# Some Factual Information re the Affordable Care Act (Obamacare)



## Raeven

There seems to be a lot of confusion about this law, and I see inaccurate information about it promulgated all over this forum. I am posting my information in Singletree because it is a forum in which â so far â I am permitted to post, and so far as I know, we may discuss whatever we like within the guidelines. I am very familiar with the law because of the work I do, which interacts with the new legislation. I am also personally a âcustomer.â 

Feel free to post questions if you have them, and if I can answer them, I will.

If your state was one of the 36 that went into the Federal Exchange, then Iâm sorry, the Affordable Care Act wonât be as affordable for you as for those states that set up their own exchanges. But in most cases, itâs still a better deal by far than you could get through a private insurance plan. It may still be too expensive, unfortunately. But suffering a catastrophic health failure is financially ruinous, too.

The ACA is *not* government-run health care. If it were, it would be Medicare. The ACA is regular insurance, sold by regular insurance companies, through either a state-run or Federal exchange. Your coverage will be just like insurance you would get through an employer. You will see doctors, stay in hospitals and have lab tests just the same as everyone else. The cost for your coverage is currently subsidized by the government while they work to bring down costs. Eventually, it is intended that premiums paid by you will equal actual costs of coverage. How they plan to do this is for another post, as is whether or not it will ultimately work. That all remains to be seen.

If you are insured through your employer, no need to participate in the ACA.

If you are on Medicare, no need to participate in the ACA.

If you have health care coverage through the Veteransâ Administration, no need to participate in the ACA.

If you are one of the millions of uninsured people in this country because you are self-employed, your employer doesn't offer coverage, you are unemployed or for some other reason unable to obtain regular insurance, then you have until Monday to start your application for the ACA. For those applying to the Federal exchange, the deadline to complete your application has been extended to mid-April. For those applying to individual state exchanges, the deadline to complete your application is Monday, March 31st.

You will have a choice of Gold, Silver and Bronze plans, with Bronze being the least expensive. For those under 30, you may elect catastrophic coverage only. If your existing plan was canceled because of the enactment of the ACA, you may also be eligible to claim a hardship that entitles you to catastrophic coverage only. Such coverage will cover you for an unforeseen medical event and hospital coverage and all preventive care tests and examinations, but if you want to go see your doctor for, say, acne treatment, you will pay for that out-of-pocket.

If you are between the ages of 21 through 65 (when you become eligible for Medicare), then you may apply for coverage through your exchange. Your out-of-pocket monthly premiums will be determined based on the number of people in your family, the level of coverage you elect (Gold, Silver, Bronze) and your annual household income. There are caps on the amount you will pay based on the relationship of your income to the Federal Poverty Level (FPL). When you run your calculations through your website, you may see a percentage figure that exceeds 100%. This is not the amount of premiums you will have to pay. It is a reflection of your income in relationship to the FPL. * Ignore it.*

The website will allow you to determine what amount of subsidy, if any, you are eligible to apply to your annual premiums. You take this subsidy up front, so your cost for monthly premiums will be the amount calculated by the insurance company (very high) *less* your monthly subsidy amount. If, like me, you are self-employed, calculate your subsidy very carefully. You will be required to pay the difference in tax if your income exceeds the amount on which your subsidy was calculated, at the end of the tax year. (Personally, I took only 70% of my available subsidy.)

Just like employer-sponsored insurance coverage, you will want to make sure your family doctors participate in the plan you choose. (This is what took the most time when I made my own selections.)

Once you have signed up for coverage, you will receive a package from your chosen insurance company with membership cards, same as if you had signed up for employer-sponsored coverage. No difference. You will be billed for monthly premiums.

If you choose to not sign up for the ACA and are not insured, then in 2014, you will be penalized through your tax return at the rate of $95.00 per adult and $47.50 per child, up to $285.00. There are several bases for exemptions from the fine. Fines will go up each year.

Other information:

*âThey can take my estate if I participate in the ACA!â False.* Regular coverage obtained through the ACA has no access to your estate. If you fail to pay your premiums, they were simply drop you from coverage, and you will pay the fine. However, if you require care via Medicaid and have no surviving spouse, then Medicaid may take part or all of your estate to pay for your care. And they have been able to do this for a very long time, since long before the ACA.

*âTheyâre going to make me pay for coverage I donât need!â True. *But then, health insurance companies have always made you do that. If you obtain coverage through an employer, theyâre already requiring this. No difference.

*âTaxpayers are being made to pay for deadbeatsâ coverage!â True.* But youâre already paying for that and have done for a very long time. Costs were hugely increased through health insurance premiums, hospital and doctor charges to pay for the uninsured. If/when overall costs are reduced, then that will save all we taxpayers from having to pay this expense. That's the idea, anyway.

Thatâs about it. This post is intended as informational only. I am not debating the fairness of the law, its effectiveness or whether or not it is the best solution to the problem of health care in this country. Hope it is useful to some.


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## Solar Geek

Thank you for taking the time to spell this all out.


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## Oxankle

What they are doing that was not done before is forcing young and healthy adults to take insurance they have no need for in order to pay for the deadbeats who never worked, never carried insurance and never gave a thought to paying their own bills.

It is these young adults, those just starting their lives on low wages, who will be penalized. 

The deadbeats who never worked and don't want to work will not notice a difference. They will not carry insurance and will continue to get free care. Fines for not carrying insurance? How do you fine a jerk who does not work and has no traceable income?


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## Raeven

Oxankle said:


> What they are doing that was not done before is forcing young and healthy adults to take insurance they have no need for in order to pay for the deadbeats who never worked, never carried insurance and never gave a thought to paying their own bills.
> 
> It is these young adults, those just starting their lives on low wages, who will be penalized.
> 
> The deadbeats who never worked and don't want to work will not notice a difference. They will not carry insurance and will continue to get free care. Fines for not carrying insurance? How do you fine a jerk who does not work and has no traceable income?


 Never need it? I&#8217;m sorry, do you not know of a young person who has done something stupid and broken a limb? Or gotten cancer? Or gotten Lyme&#8217;s Disease? Diabetes? Appendicitis? Tonsilitis? No? Can&#8217;t get hit by an uninsured driver stepping off a curb? Nothing like that? Never need it? 

