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Why is there no limit on dedictibles in this so called health insurance "reform"?

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invictus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:00 PM
Original message
Why is there no limit on dedictibles in this so called health insurance "reform"?
Why should anyone be forced to buy private health insurance that they cannot afford to use because the deductible is $5,000.00 before the insurance companies pays a single cent, and then pay only 50% after the deductible is met?
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vi5 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:05 PM
Response to Original message
1. Reform! Historical!
History! Reforminess!!!! Reforming the historical history!!!!!

What are you a freeper?!?! Stop asking questions like that and just bathe in the warm glow of history being reformed.
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leftstreet Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:07 PM
Response to Reply #1
2. lol
:spray:
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golddigger Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:51 PM
Response to Reply #2
59. Delete, wrong spot!
Edited on Tue Dec-29-09 05:54 PM by golddigger
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Greyhound Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 02:38 AM
Response to Reply #2
118. I'll second that.
:spray:

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truedelphi Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:09 PM
Response to Reply #1
3. My laugh of the week
I am drawing up a nice hot soak right now!
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sabrina 1 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:10 PM
Response to Reply #1
5. 'Reforminess'
:rofl:
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:11 PM
Response to Reply #1
7. Perfect!
And they're right. It is historic. One big historic mistake.
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polpilot Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:24 PM
Response to Reply #7
23. Historical achievement I tell you. Historic. Mind boggling achievement. HISTORIC!!
We'll change it later...when everyone's dead.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:28 PM
Response to Reply #23
30. Yes, should be much more affordable, then
After all, how much health care could dead people need?
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Nikki Stone1 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:24 PM
Response to Reply #7
95. +1
..
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bread_and_roses Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:15 PM
Response to Reply #1
14. I didn't think anything could make me laugh about this monstrosity....
...but you did it. perfect!
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ProgressIn2008 Donating Member (848 posts) Send PM | Profile | Ignore Tue Dec-29-09 05:46 PM
Response to Reply #14
52. Heh, same here. "Reforming the historical history" got me. nt
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clear eye Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:36 PM
Response to Reply #14
82. Same here. n/t
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Echo In Light Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:25 PM
Response to Reply #1
24. Uniquely American
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flvegan Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:47 PM
Response to Reply #1
55. Okay, THAT was funny.
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golddigger Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:55 PM
Response to Reply #1
60. lol
Historical deformity more like it!
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Hello_Kitty Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 03:10 PM
Response to Reply #1
124. It's like the New Dean and Great Society all rolled into one!
Only better! More ponies!
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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:09 PM
Response to Original message
4. Harry Reid had a lot to do with the DEFORM . . . he took out pharm negotiations on drug prices . . .
and some other stuff --

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jgraz Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:13 PM
Response to Reply #4
10. What? Obama dealt those away back in March. Reid had nothing to do with it.
Edited on Tue Dec-29-09 05:13 PM by jgraz
Here's one of many articles where the White House confirms it themselves: http://www.nytimes.com/2009/08/06/health/policy/06insure.html

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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:34 PM
Response to Reply #10
40. Trying to remember if I read it or heard it on C-span . . .
Edited on Tue Dec-29-09 05:35 PM by defendandprotect
Yes, I can see that Obama in WH probably made the deal -- sadly --

But maybe Reid had to make sure it was out of the written bill?

I'll see if I can come across the info again --

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jgraz Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:41 PM
Response to Reply #40
47. Well, sure. If Reid hadn't acquiesced to the White House, the provision might have been left in.
Of course, when the White House really wants to influence the Senate's legislation, they somehow find a way to do it. Funny how that works...
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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:35 PM
Response to Reply #47
81. Well . . . what I heard wasn't put quite that way . . . but agree . . .
and there was kinda list of things he took out --

If I ever recall where I got it from, I'll let you know!

Meanwhile, thanks for the correction --



And Happy Winter Solstice -- Nature's New Year!



