything else happened.
But I'm not only concerned with healthcare.
Pres. Obama is comfortable with corporate control, even if the people get screwed - there's no better proof than the TPP.
That's what Dem voters have to understand because we'll be faced with the same scenario next time around - unless we demand a different scenario.
jeff47
(26,549 posts)Your claim is Obama could have gotten single-payer passed instead of the ACA. The only way to do that is with Lieberman's vote (and other pseudo-Democrats, but Lieberman's the hardest to get).
So how do you get it? Or is your claim that Obama could have passed single-payer wrong?
No, you're realizing you don't have a good answer, and want to change the subject instead of admitting you were wrong.
polichick
(37,152 posts)from the get-go, don't you?
Where did I "claim that Obama could have gotten single-payer instead of the ACA?"
I don't think the WH ever even considered single-payer - or that the prez ever wanted it. THAT'S the point.
And it's not a matter of changing the subject - the subject is CORPORATE CONTROL, whether you're talking about healthcare or the TPP, and the fact that many Dem leaders (including the prez) are cool with it.
theboss
(10,491 posts)Just saying.
(I think we should have single payer. I don't think there is a chance of getting it passed in this country in the next 50 years).
polichick
(37,152 posts)Healthcare is a right and we should have Medicare For All.
Things will change when the people collectively demand it - but, for that to happen, voters on the right and left have to join together against the real enemies.
xocet
(3,871 posts)stops squarely on his desk.
*His failure was through either incompetence or design. Yes, the Republicans can be blamed for interfering, but President Obama was the one who threw away the support that was needed to win the 2010 midterm elections. Thereby shifting things back to deadlocked in Congress. At any rate, his failure was not because he is powerless.
jeff47
(26,549 posts)Please explain how Obama would get Joe Lieberman to vote for single payer. The senator from Aetna. Who knew he could not win reelection, so he was not going to run again. I really want to hear how, specifically, he could get Lieberman's vote.
xocet
(3,871 posts)polichick
(37,152 posts)beginning on Day One with his cabinet choices and by inviting Rick Warren to spit in the faces of those who elected him.
Maybe one day we'll know if his choices were by "incompetence or design" but it's interesting to note what does well in a deadlocked Congress: the status quo.
xocet
(3,871 posts)VanillaRhapsody
(21,115 posts)coulda surprised me....
Whisp
(24,096 posts)and when you carry it out like a spoiled 7 years old that just learned a new dirty word.
I sure wouldn't want to be around that person in real life when he gets his mad ons.
polichick
(37,152 posts)is far more dangerous than anger at those doing or enabling the screwing.
Whisp
(24,096 posts)but it sure as hell sounds like a lot of people here believe that shit.
polichick
(37,152 posts)The reason people get so frustrated with him is that they really did vote for Hope And Change - and Pres. Obama supports the status quo in many, many ways.
You don't get mad at the guy you knew was an asshole, you get mad at the one who conned you.
Whisp
(24,096 posts)Considering all the kvetching from 'the left' and all the horrible shit he has to put up with that and with the Baggers/Repugs.
He is like a fucking miracle man, not the evil piece of shit some say he is.
But I know why this is going on, not hard to figure out.
polichick
(37,152 posts)imo he's very comfortable with the corporate control of this country - which is particularly evident with his support of the TPP.
Maybe that makes a "miracle man" in your book.
Whisp
(24,096 posts)you can't turn the Titanic on a dime.
Centuries of greed and corruption can't be solved by one man - especially if that one man is being bitten by his so called friends and allies instead of them pitching in to help, they have raging tantrums like spoiled brats.
polichick
(37,152 posts)Whisp
(24,096 posts)polichick
(37,152 posts)why does he come down on the side of MORE corporate control?
Can you answer that or will you attempt to deflect - again?
Whisp
(24,096 posts)ACA was the start of the turn, did you really expect one President to magically invent single payer all in one or two terms with hostiles all over the freaking place - when every country that does have it went through years and years to finally get where they are at - and there still are problems to be solved.
ACA is a fine start to the road to something much better but everyone has to work on it. And calling the President a piece of shit is not helpful. It's Bagger Talk.
polichick
(37,152 posts)healthcare activists to the table instead of only inviting industry lobbyists.
We SHOULD expect it - and voters are fools if they don't.
It's not too much to expect a Democratic president to stand with workers against something like the TPP.
We SHOULD expect it - and voters are fools if they don't.
Over and over again, Pres. Obama chooses corporate control over the people. Why?
dreamnightwind
(4,775 posts)You are of course correct. Obama is as much a corporatist as the Clintons, who of course is the next choice of the establishment to maintain the status quo and further the interests of the wealthy at the expense of the rest of us.
If we want better, and many many people do, we will have to demand it, loudly, and not support or accept the lesser of two evils anymore. If the Democrats won't listen and continue to ram corporatism through with a happy face hiding the pain it brings to so many, they make themselves part of the problem, not part of the solution.
I am not a third-party person, I think our best chance is to stay and fight for control of the Democratic Party, but at present there is one money party with two faces. Many people realize this, many more are adversely impacted by the corporatist policies but haven't quite come around to realizing the people supposedly on their side are actually complicit. As things worsen they get closer to understanding, and that is the opportunity we have for actual change.
polichick
(37,152 posts)Bernie Sanders saying that he's serious about a run - but not sure whether to do it as a Dem or not.
That's really the question: Will the "political revolution" (as Sanders calls it) happen within the party or outside it?
I have faith that the people will eventually figure out which way to go.
dreamnightwind
(4,775 posts)I hope he goes for it, we need the discussion of the issues if nothing more than that.
There's also this:
99Rise - Demand Democracy - reverse citizen's united - corporations are not people money is not speech
http://www.99rise.org/
I am not involved in this but have seen the web site and it looks like an interesting development.
polichick
(37,152 posts)dreamnightwind
(4,775 posts)He's a little close to the Clinton camp, so I'm surprised to see this. Not my ideal candidate, but I like him, and he's very good at explaining complex issues in ways that can be understood by anyone. Definitely one of the good ones.
polichick
(37,152 posts)to the Clinton camp and wonder if he's only trying to get HRC to take on inequality.
I have read a couple of his books and thought he had a lot of important things to say about how our system works - or DOESN'T work.
lumpy
(13,704 posts)Response to jeff47 (Reply #20)
CJCRANE This message was self-deleted by its author.
Well said.
canoeist52
(2,282 posts)We ignore and revile criticism at our own peril. And betrayal can be a cruel mistress at the poles.
zeemike
(18,998 posts)And there are people here that are in denial of that...and think that the authoritarian principle of support the leader blindly is what we all will do.
And most of us here on DU will probably vote Democrat no matter what, but that will not be how middle America will see it, and the pom pom crowd will just make them more sure that it is bullshit.
VanillaRhapsody
(21,115 posts)truebrit71
(20,805 posts).."piece of shit used car salesman" I think is the ACCURATE quote...
So yes, saying that Obama sold the ACA like a 'piece of shit used car salesman' would is criticism of the ACA..
VanillaRhapsody
(21,115 posts)truebrit71
(20,805 posts)He said Obama was a piece of shit USED CAR SALESMAN.....
Context is important..
VanillaRhapsody
(21,115 posts)you cannot put that toothpaste back into the tube....
THAT is not criticism of the ACA...
truebrit71
(20,805 posts)....total fucking FAIL, but nice try anyway...
The FULL QUOTE said "Piece of shit used car salesman".
That is most definitely a valid criticism of the way this piece of shit was sold to the American people...the same way a lemon is sold by a "piece of shit used car salesman"..
VanillaRhapsody
(21,115 posts)every medical treatment or drug...they all have formularies too...
Sorry total Epic fucking fail on your part to defend that piece of shit post....
truebrit71
(20,805 posts)...and your selective editing to feed your selective outrage is actually the very definition of EPIC FUCKING FAIL...
VanillaRhapsody
(21,115 posts)But don't let a good story get in the way of your fucking narrative...
Does the NHS cover any and all medicine and treatment under the sun true?
truebrit71
(20,805 posts)...but AREN'T now?
It's almost like we were promised we could keep our old health insurance if we wanted to....
Remember that, or has that been selectively edited as well?
VanillaRhapsody
(21,115 posts)every country used formularies...even the NHS! Will even admitted that the drug was in and out of coverage...
Oh and MOST people DID keep their insurance.(if it met ACA standards)...are you auditioning for a Koch Bros. commercial?
Your objection to this President is duly noted...
truebrit71
(20,805 posts)"You can keep your coverage if you want to" = Not exactly true
"No pre-existing condition exclusion" = We won't NOT cover you, we just won't pay for what you need.
Man oh man, how do you keep upright with all of that spin?
VanillaRhapsody
(21,115 posts)Answer the question truebrit....does the NHS cover EVERY drug and treatment known to the medical profession?
(I might remind you that the NHS IS true Socialized medicine)
truebrit71
(20,805 posts)....wonder why he didn't say that instead?
It's sort of like saying that someone called the Prez a p.o.s, when in fact he called him a p.o.s. used car salesman...
theboss
(10,491 posts)It says that if you have condition x, you can either be denied all coverage outright or be denied coverage for any treatment reasonably related to condition x. (For someone with something like Diabetes, this is pretty much everything).
Will's wife has MS apparently. Prior to the ACA, she would have never been able to get an individual insurance policy of any time. She could also never quit a job unless she had a new job waiting, because group plans could have refused her coverage if she went without coverage long enough.
Today, she cannot be denied coverage. Period. And MS drugs are available. Ask Will. What is not available is the drugs she wants, because the company's formulary is different than her prior carrier's formulary.
That sucks.
truebrit71
(20,805 posts)...which some (most?) seem to find unfathomable...
theboss
(10,491 posts)She had a different policy - which she could have kept at least in the short term - that covered the drugs.
She switched to Anthem, which did not.
truebrit71
(20,805 posts)...then she changed plans, because she had to and now she isn't.
So no "You can keep your old health insurance if you want to" and "yes, we won't exclude you, but we won't pay for what you need either"...
I cannot for the life of me understand why Mr. Pitt would be so angry about that...
theboss
(10,491 posts)Before January, she would have had NO coverage in that situation.
She could still have that old coverage if:
1. She had not quit or
2. Kept COBRA (which does have a time limit of 18 months)
Also, there was no guarantee that she would always have that coverage if she stayed employed. The company could have switched to a plan that did not cover the pills. That happens every January or July across America.
Response to theboss (Reply #286)
Autumn This message was self-deleted by its author.
Auggie
(31,136 posts)Anthem replaced my policy with one that cost almost $400 a month more. Not exactly the same problem facing Will, but you can bet if ever need expensive meds there's going to be an issue.
As I replied on Will's thread yesterday about the ACA, insurance companies were not about to let anyone screw with their profits. They can't deny coverage, but it comes at a cost -- higher rates for some, reduced pharmaceutical coverage for others.