Really?

No one needs insurance. Until they do.


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## Tommyice

Ox I was young once, not as long ago as you, but I was. Guess what, I had health insurance and I USED IT! And not just for "catastrophic" stuff.


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## 355946

Thank you for the clear calm input. I am a health care provider & for years saw pts at a steep discount when they had no insurance or limited or only catastrophic. If pts don't sign up they are going to depend on charity - that hardly seems self-sufficient or fair. 


____________________________
Rabbi Hillel â 'That which is hateful to you, do not do to another. That is the whole Law. The rest is commentary.'


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## Terri

Raeven, I do not know what the Federal Exchange and Obama care have to do with each other. When you say "If your state was one of the 36 that went into the Federal Exchange", can you tell me what you mean? And, what do the states do that do NOT go "into the Federal Exchange"?


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## Raeven

Terri said:


> Raeven, I do not know what the Federal Exchange and Obama care have to do with each other. When you say "If your state was one of the 36 that went into the Federal Exchange", can you tell me what you mean? And, what do the states do that do NOT go "into the Federal Exchange"?


Sure thing, Terri.

When the ACA became law, each state was given the choice of setting up its own individual health insurance exchange to sell health insurance policies, or joining the Federal exchange, which would do it for them. If a state elected to set up its own exchange, it became eligible to receive funds meant to offset expanded Medicaid coverage. States that chose not to accept the funds went into the collective exchange, referred to as the Federal exchange. The function of the exchanges, whether run by individual state or the Feds, is simply to offer a choice of health insurance policies to people who choose to obtain coverage under the ACA.

As things stand now, the states that declined the funds and went into the Federal exchange have not been able to offer health care coverage for as low a cost as those states which set up their own because they are bearing their own increased Medicaid costs. That's why coverage in those states is more expensive to their residents.


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## viggie

I was avidly against this debacle even before it cost me my job. It also took my life savings and nearly my home in the aftermath. Now that I'm working again our insurance was slashed into basically catastrophic insurance to be compliant...and it costs more than the real insurance did. My parents are both out of work and suffering the same increases with no income to cover the increasing costs. They are desperately trying to sell their house now for funds.

There's a good reason emotions run high on this one.


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## notwyse

Thank you. You have helped me


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## Raeven

viggie said:


> I was avidly against this debacle even before it cost me my job. It also took my life savings and nearly my home in the aftermath. Now that I'm working again our insurance was slashed into basically catastrophic insurance to be compliant...and it costs more than the real insurance did. My parents are both out of work and suffering the same increases with no income to cover the increasing costs. They are desperately trying to sell their house now for funds.
> 
> There's a good reason emotions run high on this one.


viggie, I understand there are good reasons why emotions run high, and it is also why I am not endorsing the law or advocating for it one way or the other. My intention was only to offer accurate information about the law in the hope that some might find it useful. I well understand not everyone will.

I am truly sorry for the situation it has caused for you and your family. I'd be interested to hear and understand the details of what happened if you ever care to share them. Feel free to PM if you want -- and I will understand if you do not.


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## Brighton

Oxankle said:


> What they are doing that was not done before is forcing young and healthy adults to take insurance they have no need for in order to pay for the deadbeats who never worked, never carried insurance and never gave a thought to paying their own bills.


Did you have Cervical Cancer when you were 20 years old, nope I didn't think so, you have no idea what you are talking about!!

Anna


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## snowcap

The prolem is they still haven't secured the site from hackers. No one I know can afford to have their identification stolen.
If this was a private company doing this they would be in big trouble.


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## Guest

Hey!! I support your right to have an opinion, whether or not it agrees with mine. After all, the Revolutionary War was not fought for freedom for those who think like me, but for freedom for all. Even y'all liberals. Just like the liberal Thomas Jefferson, (surely a liberal, as proven by his lifelong relation with his slave, Sally Hemmings, starting when she was 14 years old) had his rights protected by the Constitution. I mean, after all, what did that liberal write? 
So, anyway, I live in NC. The little state that didn't. The numbers I got were well in excess of my income. I got my percentage using the calculator on my computer. Sorry. It really is that much. I could give you the numbers to run yourself, but my income is my social security check, and since I've been living the life I want to for so very long, my social security is very little. As you probably know, unearned income does not go into the social security tax section. 
Not to be argumentative, but factual.


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## Raeven

snowcap said:


> The prolem is they still haven't secured the site from hackers. No one I know can afford to have their identification stolen.
> If this was a private company doing this they would be in big trouble.


I can't speak to an experience on the Federal exchange, since mine was done through my own state's exchange. But on that website, I had the choice of a) Applying through the website; b) Printing out a form, completing it and mailing it; c) Calling and offering my information to a representative; or d) Applying through an insurance broker, who would assist me with my application. I chose to print out my form and submit it via regular mail.

I can tell you that I have shared far more personal information on this forum than I was required to share on my application. Also far less personal information than I have been required to give to my online banking institution.

Perhaps, however, you can point me to the documented incidents of stolen identity having occurred as a result of the six million people who have signed up for insurance through the ACA. Somehow, I haven't seen those stories -- not even here on this forum, where so many appear to really hate this law.


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## Raeven

zong said:


> Hey!! I support your right to have an opinion, whether or not it agrees with mine. After all, the Revolutionary War was not fought for freedom for those who think like me, but for freedom for all. Even y'all liberals. Just like the liberal Thomas Jefferson, (surely a liberal, as proven by his lifelong relation with his slave, Sally Hemmings, starting when she was 14 years old) had his rights protected by the Constitution. I mean, after all, what did that liberal write?
> So, anyway, I live in NC. The little state that didn't. The numbers I got were well in excess of my income. I got my percentage using the calculator on my computer. Sorry. It really is that much. I could give you the numbers to run yourself, but my income is my social security check, and since I've been living the life I want to for so very long, my social security is very little. As you probably know, unearned income does not go into the social security tax section.
> Not to be argumentative, but factual.