:)
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:24 PM
Response to Reply #10
78. How can anyone still be unclear about that?
Protecting his deal with the pharmaceutical industry was job 1 for Obama throughout this debate. And I've no doubt a deal was cut with AHIP at some point. Feingold told us as much of a scumbag as Lieberman is, even, this bill is the one the White House wanted. As ineffective as Harry Reid is, at times, he was pissed off about the Medicare expansion getting axed when Rahm came over and told him to give Lieberman what he wanted. And he brought the reimportation amendment to the floor for a vote but the White House made sure it would be voted down beforehand.
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defendandprotect Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:37 PM
Response to Reply #78
84. I knew about the White House meeting ... etal . .
but I did stumble upon this info the other day -- still can't say where ...

or why ..

but thank you all for the correction!!


:)
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ima_sinnic Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:45 PM
Response to Reply #78
87. yes, and the Rahmbaggers work overtime trying to "blame Lieberman"
and yelling that the public option "couldn't get the votes" despite ALL the "hard work" the president did trying to get it. The bill went exactly the way it was meant to go--with the only winners being the insurance companies and the bottom-feeding scum who are paid to get it for them.
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TheKentuckian Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:10 PM
Response to Original message
6. Hey now, you know their are well off people that risk too much of their hard earned money
ecerybody else that can't afford access is just too lazy to use their government subsidized and provided bootstraps.

:sarcasm:
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BuelahWitch Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:11 PM
Response to Original message
8. Yes, $5000 would be rather "dedicktable" for my income
Actually anything above about $100 would be dedicktable! :grr:
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:11 PM
Response to Original message
9. STFU and get back in line. Hater.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:13 PM
Response to Reply #9
11. Lol!
Is it my imagination or are we seeing less of this caliber of response the past few days?
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:16 PM
Response to Reply #11
17. They are all resting, celebrating their victory, how ever Pyhrric.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:23 PM
Response to Reply #17
22. Possible
I guess I wondered how many are off because the President is on vacation and Congress is in recess.
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jgraz Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:19 PM
Response to Reply #11
21. They're all too busy attacking Jane Hamsher.
Pay no attention to that corporate giveaway behind the curtain!! Look, over here!! We got Norquist!! We got Hamsher!!! No! Stop! Don't read the bill!!! We got blackface, I tell ya, BLACKFACE!!!!


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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:25 PM
Response to Reply #21
25. ROFL!
Yes, there's that but even that seems to be subdued now. Perhaps the bosses are all out of town?
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ipaint Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:31 PM
Response to Reply #21
33. LOL
:rofl: :rofl:
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Nikki Stone1 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:30 PM
Response to Reply #21
97. George Orwell really didn't say that....
:evilgrin:
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Donnachaidh Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:17 PM
Response to Reply #11
92. they will be back, watching the news broadcasts at New Years
Probably watching ANY broadcast from the White House. And they'll be trolling DU for *haters* to bait. These folks spend as much time in their basements as the freepers do.
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polpilot Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:26 PM
Response to Reply #9
26. Historic. Just historic. Hystorical. Hysterical. You're not pleased????
The health insurance companies are.
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KittyWampus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:13 PM
Response to Original message
12. My understanding is that there will be limitations on out of pocket expenses. The DU'ers snarking
above me in their posts... I'd love to know if they have more VALID insight into the question and not just kneejerk reactions to the issue.

Yes, it's a huge problem if there is NO control on deductibles and what we pay for actual services.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:15 PM
Response to Reply #12
13. Yes, $5000, over and above premiums paid.
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leftstreet Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:15 PM
Response to Reply #12
15. What fucking difference does it make, if your POCKETS are EMPTY
:shrug:
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KittyWampus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:17 PM
Response to Reply #15
20. WIth my current insurance, I have a co-pay. Not happy about it, but it's a "reasonable"- $25 per
Edited on Tue Dec-29-09 05:18 PM by KittyWampus
visit.