Ms. Toad
(34,009 posts)My plan, when the ACA was still a twinkle in Obama's eye created a "specialty drug list" which placed drugs which were previously formulary name brand in a special category, and tripled or quadupled our costs. MS medications, AIDS medications, and IBD medications were on that list.
This problem has nothing to do with the ACA, or with the inability to deny coverage.
sinkingfeeling
(51,438 posts)Voice for Peace
(13,141 posts) DonCoquixote
(13,616 posts)would be voting for McCain or Romney, and you know it.
Let me guess, you probably voted for Nader. If so, the GOP thanks you.
Voice for Peace
(13,141 posts)is spreading misinformation and discouragement, which isn't
illegal of course, but is harmful.
Your guess is incorrect, unrelated, and gratuitous.
DonCoquixote
(13,616 posts)If W. did not get into office. He did, and a lot of people are DEAD because of it.
Voice for Peace
(13,141 posts)The topic is the upside vs the downside of Blame.
Voice for Peace
(13,141 posts)the ACA on account of a few individuals' loud exclamations
and condemnations of it.
Apparently many are benefitting -- so it seems a disservice
to others to rant about how terrible it is, and to blame
this president -- who as far as I can see is trying as hard
as he can to do one of the hardest jobs on the planet.
magical thyme
(14,881 posts)1. fight the insurance company tooth and nail, right up the line. if it's not too late to switch programs, and you can find one that covers your wife's drug, switch. Within ACA, out of ACA, wherever you can get the coverage you need. And document, document, document.
2. apply your writing skills to publically document your battle for your wife. Shame the insurance company and highlight the problem to the appropriate people so they can change it. If they don't make appropriate changes, then publicize that as well.
Your outburst was totally understandable and ok. It gave you the immediate relief you needed, and galvanized supporters on your behalf.
Now it's time to stop getting mad and start getting very even. I see this as a major journalistic assignment dropped on you by the universe.
BuelahWitch
(9,083 posts)There are going to be more of this happening as people sign up. They need to have their stories told.
TBF
(32,017 posts)he is the figurehead of the status quo presently. But he is not the sole problem - it is much larger.
You have every right to be angry and frankly I can't understand why more people aren't as angry as you. Or aren't showing it.
Response to WilliamPitt (Original post)
Name removed Message auto-removed
sufrommich
(22,871 posts)truebrit71
(20,805 posts)......
Response to truebrit71 (Reply #39)
Name removed Message auto-removed
Vashta Nerada
(3,922 posts)on SNAP benefits or welfare.
Marrah_G
(28,581 posts)go fuck yourself, you piece of shit.
And if some jury decides to rule against me without seeing what the scumbag I am responding to wrote....then I will gladly take my first "hide".
Puglover
(16,380 posts)I missed that.
One of the darlings of so many here.
theboss
(10,491 posts)Ok. Good times.
This is my industry, but frankly, we are all moving around in the dark in regards to how the ACA is actually going to work. Having a drug denied is nothing new though. It's endlessly frustrating and can often be just plain cruel, but this is always how insurance works. No plan is going to have everything covered for free for all circumstances. That's the equivalent of a law against bad weather.
There may be a solution to this problem, but you provided no facts in either thread.
Hekate
(90,565 posts)He's going to break 500 posts again -- why stop now?
DanTex
(20,709 posts)Yours might be the first. In which case you probably want to contact the Koch Brothers, because with all their millions, and all their searching, every time they find someone to put on TV to complain about Obamacare, turns out that person is either fictional, or else is not actually taking advantage of the available options. Some, for ideological reasons, others because they just didn't know. But those people, the ones hand-picked by the Koch Brothers to attack Obamacare, so far every one of them is actually better off post-ACA than pre-ACA.
Still, let's assume that you actually don't have any other options. In which case, your situation sucks, no doubt about it. The question is whether Obama is at fault. ACA is providing coverage to millions of people who otherwise wouldn't have it, and in almost all cases, the coverage is better than before. This is because the regulations now are stricter than they were pre-ACA. If you compare ACA to some utopian world with no Republicans, then sure, ACA falls short. But those aren't the options available to us.
You can argue, and I would agree with you, that there should be stronger regulations, that insurance companies should be required to cover more than they do, that there should be a public option, etc. I imagine Obama agrees with you also. But there is that problem of the GOP-controlled congress.
Do you thing you would be better off in the pre-ACA world?
1StrongBlackMan
(31,849 posts)I would think the Koch Brothers would just love to hear a horror story from a widely read(?), leftist blogger. With the slightest of negotiation skills, WP's cooperation in their campaign could net more than enough to cover his wife's medication expense.
Unless, of course, this horror story devolves just like all the others ...
Vashta Nerada
(3,922 posts)The ACA sucks, but it's better than what we had before. It's one step in the right direction.
I'm holding out hope that one day congress will actually start helping the people by giving them the health care they need and not just health insurance.
VanillaRhapsody
(21,115 posts)there will NEVER be a perfect system...AND other countries with Socialized medicine ALSO use formularies. Do you think that Medicare just covers EVERY drug or treatment? So NO it WASN'T justified.
Hoyt
(54,770 posts)You had to go broke and end up on Medicaid first. Obama has improved Medicare prescription drug coverage too.
VanillaRhapsody
(21,115 posts)I wonder why?
Actually no I don't....
nomorenomore08
(13,324 posts)Please rethink that a bit.
steve2470
(37,457 posts)did you read all the advice people gave you in your first thread ?
I empathize with your anger and frustration, truly. My platinum level plan sucks on this point also.
WilliamPitt
(58,179 posts)Spent all day deploying a variety of potential remedies including appealing the denial of coverage, dealing directly with the drug company, and a few other things.
Waiting for the word.
steve2470
(37,457 posts)Last edited Fri Mar 21, 2014, 04:18 AM - Edit history (1)
theboss
(10,491 posts)So.....help me help you.
1. Was this medicine covered before?
2. Are other MS medicines covered by this plan?
3. Is there a reason that this medicine is needed and others cannot be used?
1. It was covered under her old insurance plan, but when we moved, she went to part-time and lost that insurance. I went to the exchange, and Anthem is all there is in New Hampshire. We have been trying since we switched plans to get them to cover it, a couple of months now. Her doctor called them to approve it on two separate occasions. They finally denied us that coverage two days ago.
2. I don't know, but I have my doubts. If they don't cover this one, why would they cover another one? Switching meds to something that is covered, if such meds exist, is a last-ditch option; changing from one MS med to another is not like switching from Advil to Aleve. If we have to, we will pursue that option, but I'm going to run this one to ground first.
3. See #2.
theboss
(10,491 posts)Seriously.....you can't do anything without knowing that first.
My mother went through this with some medications she took related to breast cancer. One worked. It fell off the formulary. She switched. It did not work as well. She appealed and got the original drug covered.
Yes, that is a pain in the ass, but millions of people have dealt with this issue for many years.
Frankly, the pharmaceutical companies are moving far too fast for the insurance carriers these days.
WilliamPitt
(58,179 posts)are daily injections that leave her covered in bruises, or one injection every three weeks that has some pretty cruddy side-effects.
Trying to avoid that if I can.
theboss
(10,491 posts)That's important.
Do other plans available through Anthem cover the drug she takes?
WilliamPitt
(58,179 posts)If it was only a matter of switching plans, I'd have done that weeks ago.
theboss
(10,491 posts)How was she paying for these pills before?
(I know I'm being personal here, but I still don't quite understand what happened here).
WilliamPitt
(58,179 posts)Covered everything she needed.
We moved. She went to part-time. Lost that insurance because only full-time employees get it.
Did COBRA as a bridge to this new insurance. Meds were covered under COBRA.
Not on COBRA any more. On Anthem. Meds not covered.
theboss
(10,491 posts)Also, did you ask about the meds before you signed up? Were the meds once covered and aren't now?
Like I said, this happens to people all the time when they switch jobs or their employers switch plans. And it does suck.
Hoyt
(54,770 posts)It sounds as if the OP would have lost all access to insurance when he moved without the ACA. So that's a plus. Having lost my wife, I get the med issue his family is facing, but it sounds like you guys are getting somewhere on this.
WilliamPitt
(58,179 posts)Wife went to part-time in November, but her coverage lasted through December. COBRA in January, Anthem in February.
When we signed up, the very first question we asked was about getting coverage for this medication. They told us all we needed for medication approval was to have her doctor call them and peer-approve it. He did that two months ago. When we tried to get a refill, they said we couldn't because her doctor needed to peer-approve it first, which he had done. Her doctor called them again. We heard nothing from them. Then they said it needed to go before a review board. Then they denied coverage.
It has been a bullshit runaround. They told us what we needed to do to get the meds. We did that. Then they said that wasn't what we needed to do. They basically lied to us. If they had said flat-out, "No this medicine will never be covered," we would have pursued other options and other meds weeks and weeks ago.
theboss
(10,491 posts)would have been the move.
Keep in mind that nearly every person you talk to at an insurance carrier is a moron. I've been calling them since 1999 and this is my experience.
Do you have every call, letter, discussion, etc documented?
WilliamPitt
(58,179 posts)Big stack of paper.
I'm pretty sure I've been talking to temps, mostly. During one call, when I was dealing with someone who knew nothing, I asked as a test for her to explain to me what a deductible is. She couldn't.
COBRA, in hindsight, yes. I trusted the process. Looking into getting back on COBRA as a possible solution, but I think that ship has sailed.
Thanks for talking this through with me, btw. Glad to hear I'm not insane.
theboss
(10,491 posts)Unreasonable and irrational maybe. But so is every other person when dealing with their health care. I'm used to it. We do a terrible job in educating people how this actually works.
Case in point: I was in a meeting on ACA last month and we went on the healthcare.gov site and were looking at various plan options. Everyone in the room - all people who work in healthcare - gasped at the premium costs. I asked each of them how much they contribute to their plans on each pay period. Hardly anyone knew. I asked them how much their employers contribute. No one knew. I asked them to find out, add that together, and then figure out if the premium costs were out of line.
My advice:
1. Call Anthem and ask for a clinical specialist. Try to get temporary approval for the meds until the appeal process is completed.
2. Write an appeal - without profanity - documenting everything you were told at every step. Use the phrase, "We relied on this advice provided by your employee" repeatedly. Get a letter of medical necessity from your doctor to include in the appeal. If you can, find out what the industry standard is for the drug. Do other BCBS plans approve it? Medicare? UHC? Humana? Aetna? You can probably find the top five carriers in NH and use them as an example.
3. Find out what alternative treatment options are as a backup. Like I said, this sucks, but it happens to a lot of people every year.
4. Find out what is covered under plans in neighboring states and - I dunno - move to where there is coverage or something.