A friend of mine and I were discussing the numbers you posted in another forum, and we concluded that you ran them wrong. PM me and we'll talk about it further. If I am wrong about that, you will receive a public apology from me. (Woo woo, huh?)


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## no really

Well I am one of the younger ones, my insurance took a big increase in costs, higher deductibles and out of pocket costs. I don't qualify for subsidies. Most of the younger people in my company were in the same boat as me, most of them did not sign up for the new compliant policies. We all travel a lot in our jobs and the policies are very lacking when it comes to out of network. I am going to be working overseas shortly for a year, decided just to cancel the insurance. When I am home I will use doc's in Mexico like most of my family or the VA. 

My company has offices in several states according to the HR director the number of the younger ones taking the new policies was very few.


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## arcticow

All I know is, when we ran the numbers in December to see about covering me vs. whatever employers might offer, the least expensive was gonna run me about $379 per month.. Wouldn't call that Affordable Care...


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## Raeven

zong, I apologize. You ran the numbers correctly and I got the same result as you. The only thing I would point out is that it appeared you may be eligible for coverage through some other options, and you didn't mention if you had explored those or not.


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## Raeven

arcticow said:


> All I know is, when we ran the numbers in December to see about covering me vs. whatever employers might offer, the least expensive was gonna run me about $379 per month.. Wouldn't call that Affordable Care...


AC, I know the outcomes are not great for everyone, as I pointed out in my original post. Coverage for states that opted out of setting up their own exchanges IS more expensive. I'm sorry the law doesn't benefit you and Lesley, I really am. 

For me, it lowered my monthly premiums from $835/month to $237/month.


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## Tommyice

no really said:


> Well I am one of the younger ones, my insurance took a big increase in costs, higher deductibles and out of pocket costs. I don't qualify for subsidies. Most of the younger people in my company were in the same boat as me, most of them did not sign up for the new compliant policies. We all travel a lot in our jobs and the policies are very lacking when it comes to out of network. I am going to be working overseas shortly for a year, decided just to cancel the insurance. When I am home I will use doc's in Mexico like most of my family or the VA.
> 
> My company has offices in several states according to the HR director the number of the younger ones taking the new policies was very few.


No Really about those out of network costs. Last year I had an unexpected trip to the hospital with a "special" procedure and surgery (actually two) involved. The hospital was in my plan, most of the costs were covered. I did have a high deductible, but that is what I chose when I picked my plan (my employer offered a you-build-it type of plan--they are an extremely large corporation). I did that so my bi-monthly payroll deduction would be less as I don't make a whole lot of money. Well my surgeon (who was brilliant by the way and I feel he saved my life) was not in my plan and after insurance settlement I was going to owe that man $12,000. That's pretty close to a year's salary for me. 

Long story short, I spoke with a rep from my insurance company about those emergency out of network expenses and how I was not in a situation to interview surgeons and double check network availability. They resubmitted the claims and paid them. I got the notification this week that the $12,000 has been paid to the surgeon and I don't owe him. Well, I do owe him my gratitude.

Talk to the insurance company and see if they make allotments for that. You might be surprised. I was.

Now for my disclaimer part: I don't support this law. Working in the pharmacy I can say I have seen people hurt, financially, by it. I have also seen people who have been helped by it and are getting the medical attention they need. So the only choices are to complain and moan and carry on about it OR find a solution that works better. That will be hard. I think due in large part to the "team mentality" that is pervasive in politics now. That's all I got folks.


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## Oxankle

Have any of you who signed up for Obamacare checked with your doctors to see if they will accept ObC patients?


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## Guest

I'm that guy that everybody pretends they are, like the most interesting man in the world in reverse or something. I'm actually the one that fell between the cracks. Reminds me of the Richard Pryor story "Well, uh, your honor, he was trying to buy a hospital..."

now if we can just find that woman in the brand new Escalade, going all over the country, buying groceries with food stamps, and ask her how she drives so far and so fast every day without messing up her $500 fingernail job. Or whatever it is that hundreds of people claim to have seen. I was telling my buddy Eddy about the mythical "fat woman in the brand new Escalade filling it completely full of groceries bought with food stamps, and without a beat, he told me he saw 3 fat women getting in a new Escalade full of groceries. Still had the dealer's sticker on it. And without blinking an eye he said "They were lawyers on their way to church"


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## Guest

Ox, it is just regular insurance, the difference is that you have to buy it. Or pay a fine. It's not different insurance. Some people will get medicare, some medicaid, some will have bluecross. Some, like me, will pay cash or not go to the doctor.


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## arcticow

I will pay cash, use employer's coverage, or find my own. Even if it were cheaper I wouldn't sign up through the ACA. If I can't afford coverage before the fine kicks in, oh well... Price of freedom...


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## Raeven

no really said:


> Well I am one of the younger ones, my insurance took a big increase in costs, higher deductibles and out of pocket costs. I don't qualify for subsidies. Most of the younger people in my company were in the same boat as me, most of them did not sign up for the new compliant policies. We all travel a lot in our jobs and the policies are very lacking when it comes to out of network. I am going to be working overseas shortly for a year, decided just to cancel the insurance. When I am home I will use doc's in Mexico like most of my family or the VA.
> 
> My company has offices in several states according to the HR director the number of the younger ones taking the new policies was very few.


To TI's post, I would only add the following: I work with a lot of companies who are trying to get the most bang for their buck with health care costs. I have been made well aware of the rising costs of health insurance/deductibles/out-of-pocket expenses for several years. I asked myself, why is that? Why are these costs rising so precipitiously? I did some research. I did a LOT of research.

Health insurance companies' profits were averaging around 40%. One component of the ACA requires that health care companies hold their profits and administrative costs to 20%. Hopefully it will help.