The 17% premium increase we just got for Blue Cross is not reasonable. We must now pay $600 A MONTH.

I am stacking what I pay now against what is going to happen.
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jgraz Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:16 PM
Response to Reply #12
18. Yes, but they meant out-of-pocket expenses for the *insurance companies*
Did you know we still have "reasonable" annual caps on payouts?

And no, there are no limits on rates or deductibles. There's just a requirement that a certain percentage of revenue be spent on medical expenses.

Now, if you can only make a 20% profit on revenue and you want to make more money, what do you do? Why, raise your rates, of course! Go ahead, there's no limit! :banghead:
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:26 PM
Response to Reply #12
27. The limits are $5000 and $11,900 depending on which level of coverage you buy
See, nice and affordable. Not.
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:13 PM
Response to Reply #27
71. Those are max
it is lower for those making less and that number includes copays.
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Schema Thing Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:15 PM
Response to Original message
16. There are limits. Why are you saying there are not?
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:17 PM
Response to Reply #16
19. Yup, $ 5000.00
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enlightenment Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:42 PM
Response to Reply #16
49. I think there is some confusion about exactly what they mean by
Edited on Tue Dec-29-09 05:44 PM by enlightenment
limits on out-of-pocket expenses - and nothing is clearly explicated in the bill (I've read the parts pertaining to this several times - referenced the IRS code sections to which it refers - still can't figure out exactly what they mean. . .)

Under the current arrangement most people have with insurance companies, they pay three 'things':

They pay a monthly premium, regardless of whether or not they need medical treatment.

They pay an annual deductible of some amount - meaning that the insurance pays little or nothing on any claim until that amount is met by the insured person.

After the deductible is met, they pay whatever remains after the insurance company 'picks up' their percentage of the allowed charge for a medical procedure.

For example (just making up numbers off the top of my head and simplifying what insurance covers for this):
------------------
A single person buys insurance that charges them $1,200 annually for the premium and covers all medical procedures at 80% of the 'allowed' cost per procedure. The coverage also comes with a $1,000 annual deductible before coverage kicks in.

So, the person is paying $100 per month regardless of use, to maintain coverage (the premium).
They are responsible for the first $1,000 of the cost of any medical treatment they receive. That is the 'out-of-pocket' cost.
They are also responsible for at least 20% of any medical procedure they receive, after the deductible is paid.

They get sick and go to the doctor. The initial tests and treatments mount up until they have paid the $1,000 deductible. Then they are hospitalized. Their bill breaks down sort of like this:

Two days of intermediate care in a semi-private room: $300 per day - $600
Drugs: $100 per day - $200
Supplies: $100 per day - $200
TOTAL OWED to the hospital: $1,000

The insurance company pays 80% of allowable costs. They report that the allowed costs are:
Room charges: $250 per day - $500
Drugs: $75 per day - $150
Supplies $75 per day - $150
TOTAL ALLOWED: $800
TOTAL PAID at 80%: $640

Amount the covered person is responsible for paying (on TOP of the deductible, remember): $360
That is not considered an 'out-of-pocket' cost - it is simply the cost that remains after the insurance has paid their 'part' of the bill.
-----------

Now, that's how it operates (more or less, depending on the plan, etc) right now. The question is, is this the way it will operate under the new provisions.

What, exactly, does 'out-of-pocket' mean? Does it include the deductible AND the percentage cost (keeping in mind that for the subsidized plans, the value of the 'Silver' plans are set at 73%, not 80%)?

I'm not criticizing this - I'm asking the question, as is the OP. So far, I haven't seen anything in the bills or the CBO accountings that clarify this issue. A few bloggers have suggested that's what it refers to a total limit on debt owed, but I'd like to see it in the fine print, too.

edited to move a line I put in the wrong place . . .


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depakid Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:05 PM
Response to Reply #49
69. Our of pocket expenses will not include denied claims (or items in claims)
Edited on Tue Dec-29-09 06:05 PM by depakid
and nothing in the bill provides effective recourse under such circumstances (i.e. ERISA preemption is still in place).