PS
My suspicion is that her prior coverage was a rarity.
msanthrope
(37,549 posts)attest to this being a frustrating process. This is pretty much what I did when I appealed the initial 'no.'
theboss
(10,491 posts)That would have solved the problem immediately.
msanthrope
(37,549 posts)way up the chain--refusing to take 'no' from the people who aren't empowered to give you a 'yes,' anyway!!!!
THANKS OBAMA!!!!
WilliamPitt
(58,179 posts)Yelling is part of the program. It's called venting, and it helps.
theboss
(10,491 posts)Your problem is that your wife's insurance policy - a policy she could not get prior to the ACA - had a drug formulary you are not happy with. You declared that to be Obama's fault.
Cha
(296,893 posts)
AtheistCrusader
(33,982 posts)I understand your frustration. 
blindersoff
(258 posts)I've been doing them (IM injections) since 2010 with very minimal problems. About 2 years ago Avonex came out with a pen that made it much easier. Side effects (flu like symptoms that last about 12 hours after the shot) only persisted for a few months. But that's just my reaction -- others have worse reactions. Now I've gotten to the point that I don't even have to premedicate with aleve beforehand. The injections are not fun, but so far I've not had any progression that I know of.
Aubagio is one of the newest of the meds, and this might be why it's not covered. Avonex and the other injectibles have been around for quite awhile and have somewhat of a track record.
1StrongBlackMan
(31,849 posts)It's not really about a life or death thing, like you are portraying it, now is it?
WilliamPitt
(58,179 posts)You're clueless.
theboss
(10,491 posts)And another poster said those are acceptable and long-standing.
I'm not an expert on MS by any means, and don't know alll the side effects of the various drugs, but it sounds like some kind of widely accepted medication is available.
1StrongBlackMan
(31,849 posts)And to be honest, this histrionics (along with his other F@$% you, Mr. President" posts) makes me think WP is being less than forthright as to his motives/intentions.
1StrongBlackMan
(31,849 posts)There is a huge difference between saying "I am being denied coverage for the deadly-necessary medication needed to treat my disease" and "I am being denied coverage for the deadly-necessary medication OF MY CHOICE that is needed to treat my disease."
And you know this!
shireen
(8,333 posts)People react differently to the same drug, from relief/no side effects to no relief/bad side effects. Insurance companies don't always appreciate that subtlety.
Will, if you know why the board denied it, please explain in your appeal that she needs that specific medication for a reason. If something works, the insurance companies should just let the patient continue that therapy -- what they're doing to your wife is utterly disgusting. I'm so sorry you're dealing with this crap, and I hope it get resolved soon.
blindersoff
(258 posts)MS drugs (as I noted in some previous posts) only offer a 30% potential of slowing down or stopping progression of the disease. SOmetimes they work and sometimes they don't. A person can still have just as much progression on the drugs as off. Many people with MS don't take disease modifying drugs for just that reason. The side effects, the inability to predict efficacy and the cost are often factors. MS is a horrible disease... for some people much worse than others. Totally unpredictable. Not fun
uppityperson
(115,677 posts)She was diagnosed late, had the steady progression, made it 15 yrs after the initial diagnosis. It sucked and continues to suck. I am glad they are working on more treatments to slow it down, hoping they will continue to do some research and wish it was a lot more.
Insurance companies exist for 1 reason and that is to make money by taking premiums and denying payment as much as possible. verifiable communication trail and lots and lots of patience which is extremely difficult when you are talking life, death, quality of life.
I hope you can get through to the insurance company, persevere with the calls and writing and work your way up and up and up. Keep copies of everything you send, having it is writing is the best as they way there is a verifiable trail.
There may be other medicines but finding what works for the person and being able to continue with it is so very necessary for longevity and quality of life. "there are other medicines" is like telling someone with high blood pressure to just cut out salt.
Best wishes to her and to you and let us know how it all proceeds.
BuelahWitch
(9,083 posts)Your priorities are completely fucked to hell.
1StrongBlackMan
(31,849 posts)but history and context, matter.
I will reflect.
Ms. Toad
(34,009 posts)And doctors' offices (even when they are wonderful from a medical practice perspective) sometimes screw up royally with insurance.
I went through this run-around with one of my spouse's medications. There was a very simple process to get the medication covered. It was in our certificate of coverage. I gave the information to my spouse to get it to her doctor (who is a medical miracle worker, and should have enough administrative experience to have found it on his own). They kept telling my spouse they had appealed and it had been denied. Repeatedly. I would call the insurance company (I interface with the insurance companies for everyone in our family), and they kept telling me there had been no appeal.
It turned out that the doctor's office had just been repeatedly faxing the prescription in without the paperwork necessary for this particular step medication (one which has to be a second choice, when something else failed). They told my spouse that they had repeatedly called and had been repeatedly denied, but could not give me a claim number (which would have been generated if it had actually been appealed and denied). I finally was able to initiate the review process through the insurance company, who got the doctor's office on the phone - and the prescription was approved that day.
In this case, it was the initial approval for step-therapy, not an appeal. But don't just take your doctor's word that they have gone through the proper process. Read your certificate of coverage. Talk to the insurance company. Make sure, first, there isn't a simple internal way to get the medicine covered. If not, find out the formal appeal process and insist the doctor follow through - or fire the doctor. (We have had to fire one doctor who refused to help us through the appeal process - it really is something you need a strong doctor advocate for.)
Good luck.
Hekate
(90,565 posts)... for those who really want to be helped, and not just howl at the wind. I hope several people are taking notes.
Thank you.
theboss
(10,491 posts)People should know that.
Thanks.
blindersoff
(258 posts)It took about 3 weeks for BioGen to get back to me with approval for the copay assistance (and I made several calls to them to nudge them), but when they did I was pretty happy. I wasn't even sure I would be approved for assistance because my husband and I make a fairly good income.
VanillaRhapsody
(21,115 posts)do you think they do that in other countries with Socialized medicine?
steve2470
(37,457 posts)UK and other countries with single payer have similar issues. Still, of course, I'd rather have single payer and then tweak from there.
Demo_Chris
(6,234 posts)That's what the insurance companies wanted -- the greatest corporate payoff in history --and that's what Obama delivered. Just remember this: no matter how badly they treat you, how much they charge, or how little they cover, you MUST, by law, purchase their product. If the ACA covered fast food instead of insurance, the counter workers could openly spit in your food-- hack up so lungers right in front of you and vomit them into your burger-- and you would STILL have to buy it (and the cheerleaders here would tell you that 'At least you have food.')
That's the ACA. That's Obama's grand program. You have to buy it, no matter how foul it is, and at any price they choose to charge.
But don't worry if it's overpriced, because Obama has a plan for that too. Government sugar. The insurance companies can charge whatever they like, and if you cannot afford it all on your own we'll just add it to the national debt-- because fuck the future.
leftstreet
(36,101 posts)polichick
(37,152 posts)and that's why a lot of people aren't so keen to "get to work" on the next sorry-ass election of corporate servants.
truebrit71
(20,805 posts)....I feel like a sucker every, single time...first Slick Willie, now Pres. Hope and Change....I hope I won't get fooled again...
polichick
(37,152 posts)truebrit71
(20,805 posts)True healthcare reform would have abolished the need for health insurance entirely...
elias7
(3,991 posts)this legislation is incremental, and the only realistic approach
truebrit71
(20,805 posts)...he started negotiating from the middle, having already conceded most of the ground, and was then forced to accept the weak-ass POS that Max Baucus presented him....his negotiation skills were dreadful on every single meaningful piece of legislation he offered...Frankly I'm shocked SS hasn't been laid on the table naked and bare for the rethuglicans to tear to shreds for their benefactors...but then Obama still has 3 years left to "negotiate" that away too...
Hoyt
(54,770 posts)I thought it was a good plan, but it was flatly defeated and no significant health care legislation -- other than Medicare prescription drugs -- was seriously proposed until now.
truebrit71
(20,805 posts)....why Americans INSIST on over-paying for something that should be free?
woo me with science
(32,139 posts)It is well past time to be angry.
truebrit71
(20,805 posts)ProSense
(116,464 posts)That's what the insurance companies wanted -- the greatest corporate payoff in history --and that's what Obama delivered. Just remember this: no matter how badly they treat you, how much they charge, or how little they cover, you MUST, by law, purchase their product. If the ACA covered fast food instead of insurance, the counter workers could openly spit in your food-- hack up so lungers right in front of you and vomit them into your burger-- and you would STILL have to buy it (and the cheerleaders here would tell you that 'At least you have food.')
That's the ACA. That's Obama's grand program. You have to buy it, no matter how foul it is, and at any price they choose to charge.
But don't worry if it's overpriced, because Obama has a plan for that too. Government sugar. The insurance companies can charge whatever they like, and if you cannot afford it all on your own we'll just add it to the national debt-- because fuck the future.
...nonsense.
Debunking nonsense about profits: http://www.democraticunderground.com/10024689326#post12
STUDY: Average Obamacare Plans Are Cheaper Than Employer-Sponsored Ones
http://www.democraticunderground.com/10024415004
It turns out that there has, in fact, been no such rush to reduce work hours. Indeed, numbers released last week reveal that precisely the opposite is taking place.
According to the Bureau of Labor Statistics (BLS), the number of part-time workers in the United States has fallen by 300,000 since March of 2010 when the Affordable Care Act was passed into law. What’s more, in the past year alone—the time period in which the nation was approaching the start date for Obamacare—full-time employment grew by over 2 million while part-time employment declined by 230,000.
And it gets even more interesting.
http://www.dailykos.com/story/2014/03/18/1285643/-Every-Democrat-who-wants-to-win-should-memorize-Rick-Ungar-s-piece-on-the-FACTS-about-Obamacare
http://www.democraticunderground.com/10024689041
Under Obamacare, Disney World Will Promote Its Part-Time Workers To Full-Time Status
http://www.democraticunderground.com/10023767654
Obamacare also improved the Medicaid drug rebate program, which is one of the best.
<...>
The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.
The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drug’s coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html
The ACA increased the Medicaid rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html
<...>
Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drug’s price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).
- more -
http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates
The President has proposed the same rate for Medicare (http://www.democraticunderground.com/10022670043 ), which would save even more than the Senate proposal (http://www.democraticunderground.com/10022725266), $164 billion to $141 billion, respectively.
markpkessinger
(8,392 posts). . . A person always has the perfectly legal option of declining coverage, and paying the tax penalty (which is much lower than an annual premium).
Demo_Chris
(6,234 posts)In 2016 it will be $700 per person or 2.5% of income, whichever is greater. For the vast majority of Americans who are barely making it today that's a HUGE penalty.
lumpy
(13,704 posts)Demo_Chris
(6,234 posts)
mike_c
(36,270 posts)That affordable care part was just brilliant PR.
WilliamPitt
(58,179 posts)I think the insurance industry hates this bill, specifically because of the pre-existing conditions clause. Millions of sick people signed up for insurance, and that costs the industry a lot of money, especially since healthy people are not signing up as quickly as the administration expected...so the industry is protecting its profits in other ways, like denying coverage for medications.
theboss
(10,491 posts)I think providers hate it at the moment more than carriers to be honest.
