Serious question: What does the HCR bill do for people who have insurance through their employers?

[Hello_Kitty]

Does it change anything for them? I mean, other than charging excise taxes on some plans.

[Nikki Stone1]

1. Isn't taxing employer-based insurance plans enough?

That's huge.

[quiller4]

2. Only very high-end plans are subject to tax. There is another change

in that people will have the ability to opt out of employer plans and into exchanges if they are not satisfied with what their employer offers.

[Bluebear]

3. the "very high-end plans" that labor took in exchange for pay concessions for years.

[Hello_Kitty]

7. Projected to be 20% of employee sponsored plans by 2019.

But hey, Ezra Klein explained how the excise tax is necessary because workers are "too separate from the costs of their plans". IOW, they need more co-pays and deductibles so they'll stop using their health care plans so much.

[AllyCat]

24. yep. That's what has happened to us. My employer offers 3 plans

and wants everyone to buy the inexpensive plan that forces us to use the docs at our hospital and budding new clinics inconveniently located for anyone not in the major city in which my hospital is located. They are trying to phase out the most expensive, comprehensive plan that we've been fighting to keep for years. The MOR plan (my plan) is the next on the chopping block. So if this stupid bill passes, these two plans will probably be considered the "cadillac" plans and be taxed 8% What will happen? everyone will migrate to the cheaper plan that requires we use this hospital for everything (no real pediatric group and those that are here are NEW, NEW, NEW, unknown, un proven). Then the employer can effectively kill off the plan that actually covers just about everything. Then raise the premiums and deductibles to use their docs, the first of which I used was just HORRID. And in exchange, we took a hit on pay. Now they'll get rid of both things at once.

[truedelphi]

25. But why should anyone have tax free insurance plans

And decent coverage?

After all, we average folks didn't pay the Congress critters as much as the Big Insurers and Big Medical Interests in the way of campaign donations.

Nor did we bother to cough up $ 30K a piece to meet with Ezekiel Rahm.

[AllyCat]

26. Taxing health benefits is immoral and unethical. It's like taxing food.

(which many states do).

[truedelphi]

28. Oh I agree. Sorry if my sarcasm

Was not detectable.

[AllyCat]

29. Ok! Thanks. Internet is so flat that I didn't catch it

:hi:

[truedelphi]

34. As someone who jsut misread the header

"Multi organ transplant" as "multi orgasm" tranplant (I even started to think maybe orgasms can be tranplanted,) I really truly know the feeling.

:hi:

[Hannah Bell]

27. That;s the "cost-cutting" angle: forcing people into cheaper plans where

they'll get & thus use fewer services.

Isn't it clever?

There's also the other angle where employers drop plans, forcing people to buy private insurance & probably cheaper plans than they'd get through their employer.

[Hello_Kitty]

5. No they can't!

If your employer offers coverage you cannot opt into the exchange.

[Nikki Stone1]

6. Define "Very high end plan".

.

[laughingliberal]

9. It is defined by the cost of the premium

The bill in the Senate that taxes these plans calls for an excise tax on plans which cost $8500 for individuals and $23000 for a family. It's kind of nuts cause the cost of the premium is not, necessarily, indicative of the value of the policy. A lot of companies who employ large numbers of women or older workers may be paying rates close to this now for fairly routine coverage.

[clear eye]

8. I don't think so about being able to buy from the exchange.

The last I read is that if your employer offers you insurance that is not deemed unaffordable for your income, you are not elegible to buy in the exchange.

Please be careful what you write about such an important issue.

[Kokonoe]

18. The reason its called very high end is because it cannot be denied.

That should be a clue that people will not be covered by the new plan.

[jmm]

32. About $8,000 individual, $21,000 family is considered a high end plan

This, especially in some areas, is the starting point for decent coverage and hardly the Goldman Sachs CEO no deductible, copay, etc coverage that is presented as the face of the issue.

[Hello_Kitty]

4. Oh yeah. And you know it will be in the final bill.

But I want to know if there's anything else. Everything we hear about it has to do with the exchanges and covering the uninsured. I fail to see how this "reform" will be celebrated if it doesn't do anything for people who get crappy coverage through their jobs.

[Cleobulus]

10. As far as I can tell, no, unless the premium is greater than 9.8 percent...

of your income, then you might get a subsidy. In my case, the deduct and copay limits in the Senate bill aren't greater than the plan my employer offers, so no discounts there, even though I can't afford that either. I may be able to get a subsidy, then again, most likely not either. I can't afford what's offered now through my employer, so I don't see how the reform will help.

[Hello_Kitty]

11. I guess the majorities in polls who don't think it will help them are right. eom

[gateley]

12. And I have a question - IF we somehow get a Public Option, my niece, who is

very happy with her employer coverage, is sure that the employer will pull the coverage as they now offer it, and essentially tell the employees - you're on your own, or, we (the employer) will change our coverage to the public option and continue to pay part of your premiums.