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## no really

Tommyice said:


> No Really about those out of network costs. Last year I had an unexpected trip to the hospital with a "special" procedure and surgery (actually two) involved. The hospital was in my plan, most of the costs were covered. I did have a high deductible, but that is what I choose when I picked my plan (my employer offered a you-build-it type of plan--they are an extremely large corporation). I did that so my bi-monthly payroll deduction would be less as I don't make a whole lot of money. Well my surgeon (who was brilliant by the way and I feel he saved my life) was not in my plan and after insurance settlement I was going to owe that man $12,000. That's pretty close to a year's salary for me.
> 
> Long story short, I spoke with a rep from my insurance company about those emergency out of network expenses and how I was not in a situation to interview surgeons and double check network availability. They resubmitted the claims and paid them. I got the notification this week that the $12,000 has been paid to the surgeon and I don't owe him. Well, I do owe him my gratitude.
> 
> Talk to the insurance company and see if they make allotments for that. You might be surprised. I was.
> 
> Now for my disclaimer part: I don't support this law. Working in the pharmacy I can say I have seen people hurt, financially, by it. I have also seen people who have been helped by it and are getting the medical attention they need. So the only choices are to complain and moan and carry on about it OR find a solution that works better. That will be hard. I think due in large part to the "team mentality" that is pervasive in politics now. That's all I got folks.


Thanks for the advice our HR rep did that first thing since most of us do travel. It was a total no go, the only way was a very large increase in our costs.

But thanks anyway.


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## no really

Raeven said:


> To TI's post, I would only add the following: I work with a lot of companies who are trying to get the most bang for their buck with health care costs. I have been made well aware of the rising costs of health insurance/deductibles/out-of-pocket expenses for several years. I asked myself, why is that? Why are these costs rising so precipitiously? I did some research. I did a LOT of research.
> 
> Health insurance companies' profits were averaging around 40%. One component of the ACA requires that health care companies hold their profits and administrative costs to 20%. Hopefully it will help.


All probably true but it doesn't help with our costs, they are still very high for our age group. The new policies are not cutting it with us in the younger age group.


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## Raeven

no really said:


> All probably true but it doesn't help with our costs, they are still very high for our age group. The new policies are not cutting it with us in the younger age group.


And there's absolutely no guarantee of success with this new health care scheme. There are lots of things wrong with it, I certainly am aware of that. I have only been attempting to share factual information in response to the many erroneous posts I have seen around the forum.


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## arcticow

And we're not shooting at the messenger, so no need to duck... LOL


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## Raeven

LOL, AC... I've been ducking all week... I'm getting used to it.  But thank you!!


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## no really

Raeven said:


> And there's absolutely no guarantee of success with this new health care scheme. There are lots of things wrong with it, I certainly am aware of that. I have only been attempting to share factual information in response to the many erroneous posts I have seen around the forum.


All info is appreciated and I truly think is some really good things about it, the no lifetime caps and the ability to get insured with pre-existing condations. But for me it is to big an increase in cost, in comparison to last year and the limits.


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## Raeven

Oxankle said:


> Have any of you who signed up for Obamacare checked with your doctors to see if they will accept ObC patients?


I've seen all my regular health care providers. All covered, all the same care, all no problem. I DID make sure to choose a policy that included them in their network. It's the same care, as zong explained.


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## Raeven

The existing health care system is leviathan. I imagine that any attempt to revise it is going to be long, painful and hugely unpopular. Like turning a rudderless ship, when you think about it.


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## elkhound

read this please.......what a crock.....every rural person should be outraged......i tell ya this is not going to end well....read the difference between rural colorado to city...same plan.........there should be outrage.

http://news.msn.com/in-depth/rural-residents-confront-higher-health-care-costs


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## Guest

He was already paying $1200 a month, according to the first paragraph. Heck, the price of junky, store brand pork sausage went up 50% in the past year, too. 
I'd have to think real hard about buying any insurance at all last year, if it was $1200 a month then, too.

Ain't nothing gonna end well, Elk. That's why all the posturing and craziness is a waste of time. Everybody is gonna end up dead. And 99% of them will think, with their last breath "Hey, I coulda been living and enjoying it all these years, instead of worrying and arguing about politics."

It ain't the end that counts, it's the space between now and then that's important.


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## elkhound

zong did i understand correctly...a silver plan in aspen is $483 ...in denver its $280....for same plan

i mean i dont understand that...


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## Raeven

Thanks, elk. That's good information to have. I appreciate you sharing it. The burden of the law is not fairly distributed across the board and those things must be addressed and fixed if it is to have a hope of succeeding.

I would point out, however, as the article did itself: This problem was not created by the ACA. The problem of delivering care to rural areas is highlighted because of the ACA, but not caused by it.


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## Tommyice

Interesting article Elk. I'm glad to see NJ treats all of residents equally. LOL We have a lot of rural--in fact there's parts of the barrens that make Deliverance look like Central Park. I wish the article would have gone into more of why the other states are reluctant to do what states like NJ did--single zone that is.


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## Guest

The guy in the story, it says his insurance went up 50%, to $1800. That means it was already $1200. The additional 50% made the 1800 it is now. Thats not related to the different in different areas of the state, just that one guy's. Heck, when I wanted to find out how much my cost would be, they wanted the county. I'm gonna run a quick check and see if theres much difference in a different county here, and will do an ETA on this post in a couple minutes.

ETA: Yep, same set of numbers, different counties, different costs.


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## elkhound

yea jumping from 1200 to 1800 is outrageous......who can stand a increase like that.i know this guy is a rancher/ business owner...but i mean thats 600 has got to come from somewhere...there goes employees raises if he has any....or like he said irrigation upgrades and something else....so in truth his productivity is not going to be as good if he had the extra/newer equipment to produce more.


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## Guest

Well, I guess that it's good for some people, and hard on some people. Because of my well known distaste for the medical industry, I opt out of medical care, period. Be danged if I'll spend my life savings buying insurance when I'm clearly never going to use it. No matter what, the cost was too high last time we did hospital business in this house.


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## Oxankle

Here's another fact; 
Obamacare was forced upon the nation by a know-nothing president without any consultation with Republicans, without allowing the bill to be read or debated and without any input from the nation's medical profession. Now it is being amended by the president without consultation with congress in order to avoid implementing its most onerous provisions before the mid term elections.

The bill also gives exemptions to political allies of the Democrats--the unions and community groups. 

Another fact or two; companies are not hiring full time employees because the have no idea what the impact of this law will be. Some doctors are changing professions and older doctors are simply retiring rather than put up with the greatly enlarged data processing requirements and lower reimbursement foisted upon them. 