But the real - unspoken - goal of the bill is to eliminate the use of ERs as primary care providers. I think the ACA will ultimately allow that to happen. And how it is going to happen is going to surprise people - providers are ultimately going to be the one paying certain patients premiums.
TBF
(32,017 posts)The doctors in our area are very vocal against it.
I can see it from their perspective as (albeit highly-compensated) workers. They go to school, have loans to pay off, and this will ultimately limit their profit (insurance company middlemen are still there skimming off the top, gov't involvement drives cost down).
This is the problem with everything being based on making profits (capitalism).
Where I would like to see humans move in the future - resource based economies.
theboss
(10,491 posts)For the docs I've talked to, it's a combination of some limitations on compensation combined with a potential big influx of patients. And I do think that is a legitimate gripe. The problem with healthcare is scarcity and there is not a lot we can do to fix that in the short term.
Where I think docs are missing the boat is the disconnect they have with their business offices. If the ACA streamlines paperwork, it's a boon.
Hospitals - where I make my living - actually like it in theory, because every hospital has the same problem. Uninsured patients filling up their ERs. You can't have the least likely to pay receiving the most expensive treatment. Every ER in the country has patients who show up every month for "life-threatening" illnesses that should be handled more cheaply. Every ER in the country has dialysis patients who should be going to a clinic every week, but don't and therefore wait for their kidneys to start to fail and go to the ER. It's madness.
TBF
(32,017 posts)they are not functioning as intended. I can see that clearly in my suburb. Heaven help you if you have a kid who falls or something and needs to see a doc after hours - the ERs are full of folks with sniffles who should have been at a primary (for a $25 copay) earlier in the day but they don't have any coverage. I think it has gotten worse in this age of low-paying, part-time service jobs. At least factory jobs back in the 1900s came w/benefits but so many of those jobs have been moved out of this country. It's a very sad situation.
mike_c
(36,270 posts)There is only ONE provider in the entire northern part of my county-- where nearly everyone lives-- who accepts Covered California policies. It's the local Open Door Clinic, which ironically treats indigent and otherwise low income patients anyway, which means that they could go there regardless of the ACA. But they're the ONLY provider for exchange policies. The insurance companies set the rates they pay providers at 30%-50% of whatever is normal for their "regular" individual policies, so every other provider here has refused to participate, and turns away patients who have policies purchased via the California Exchange.
All those policy holders have to do to get health care is "upgrade" their coverage to another plan which, not surprisingly, the same insurer will be happy to sell them, at considerable cost.
Auggie
(31,136 posts)
sweetapogee
(1,168 posts)And if you are, it is very possible that either rates will go up by a significant amount or the government will bail out the insurance industry or both. A bitter pill but it could happen.
nationalize the fed
(2,169 posts)written into the law
Obamacare 'Bailout' For One Insurer Will Cost Up To $450 Million In 2014
Forbes 2/06/2014
There’s been a lot of discussion about whether the risk adjustment tools embedded in ObamaCare amount to a bailout for the insurance companies, or are a reasonable feature of the law. There’s been far less information about how much money the insurers stand to gain from these measures, to offset their expected losses.
Now we have some hard numbers. Humana announced that it expects to tap the three risk adjustment mechanisms in ObamaCare for between $250 and $450 million in 2014. This amounts to about 25 percent of the insurer’s expected exchange revenue. This money is needed to offset losses that the insurer will take as a result of slower enrollment in its ObamaCare plans, and a skewed risk pool that weighs more heavily toward older and less healthy members than it originally budgeted.
More than half of the money will come from the $25 billion reinsurance pool that ObamaCare provides (collected through a tax on employer-sponsored health plans). The other half will come mostly from the risk corridors. Humana is expected to book the money as revenue to offset shortfalls between what it collects in exchange premiums and pays out in medical claims.
The company blamed the Obama Administration’s decision late last year to extend grandfathering of individual market plans for the overall deterioration in the risk pool. That means that Humana (like other insurers) was counting on people from the individual market being forced to transition into ObamaCare plans. It’s widely perceived that the Obama Administration counted on that migration as well. But Humana’s statement was a very clear expression of this expectation...
http://www.forbes.com/sites/scottgottlieb/2014/02/06/obamacare-bailout-for-one-insurer-450-million-in-2014/
There's a money pipeline directly from the American Tax Payer straight into the mouth of the lying, corrupt, bloated insurance companies bottom lines. This is a total disaster, one which will get much worse before it starts to get better.
And for those that think this is a step towards single payer, it takes a special kind of "hope" to think that now that everyone is mandated to buy this insurance it's the road to less insurance company involvement. Absurd. Look at a stock chart.
woo me with science
(32,139 posts)Puzzledtraveller
(5,937 posts)That shit was written, bought and paid for before he took the oath of office, heck before anyone knew who Barack Obama was.
ChisolmTrailDem
(9,463 posts)leftyohiolib
(5,917 posts)ChisolmTrailDem
(9,463 posts)leftyohiolib
(5,917 posts)ChisolmTrailDem
(9,463 posts)came within one post of my post and has failed to respond to my question.
leftyohiolib
(5,917 posts)but apparently youre outrage machine is cranked to 11 and now are unable to answer a simple question
ChisolmTrailDem
(9,463 posts)a "piece of shit used car salesman" and to use DU to exclaim "Fuck you, Mr. President".
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686242
I'm also pretty sure that most DUers could not have gotten away with saying those things.
Finally, my "outrage machine is cranked to 11" is an inaccurate statement. I'm only curious as to why some posters can get away with saying things that others cannot. That's all.
I asked the OP directly (not you, btw), and he so far refuses to answer.
Whisp
(24,096 posts)banned frm DU twice for really over the top awful behaviour and allowed to come back.
go figure, because I sure can't.
and he knows he can say whatever the fuck shit he wants, and get away with it.
msanthrope
(37,549 posts)Whisp
(24,096 posts)truebrit71
(20,805 posts)...did you question that poster as well, or is your outrage just directed at someone that says something you don't like about Obama?
ChisolmTrailDem
(9,463 posts)about why only a certain poster is allowed to get away with trashing our president. I was not talking about trashing another DUer, which seems widely acceptable versus what Pitt said.
Also, I'm as critical about what Obama has done as he deserves. I'm not a hugh fan of ACA. I was merely curious as to why that particular poster can get away with saying that about the president when others have been subject to punative measures, including banning.
Don't allow your misrepresentation of my intent to get in the way of my attempting to find out why some posters are allowed to say whatever they want and others are not.
And, btw, your outrage at your perceived notion of my outrage is ... curious. Also, btw, I am generally a fan of Pitt's writing.
leftyohiolib
(5,917 posts)arguement nor was i taking any sides in it iwas just curious. sorry about the outrage comment..
i've noticed that here as well, it also happens with postions on certain subjects.
Autumn
(44,986 posts)That's the signature piece of legislation offered by the President of the United States. That's what he called it. Insurance Finance Reform. Think about that.
http://www.whitehouse.gov/the-press-office/statement-president-house-passage-health-insurance-reform-legislation
ProSense
(116,464 posts)Americans like Katie Gibson, a cancer survivor from Bozeman, Montana, who shared her story with me this summer. Because of a medical condition Katie's insurance policy was suddenly revoked when she needed it most, even though she was paying her premiums. I called Katie this morning and I told her that when the bill that passed last night becomes law we'll be able to protect Americans just like her from the kinds of insurance company abuses she had to endure. And I told her that it was because of her willingness to share her story and the extraordinary activism that she and people like her all across the country displayed -- not just this year, but over the last several years -- that we are finally this close to getting reform done.
"That's the signature piece of legislation offered by the President of the United States."
You're correct.
Sanders: “How many people will die if the Affordable Care Act is repealed?”
http://www.democraticunderground.com/10024689831#post3
Autumn
(44,986 posts)It's good for some and others not so much.
Hell I like the way the Insurance Fiance Reform is helping me pay the insurance company their money, I sure couldn't afford it on my own . Now I would rather pay Medicare or Medicaid or VA my share and I would MUCH rather see tax dollars going to government programs that you , help people, rather than private companies.
But only because I believe our government does do a good job. They handle Medicaid and Medicare and VA very well . That's what health care reform should be modeled on.
ProSense
(116,464 posts)"They handle Medicaid and Medicare and VA very well."
...I'm sure the insurance companies are to thank for the fact that more than 17 million people are newly eligible for Medicaid.
In fact, counting the people who are discovering that they were eligible prior to the law, it's likely more than 20 million people will benefit.
Autumn
(44,986 posts)
LuvNewcastle
(16,838 posts)until we all get mad and grab our pitchforks and light our torches and chase the monsters down. If you aren't mad nowadays, you must have your head up your ass.
theboss
(10,491 posts)There is no plan, that is going to cover everything for everybody under all circumstances.
(And I support single-payer fwiw).
LexVegas
(6,031 posts)I believe the enduring legacy of the ACA will be that it was a bridge to universal healthcare.
Sarah Ibarruri
(21,043 posts)
Purrfessor
(1,188 posts)prior to the ACA. And if it wasn't covered then how is it Obama's fault it isn't covered now?
theboss
(10,491 posts)I'd like the answer to that too.
bluestate10
(10,942 posts)hot to avoid answering. My guess is that we aren't hearing the full story.
1StrongBlackMan
(31,849 posts)Well ... just because!
AtheistCrusader
(33,982 posts)The President couldn't get it. Recall, the President does not write legislation, (though he can request it).
So the buck thingy may exist, but it got around, bigtime.
theboss
(10,491 posts)Maybe not this particular drug. But something someone is currently receiving would go away.
AtheistCrusader
(33,982 posts)Moving off a profit-driven health care model will always have teething issues.
I'd rather fight those issues, than trying to get people covered for medication that is necessary to live, that cannot be afforded by people making less than the top 10% of income nationwide.
theboss
(10,491 posts)It will pass.
Okay...here it comes......
Jesus Christ, you are all a bunch of entitled pricks. Half this shit you "need to live" didn't exist ten years ago. All of you bastards are all the same. I have doctors calling me because I switch their favorite electrode to one that does the same goddamn thing for half the cost - a cost the hospital is not getting reimbursed for, I might add. But because the salesman for the first electrode took you to Maui in 2004, I have to stay with the overpriced one forever. And I got a patient on the other line, bitching because he has to take a medicine that does the exact same thing as his other medicine except the first medicine makes his poop a little browner than he likes or something. Except the proper poop medicine costs twice as much. By the way, his doctor is happy with the switch because the improper poop medicine rep took him scuba diving last March. I hate all of you.
/rant over
AtheistCrusader
(33,982 posts)Let it out. I fully agree with you, and insight like what you just shared into the underbelly of the medical world is badly needed.
