Using the 5 percent number to slam coverage via a public option is uninformed.

[ProSense]

That number is based on the unemployed and uninsured. Reform will cover 15 million uninsured (one-third of the uninsured or 5% of Americans) via the public option. That does not mean that the other more than 30 million uninsured will go without coverage. Many of the uninsured people are actually employed, and many are employed in small businesses. More than 16 million will get coverage via subsidies and credits:

Health Insurance Subsidies for Low-Income Workers Most Efficient Way to Expand Coverage, Says New Urban Institute Report

WASHINGTON - August 29 - A new Urban Institute report on workers without health insurance suggests that the most efficient way to increase coverage is to target subsidies toward low-income workers. The report offers the most detailed picture yet of the uninsured working population—now numbering more than 16 million—and compares the relative merits of two key vehicles for expanding coverage: tax credits or public programs. It also contains some surprises: though Hispanics are less likely to be covered overall, they accept employer offers of health insurance at the same rate as whites and African Americans.

more

In fact, the CBO determined that the HELP bill will cover 97 percent of Americans.

[ProSense]

1. Why not come on in with your rebuttal? n/t

[DrToast]

2. Who is doing that?

[Peacetrain]

3. Big Hearty Rec!! Thank you for posting that.. I have been going round and round

with a few chatters about this.. when the 5% number was used by the President it was a CBO number estimate of those who would apply..not a limited number.

[dflprincess]

4. Your link says that 97% of us will have coverage -

it does not say we will have coverage that allows access to health care, nor does it say that 97% of people will be covered by the public option.

And that is the problem with the "reform" we're being offered. We'll be covered because most of us will be forced to buy a shoddy product from a for profit company that makes large campaign "contribution". And a good many of us - including those who qualify for the public option (if it's like the one in HR3200) - will be stuck with a plan that still requires us to pay thousands in annual out of pocket expenses plus whatever part of the premium we're on the hook for.

You can sugar coat this crap all you want, but we're still going to be worse off than any civilized country when it comes to people actually being able to get care.

[ProSense]

5. "nor does it say that 97% of people will be covered by the public option" What? n/t

[dflprincess]

8. The link you provided to the Huffington Post article

says several times that 97% of population will have coverage it does not say where that coverage is coming from. But it does say a government run plan would complete with private insurers. No details are given as to what the requirements for being eligible for the public option are. And, again, coverage does not equal care.

[DJ13]

6. +1

:thumbsup:

Many folks are so brainwashed into accepting the smallest of crumbs from our overlords that they think a crap bill that keeps us forever tied to the insurance industry is a good thing, instead of seeing it as a continuing betrayal by our elected officials it really is.

[ProSense]

7. "Many folks are so brainwashed into accepting the smallest of crumbs" Many

folks are delusional if they believe Obama's original plan was a public option for all.

[DJ13]

9. Never said it was

But it was a damned bit better than this watered down excrement were being talked into.

It went from a goal of 100% coverage at low costs to maybe, if were lucky, only 3% (more like 10%) wont be covered, and with the exact same kind of mandates Obama once derided Hillary for proposing in the primaries.

[ProSense]

10. "It went from a goal of 100% coverage at low costs"?

When did anyone claim that there would be 100 percent coverage?

"if were lucky, only 3%..."

Consider yourself lucky. Hillary's plan sucked for other reasons, similar to Edwards'

[DJ13]

11. When did anyone claim that there would be 100 percent coverage?

That WAS an Obama priority while he ran for office, wasnt it?

I knew we were going to get screwed over when the WH stopped calling it health care reform and rebranded it health insurance reform.

That implied that most everyone would be stuck with their private insurance, whether they wanted it or not.

[ProSense]

12. "That WAS an Obama priority while he ran for office, wasnt it?" What? n/t

[inna]

46. exactly. +1 nt

[Mass]

13. And many will just not be able to pay for insurance and get a waiver.

This seems to be the general solution to the fact the middle class cannot (and still will not be able to) pay for insurance: they'll get a waiver. So much for universal healthcare.

[ProSense]

14. Not true

Sec. 202. Exchange-eligible individuals and employers. Defines who is eligible for participation in the Health Insurance Exchange including employers and individuals. In year one, individuals not enrolled in other acceptable coverage are allowed into the Exchange as well as small employers with 10 or fewer employees. In year two, employers with 20 and fewer employees are allowed into the Exchange. In subsequent years, the Health Choices Commissioner is granted authority to expand employer participation as appropriate, with the goal of allowing all employers access to the Exchange.