Do we know at this point, if that will actually be possible? I'd love to shut her up about this.

[proud2BlibKansan]

15. They have talked about doing this where I work

Health insurance is a huge expense for most employers so I don't think it's a stretch for employers to consider dropping it.

[gateley]

22. I know -- When I was working I never grumbled too much about my increasing

premiums because I saw what my employers were paying for each of us. We ALL get nailed, employers and employees alike!

If we DID somehow get a Public Option and a lot of employers went that route, I think in the long run it would help us get to a single payer/universal plan much more quickly. :shrug:

[clear eye]

20. She's got it wrong, but the reality may not be much better depending on

if her employer has over 25 employees, and if the plan she likes so well offers benefits worth >$8K/individual or $21K/family. If it's that generous a plan, the dreaded "excise tax" that labor organizations tried unsuccessfully to take out, kicks in to the employer. That would be an incentive for her employer to switch to a worse plan, but there is no "public option" for the co. to buy.

No one can force her employer to keep the current plan (same as before the new law). Nothing can force the insurance co. to keep offering a particular plan either, though they will be allowed to offer existing plans to businesses even if they don't match the new law's requirements for 5 years if they don't change anything in the plan. It doesn't look like the final bill will have a public option. The public option was for individuals only in the House bill. The law actually exacts penalties for employers (except very small businesses) that don't provide insurance. She may be confusing the term "public option" w/ the exchanges. Only small businesses (under 25 employees) can buy from the exchange. The law offers some tax credits for small businesses who insure their employees from plans either in or out of a special small business exchange. The insurance in the exchanges most likely won't be a bargain.

So the situation is this: If her employer has over 25 employees, there's a strong disincentive to drop coverage. The only danger there is that if the plan is taxable there's a strong incentive to switch to something cheaper (and worse). These businesses will not throw their employees out onto the exchanges b/c of the penalties for not insuring them.

If her employer has under 25 employees, the co. will get tax credits to help them to continue to insure her. Still if the plan is so generous that it's taxable, there is the same disincentive to continue it as larger cos. have. In this case they can toss her out onto the exchanges on her own or buy a plan from the special small business exchange. The plans from the small business exchanges won't come w/ any greater tax credits than one the co. already has.

The real downsides in this bill affect all of us except those who qualify for Medicaid. The biggest is the mandate w/o a public option or strict cost controls to keep the premiums in line. Also insurance cos. are exempt from anti-trust laws. This combination will greatly exacerbate the already rising premiums. By including gov't tax credits for the parts of the premiums over a certain % of the customers' incomes, there is no market forces to apply a downward pressure on premiums. However, given the budget crisis our gov't is and will continue to be in for many, many years, the money for those credits and for helping the states expand Medicaid will have to come from somewhere. It's quite likely that the middle class will find that they are given a tax credit of, say, $2K in 2014, while their taxes have risen, for instance, $3K a year for 5 years (total $15K) before then in expectation of the future expenses. This is on top of having to pay the major part of the premium themselves and the out of pocket expenses not covered by insurance.

There are no laws defining what are "experimental" or "elective" treatments, so the law doesn't stop denial of service abuses. The states are mandated to greatly expand Medicaid w/o adequate help from the federal gov't, so state budget crises and increased state taxes are likely. The insurers are allowed to charge premiums 3x higher than what they charge the rest of us for customers w/ pre-existing conditions and for those 55 - 64 yo. All this amounts to another hit on the federal and state treasuries potentially equal to the bank bailouts and continuing forever. It also locks us in to a model of employer-provided insurance that makes our products and services less competitive than those of other countries thereby continuing high unemployment. It specifically bars states from setting up single payer plans of their own. I see this bill as another corporate attack on the middle class, and potentially ruinous to the country financially.

After all this, a large % of working people will only be given by their mandated employers or be able to afford on their own, plans that have such high deductibles and copays that if they need expensive treatment, the bills may still bankrupt them.

The plan that looks likeliest to emerge is very similar to the Massachusetts plan that was bankrupting that state even before the economic crisis that began w/ the bank bailouts. There are also still many medical bankruptcies of individuals.

I'm sorry I don't have happier news.

[gateley]

21. Boy, thanks for the education! Now I get it, and I'll pass it along. There isn't

much happy news with this current plan -- as it stands, now -- sorry to say. :hi:

[recoveringrepublican]

31. Why would they need a public option to do that? Why wouldn't they just do it yesterday?

I hate that argument. Employers who offer AFFORDABLE health benefits do it to attract quality employees, not out of the goodness of their bleeding liberal heart!