Nothing motivates people like seeing how badly they are getting fucked over.
I wouldn't even call that a rant. And I agree, a lot of these medicines are new, R&D is high, supplies constrained, I get that.
If I could snap my fingers and make one change, I'd adopt Germany's health care model overnight. Do you think that would be good or bad?
bravenak
(34,648 posts)I hate us too.
Autumn
(44,986 posts)saying something about Obama and you post something like that directed at your fellow DU members.
Boggles the mind. 
Here's your post
"Jesus Christ, you are all a bunch of entitled pricks. Half this shit you "need to live" didn't exist ten years ago. All of you bastards are all the same. I have doctors calling me because I switch their favorite electrode to one that does the same goddamn thing for half the cost - a cost the hospital is not getting reimbursed for, I might add. But because the salesman for the first electrode took you to Maui in 2004, I have to stay with the overpriced one forever. And I got a patient on the other line, bitching because he has to take a medicine that does the exact same thing as his other medicine except the first medicine makes his poop a little browner than he likes or something. Except the proper poop medicine costs twice as much. By the way, his doctor is happy with the switch because the improper poop medicine rep took him scuba diving last March. I hate all of you."
/rant over
theboss
(10,491 posts)Those bastards!!
Autumn
(44,986 posts)directed at him. Agree those pharma salesmen are bastards
valerief
(53,235 posts)nadinbrzezinski
(154,021 posts)And your congressional delegation (use their constituent services), and appeal this. Also call your local media. I hate to say it, but companies hate the bad press.
It should not be the case, why we truly need single payor, but it is what it is.
I am sorry you need to go through this.
But for the moment stop posting, and get to that. And if you need help with research, let me know. I mean it.
(And once again this is why we need to get the companies out of the profit business. Health care should never be for profit)
theboss
(10,491 posts)I'm not sure people are going to get up in arms because they aren't covering something that they never covered (presuming they never covered it).
The right moves are going through the internal appeals process and after that, going to the commissioner.
nadinbrzezinski
(154,021 posts)How many formularies? How many insurance companies? All programs under the ACA should have one. If FDA approved, medication is in there. If experimental and under study, NIH picks the tab. Of course, I am talking of a civilized country here, with a civilized medical system, we are only 37 because of outcomes among the well to do. Our rural outcomes are really bad, same with urban poor.
This is systemic. And this is a federal program, where federal congressional delegations come in. The company is counting on that not happening. Most people do not.
theboss
(10,491 posts)I assume you are going to put really strict cost controls on this formulary. Otherwise, premiums are going to be a bigger disaster than they currently are.
nadinbrzezinski
(154,021 posts)Insurance companies are in for the money. VA has a formulary, like all socialized medicine it's not written in stone.
We need single payor and to get the profit motive out of the system.
We spend like there was no tomorrow, but we are 37 in outcomes. But yes, formularies either become extremely flexible, or we use a single one nationwide.
Single payor, I really have no idea what is so difficult about this concept for many Americans to embrace.
bluestate10
(10,942 posts)nadinbrzezinski
(154,021 posts)that alone drops the costs of meds. Just ask Canada. They use the same meds we use, mostly, and their costs are immensely lower.
Second, that formulary (look at Canada) has all meds authorized by FDA, so the med in question is not excluded. If they are experimental Health Canada covers the cost. In our case it would be NIH. It be a mystery to patients how the hell their meds get to the list, and that is ok. They would not have to fight these stupid shitty battles either, that only add to the tension and stress that is not conducive to good health.
Third, that is what most civilized nations do. Take profit out of the medical field.
WilliamPitt
(58,179 posts)Well, when we signed up, the very first question we asked was about getting coverage for this medication. They told us we needed to have her doctor call them and peer-approve it. He did that two months ago. When we tried to get a refill, they said we couldn't because her doctor needed to peer-approve it first, which he had done. Her doctor called them again. We heard nothing from them. Then they said it needed to go before a review board. Then they denied coverage.
That's doing something wrong. Telling us all they needed to approve it was a doctor peer-review, getting that review from the doctor twice, and then abruptly moving the goal posts before denying coverage is doing something wrong.
theboss
(10,491 posts)I think you should be able to get coverage until it goes to the review board at the very least.
WilliamPitt
(58,179 posts)Spent the morning on the phone making a guy named Dan not feel good about his employers by explaining this whole runaround to them. You told us this, we did it, and then you told us that wasn't it. I think I made a dent: he kept me on hold while he called my wife's doctor himself to initiate a (third) peer-review process. I'm guardedly not completely without hope.
theboss
(10,491 posts)Dan's a peon.
You need to get to a clinical person there. You need a written appeal. You need your doctor to write a letter. You need to send it certified mail.
msanthrope
(37,549 posts)insurance company....
Letters. The doctor needs to write one. You need to write one.
And by the way---this isn't an ACA problem. It's a formulary problem that existed long before the ACA. You may have appeal rights under the ACA--you should check that out.
mcar
(42,279 posts)Some of them offer free meds to qualifying people.
We did this with my MIL when we pulled her out of Medicare D a few years ago. Her Med D insurance company did a bait and switch on her most expensive non-generic meds, changing the formulary after she had re-upped with them (an unbreakable contract on MIL's part). She was stuck for a year, but the next year she opted out of Med D.
I noticed in the small print on the Medicare website a link to pharmaceutical company websites, which then linked me to their free meds pages. With very little effort, we were able to get her most expensive meds for free for several years. Saved her a bundle till she passed away late last year. Most of them just asked for a few years of tax returns and their income requirements weren't severe.
theboss
(10,491 posts)Kudos to you, sir and/or madam.
ChiciB1
(15,435 posts)to be very well informed on OH so many things. I saw Will P's post yesterday and then again today. Been taking soooooo much of my time reading ALL the 100's of comments, but I myself have been denied medication coverage. BUT I don't have insurance through ACA. I have a Medicare Retiree Replacement PPO, from Humana. My Dr. already stated it was medically necessary, AND he filled out forms & sent them to Ins. They still denied & sent me paperwork to APPEAL within 60 days. This is a medication he's prescribed for me on a monthly basis, but all of a sudden they say no. I suppose it's age related, but saw him again and had already checked with local pharmacy for a price. It was $10.00 so I had it filled & told them NOT to use my insurance. However, when I picked up the script I was informed I could appeal again and pay only $6.77. Not worth it to me at this time.
I suspect I'm going to get another medication I take monthly denied because it's not on my formulary and it's seriously infuriating having to go through this process. Are you saying I should contact my state Insurance Comm. about these denials even when my Dr. tells the insurance company it's medically needed and they still deny?
I'm sure I KNOW why I'm getting denials. but why should "we the people" have to submit appeals time & time again? I live in Florida, my Representative is Vern Buchanan (big R) and state legislation is Repuke controlled, AND my Governor is Rick Scott! Whatta ya think?? Order from Canada??
BTW, I have friends who have gone the Canada route and at a much cheaper price. I thought it was illegal but don't know for sure.
Sorry this is so long, but your suggestion sounds valid, but wondering if it will do much considering where I live. I see this happening over and over with my friends AND want to say that it isn't something specific to ACA.
THIS IS AN ISSUE where insurance seems to be controlling what THEY think is good for you. I DO NOT understand why, if a medication you've been taking for a long time and has NEVER caused ANY adverse outcomes that they can now say they won't cover it!
And to Will Pitt, I'm so sorry for what you're going through... but as I pointed out, I haven't changed my insurance because it has good coverage through my husband's Union job, from which he's now retired. I wonder if it's not something cooked up between Ins. & Big Pharma. I DON'T understand this myself!!
nadinbrzezinski
(154,021 posts)since it is an abuse.
Also since this is a medicare issue, your delegation.
(And if I may add, your local media)
The companies count on people not taking it outside the realm of the denial and appeal process. We should have a single formulary negotiated by the Feds, but that be a national single payor system. For the moment we need to find way to put pressure.
Regardless, most people think the commissioner only covers car insurance, and that is mostly what they concentrate on cars. Look for a health insurance commissioner. Some states have a specific one, here.
http://www.ohic.ri.gov/
Here is OH specific
http://www.insurance.ohio.gov/Pages/ComplaintMain.aspx
ChiciB1
(15,435 posts)issued by the Feds. Simply put, because a person passes a certain age, they are being denied the medication. BUT, a person 20 years younger "might" have more of a problem than me. I did say the medications I'm talking about aren't new medications. I've been taking them for a long time WITHOUT any adverse reactions. I responded to a ProSense post, and don't think I've agreed with her on anything ever, but I DON'T think this is an ACA problem. It's the Medicare Formulary that has changed.
A cookie-cutter, one size fits all approach to what they feel a person should or shouldn't take. What I had stated to her was that without taking the medication I've been taking, that NOT taking it could cause MORE of a medical problem and actually cost more in the long run. And, possibly put my health at risk in a negative way.
Just not fair. I'm not alone, I'm hearing this more & more. I understand that elderly people get loaded down with meds they don't need and don't understand and it is dangerous. However, if a person sees a doctor on a regular basis - like monthly - and fills out the forms advising them to approve the medication and they still deny, I'm one who has to deal with the consequences. I have a chronic condition & we've tried other types of treatments (many) and the only other option would be surgery. Surgery isn't always an answer and it could make it worse.
Anyway, you get the picture. Thanks for the info anyway, I do appreciate it.
nadinbrzezinski
(154,021 posts)and your two senators. They all have constituent services.
ChiciB1
(15,435 posts)Thanks again. I'm not one to take anything lying down & Vernie (Buchanan) and I have had several interactions in the past. Town Hall meetings, ya know. Don't think I'm his "fav" personality. I think my best bet is Bill Nelson, I'm on his mailing list. Can't see me checking in with MARCO RUBIO even if he has services!!!
Guess if you live in OH, you know how it feels. Florida, great weather and nice place to live..... BUT!
nadinbrzezinski
(154,021 posts)and trust me, Feinstein is not in my priority list.
That said, and no, he is not my congress critter, but as much as I have a problem with Congressman Hunter and his politics, his staff really tries to help his constituents.
ChiciB1
(15,435 posts)out there who aren't all colored RED! Somehow I thought you were in Ohio. And, Bill Nelson is nice enough but I'm more of a Bernie Sanders type!
Buchanan CAN get abrasive and dismissive... lived in this area a very long time and don't think there has EVER been a Democrat elected to Congress. Chtristine Jennings gave him a run. but seems some ballots got lost and floated away in the bay! Or something! Was there for the recount and didn't know whether to laugh or cry! Weird anyway.
And so it goes...
nadinbrzezinski
(154,021 posts)and his voting record is actually worst than Issa's. His father's was slightly better. But his staff really tries to help constituents. So just because the rep himself might be an ass... do not completely dismiss the staff.