<...>

Sec. 242. Affordable credit eligible individual. In order to receive affordability credits, individuals must have individual coverage through an Exchange-participating health benefits plan (though not through an employer purchasing coverage through the Exchange). Family and individual incomes must be below 400% of the federal poverty limit to access the affordability credits, and the individual generally must not be eligible for Medicaid. In general, employees who are offered employer coverage are ineligible for affordability credits within the Exchange. Beginning in year two, employees who meet an affordability test showing that coverage under their employer-provided plan would cost more than 11% of income, are eligible to obtain income-based affordability credits in the Exchange.

PDF

No matter how many times this is posted, it's continuously ignored.

[dflprincess]

16. But you can be on the hook for a premium that's 11% of your income

a single person making $43,000 (400% of the FPL) will not be eligilble for subsidies and could be looking at a premium of $394/month. And, HR3200 would allow annual out of pockets of $5,000 plus anything else not covered by their policy (items not covered would include dental & vision in the public plan).

Also, the 400% is not engraved in stone. At least one of the proposals being kicked around the Senate puts the income cap at 300% of the poverty level ($32,250 for a single). And Pelosi has indicated that dropping the income cap is not "off the table".

There may be more people paying for "coverage" but there will still be an awful lot of people who can't afford care.

[ProSense]

17. People under 400% of the FPL are paying up to three times that percentage now.

"items not covered would include dental & vision in the public plan," those are separate plans now, and certainly not covered under Medicare.

[dflprincess]

18. Well, God forbid we get anything better than we have now

And it's certainly unreasonable to expect that if we're going to be forced to pay for insurance that we might actually be able to have access to care.

[ProSense]

19. And some of those people will be paying one-tenth of that after reform

What was that about better?

[dflprincess]

20. And most, maybe more, people will still be underinsured

because even though they're being forced to contribute the for profit corporations they still won't be able to afford to get care. If you have a chronic condition and are looking at $5K-10K in out of pocket expenses every year you're still going to go into debt to pay your medical bills.

That's the system we have now and it doesn't work.

[ProSense]

21. Not true. n/t

[dflprincess]

23. What's not true?

Those out of pocket amounts come right out of HR3200. Maybe you can come up with an extra $5,000 (or $10K for a family) every year, but most of us can't. The private insurers refer to these high deductible policies as "consumer driven". There are indications that these kinds of plans cost everyone more in the long run because people put off medical care until a situation becomes urgent.

Everything that's being discussed in Washington is designed to shore up a private industry that has been robbing us blind for years and can't be sustained if we're not forced to contribute to it. If we're going to be forced to pay these crooks, the least we should get for our money is care - and that means no more deductibles. There is no reason why we can't have a system that doesn't charge at point of service. Nearly every other country manages to do it and the only reason the U.S. won't is that our Congress and President have sold us out to their campaign contributors.

[ProSense]

25. Here

"people will still be underinsured because even though they're being forced to contribute the for profit corporations they still won't be able to afford to get care....That's the system we have now and it doesn't work."

Huh?

[dflprincess]

26. If you have a policy that requires you to spend $5,000 before it kicks

in and covers anything, you're probably going to avoid going to the doctor. If you're paying for insurance, but you still can't get care, you're under insured.

More and more employers are going to policies with those kinds of deductibles and more people, especially those with chronic conditions are not getting the care they need. People are also apt to put off or skip preventative tests because they worry they won't be able to afford any follow up care the test may indicate they need.

HR3200 permits the same kinds of out of pocket (quaintly referred to as "cost sharing" in the bill). If you can't afford to pay $5k in out of pocket expenses now, you won't be able to with the "reform" being proposed either and you still won't get the care you need. Just what we have now.

[ProSense]

28. That is not how that works.

Nobody pays $5,000 up front before they get to see a doctor.

[paulk]

30. what do you think a deductable is?

you're not not really that dense, are you?

[ProSense]

40. Do you even know what you're talking about?

Most insurance plans are not high-deductible plans (certainly not with $5,000 deductibles), which are typically plans that insurers currently apply to those they identify as high-risk. These deductibles typically become debt. This will change after reform.

[paulk]

44. from your link

Rising Deductibles
A deductible is the amount of money a person must pay out of his or her own pocket before health insurance begins to cover the cost of medical expenses. Deductibles have risen substantially over time.