So, btw, is rescission for "fraud" or "misrepresentation."
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enlightenment Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:44 PM
Response to Reply #69
101. I agree, depakid.
I was trying to leave my feelings about this thing out of it and just address what seemed to be the question. I don't think I've seen an answer to that question yet - though I have seen a lot of dancing around the issue with many, many words and terms and protestations and assertions and such.

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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:26 PM
Response to Original message
28. There are limits. What are you talking about?
Are you talking about the "young invincible" or "catastrophic" bare-bones plan? For people who don't "think" they need coverage at all? :shrug:
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invictus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:27 PM
Response to Reply #28
29. What are the limits?
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:32 PM
Response to Reply #29
36. here ya go

Available Coverage: A qualified health plan, to be offered through the new American Health Benefit
Exchange, must provide essential health benefits which include cost sharing limits. No out-of-pocket
requirements can exceed those in Health Savings Accounts, and deductibles in the small group market
cannot exceed $2,000 for an individual and $4,000 for a family.
Coverage will be offered at four
levels with actuarial values defining how much the insurer pays: Platinum – 90 percent; Gold – 80
percent; Silver – 70 percent; and Bronze – 60 percent. A lower-benefit catastrophic plan will be
offered to individuals under age 30 and to others who are exempt from the individual responsibility
requirement.



The $2000/$4000 applies to the cheapest "Bronze" plan. The ones with higher actuarial values will have lower co-pays and lower deductibles.
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LWolf Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 08:02 AM
Response to Reply #36
121. So....
I pay a premium which, at this point, is more than double my monthly grocery bill. Then I pay another $2000, and I also pay all the copays.

When do I pay my mortgage? Or the life insurance that I really need to be sure my dependents will be okay, since I'm not getting any health care?
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:28 PM
Response to Reply #28
31. Yup $5000.00 out of pocket .
on top of the premiums.
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:33 PM
Response to Reply #31
38. No, $2000 individual and $4000 family for the cheapest plan.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:36 PM
Response to Reply #38
42. Oh, that's much better.
:rofl: :rofl: :rofl: :rofl: :rofl: Do you know alot of low income families that can cough up $4000.00 on top of any premium paid???
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:42 PM
Response to Reply #42
48. Considering they're getting subsidies, yes. Except, of course,
for the lower-level families who will be eligible for Medicaid.
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OmmmSweetOmmm Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:26 PM
Response to Reply #42
79. !!!!!!!
:rofl:
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Nikki Stone1 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:35 PM
Response to Reply #42
108. Even middle income families.
2K is a lot when you are raising kids.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:40 PM
Response to Reply #38
46. Those are the "deductibles", also add the 20%-40% co-payment.
Out of pocket could easily reach 11000 for a family. Can you afford that??No soap, this bill sucks ass. all who shill it seem to only care about giving a "victory" to this administration.
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:44 PM
Response to Reply #46
51. Don't forget the subsidies, Or the expansion of Medicaid
for those who can't afford it. Oh, and where do you get 20%-40% co-pays? More like $25 in most cases. Besides, there are limits on out-of-pockets as well.

Can't you read?
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:49 PM
Response to Reply #51
58. The subsidies are for the premiums. These are OVER AND ABOVE any premium.
You should read about the "levels" of coverage. 60% , means they pay 605 of costs. True, some preventive care is included or carries a small co-pay, but don't get sick!The out of pocket limits are $5000-$11,000 hardly "affordable." Quit relying on your stupid "summary" from your senator who is shilling for the bill.
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quiller4 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:00 PM
Response to Reply #46
64. Out of pocket is capped, too. No way to get to $11,000.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:01 PM
Response to Reply #64
65. dream on.
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KittyWampus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:19 PM
Response to Reply #65
73. Again, you are presented with FACTS and then just spew crap. It's obvious you are not here to join
in a meaningful discussion. Whether you intend to or not, you are being nothing but disruptive.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:38 PM
Response to Reply #73
85. Facts? no I was "presented" with a piece of a "summary" put out by a Senator who is shilling ..
Edited on Tue Dec-29-09 06:39 PM by MNDemNY
for the bill. Read the bill, not just bits fed you by a shill. sorry to burst your Obama loving bubble, but this so called reform, does more harm than good.
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Name removed Donating Member (0 posts) Send PM | Profile | Ignore Tue Dec-29-09 06:18 PM
Response to Reply #46
72. Deleted message
Message removed by moderator. Click here to review the message board rules.
 
MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:36 PM
Response to Reply #72
83. You seem to not understand the difference between,...
"deductibles" and "out of pocket expenses" two different animals. add them up, and you could pay as much as 11,000+ ON TOP of any premium(that is a third "animal', in case you don't get that , either.)
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:53 PM
Response to Reply #83
88. Deductibles are included in the out of pocket limit
COST-SHARING.—In this title—
(A) IN GENERAL.—The term ‘‘cost-shar
ing’’ includes—
i) deductibles, coinsurance, copayments, or similar charges; and
ii) any other expenditure required of
an insured individual which is a qualified
medical expense (within the meaning of
section 223(d)(2) of the Internal Revenue
Code of 1986) with respect to essential
health benefits covered under the plan

and reduced based on income

(1) REDUCTION IN OUT-OF-POCKET LIMIT.—
(A) IN GENERAL.—The reduction in cost22
sharing under this subsection shall first be
23 achieved by reducing the applicable out-of pocket limit under section 1
302(c)(1) in the case
25 of—

(i) an eligible insured whose household
2 income is more than 100 percent but not
3 more than 200 percent of the poverty line
4 for a family of the size involved, by two5
thirds;
(ii) an eligible insured whose house7
hold income is more than 200 percent but
8 not more than 300 percent of the poverty
9 line for a family of the size involved, by
10 one-half; and
(iii) an eligible insured whose house12
hold income is more than 300 percent but
13 not more than 400 percent of the poverty
14 line for a family of the size involved, by
15 one-third.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:03 PM
Response to Reply #88
91. Yes, like I said..Add them up...
and you get up to 11900. Is that not true???????
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:18 PM
Response to Reply #91
93. At the top income bracket yes
below 400% FPL those caps are reduced.
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Hello_Kitty Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:29 PM
Response to Reply #93
96. Top income bracket??!?
You consider $44k a year to be "top income"?
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:35 PM
Response to Reply #96
99. This bill does.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:34 PM
Response to Reply #93
98. For a family of 4, that would be under 60,000 per year.
So a family making somewhat< 60k could be made to pay 11,900 out of pocket + (I/ll be nice)8000 in annual premiums for a total of 19,900 for health care. almost 20% of their PRE-TAX income?? You call that affordable?(and the premium could be substantially higher)
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:52 PM
Response to Reply #98
102. A family of of four making 60,000 is below 400% FPL
so there out pocket limit is reduced to 7,900 and they'd eligible for premium subsides.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:07 PM
Response to Reply #102
104. So your still talking 12-15000 bucks.
affordable??? no.
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:18 PM
Response to Reply #104
107. You act like that is what a typical family will pay
that is worst case scenario and it's better than situation today, they're no limits now of any kind on what a family pays and if they're hitting their lifetime or annual cap then they're really screwed. With preventive care having no cost sharing it will eliminate a lot of basic health cost.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 09:03 PM
Response to Reply #107
113. You mention annual cap.
This bill allows annual caps. Which drastically add to the "worst case scenario".This bill only entrenches us in a profit driven employment based system that has proven to be unworkable. it does more harm than good. Kill it.
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 09:19 PM
Response to Reply #113
115. That was fixed in the managers amendment
Edited on Tue Dec-29-09 09:23 PM by SpartanDem
caps will set by HHS until 2014 when they're elimanted
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 10:30 PM
Response to Reply #115
116. So there are caps.
Edited on Tue Dec-29-09 10:33 PM by MNDemNY
Where are you getting your info? is there a pdf available for the latest senate version?I would much appreciate a link,
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 11:21 PM
Response to Reply #116
117. no single pdf including all changes
but the amendment is available