ChiciB1
(15,435 posts)Can't hurt trying. I think Buchanan was voted one of the most corrupt Rep. in Congress, but I have heard people say he does take time to help veterans here. Worse than Issa, way down on the totem pole! Still, given the climate of late not sure who ranks where. But, as I said this is an issue that needs some real attention. The fact that I'm complaining about Medicare formularies could perk him up. Still, we did march around his office 2 times, he wasn't there and his staff did invite us in. We were "urged" to sign our petition to him.
Dahum, got my name! LOL
nadinbrzezinski
(154,021 posts)yes, Hunter is especially good with vets, since he is one.
Do not get me started on corruption...
ChiciB1
(15,435 posts)But Buchanan was/IS actually a car salesman! Has mounds of lawsuits filed against him, and many when he first got elected!
Think he owns 3 dealerships, but could be 4. Don't think he has his name on them right now. Buchanan isn't a vet., but this is Florida and this county is one of the 3 more prosperous in per capita income. Exclude me from them, but we do have a lot of very rich people here AND quite a few tennis players & celebrities.
But, one very well known rather liberal author. Stephen King lives here in the winter. Actually not far away from me... but on the Key facing the Gulf. My son worked for a very, very famous tennis player that also lived in the same area. She was one of my all time favorites, but when the economy crashed she sold out and moved. Still a lot of tennis players here. I LOVE tennis!
Okay, got off subject. Will talk again, need to get the garbage out & eat some mashed potatoes??? I know, weird. I saw dentist today and had some surgery so haven't eaten yet!
I did get out to San Fran once and really enjoyed it, but much too expensive. It was different for sure!
valerief
(53,235 posts)Probably during the HMO days, when they went from being non-profit to for-profit.
I wonder if medical insurance will become the new 'rape insurance,' an addendum to what should already be covered, so that the very wealthy profit even more off people's pain and misery.
Hoyt
(54,770 posts)leftstreet
(36,101 posts) Puzzledtraveller
(5,937 posts)I have seen hard working families get left out in the cold, some of my clients, ineligible for medicaid, perhaps approved for subsidy, know as APTC yet they do not have a dime to spare even for a reduced premium. In some cases they aren't even approved for that and you know they are not living high on the hog so paying the full rate for insuring themselves is a non option. I wish people would stop conflating the numbers now covered under the expansion of medicaid in some states as being the success of the ACA. In fact medicaid could have been expanded completely without being tied to the ACA and probably in all states.
ohheckyeah
(9,314 posts)know what a person can afford? Income doesn't tell the whole story, does it. That's the mess I'm caught in...no subsidy for me but I can't afford the insurance so I get to pay a penalty. The ACA is a cluster for many people.
Puzzledtraveller
(5,937 posts)That's what my coworkers and even my clients have been saying. In the case of what I do which is SNAP and Medicaid including all the programs since ACA, expanded medicaid and HBE, the market place I get to see the reality of the average working family as we look at their income, expenses etc. When it comes to "what were they thinking?" when they passed this I can only surmise it is the disconnect all too common in Washington that lead them to believe we, low and middle income America actually had money to spare.
ohheckyeah
(9,314 posts)they don't know my expenses or why I have them. They don't know that my husband was "reorganized" out of a job and that I haven't had work for a year. We don't live extravagantly but we also didn't have a big bank account to make up for the income losses, so you get behind and you get into debt. Was a mandate a really good idea following a depression? Seriously?
Whisp
(24,096 posts)woo me with science
(32,139 posts)Yo_Mama
(8,303 posts)There are too many gaps. It's almost as if we took a badly-functioning system and doubled down. But I guess we had to try this before dealing with our real health care system problems.
The thing is, I was not ever sure it would lead to a real health care system, and now I am even less sure. There are so many "exemptions" that I can see the political battle just converting to maintain those exemptions, and with only a few million people really forced into the system, not enough political will will be exerted to force change.
If so, I'm going to be really unhappy.
Douglas Carpenter
(20,226 posts)exactly the same people who would be screaming bloody murder about it if a Republican was in the White House right now. Mao's red guard would have admired such lockstep party discipline.
msanthrope
(37,549 posts)This a drug not covered under the Anthem formulary. This happened before the ACA, and even if we had single payer, we would have to deal with a formulary (like the UK and Canada.)
This is a very common problem. As I have a disabled daughter who currently takes two medications not on the Blue Cross formulary, but are covered by Blue Cross, I am quite familiar with the process.
I really wish Will would have simply asked for help. There are many DUers who have already fought this fight, and could tell him how they did it.
Douglas Carpenter
(20,226 posts)People were sold on the idea that this is exactly the kind of situation the ACA would correct.
theboss
(10,491 posts)There is no healthcare solution that offers that.
Douglas Carpenter
(20,226 posts)theboss
(10,491 posts)I'm not a doctor nor an expert on this, so I'm not going to go down the path of why one drug is better than the other. But she can get treatment.
At the end of the day, a person with MS can buy healthcare coverage and have prescription drugs covered.
That's what the ACA promised.
And there is a why to get the specific meds she WANTS covered. Several people have told Will the process.
msanthrope
(37,549 posts)Medicare has one. The UK has one. Canada has one.
The ACA gives you new rights to dispute a denial.....and Will needs to write an appeal. The doctor needs to write a letter.
This isn't an ACA dispute.
JoePhilly
(27,787 posts)But maybe she's one of Mao's soldiers.
geek tragedy
(68,868 posts)been enacted.
Sorry that reality gets in the way of those who are coming around to the "repeal Obamacare" crowd's way of thinking and who probably believe the Koch Brothers ads they see on tee vee.
T
msanthrope
(37,549 posts)ProSense
(116,464 posts)while misleading information is being spun as fact. Sheesh!
msanthrope
(37,549 posts)bluestate10
(10,942 posts)it can catch up?
Whisp
(24,096 posts)With friends like that who needs enemas.
Putting all your chips on that person's opinion on a matter as serious as this is just plain stupid and careless.
Agnosticsherbet
(11,619 posts)As long as there is a profit to be taken from health Care, we will never get the best our money can buy.
Response to WilliamPitt (Original post)
KamaAina This message was self-deleted by its author.
brush
(53,745 posts)You're a writer. You certainly know how to express anger better than that.
This is DU, not Freeperville.
truebrit71
(20,805 posts)"piece of shit USED CAR SALESMAN"....
Words, and context are important. As you point out, this is DU, not that other place..
pnwmom
(108,960 posts)Medicare and Medicaid use a formulary, and so do the national health systems of Canada, Britain, and other countries around the world. And if you're on a single payer system, you can't switch to another single payer system if your medication isn't on the formulary.
Despite the bad advice your "friend" gave you, you do have the option of checking the formularies of all the other plans offered in your state to see if one of them lists the specific drug your wife needs. And I hope you do. Don't listen to your friend anymore, with the false information. He's not helping.
I have nothing but compassion for the situation your wife is going through and I have had a loved one with this horrible disease. But the problem with the formulary you've run isn't a result of Obamacare. It could occur under any health care system.
Also, the ACA provides for internal and external appeals, and for an exception process for a doctor to request a medication off the formulary. If you don't switch insurers, I hope you pursue all this. Good luck!
LiberalAndProud
(12,799 posts)Health insurance reform was a big thing in the 2004 primaries. Our candidates trotted one sad healthcare story after another. The thing is, neither one of them ever said they would try to get universal healthcare for any of us.
I am very aware that my own Ben Nelson, who's vote was crucial to passing even this very imperfect legislation, absolutely REFUSED to vote for any legislation that even included a public option. I don't blame Obama for the hash we ended up with. He could have done better trying to put it together maybe, but this is what we would have gotten even if we had chosen Clinton instead. This was *it*. I don't love the ACA and never have. It concerns me that we will be held hostage to increasing medical / insurance costs with virtually no mechanism for price policing. It concerns me that there are too many people in the middle served too poorly by this legislation. It annoys me that it really did me, personally, no good at all but will cost me plenty. Still, I rejoice that some people who were truly at the end of their resources got something better.
The OP isn't a fan of our president. I get that. But this fuck you used car nonsense is very much the same tone in which a certain death threat was made in earlier days. I, for one, am over it.
ScreamingMeemie
(68,918 posts)I wasn't able to do that before.
I wish your wife well, these things suck. I am glad she has someone to advocate for her. It sucks when you lose that and you're on your own while dealing with it.
Tierra_y_Libertad
(50,414 posts)Holding them accountable for what they do (or, don't do) is also not PC...if they're Democrats.
See engraved stones for details.
truebrit71
(20,805 posts)...and the 'toe-the-line' crowd are not shy in enforcing those rules either..
NCTraveler
(30,481 posts)I felt it to a lesser extent when signing up my so. I am truly sorry about this. There is one simple fact at play here. It should be the AIA, not the ACA. The Affordable Insurance Act. In no way does insurance = necessary care.
hue
(4,949 posts)Patent Foramen Ovale or Atrial Septal Defect are not uncommon. Many folks live their lifetime without ever knowing and some have several holes of varying sizes. There is def a risk of stroke from this condition esp as the person grows older. The condition is usually diagnosed with a trans esophageal echocardiogram (ECHO).
The person with this condition should be on anticoagulants to prevent a stroke.
There is a safe & relatively quick solution if a person shows symptoms of a "stroke". It is a procedure called ASD or PFO closure which involves a cardiology interventionalist using a catheter to access the heart a deploying a mesh over the hole/s which then becomes incorporated into the Pt's septum and closes the hole. The procedure takes about an hour. There is no incision but just a small catheter hole usually in the Pt's right groin. It is usually tolerated very well.
Not all hospitals do this procedure and it is best to search for one that will accept You and assist You with financial counseling.
As far as single payer goes the Affordable Care Act has a provision for this if the state decides to go this route as Vermont did. I doubt if national single payer would have passed in this political climate as the ACA was blocked ferociously as You know. But if and when states can get their constituents together and pass this--I think in the future more will--the DOOR IS OPEN to them.
JoePhilly
(27,787 posts)
riverbendviewgal
(4,252 posts)Obama is a big disappointment to me too.
ACA is not close to the Canadian health care.. Canada negotiates our prescription drugs with the Pharmas. We still pay more than Europe.
I live in Ontario . I am over 65 so I pay $100 a year limit toward my prescription drugs, no matter how expensive.
Those who are poor and under 65 will get governnment and those who are not and work have company benefits or have supplementary plans that cover drugs, dental, hearing, sight and massage, semi private room. Mine is $1600 a year.
I just did my taxes and my health care amount that my taxes pay is $600 for the year..
Obama disappoints me because he signed FATCA.
I have been practically crucified on DU on bringing it up.
theboss
(10,491 posts)Are there formularies in Canada?
riverbendviewgal
(4,252 posts)My doctor makes a prescription and my pharmacy fills it. That is it.. There is no calling around.
Supplemental insurances have to pay it .. When I worked my drug plan paid 80 percent. I paid 20 percent and added what I had to pay to drug expenses to my income tax claims.