And again; how are you going to fine people who have never worked and have no intention of doing so? The young people who DO work and have had jobs that provided insurance are now finding that their plans are dropped. 

Further, the insurance companies are going to lose big time even with the premiums set as high as they are. Most people don't know that ObC stipulates that they will be made whole by the taxpayer. 

fINALLY, you had better believe that as soon as this monster is fully implemented, all cities and other political entities will drop their insurance benefits and place their employees on ObC. The Fed. government already did this with their retired employees when Medicare was passed.
Ox


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## Terri in WV

elkhound said:


> read this please.......what a crock.....every rural person should be outraged......i tell ya this is not going to end well....read the difference between rural colorado to city...same plan.........there should be outrage.
> 
> http://news.msn.com/in-depth/rural-residents-confront-higher-health-care-costs


This is another thing that burns my britches. ^^^

They claim higher premiums for rural people because lack of doctor's in the area. Well, with that higher cost that rural folks pay, are they going to then provide the doctor's that they are paying a premium for? Of course not! The rural folks will be traveling, at their expense, to visit the same doctor's that the city people are going to. I don't see how they can even justify this and be allowed to do. This looks to be how they'll bump up their bottom line of 20%.

I'm going to have to run the numbers for us in one of the default states and see what we'd have to pay then, as I can't imagine them being less affordable than what was coming up for this state.


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## no really

Got an 0300 fight in the morning, need a nap. I am opting out of the new insurance. It just doesn't work for me. To expensive especially in my age bracket, I am lucky in the fact I have other options.


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## Guest

I got eleven-teen things to do early tomorrow too. I want to say I'm impressed that we could carry this conversation this far without any hate, putting down the old, infirm, and less fortunate, calling decent people fascists or socialists, and acting like a bunch of 5 year olds in general. I always liked this subforum because, despite the many personal idiosyncrasies here, the occasional doubts of self-worth, and the sometimes petty bickering, this is the HT subforum with the best informed and best mannered people. Heck, we didn't even get any preaching in this thread!! Yet


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## Guest

So, for the further education of the public, would you please outline the detail of the "Bronze Plan" at $379/month for Arcticow? I would, but I'm mad as hell about this "affordable MANDATORY" health care insurance.


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## FarmboyBill

Chuck. Im wondering where in the world you get the idea that any plan sent to congress or senate would get acted on in your lifetime?? Thecongress and senate have allowed for the financial situation to evolve, and that over a course of a decade, and in that time they couldn't see which way the country was heading and do something to try to stop it before the dam burst and many people lost everything. Their homes, there savings, there jobs. Yeah, Bushes rubber stamped it, but Congress and Senate arrainged it to suit them and got the ball rolling.
IF someone got in and killed 1/2 of each. You likely wouldn't notice a bit of difference in the other 1/2.Ive never failed to vote for a offce needing filled since Johnson. But, ive finally come to where I can see, IF I cant vote against ALL the congress and Senate, My vote for the pres, and Okla officials don't amount to much.
The pres cant do much, and the congress and senate WONT do anything, and so there you are. A joke to the rest of the worlds democracys, and a bigger joke it would be if they wernt so worried about us taking the final financial dive and hauling the rest of them in for the ride.
I have a SLIGHT bit more respect for those who went to Canada now.


----------



## oneraddad

Anybody use the VA ?


----------



## Raeven

Oxankle said:


> Here's another fact;
> Obamacare was forced upon the nation by a know-nothing president without any consultation with Republicans, without allowing the bill to be read or debated and without any input from the nation's medical profession. Now it is being amended by the president without consultation with congress in order to avoid implementing its most onerous provisions before the mid term elections.


This is a political statement. I won't respond to that. I'm not advocating or defending the law. It is the law, people are entitled to the facts and I provided them to the extent I am able, so they may make a more informed decision about if the law will be of help to them. You have your opinion and I'm not here to refute that.



Oxankle said:


> The bill also gives exemptions to political allies of the Democrats--the unions and community groups.


False statement. If you have proof to the contrary, please cite it. I have researched this and am satisfied you are misstating what is true.



Oxankle said:


> Another fact or two; companies are not hiring full time employees because the have no idea what the impact of this law will be. Some doctors are changing professions and older doctors are simply retiring rather than put up with the greatly enlarged data processing requirements and lower reimbursement foisted upon them.


Also false. Below is a graph that shows when full-time and part-time hiring changed:












Don't fall for this lie.



Oxankle said:


> And again; how are you going to fine people who have never worked and have no intention of doing so? The young people who DO work and have had jobs that provided insurance are now finding that their plans are dropped.


There are deadbeats and there will always be deadbeats, no matter what plan you implement. Why don't you offer some solutions to the problem of collecting from them? Again, I am not defending the law. I am merely trying to state true information in the face of a lot of falsehoods that I have seen around this forum.



Oxankle said:


> Further, the insurance companies are going to lose big time even with the premiums set as high as they are. Most people don't know that ObC stipulates that they will be made whole by the taxpayer.


Sorry, but I've seen zero evidence of this. Please point me to your source of this information, and I will be happy to take a look at it. 



Oxankle said:


> FurtherfINALLY, you had better believe that as soon as this monster is fully implemented, all cities and other political entities will drop their insurance benefits and place their employees on ObC. The Fed. government already did this with their retired employees when Medicare was passed.
> Ox


I'm sorry, are you not on Medicare? Or do you have benefits through the Veteran's Administration? Either way, those are single payer systems and generally very well appreciated by those with access to them. I'm not understanding your point.


----------



## Raeven

bostonlesley said:


> So, for the further education of the public, would you please outline the detail of the "Bronze Plan" at $379/month for Arcticow? I would, but I'm mad as hell about this "affordable MANDATORY" health care insurance.


Lesley, how on earth can I do that? I have no idea what figures you and he used to get your quote, or how you are impacted by your state's decision to decline expanded Medicaid funds. Given that my premiums are $237/month for me alone, I guess $379/month for 2 people doesn't sound that bad. YMMV, obviously.