For preferred provider organization (PPO) plans purchased through an employer, the average family deductible increased 30 percent in just two years, from $1,034 to $1,344.3 This effect is more pronounced for small firms, where PPO deductibles increased from $1,439 to $2,367 — a rise of 64 percent.4

Families purchasing insurance through the individual market face deductibles that are more than two times greater than families with employer-sponsored PPO plans. The average deductible for a family plan in the individual market was $2,753 in 2007. This is an increase of nearly one-quarter from 2004, when it was $2,220.5

A growing proportion of families purchasing health care directly from insurance companies in the individual market are burdened by rising deductible costs. The percentage of families with a deductible over $2,000 increased from 41 percent to 59 percent in the past four years.6 One in five families covered with employer-based insurance also had a deductible over $2,000 in 2008.7

The prevalence of employer-sponsored high-deductible plans (also known as consumer-driven health plans) has increased– from 2005 to 2008, the percentage of firms offering such plans rose from 4 percent to 13 percent.8 For Americans receiving coverage through an employer, the average deductible under this type of plan was $3,511 in 2008,9 while the average deductible in the individual insurance market in 2007 was $5,329.10

- And that number was from 2007.

What do you mean by "reform" There is nothing in HR3200 that addresses high deductibles, other than an undetermined cap on total expenses, or "extraordinary" costs that would cause bankruptcy.

http://docs.google.com/gview?a=v&q=cache%3AbeYcIE0BVHwJ%3Awaysandmeans.house.gov%2Fmedia%2Fpdf%2F111%2FFAQsaboutHR3200.pdf+will+reform+change+deductibles+in+hr3200&hl=en&gl=us&pli=1

9. What should I expect to pay out-of-pocket in the reformed health care
system?
The bill broadly outlines the coverage requirements for the essential benefits package
that every qualified plan will be required to cover and ties that package to the average
of what employers offer today. So, you should expect your cost-sharing to be similar
to what you‘re paying today, except with important additional protections for high
costs.
This bill will cap annual out-of-pocket expenses for everyone who obtains qualified
coverage. This means that if you or someone in your family gets sick, you won‘t have
extraordinarily high medical costs that cause bankruptcy because there will be a
maximum cap on those expenses.
If you are purchasing your coverage within the new Health Exchange, there will be
four plan types available to you – each covering the essential benefits package, but
with differing levels of cost-sharing. The basic plan will have the lowest cost
premium, but will charge more cost-sharing; you can then buy up to an enhanced
policy that will charge less cost-sharing; or purchase a premium policy which will
have the least cost-sharing of all. Some of the premium plans will also cover ―extra‖
benefits (such as dental or vision benefits for adults) that you can pay an extra
premium for if you want extra benefits included in your coverage.
It is important to know that if your family income is less than 400 percent of poverty,
you will receive help with your cost-sharing on a sliding scale basis depending on
your income.

[jannyk]

32. How wrong can you possibly be??!!!

Both my husband and I have to shell out $5,000 each per year ON TOP OF our $6,000 annual premium. After we cough up $5k each, the insurance still only covers 80% of any bill and NO meds!!!

What fucking bubble do you live in anyway?

[ProSense]

37. Everyone's circumstances is different. Without knowing yours, it impossible to

know if you're actually paying $5,000 up front before you are able to see a doctor.

[sybylla]

38. Same here.

We're lucky, as a self-employed family of four, that we've been very healthy. But I haven't had a checkup for four years because the insurance only pays the first $300 dollars of one physical every other year and then I have to pay for everything that comes after up to $3000 and then 80% thereafter. If the doctor wants to investigate something further, I can't afford the expense of follow up in this economy and certainly not the premium increase that will naturally result. If I were chronically ill, it's a nightmare scenario.

Anyone who thinks locking in that kind of insurance system for everyone is a good thing isn't living in the real world.

[bornskeptic]

54. Under HR3200 cost sharing for preventive car would be prohibited.

Annual physicals and other medically necessary tests and screenings would require no out of pocket expenditure.

http://energycommerce.house.gov/Press_111/20090714/hr3200_summary.pdf

[inna]

47. bookmarking this thread for your informative and concise posts.

what a cruel joke of a reform.

we have been sold out.

[ProSense]

24. delete n/t

[4lbs]

58. That's true. Both my parents are on MediCare, but they also pay several hundred extra monthly for

supplemental Kaiser Permanente health coverage.

They both had to have cataract surgery and get new glasses. MediCare didn't cover the surgery, but because they had Kaiser supplemental, they went to that HMO's facilities and got it done. They also got their glasses from Kaiser's vision care center. $150 each, with eye surgery and senior discounts.

Total cost of the surgeries and glasses was $25 (co-pay) + $150 for glasses.

Then my father had to have dental work done. Neither MediCare nor Kaiser covered it. He had to go out-of-pocket for $500.