My husband and son were both diagnosed two months apart with Glio Blastma Multiform brain tumour (son) and Non - Hodgkins Lymphoma. They had all kinds of drugs... Nothing was ever denied.
It is such a godsend to just concentrate on getting better or taking care of your loved one and not worrying about medical bills.
My brother says the USA is the greatest country in the world with the best health care. I keep telling him NO, not when many do not get this "greatest health care" and many go bankrupt even with medical insurance.
For shame America. Stop making the MIC rich and make your people well.
riverbendviewgal
(4,252 posts)I know my drugstores give generic drugs unless the doctor specifies otherwise.
I have never had a problem with getting what I need or paying for it.
nadinbrzezinski
(154,021 posts)which are negotiated by the state with directly with the companies, for pennies on the dollar of what we pay in the US.
The Formulary, yes formulary, it is a single one, and includes every drug approved by Health Canada. They still pay pennies on the dollar.
Experimental drugs are paid for by Health Canada.
See, I was not crazy when I told you this is how it should be handled. We are 37 in outcomes and number one in cost. WHOOHOO, we are number one!!!!
The difference is patients do not have to fight the insurance companies to get the care and meds they need. It is truly a mystery to them on how this is decided, and there is no worry about it. This is decided at a national policy level, by people qualified in health care, like you know experts. Though on the down side, your career field is almost non existent in Canada, since you are not needed.
By the way, thanks for helping Will.
Skidmore
(37,364 posts)I thought you were more politically sophisticated than this. I thought you had some understanding of political wheeling and dealing. I think I've been wrong. If you are as astute as you would have us to think, then you should realize that there are times when legislation can be crafted from whole cloth and then there are other times when it must be pieced together over time. This is one of those times. Let's work on getting a congress that will be able to work with a nice chunk of good cloth. We have a election straight ahead. I'm so tired of the binary thinking because it does not help move things forward. There is nothing progressive about standing in one place and finger pointing or screaming. Get a congress that will do it's job. The last time I checked, Congress still has the power of the purse.
Jefferson23
(30,099 posts)healthcare reform is not responsible for it is simply not true. It is a direct consequence of
a flawed improvement. I read another posters comment to you where they were able to find
relief from their situation through their congressman. I hope your wife's situation finds a remedy
quickly too.
Best to your wife.
badtoworse
(5,957 posts)Skittles
(153,122 posts)I'm so very sorry you are going through this, and that gal of yours is one lucky lady to have you fighting for her
gulliver
(13,168 posts)Nor are you being straight. It's obvious whose fault it really is. Really obvious.
I was waiting for you to say the one thing that would get you off the hook. Namely, that you checked and found that you couldn't have chosen a different ACA plan. You haven't done that.
This piteous spectacle raises a balance-of-compassion problem. Should we feel so sorry for you that we let you damage others with a misleading, destructive, and ultimately even self-serving diatribe? I don't think we should.
ProSense
(116,464 posts)"You don't have it straight."
Facts don't matter here.
bluestate10
(10,942 posts)which work as well as the drug regimen the OP is demanding.
Cha
(296,893 posts)Well stated.
KatyaR
(3,445 posts)I'm so sorry for your family, Will. I wonder how many more stories we'll hear about this.
We are all living in an illusion. When the hell will we wake up and DO SOMETHING ABOUT OUR COUNTRY? 
bluestate10
(10,942 posts)Junkdrawer
(27,993 posts)The ER visit was inconclusive, the specialist clearly saw the break.
Obviously, he DIDN'T have a broken arm. Q.E.D.
Took 6 months to straighten that one out. Everyone I called agreed....then I would get yet another EOB with $0 insurance contribution and the same bad Reason for Denial. Finally a plea for supervisory help was answered.
raouldukelives
(5,178 posts)Or better yet, diverted to corporate interests. The people at the top in this country saw what was coming down the pike. The years of stories of health insurance nightmares and of people unable to afford any coverage. The film Sicko raised national debate to sky high levels on the issue. People were pissed, they had enough and were rallying to fix it.
But, instead of allowing the peoples voice in the matter, only the insurance corporations were allowed to speak.
None of this was by accident. It was, in essence, the very least that could be done while still being able to say, we did something.
Now the great push for single payer has subsided, now the people are more complacent, now the pain profiteers can chuckle and breathe easier again. All is at it should be.
840high
(17,196 posts)
Skittles
(153,122 posts)and these are the INTRODUCTORY prices
blkmusclmachine
(16,149 posts)pragmatic_dem
(410 posts)a bad blood test will cost me $900 extra per year. $1800 more per year if spouse has one as well. The implication is that I am not healthy because of lifestyle. However, executives don't have any lifestyle exceptions and get special premium plans for families.
On edit - note this is corporate plan. Never had a company plan that required health screenings for tiered coverage before, but I guess it is allowed.
Spitfire of ATJ
(32,723 posts)Cha
(296,893 posts)Bernie Sanders among others. Damn thing squeaked by.
Spitfire of ATJ
(32,723 posts)That step being that it is the RESPONSIBILITY OF THE GOVERNMENT to care for the people.
THAT is the primary issue the Republicans are fighting against as they believe anything that is a human need should be FOR SALE.
If they had their way instead of being fined for polluting the air, fresh air should be a commodity to those who want it. and can afford it.
Survival of the richest.
Cha
(296,893 posts)anything beyond a first step.. Backwards would feed their soulless entities.
But, it can get stronger.. we can build on this First Step.
Spitfire of ATJ
(32,723 posts)Or, as I put it in this familiar meme:
Cha
(296,893 posts)NYC_SKP
(68,644 posts)In case anyone wonders why some of us are upset about a post that looks so innocuous, here's the original:
What I've learned about the Affordable Care Act
What I've learned after a three-month war with these fiends: the ACA says the insurance companies cannot deny coverage to those with pre-existing conditions, which is true as far as it goes. But they can deny coverage for the life-saving medications necessary to treat those conditions. The insurance company I signed up with through the ACA exchange just denied coverage of my wife's multiple sclerosis medication. We're "covered," to the tune of $700 a month...just not for what she really needs.
A cozy loophole, that.
Fuck you, insurance industry.
Fuck you, Mr. President, you piece of shit used-car salesman.
From my heart and soul, fuck you.
12
Anger is a gift.
It was a good idea to edit, but there's no indication in the OP that it was edited.
Chan790
(20,176 posts)Medicare uses formularies. So does Tri-Care; Medicaid; the British, French, German and Canadian National Health Services; virtually all private insurers and every single healthcare proposal put forward in the United States since LBJ was in office. (For the most part, those formularies are fairly similar...the decisions to include or delist a medication are typically based on scientific studies and all formulary-review boards have access to the same data. They're usually not this controversial.)
It's the best medical solution to actual issues of cost containment and best outcomes, that's why it's a universal solution. Lots of things don't get covered because they're expensive and they work less-well than a cheaper option. I daresay that's the way it should be.
I feel bad for him and there is a process to obtain coverage...but it's a pain in the ass. He needs to work the system. This isn't an ACA issue or an Obama issue...it's really a patient-care issue. He'd be dealing with it even if we'd enacted Medicare for All or a National Health Service single-payer model. If it's really the best drug for Mrs. Pitt, she'll get the medication. Ideally, they should have covered it during the review...that's a good fix for when we fix Obamacare down the road, mandating coverage of previously-covered medications during appeals and reviews. That patients would be kicked off their meds pending review is an outcome that should have been foreseen.
theboss
(10,491 posts)Why is nobody getting that?
The Wizard
(12,536 posts)The insurance lobby paid 1.4 million a day while the health care debate was happening to get language inserted into the bill that essentially made sure the big money kept flowing to the big money. We got hosed.
https://www.goodreads.com/book/show/261441.U_S_A_
KauaiK
(544 posts)I don't know in what State you live, but most states have a state level administrative department where you can appeal for help. I have been dealing with insurance companies / pharmaceutical formularies for years w/ my son. California created an office with one during the peak of the AIDS crisis. This CA office helped get the CA version of parity law enacted; that coverage for mental health has to be the same and to the extent of coverage for any other medical problem. I am currently in dispute with the Rx administrator of my insurance who wants to replace a medication for bleeding ulcers with an over-the-counter antacid.
This root of this issue is the pharmaceutical companies and their demand for obscene profits. No one is denying them the ability to recoup their R&D costs; but right now it's seriously out of whack.
.
DeSwiss
(27,137 posts)...I see you're looking back.
- We don't do that anymore, remember?
K&R
You never really lubbed him didya????
jazzimov
(1,456 posts)No, the "system" is not perfect. But it's better than it was.
Don't blame the President for making the system better than it was. Yes, it still sucks, but it is better than it was. And it took a lot of work to get it where it is.
Look at the guy to your left, then look at the guy to your right. Then expand your view to everyone in the country. THEY are the reason that our system sucks. Some, including the current President, tried to make the system "better". They would love to make it perfect, but they will settle for better. At least for now.
I would love to have a Medicare for all single-payer system and true Universal Health Care. But Congress won't vote for it. Hell, we couldn't even get a Public Option. Because "some" people were afraid it would lead to a single-payer system.
So, to be straight - don't blame the people working to make the system better. Put the blame where the blame belongs.
Again, to help you get it straight, put the blame where the blame belongs.
Will, you are such a great writer. One of the things I used to respect about you was your ability to see through the BS. But more than that, you could write about it in such a way to make it clear to the common man - such as me. Now, it appears that you are subject to the BS yourself. It's possible that I have changed - but I don't think so. The other possibility is that you have changed.
Hekate
(90,565 posts)It's been a long 13 years for all of us. You notice that even those of us who disagree with Will pretty vehemently on this issue keep wishing him and his wife well, and offering suggestions to mitigate the situation. For our troubles we are told we have holes in our hearts. It makes me rather sad.
mrmpa
(4,033 posts)Under Federal guidelines, I qualify for Medicaid, my governor won't expand Medicaid coverage. Insurance will cost me $500 a month, I can't afford it.
I am in a bit of a quandary. I have to get a cataract removed, if I buy the $500 insurance the surgery will cost me approximately $4,000 (deductible $7500) so insurance is $6000 + $4000=$10,00 (more than my income). I go to a free clinic, was seen at their vision clinic and was referred to a Doctor & hospital that will do the surgery at no cost.
Maybe not so much of a quandary, I'll take the IRS penalty next year.
raptor_rider
(1,014 posts)On Medicaid when I lost my job back in 2011. They have been on it since. My daughter is type 1 diabetic. Has been for over 7 years. To keep her alive, by basic means, is almost $1200.00 a month. That's just insulin, syringes, and test strips (which are a $1 a piece!)
My daughter is on the insulin pump. Just for only 5 months. Her hgA1C went from a 10.7 to a 7.2!!! Which means her blood glucose levels are in the range of 150, compared to 300. When she was dx'ed at age 9, her A1C was 17.9. Almost lost her.