Paragraph (2) makes clear that the regulation goes into effect in 2014, the year the new insurance exchanges would be up and running.) Prior to that time, insurers would still have some leeway to impose limits, although the authority appears to be subject to some government oversight. A senior Senate aide explains:

http://www.tnr.com/blog/the-treatment/the-senate-bill-no-annual-and-lifetime-limits


http://democrats.senate.gov/reform/managers-amendment.pdf
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:56 PM
Response to Reply #38
90. Only for employer sponsored plans
and that is deductibles only

ANNUAL LIMITATION ON DEDUCTIBLES FOR
15 EMPLOYER-SPONSORED PLANS.—
16 (A) IN GENERAL.—In the case of a health
17 plan offered in the small group market, the de18
ductible under the plan shall not exceed—
19 (i) $2,000 in the case of a plan cov20
ering a single individual; and
21 (ii) $4,000 in the case of any other
22 plan.
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Warren Stupidity Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 07:51 AM
Response to Reply #31
119. 2009: $5,950. And indexed to inflation.
So actual out of pocket expenses including deductibles can be around 10,000, with that number indexed. Isn't it great how when charges to the peasants are set up they are always indexed? Notice how the minimum wage isn't?
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TheKentuckian Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:31 PM
Response to Reply #28
34. The limits are shifts not limits
After your premiums and $5,000 or so they'll get their money from Uncle Sam and you can pay the remainder in taxes.
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:37 PM
Response to Reply #34
43. NO. Here, read the summary.
http://casey.senate.gov/imo/media/doc/long_summary.pdf

And the only taxes will be on the "Cadillac plans".
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TheKentuckian Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:55 PM
Response to Reply #43
61. Where do you think the money will come from, magic?
Big insurance ain't picking up the tab. They'll raid the general fund, cut into subsidies, or find an excuse to not pay. All of which will eventually mean more taxes or less benefits.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:42 PM
Response to Reply #43
86. Your "summary" is put out by a senator who is shilling for thisbill.
READ THE WHOLE BILL WAKE THE FUCK UP!!!!!
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Skittles Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:31 PM
Response to Original message
32. catching on are ya?
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KittyWampus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:20 PM
Response to Reply #32
74. Did you actually read this thread? There ARE limits.
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Skittles Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:21 PM
Response to Reply #74
76. LOL
just wait and see
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invictus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:32 PM
Response to Original message
35. What happens if you don't have $5,000 because you spent all your money on the premiums?
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:34 PM
Response to Reply #35
39. Gitmo.
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:39 PM
Response to Reply #35
44. The OP is either lying or hasn't read the bill. Unless he's talking
about the "young invincible" plan available to those under-30 who don't think they need coverage at all.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:44 PM
Response to Reply #44
50. YOU are only citing Deductibles, there is also co-payments..
20%-40% depending on plan. TOTAL OUT OF POCKET FOR A FAMILY COULD EASILY BE $11,000.00+ per year.I would direct your attention to a PDF of the bill itself, instead of a summary from a shill of said bill, but it ain't out there.
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quiller4 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:04 PM
Response to Reply #50
68. co-payment percentages are capped, too. The only way to
reach $11,000 is to count premium expense, too.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 09:43 AM
Response to Reply #68
122. Not for a couple, or a family.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:48 PM
Response to Reply #35
56. Then you have a nice policy to frame and hang on the wall. nt
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mdmc Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:33 PM
Response to Original message
37. I thought it did cap deductibles?
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johnaries Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:34 PM
Response to Reply #37
41. It does.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:56 PM
Response to Reply #41
62. Yup, at 5000-11000.
yipee.
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KittyWampus Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:21 PM
Response to Reply #62
75. stop lying. It is NOT $5000-11000. It has been repeatedly told to you it isn't that much
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:33 PM
Response to Reply #75
80. But you can repeat it 300 times, it still IS that much.
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:57 PM
Response to Reply #37
63. $2000 for an individual, $4000 for a family nt
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RedCloud Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:40 PM
Response to Original message
45. dedictibles??? That's worse than killing grandma, if you are a guy, that is.
Being stripped of our manly adornments just to pay the bill. A freaking outrage, I tells ya.
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Better Believe It Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:46 PM
Response to Original message
53. Because it's not a reform? This is a quiz .... right?
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WT Fuheck Donating Member (392 posts) Send PM | Profile | Ignore Tue Dec-29-09 05:47 PM
Response to Original message
54. your quotation marks tell the story.
the label says "reform," but the bottle contains a poisonous distillation of "more of the same."
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SoCalDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 05:48 PM
Response to Original message
57. It's the Fernando Lamas version of health care.. yoooooo loooook mahhhvelous
like fluffy icing on a delicious cake...but when you cut into it, you discover it's icing on a balloon & you've got it all over your face