----------



## elkhound

heres something i just noticed.....i find it very strange....i posted the link to the story from msn at 9ish...in less than a hour it was gone..it was first story page on the scroll thingy.

i find that interesting.


----------



## Raeven

Terri in WV said:


> This is another thing that burns my britches. ^^^
> 
> They claim higher premiums for rural people because lack of doctor's in the area. Well, with that higher cost that rural folks pay, are they going to then provide the doctor's that they are paying a premium for? Of course not! The rural folks will be traveling, at their expense, to visit the same doctor's that the city people are going to. I don't see how they can even justify this and be allowed to do. This looks to be how they'll bump up their bottom line of 20%.
> 
> I'm going to have to run the numbers for us in one of the default states and see what we'd have to pay then, as I can't imagine them being less affordable than what was coming up for this state.


All I can say to this is, I am a rural people, too, and here in Oregon at least, we're not suffering such things. But my state got on board with the law and tried hard to work with it in the spirit of it. 

Every state is different, and as I said before, if it is to succeed, these things must be fixed. I don't disagree with that in any way. If it fails, well... I guess we cross that bridge when we come to it.


----------



## Terri in WV

Elk, your link is still coming up for me.

I went and fiddled around on the ehealth insurance site.

A random spot in Oregon gave me good rates, by $237 from the next area I checked.

The next best was zong's area.

Kentucky came in third.

And the house in WV is giving me the worst rates and co-pays....sigh

Find me a place in your area Rae, I might be moving west....How bad's your taxes?


----------



## Raeven

LOL, Terri, I would LOVE for you to be my neighbor!! 

As for taxes here, well... depends on what you're comparing it to... compared to California? A big yawn. Compared to where you are? Maybe not so fun. :facepalm:

We have no sales tax, but property tax can be a little steep. Depends on where you live.


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## elkhound

terri..its still coming up but its removed from being first story in header on their site.


----------



## Terri in WV

There's another thing to me that just stinks.

It seems that if one is healthy and doesn't go to the doctor much/at all they're getting penalized for it with high deductibles.

For example, I'm using Ky figures(rounded):

Cheapest bronze plan: $759 mth+$12,600(family deductible)=$21,708 yearly before they kick in and pay.

Cheapest gold plan: $1,276 mth+$1,500(fd)=$16,812 yearly.

A difference of $4,896

I'd be better off getting the gold plan and going willy nilly with doctor visits for us. It'd end up costing the insurance company a whole lot more and me a lot less.


----------



## Raeven

Remember, all preventive care will cost you nothing. That means physicals, mammograms, colonoscopies, blood tests, etc. cost you nothing out-of-pocket and do not count toward limited doctors' visits (if your plan restricts them). That might help you to decide which works better for you.


----------



## viggie

Interesting how it only seems to benefit one person here.


----------



## Oxankle

Raeven; the points I made; the impossibility of collecting fines from those not reporting income is common sense. 

The "make whole'' provision in the law for insurance companies has been widely reported in the newspapers. 

The imposition (added cost) of medicare upon government employees can be verified by anyone who ever worked for the Fed. government. My point is that until Medicare was passed we did not HAVE that cost. What is political about that? 

Yes, I have good insurance--you can be certain that as soon as Obc is fully implemented all government employees, Fed, state, city--will be stuck on it.


----------



## willow_girl

> Interesting how it only seems to benefit one person here.


I went from being uninsured to having very good insurance for $188 a month. Obamacare picks up about 3/4 of the tab.

As a healthy person with no serious preexisting conditions, I could have purchased affordable health insurance prior to Obamacare, but took the risk of going without it for almost a year because I didn't expect to need health care. If Obamacare didn't exist, I probably would have bought insurance on the private market eventually, or closed my business and went to work for one that would have provided me with insurance. 

I don't think the government needs to subsidize people like me, but if it's bound and determined to do so, why, I guess I'll let it. 

In recent years, I've paid a lot in taxes, and I'm happy to get some of that money back!


----------



## painterswife

viggie said:


> Interesting how it only seems to benefit one person here.


Why would anyone come on here and tell you if they benefited? So that they can be berated because someone thinks they are stealing from them? That is what happens.


----------



## Oxankle

There was a time when people were shamed if they depended on others to pay their bills. Now it seems to be the thing to do.


----------



## notwyse

Raeven....can a person opt out of medicaid and purchase a higher plan? I would guess you could....but it took my application and said I qualify for medicaid and they would contact me. This feels really weird....my income fluctuates wildly...and I fall below poverty level this year....but my assets do not reflect that and it is because of my allowed deductions.


----------



## Guest

Raeven said:


> Lesley, how on earth can I do that? I have no idea what figures you and he used to get your quote, or how you are impacted by your state's decision to decline expanded Medicaid funds. Given that my premiums are $237/month for me alone, I guess $379/month for 2 people doesn't sound that bad. YMMV, obviously.


It's $379/month just for Arcticow...
what I meant was..the details of the Bronze coverage..what you get for $379/month ..the price varies widely state by state, county by county, but the "plan" doesn't. High co-pays make the $379/month into a much higher figure if you have to actually USE the insurance.

This ACA was touted as the salvation for all Americans, to insure all and PREVENT losing your assets if you have the misfortune to become ill.

Have a heart attack with the Bronze Plan and you will have a horrendous hospital bill and out-of-pocket co-pays..you'll still lose your assets and the deadbeats wll lose nothing, and the plan that you USED to have which gave you the same bare bones coverage at $138/month is no longer allowed to be sold.

Edited to add.the Bronze Plan is a 60-40 plan. In addition to high premiums monthly, and co-pays and deductibles, you get to pay 40% of the medical bills out of your pocket. For the wealthier people who can afford much higher monthly premium, there is of course better coverage. So much for "levelling the playing field"...even if Missouri participated, we make enough $ so that, like most of Missouri middle class, we get screwed with double, triple premiums for bare bones coverage.


----------



## painterswife

Oxankle said:


> There was a time when people were shamed if they depended on others to pay their bills. Now it seems to be the thing to do.