If they stopped offering affordable high quality health care how many of their employees (ok, well assume the economy is better) would just find another job?

The sole reason my husband works where he does is because of the benefits.

[LouKneeLib]

13. ......

Steals from the middle class. :woohoo:

[dhpgetsit]

14. There are new regulations that insurance companies operate under.

So they can't rescind you are limit your lifetime benefit.

[Hello_Kitty]

16. Okay, that's good. eom

[Igel]

17. A few.

They'll be taxed, if the employer pays over a certain amount. Since that's not indexed to inflation, it means more and more people will be taxed. This is assumed in the bill and the CBO analysis.

The government requirements will cause rates to rise almost immediately. You can't alter the policy to say that more things must be covered without having it compensated for by more payments.

Current plans will be grandfathered in for a while, but they can't be changed. Of course, my insurance policy changes slightly every year--and with the mandated policies and their benefit packages the private, employer-offered policies will seem unresponsive and probably less attractive if they don't change. If they change, then they have to satisfy government requirements. Moreover, if some don't change, they may stop satisfying the government requirements.

The grandfather clause expires eventually, so they'll have to meet government requirements after a while anyway. It's likely that at that point your employer won't want to pay.

The entire Senate bill assumes that many employers bail and cease offering insurance. It also assumes that the money saved is passed along to employees.

[quaker bill]

19. It reduces uncompensated care

by requiring the currently uninsured to contribute to the risk pool. This will lower costs for insurance.

It requires insurance companies to offer plans with a higher loss ratio, this means more of premiums spent delivering healthcare. It lowers cost.

It removes lifetime maximum benefit limits, something that might have saved my father's life, and he had very good insurance, the sort you can't even buy anymore.

[thotzRthingz]

23. just a note regarding U.S. Armed Forces, Veterans, Retirees (on TRICARE)...

Neither the HOUSE nor SENATE versions will have any effect on "health care programs" already being administered for these. I'm a 30-year Navy-enlisted retiree, TRICARE covers my spouse and myself (all kids are now on their own). I personally "DO" neither doctors nor hospitals (haven't since FORCED to comply with my retirement physical), my spouse doesn't "DO" them either.

I avidly DEMAND a "public option" (although would have preferred a SINGLE PAYER push, from the onset of reform talks). I think that's the best chance to eventually move into SINGLE PAYER, sooner rather than later. Our FOR-PROFIT health care system SUCKS THE BIG ONE, and will only get worse, if no real cost-containment and competition is instituted (via a public option).

...just my 2cents

[WillowTree]

30. What I don't get is the rationale for...

.... penalizing employers that provide better than average benefits to employees. If there's any logic in there, it totally escapes me.

[IndianaGreen]

33. CWA Presents 18 Studies Outlining Negative Effects of Excise Tax

CWA Presents 18 Studies Outlining Negative Effects of Excise Tax

December 22, 2009

Specifically, the reports show:

· The excise tax will affect large numbers of health plans that reach deep into the middle class.

· High-cost plans typically are not due to "excessive" benefits. They are largely due to demographic factors in the workforce – age, gender, chronic conditions, and type of industry – and local pricing and practice patterns.

· The excise tax will not let many workers keep the good health plan they have now. To avoid the tax, affected health plans will significantly reduce benefits and increase cost-sharing (deductibles and co-pays) in order to get premiums below the thresholds at which the tax applies. These cuts will be dramatically larger in the second decade as the difference between health plan inflation and the rate at which the thresholds increase grows exponentially.

· The excise tax will destabilize the employer-based system resulting in plan terminations, higher costs to workers, and a shift to lower-cost high deductible health plans with limited benefits.

· There is no evidence that the excise tax "bends the cost curve" – reducing the underlying rate of growth and inflation in the health care system. There will be some modest reduction in health care costs to employer plans and to overall health expenditures – not because the excise tax bends the cost curve but largely because it reduces the amount of health care for which people are covered.

· The excise tax will not bend the cost curve because it does not address the fundamental cost-drivers in our health care delivery system so that care becomes less expensive and is delivered more cost effectively.

· Higher cost sharing will lead to lower utilization and foregoing needed care, which will result in worse health outcomes and increased health disparities.

· Lower utilization has done little to reduce costs in the United States. We are already near the bottom in hospital and physician usage, but our health costs are 50 percent more than the next highest spending country.

· The excise tax is a large tax increase on middle class Americans, and it is a regressive tax increase, especially when compared with the surcharge on wealthy individuals proposed in the House of Representative's legislation.

· Most employers will not increase workers' wages in exchange for cutting health benefits, contrary to assumptions made by the Congressional Budget Office (CBO).

http://www.cwa-union.org/news/cwa-presents-18-studies-outlining-negative-effects-of-excise-tax.html