[eridani]

33. 11% of incone is both morally disgusting and totally unnecessary

That is for shitty insurance that only pays 70% of your bills after they've robbed you blind. The Netherlands has mandated private insurance for 100 euros/month/adult, with NO copays or deductibles. No age discrimination either.

[Bluenorthwest]

41. It is also far higher than the percentage of income Congress pays

for their plans. Far higher.

[dflprincess]

43. Excellent point n/t

[Nuclear Unicorn]

42. Thank-you, Thank-you, Thank-you

I'm being excoriated in the GD forum for having the temerity to suggest the president is not a corporate stooge, that the so-called mandate has waivers, that coverage will be more accessible and people will be able to migrate to a publicly subsidized policy regardless of income.

[inna]

27. +1,000. thank you, dflp.

[ProSense]

29. -1001 n/t

[bleever]

15. I appreciate your posts on this evolving discussion,

because you bring facts that help us shape the debate and push for real, systemic reform that will achieve the goals of universal coverage and cost containment.

[ProSense]

22. Thank you. n/t

[flyarm]

31. Nadler:“At Least Some of Us ARE Fighting Back” on Health Care

Nadler on AmericaBlog: “At Least Some of Us ARE Fighting Back” on Health Care
By: Jane Hamsher Monday September 21, 2009

http://campaignsilo.firedoglake.com/2009/09/21/nadler-on-americablog-at-lease-some-of-us-are-fighting-back-on-health-care/#comments

Rep. Nadler: At least some of us ARE fighting back, and in the health care fight, the public option is still very much alive only because the progressives have stood together and held our ground and said that, regardless of what the President or Leadership says, we won't vote for any bill w/o a public option.

[eridani]

34. Unfortunately, all the bills are useless, as nothing happens until 2013

That is 2 election cycles for Dems to get creamed explaining why the heath care system keeps getting shittier despite passing reform.

[Inuca]

35. Not true

SOME things that need time to be set up, such as the exchanges, will not happen for a few years. Others will happen right away. Remember the speech before COngress? "the moment I sign the bill..." Pre-existing conditions, caps, etc. will happen much faster.

[eridani]

45. Eliminating pre-existing conditions is useless unless insurance premiums are limited

Means nothing to me anyway--they won't double my premium because of my diabetes--I'll just have to pay a doubled premium because of the age discrimination written into the law.

[amandabeech]

55. Doubled will be the best. The Baucus plan quintuples the rate for older people.

I'm really looking forward to it.

[emulatorloo]

36. interesting article -- thanks n/t

[slipslidingaway]

39. Who would be eligible for the public option changed from what...

was originally proposed.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8663720&mesg_id=8665219

Bottom of page 5, I erroneously said it was on page 9 in my prior post, the entire pdf is 9 pages

http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf

"...(2) NEW AFFORDABLE, ACCESSIBLE HEALTH INSURANCE OPTIONS. The Obama-Biden plan will create a
National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be provided for people and families who need it..."


September 9th speech...

http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/

"...So let me set the record straight here. My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. (Applause.) Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates...

...Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. (Applause.) And the insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. (Applause.) Now, let me be clear. Let me be clear. It would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up..."


The plan changed from one that would available to Any American and mandates for children to a plan that would be available to only the uninsured and mandates for everyone. That is one reason why President Obama stated that less than 5% would be enrolled by 2019, will that be enough to keep the insurance companies honest and provide real competition? We were told that was a function of the PO.

:shrug:


The Incredible Shrinking Public Health Insurance Option
by Time for Change

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6576051&mesg_id=6576051

[democrat2thecore]

49. THANK YOU. This is KEY to the ProSense propoganda machine -nt

[kath]

50. ProSense propaganda machine is write - who exactly is s/he working for?????

[slipslidingaway]

51. You're welcome and of course ProSense has not replied except...

to tell me that I do not understand the meaning of "OR" in this thread.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8663720&mesg_id=8665265


Another part of the plan was to negotiate for lower drug prices, saving up to 30 billion annually, but now it appears that a deal was reached to save 8 billion annually??? Over ten years that is 220 billion!

Of course if you question any of this you are labeled a whiner, nay sayer etc. and are met by a group of defenders.

:(

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8666832&mesg_id=8667598

"...Allow Medicare to negotiate for cheaper drug prices.