If you are NOT currently covered, AND you do NOT go to the doctor, you will get insurance (which you will pay for, one way or another), but you're very likely to still not go to the doctor..

If you have a great plan, and use it moderately now, you will still have what you have, but will probably pay more (one way or another), and your "doctoring" will not change much..

If you have either of the above situations going on, your co-pays are going up, as are your deductibles and premiums, but if you get a serious illness, you will be covered.

If you are poor, (depth of poverty & eligibility to be determined by unknown people at a later date) Medicaid may save your financial life...but medicaid is always subject to the whims of the party in power..at the state level./
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Lydia Leftcoast Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:39 PM
Response to Reply #57
109. Off topic: Awww, what a fantastic kitty picture!
:loveya:
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SoCalDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:42 PM
Response to Reply #109
111. My baby "hugs" me .. I fell in love with these internet kitties
:)
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quiller4 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:01 PM
Response to Original message
66. There are limits in both house and senate plans.
$5,000 deductible/50% plans exist now but could not if either HCR bill were adopted.
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TicketyBoo Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:04 PM
Response to Original message
67. FYI
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:08 PM
Response to Original message
70. There are limits
Edited on Tue Dec-29-09 06:16 PM by SpartanDem
and in the bill the limits on out of pocket limits include deductibles and copays

Making Coverage Affordable: New, refundable tax credits will be available for Americans with incomes between 100 and 400 percent of the federal poverty line (FPL) (about $88,000 for a family of four). The credit is calculated on a sliding scale beginning at two percent of income for those at 100 percent FPL and phasing out at 9.8 percent of income at 300-400 percent FPL. If an employer offer of coverage exceeds 9.8 percent of a worker‟s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive credits. Out of pocket maximums ($5,950 for individuals and $11,900 for families) are reduced to one third for those with income between 100-200 percent FPL, one half for those with incomes between 200-300 percent FPL, and two thirds for those with income between 300-400 percent FPL. Credits are available for eligible citizens and legally-residing aliens. A new credit will assist small businesses with fewer than 25 workers for up to 50 percent of the total premium cost.

http://dpc.senate.gov/healthreformbill/healthbill05.pdf

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OmmmSweetOmmm Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:23 PM
Response to Original message
77. THANK GOD IT PASSED!!!!!!
:rofl:
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amborin Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 06:54 PM
Response to Original message
89. plus, many people will find the co-pays prohibitively expensive
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pinto Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:20 PM
Response to Original message
94. Out-of-pocket costs under one proposal, based on income -
Edited on Tue Dec-29-09 07:20 PM by pinto
http://www.kff.org/healthreform/sidebyside.cfm