I'm very glad to be on my husbands insurance and my kids on Medicaid. I wouldn't even touch something that I really don't know about to cover my kids health if my life depended on it.
madfloridian
(88,117 posts)You needed to point this out even if it is not popular here. Yes, our party leaders do need to take responsibility for the programs they pass.
Drugs are going up so much now.
I hope there is a way for your wife to get the medication she needs.
So sorry.
Coyote_Bandit
(6,783 posts)When Obama first campaigned for President he supported single payer - even though he and his minions couldn't manage to fight for a strong public option when it came time to do so. The old bait and switch.
And ACA is federal law funded almost exclusively by federal taxes yet it can have widely different financial impact on a particular citizen based solely on his state of residence. We want to blame the states and he courts for that. Thing is if the law had been structured to actually create a public option then there would be no reason for state involvement though the use of Medicaid programs. Serious lack of foresight and planning and a major fail for millions of people.
Not that ACA is a complete failure. But we could have done better. We should have done better. But the President was more willing to make a deal than fight for a strong public option.
Color me unimpressed for reasons that include issues of trustworthiness and credibility as well as competence in planning and implementing ACA. This signature piece of legislation is nothing more than further evidence that our current incarnation of government of the people, for the people and by the people is a failure. Small wonder so many aspire to apathy.
sinkingfeeling
(51,438 posts)Multiple Sclerosis
Ampyra
Aubagio
Avonex
Betaseron
Copaxone
Extavia
Gilenya
H.P. Acthar
Rebif
Tecfidera
Tysabri
To be sure the specialty drug is covered, call the specialty pharmacy at 800-870-6419, Monday-Friday 8 a.m.-10 p.m., Eastern time.
http://www.anthem.com/employer/co/f3/s3/t0/pw_b130446.pdf?refer=ahpprovider&state=nv&refer=ahpprovider&state=nv
They also have a eReview for clinical reviews:
eReview
eReview: New option for Pre-certifications/Authorizations
As part of our ongoing efforts at Anthem Blue Cross and Blue Shield to ensure you are receiving the best possible service, we would like to introduce you to a new, more convenient clinical review option called eReview. eReview allows you to send information to and receive information from us about requests for service via secure email.
How the process works: With just a click of a mouse, the Provider can send demographic/clinical information to Anthem via secure e-mail. The information is then received by an Anthem associate from a shared e-mail mailbox. The Anthem associate then processes the information and responds with the authorization decisions, including the authorization number, to sender via a secure link.
Getting started: All you need to get started is access to e-mail. See the information posted below on further details to get you started today! Information includes frequently asked questions, eReview Request form, and an eReview Information Sheet that includes screen shots that walk you through the process.
Attachments: Attach any medical records or notes to the eReview request. Again, all information is sent secure email to ensure HIPAA compliance. If you don’t have medical records electronically, you can still use eReview, and just fax in any medical records that need to be attached to 800-763-3142 and include you eReview information in the fax cover sheet.
eReview Welcome Letter
And here's a link to their document on how to expedite appeals:
http://www.anthem.com/provider/nv/f5/s1/t0/pw_e205625.pdf?refer=ahpprovider&state=nv
It starts on page 125 and says the expedited appeals will be done within 72 hours.
I hope this is of help to you.
mzteris
(16,232 posts)Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a lack of coverage for millions. The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through Health Insurance Marketplaces, and insurers will be prohibited from charging more or denying coverage to anyone based on the state of their health.
and it's NOT you!
From the ACA: "Health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition."
I'm not sure when medication didn't fall under COVER you . . .
There's this: "All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover.
The essential health benefits include at least the following items and services:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (such as surgery)
Maternity and newborn care (care before and after your baby is born)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
Learn more about how the Health Insurance Marketplace works, the kinds of plans available, and the four categories of coverage.
Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)"
Granted, I've not delved a whole lot into the ACA as it's not been necessary so far, but it seems pretty plain to me. Maybe things like which plan and the options they offered and that you chose MAY be a factor (again, not sure how that part works) or I suspect some of the STATES may have tinkered with it to a huge extent (cough - WI - cough). I don't know where you live, but again, could be a factor.
****
If you're PCIP eligible, you might want to check this out: "before the Affordable Care Act, Americans with pre-existing conditions who did not receive health coverage through their employers had few affordable options to get the care they needed. In most states, insurance companies could refuse to sell them coverage, charge higher premiums, or offer them coverage that excluded benefits for their health conditions.
The PCIP program is temporary and was created to make health coverage available and more affordable to people who qualify.
To qualify for PCIP, you must:
Have a pre-existing condition
Be a U.S. citizen, or live in the U.S. legally
Have been without health coverage for the last 6 months
You are NOT eligible for PCIP coverage if:
You have other insurance coverage, even if it doesn’t cover your medical condition (note: admittedly don't understand that part. That doesn't fit with everything else I've heard about HCA. Though maybe a company an "not cover particular conditions, they just have to cover pre-existing conditions they DO cover... hmmm...)
You’re enrolled in a state high risk pool
You have Medicare, Medicaid, CHIP, VA or TRICARE coverage
You have job-based coverage, including COBRA, or continuation of coverage, even if it’s about to end
You have a limited benefit plan
Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a lack of coverage for millions. The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through Health Insurance Marketplaces, and insurers will be prohibited from charging more or denying coverage to anyone based on the state of their health.
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Hope this helps. Good luck. I know you're dogged and determined and I wouldn't want to get on your bad side. My tactic is to refuse to talk to underlings and go straight to the supervisor's supervisor's supervisor's manager or higher. I become a royal pain in the ass and refuse to go away. I ask for names and extensions or ID numbers since - of course - they don't want to give out their last names I make very sure I make note of their cooperation or lack thereof and their attitude. I make notes of times (all of this if probably second nature to you!!) But I ALSO very definitely leverage whatever I have. And at this point I have some leverage with the companies I do deal with because they want OUR company's business in a bad way - but that's another story.
I don't want to make it seem like I'm lecturing, Wil, just want to offer what little support, advice, and experience I may have. You may have already done all of this. (Probably, since I know you're smarter than I am!) But I am pretty ruthless when it comes to dealing with things like this and I have whooooole lot of experience dealing with customer service and escalating to someone who can actually DO SOMETHING!!
YOU, my friend, should have tremendous leverage. The words - "I'm a journalist", I have "X" readership/ membership/audience, etc. and the words "I have an internet and I'm not afraid to use it" usually garners the attention of moving to the higher up even for the rest of us. If they stonewall you, go to their PR department or their sales manager or VP. Hell, I've been known just to call the freaking CEO if they keep refusing to cooperate or do what I need. I WILL get results one way or another. Being a royal PITA makes them want you to "just go away" a lot of times so they cave. The fact you you can affect them with negative publicity (an anathema) even more than me moving my company's businese elsewhere - - I would leverage to the hilt.
alarimer
(16,245 posts)Red states have refused to the Medicaid expansion. This screws a lot of poor people in those states who still do not have coverage. Now this is not the President's fault, but it is a flaw in the plan that I'm not sure anyone really predicted would happen.
The other thing that gets me is that some states have a lot of plans and options for people (mostly larger, mostly blue states) and in other states you have literally no choices. Or one choice, which doesn't really make it a choice.
I don't know why no health plan is nation-wide. I'm guessing there are laws that prevent this, but it would be so much easier if they were.
But yea, maybe the ACA was better than nothing, but not by much.
Possibly it's true that it is the best they could do, but I think the fans are really not listening to the very real problems that exist because of it or will not be solved by it.
OwnedByCats
(805 posts)Last edited Fri Mar 21, 2014, 04:19 PM - Edit history (1)
My dad is in a similar situation. He signed up back in October for a plan on the exchange. He chose a company that he was familiar with in the past that he had before, a company he knew his hospital took, and to be honest, the only company that offered him a plan he could afford. My dad has various issues - arthritis that is now bone on bone pain in his hip, heart condition, diabetes and a very nasty infection on his leg. He was seeing various doctors at this hospital, after he was told they took his insurance.
The insurance company messed up. They didn't put on his insurance card what his plan was, ei. silver, gold, platinum, so the hospital thought they took it. Then we find out they don't take it. Turns out this hospital has discriminated against plans bought on the exchange. They take employee plans from this company, but not ones bought on the exchange, so after he had several appointments, he then found out the ins will cover none of them. He has had to change his hospital and all his doctors.
This would be ok, a pain, but not the end of the world - except for one thing. My dad was going to a specialist in this hospital for the leg infection. No other specialist for this within a reasonable driving distance (under 400 miles) takes his insurance. These appointments are expensive and he can't afford to pay them outright. My dad cannot travel hundreds of miles away. So he's basically uninsured for this problem. His PCP is not prepared to treat this infection. I'm scared he's going to lose his leg.
Everybody can say all they want that these things should have been checked. Back in Oct nobody knew his hospital would not take the exchange plan, that was never even known about at the time. He chose the one he could afford, the one he knew his hospital had taken forever upon their insistence that they took it - even back when he had a policy with them through his employer. What he didn't foresee, was that this hospital decided at some point the exchange plan was not good enough for them to accept. Luckily though, next year he'll get Medicare - I just hope he can keep his leg long enough.
So I see all kinds of red tape. If it's not your insurance company trying to get out of paying up in their various ways, it's a bitch to find doctors accepting your insurance AND taking new patients, or the clinic or hospital takes it, but their doctors don't, or you simply can't find a specialist in your area that takes the insurance. It's made so complicated that it's just insane.
I wanted single payer so of course I'm already disgruntled.
Edited to add: I did find out today that the hospital that took the insurance but the doctors did not for his leg infection, after some digging he was able to find one that does. Had to do that extra digging but at least we found one. He has to wait a couple weeks for an appointment, but that's better than having to wait a year from now.
Gosh, this stuff shouldn't be so hard
Gothmog
(144,951 posts)Some nurse decided that I did not really have sleep apnea despite a prior sleep study. This sleep study was to determine the correct pressure for the CPAP machine. I first appealed within the Blue Cross system and then I filed an appeal with the Texas insurance commission. The internal appeal was going nowhere until Blue Cross got notice received notice of the complaint filed with the insurance commission. Blue Cross was very upset with me and threathened to have all of my claims would have to be reviewed until the insurance commission told Blue Cross that such conduct would be considered retaliation.
Needless to say, I had the claim resolved in very short order. Admittedly as a lawyer, I knew which buttons to push and how to get the insurance commission interested. Ann Richards was still governor of Texas and the insurance commission was still staffed by people who cared about patients. I am not sure the insurance commission would do the same today under Perry but I would still try.
The moral is that it does not hurt to appeal and pursue remedies both with the insurance company and with the applicable regulator.
nomorenomore08
(13,324 posts)MATTERS. I'm so sorry you're going through this, and just as sorry for some of the responses you've gotten here. People really have their priorities screwed the hell up.