The 2003 Medicare Prescription Drug

Improvement and Modernization Act bans the government from negotiating down the prices of
prescription drugs, even though the Department of Veterans Affairs’ negotiation of prescription drug
prices with drug companies has garnered significant savings for taxpayers.32 Barack Obama and Joe
Biden will repeal the ban on direct negotiation with drug companies and use the resulting savings, which
could be as high as $30 billion,33 to further invest in improving health care coverage and quality...

http://www.slate.com/id/2224621

"...Candidate Obama, citing a paper by Roger Hickey, Jeff Cruz, and Dean Baker of the Institute for America's Future, put the savings at $30 billion a year, which over a decade would be roughly twice the $156 billion savings envisioned by the energy and commerce committee. (Hickey, Cruz, and Baker proposed matching not Medicaid drug prices but those negotiated by the more straightforwardly socialist Veterans Administration.) By this reckoning, Tauzin swindled not $76 billion from President Obama but $220 billion. That's nearly half what the House health reform bill expects to raise with its proposed surtax on incomes above $350,000! ..."

[democrat2thecore]

53. You're right and what makes that ESPECIALLY troubling .....

What makes it even WORSE is that Obama campaigned HARD on the negotiation for drug prices and specifically called Tauzin out by name as somebody that anyone wanting health reform needed to "stay away from." Guess who the deal was made with? Yep. Billy Tauzin.

[slipslidingaway]

57. Many campaign videos in this Huffington piece speaking of negotiating...

for lower drug prices.

http://www.huffingtonpost.com/2009/08/09/flashback-obama-promises_n_254833.html

Posted in this thread...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8674647&mesg_id=8674647

[SpartanDem]

52. Both statements are in fact correct

Yes, the exchange is limited to those not enrolled in employer insurance. Just like today there's nothing stopping you from dropping your employer coverage. In fact the bill make explicit provisions dealings with this issue. The second excerpt from section 202 deals with eligibility for the exchange notice it doesn't say OFFERED insurance, it says ENROLLED. Section 311 below explains employer obligations including when an employee declines coverage.

SEC. 311. HEALTH COVERAGE PARTICIPATION REQUIREMENTS.

An employer meets the requirements of this section if such employer does all of the following:

(1) OFFER OF COVERAGE- The employer offers each employee individual and family coverage under a qualified health benefits plan (or under a current employment-based health plan (within the meaning of section 102(b))) in accordance with section 312.

(2) CONTRIBUTION TO WARDS COVERAGE- If an employee accepts such offer of coverage, the employer makes timely contributions towards such coverage in accordance with section 312.

(3) CONTRIBUTION IN LIEU OF COVERAGE- Beginning with Y2, if an employee declines such offer but otherwise obtains coverage in an Exchange-participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 313.


Individuals-

(1) INDIVIDUAL DESCRIBED- Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who--

(A) is not enrolled in coverage described in subparagraphs (C) through (F) of paragraph (2); and

(B) is not enrolled in coverage as a full-time employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.

[slipslidingaway]

56. You can also look at the Senate HELP bill which limits participation...

if an employee is offered affordable coverage by their employer.

http://ellenshaffer.blogspot.com/2009/07/senate-help-bill-doesnt-help-enough.html

"...Eligibility. Employees with access to coverage from work are excluded from enrolling in the Community Health Insurance option (Subtitle B, Sec. 3111,(b)(C); and Sec. 3116 (4)(a)(4)(v)IV), pp. 132-133). An individual who is eligible for employer-sponsored coverage can join the public plan only if the workplace plan's coverage doesn't meet the standard for minimm qualifying coverage, or if it is not affordable ((4)(v)(IV) and (4)(B)pp.132-4). A plan is unaffordable if the premium is greater than 12.5% of the indivudual's adjusted gross income (AGI) (Sec. 3103, p. 70) An employee with an AGI of $50,000 a year, who pays $500 a month for insurance, would not qualify to join the Community option. $50,000 times 12.5% equals $6.250, more than the annual premium of $6,000. An individual with an AGI of $100,000, paying $12,000 a year for family coverage, also just misses the 12.5% mark, which is $12,500. If the same person paid $13,000 a year for coverage she would qualify..."

Discussed in this thread as well.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6510650&mesg_id=6510650

[SoCalDem]

48. Correcting the "low-income" worker is the underlying problem in the mix.

The whole idea that low income workers will buy insurance is an issue that has to be dealt with.

Unless it's free or nearly free, they cannot actually even buy it. When what you make now is not enough to live on, where will the extra money come from ?

If plans for the working poor have to be heavily/totally subsidized, it will just be like putting them all on medicaid, with fewer services available. And watch "generous" states to stop offering medicaid to lots of people currently on it, in favor of saving a few bucks, when these people get dumped into the "new plans".


I can see people ending up with less care..not more..

[hokies]

59. It covers 97 percent because it threatens to tax you thousands if you don't buy health insurance

Only pointing out the obvious. It's still clear that the public option is hardly an option at all, since it covers few Americans.