The assumptions that are made to make that statement are a perfect example. Being able to buy insurance that you could not get before does not mean you are not paying your bills.


----------



## Tommyice

zong said:


> I got eleven-teen things to do early tomorrow too. I want to say I'm impressed that we could carry this conversation this far without any hate, putting down the old, infirm, and less fortunate, calling decent people fascists or socialists, and acting like a bunch of 5 year olds in general. I always liked this subforum because, despite the many personal idiosyncrasies here, the occasional doubts of self-worth, and the sometimes petty bickering, this is the HT subforum with the best informed and best mannered people. Heck, we didn't even get any preaching in this thread!! Yet


Yet you felt like jinxing us anyway. LOL!

What you described is why many of us post questions here that could be answered just as well in the other subforums here.


----------



## Guest

Raeven said:


> Remember, all preventive care will cost you nothing. That means physicals, mammograms, colonoscopies, blood tests, etc. cost you nothing out-of-pocket and do not count toward limited doctors' visits (if your plan restricts them). That might help you to decide which works better for you.


One has to clearly define "preventive" care here.
If a person has a lump in their breast , the mammogram is diagnostic, not preventive and therefore is charged

If a person has a colonoscopy due to symptoms, there is a whopping fee for this $650 here in my world, plus a separate fee of $500 for the anesthesia, and $250 for a biopsy, if any. Screening colonoscopies are not billed to the patient.

Screening tests are not the same as diagnostic tests.Same test, different billing.


----------



## Tommyice

Lesley that billing crap has been going on for so long. My brother died in 1994 from liver cancer that had developed from undiagnosed Hepatitis C (or D--it's been a while). It was undiagnosed because he was a self employed artist/designer and never had health insurance until the last year of his life when he went to work for a furniture company. Anyway, he was coming home to live with us and insisted we all get the vaccine. I went to my doctor for the first shot (one of at least 3 I would need to develop the immunity). Got a bill for $100--the insurance I had at the time didn't pay for preventative care. When I said something to him about the insurance company should pay the $100 rather than the $100,000+ for a new liver for me should I contract the hep, he did some creative rebilling. 

I live in the insurance armpit of America and I can tell you whether it health, auto or home, the insurance company will always win and charge you out your hineyhole for the pleasure.


----------



## elkhound

Tommyice said:


> I live in the insurance armpit of America and I can tell you whether it health, auto or home, the insurance company will always win and charge you out your hineyhole for the pleasure.



this was also designed and negotiated behind closed doors....after being told it would be seen by all....the elitist and their dirty little back room dealings...nothing has changed....except the sheerers are cutting deeper in us sheep.

i thought us dogs said bow wow bark bark not baaaaaaaaa !!


----------



## where I want to

Sounds nice but the so did a trip on the Titanic. It is a law that takes from some, who may be less financially able than those it favors, to give a lot to a selected few. The people who end up paying for it are least likely to benefit from it.
It makes those who get a subsidy happy while angering those who don't yet have to pay. If Medicare is too expensive to be maintained, than this money hog is ten times worst.
In the process it deranges everyone else's health care for the worse.


----------



## Tommyice

Hey Elk you accusing me of being a soft, cuddly, adorable sheep. 

Your cartoon is appropriate in that the butt end is exposed first. LOL!


----------



## elkhound

Tommyice said:


> Hey Elk you accusing me of being a soft, cuddly, adorable sheep.
> 
> Your cartoon is appropriate in that the butt end is exposed first. LOL!



thats the end for all things medical and financial dealings lately.


----------



## Guest

Tommyice said:


> Lesley that billing crap has been going on for so long. My brother died in 1994 from liver cancer that had developed from undiagnosed Hepatitis C (or D--it's been a while). It was undiagnosed because he was a self employed artist/designer and never had health insurance until the last year of his life when he went to work for a furniture company. Anyway, he was coming home to live with us and insisted we all get the vaccine. I went to my doctor for the first shot (one of at least 3 I would need to develop the immunity). Got a bill for $100--the insurance I had at the time didn't pay for preventative care. When I said something to him about the insurance company should pay the $100 rather than the $100,000+ for a new liver for me should I contract the hep, he did some creative rebilling.
> 
> I live in the insurance armpit of America and I can tell you whether it health, auto or home, the insurance company will always win and charge you out your hineyhole for the pleasure.



just FYI, Medicare ( the Fed health program) also refuses to pay for hep vaccines. after I was introduced to sewer water, I needed protection from hepatitis A...each injection of the vaccine cost me $125..so I paid $250 to get the vaccine..the Feds, who make the ACA decisions, don't include the costly vaccines in Medicare, only the el-cheapo ones , while now forcing the insurance carriers under ACA to give them out for free...

What about the Zoster vaccine? Is ACA going to make the insurors pay for that one???? Medicare doesn't.


----------



## where I want to

Also "free screening" , beside being paid by the premiums in the first place, is not so free. I had a screening test that was "free." The xray, costing $80 was free- the radiologist reading it cost $160. It cost me more being "free" than it cost me when it wasn't.

Free means you will be encouraged to get tested for those things the government deems good for you and that everyone pays for that government choice.


----------



## MoonRiver

Raeven said:


> All I can say to this is, I am a rural people, too, and here in Oregon at least, we're not suffering such things. But my state got on board with the law and tried hard to work with it in the spirit of it.
> 
> Every state is different, and as I said before, if it is to succeed, these things must be fixed. I don't disagree with that in any way. If it fails, well... I guess we cross that bridge when we come to it.


There seems to be some question about how well Oregon has done. In fact, it sounds like an almost total failure, if the article (3/31/14) is to be believed.


> CoverOregon.com, the state&#8217;s equivalent of HealthCare.gov, is the only insurance exchange in the country on which people still cannot buy coverage entirely online. The flaws are so deep that Gov. John Kitzhaber concedes the state may give up on its own exchange and move to the federal HealthCare.gov next year. The challenges were so persistent that the state received federal permission to add a full month to its open enrollment season. The deadline for most of the country to become covered is 11:59 p.m. Eastern time Monday; here, enrollment will run through April.
> 
> The finger-pointing and political posturing have escalated as the exchange story has unfolded. Now, as states like Washington to the north and California to the south celebrate their progress, Oregon&#8217;s controversy is in full eruption. Kitzhaber, who is running for reelection this fall, faces mounting questions over whether he could have stopped the disaster. And the exchange board is hunting for its third leader since December.


http://www.politico.com/story/2014/03/obamacare-in-oregon-a-failed-exchange-105189.html


----------



## oneraddad

No Vet's here, huh ?