Lower the out-of-pocket spending limits established in the essential benefits package ($5,000/individual and $10,000/family) for eligible individuals and families with incomes up to 400% FPL (Federal Poverty Level) to the following amounts:

133-150% FPL: $500/individual; $1,000/family

150-200% FPL: $1,000/individual; $2,000/family

200-250% FPL: $2,000/individual; $4,000/family

250-300% FPL: $4,000/individual; $8,000/family

300-350% FPL: $4,500/individual; $9,000/family

350-400% FPL: $5,000/individual; $10,000/family

(Effective January 1, 2013)

Provide affordability cost-sharing credits to eligible individuals and families with incomes up to 400% FPL. The cost-sharing credits reduce the cost-sharing amounts and annual cost-sharing limits and have the effect of increasing the actuarial value of the basic benefit plan to the following percentages of the full value of the plan for the specified income tier:


133-150% FPL: 97%

150-200% FPL: 93%

200-250% FPL: 85%

250-300% FPL: 78%

300-350% FPL: 72%

350-400% FPL: 70%

*************************************
(for reference) Federal Poverty Level data ~ pinto

http://liheap.ncat.org/profiles/povertytables/FY2010/popstate.htm

http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/FPL%20Chart%20for%20PE.pdf

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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 07:36 PM
Response to Reply #94
100. Plus the premiums.
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grahamhgreen Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:02 PM
Response to Original message
103. And this is just where they are starting! After Big Crapsurance gets the trillions - the sky is the
limit!!!!
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HughBeaumont Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:14 PM
Response to Original message
105. Well hey, if taxophobic Dumberica would have wised up . . .
. . . and not elected nation-ruining, anti-everything-that's-NOT-Uhmurkin Reagans and Reaganites for 28 years, we probably wouldn't be having this discussion. "WAAAAAAAAH!! My tax dollars should go to protect ME, a law-'bidin' sitizen, from those murderin' Roooskies/Commies/AY-rabs/Mooooslims, not to support those goddamn (insert racial slur here)'s nine crack babies!! Least thats'n whut the Teevee tells me!"

Unaffordable out-of-pocket theft is NOT reform. It's an unlubed rusty shaft.
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RB TexLa Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:15 PM
Response to Original message
106. Why should people have a limit on what deductible they choose? The higher a deductible the less I
Edited on Tue Dec-29-09 08:26 PM by RB TexLa
have to pay the insurance company, I'd rather it go in my HSA.
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Autumn Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 08:40 PM
Response to Original message
110.  "The Insurance Industry Profit Protection Act of 2009"
Edited on Tue Dec-29-09 08:48 PM by Autumn
call it what it is and then you will see why there are high deductibles.
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Kansas Wyatt Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 09:00 PM
Response to Original message
112. Oh Pom Pom Squad, you people need to be sure that...
You are front and center when the shit hits the fan with the American People on this ALLEGED health care reform SHIT Bill.

Because, for the Democratic Party, you are what BushBots were to the Republican Party. You have just squandered 30 years of waiting, for the sake of your Messiah's sell-out. With alleged friends like you, who needs republicans to jam it up the ass of the American People? Oh that's right... You are Republican Lite.

RAH! RAH! RAHM!!!

Oh, and do not act so surprised when the Republicans KEEP the mandates in place, while gutting and cutting everything out of it that actually did help people, after the shit hits the fan, then the Democratic Party. You were warned dumb fucks!
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Generator Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Dec-29-09 09:06 PM
Response to Original message
114. Because it's important that rich people stay rich
That's the public mantra of the Republican party,the partly public mantra of the blue dog Dems, and the hidden one of the Democrats. I know they are certainly rich and have health care for life. Follow the money yee fools.
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LWolf Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 07:58 AM
Response to Original message
120. +1
:thumbsup: :thumbsup:
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inna Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Dec-30-09 02:49 PM
Response to Original message
123. Yes there ARE limits, see this thread for numbers:
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