I get all my care from the VA and don't have any worries about medical care for the rest of my life.


----------



## Guest

Yet another example of how ACA works in reality..

A man has no insurance..because his job is 28 hours/week which is Part-time employment so his employer doesn't have to provide insurance. 

He has a need for a $4/month prescription medication..his medical doctor moved out of state, so the man makes an appointment with a new physican. The fee for a "New patient extended visit" is $120.00. The man is required to pay $50 up front by the physician's office and is subsequently billed an additional $70 which he pays when he gets the bill. Total cost out of pocket $120 for the visit and $4 for the prescription medication which has 6 refills. 

ACA mandates that this man obtain health insurance, or pay a fine which the IRS will monitor. The man lives in rural Missouri. There is ONE insuror which provides ACA coverage..one. The least expensive monthly premium is $379.00
So IF the man signs up for the Bronze Plan under ACA, he pays $379..and then when he sees that new physician, he pays 40 % of the bill=$48, and then the $4 for the medication...so with NO insurance, his out of pocket is
$124...

WITH Obamacare, his cost becomes $379 for the month of coverage, plus the deductible of 40%=$48, for a total of $427 plus the $4 for the med=$431...


or he can pay a yearly fine via the IRS...


----------



## elkhound

bostonlesley said:


> Yet another example of how ACA works in reality..
> 
> A man has no insurance..because his job is 28 hours/week which is Part-time employment so his employer doesn't have to provide insurance.
> 
> He has a need for a $4/month prescription medication..his medical doctor moved out of state, so the man makes an appointment with a new physican. The fee for a "New patient extended visit" is $120.00. The man is required to pay $50 up front by the physician's office and is subsequently billed an additional $70 which he pays when he gets the bill. Total cost out of pocket $120 for the visit and $4 for the prescription medication which has 6 refills.
> 
> ACA mandates that this man obtain health insurance, or pay a fine which the IRS will monitor. The man lives in rural Missouri. There is ONE insuror which provides ACA coverage..one. The least expensive monthly premium is $379.00
> So IF the man signs up for the Bronze Plan under ACA, he pays $379..and then when he sees that new physician, he pays 40 % of the bill=$48, and then the $4 for the medication...so with NO insurance, his out of pocket is
> $124...
> 
> WITH Obamacare, his cost becomes $379 for the month of coverage, plus the deductible of 40%=$48, for a total of $427 plus the $4 for the med=$431...
> 
> 
> or he can pay a yearly fine via the IRS...



preach it sister !!!!!!!!!!!!

welcome to americorp....we have reached our transitioning point....through back door dirty deals .

i hit the like button because i understand..but felt dirty after hitting it cause it seemed as if i was saying i liked it....oyyyy.....:stars:


----------



## Guest

I wonder how many people know the insurance companies low-balled their premium quotes to entice more customers knowing the government had already agreed to bail them out so they wouldn't lose money .
In 2015 the premium rates will raise to compensate for the low-balling since the government will no longer be obligated to bail them out . If you think the rates you are getting now are high , just wait !


----------



## where I want to

WV Hillbilly said:


> I wonder how many people know the insurance companies low-balled their premium quotes to entice more customers knowing the government had already agreed to bail them out so they wouldn't lose money .
> In 2015 the premium rates will raise to compensate for the low-balling since the government will no longer be obligated to bail them out . If you think the rates you are getting now are high , just wait !


The Democrats fully intend to kept that info under wraps until after this year mid term elections. When they will display total shock that the mean insurance companies are doing this while affirming loudly they did not know.
And a lot of people will going along with this lie because it is easier than rethinking all the other illusions they prefer to keep.


----------



## Raeven

viggie said:


> Interesting how it only seems to benefit one person here.


 There are roughly 315,000,000 people in the USA. About 6,000,000 have signed up for the ACA. Thatâs less than 2% of the population. Are the number of people here on HT who have a) enrolled and b) been willing to discuss a positive experience really that much of a surprise to you?


----------



## Raeven

Oxankle said:


> Raeven; the points I made; the impossibility of collecting fines from those not reporting income is common sense.


 And the point *I* made, which you ignored, was that this is an old problem, irrespective of what system we have in place. It is not created by the ACA. As I have previously stated, you are already paying for deadbeats. It was just more invisible before the ACA.



Oxankle said:


> The "make whole'' provision in the law for insurance companies has been widely reported in the newspapers.


Everything Iâve read about the âmake wholeâ provision to which you refer is that it applies only to matters that go to litigation, and only for health plans that are within ERISA. Again, please cite me to information to the contrary, and then weâll be on the same page to have a discussion. 



Oxankle said:


> The imposition (added cost) of medicare upon government employees can be verified by anyone who ever worked for the Fed. government. My point is that until Medicare was passed we did not HAVE that cost. What is political about that?
> 
> Yes, I have good insurance--you can be certain that as soon as Obc is fully implemented all government employees, Fed, state, city--will be stuck on it.


 Iâll take that bet, Ox. Ainât gonna happen.


----------



## where I want to

Raeven said:


> There are roughly 315,000,000 people in the USA. About 6,000,000 have signed up for the ACA. Thatâs less than 2% of the population. Are the number of people here on HT who have a) enrolled and b) been willing to discuss a positive experience really that much of a surprise to you?


The advantage only falls to a few of the maybe they pay for it millions. The majority are there because their insurance was cancelled or made unaffordable by Obamacare. It's a matter of the bill forcing participation rather than it being a good thing for the country.
As I said, those subsidized love it- those not but paying for it are just there because they have to be.


----------



## Raeven

Oxankle said:


> There was a time when people were shamed if they depended on others to pay their bills. Now it seems to be the thing to do.


 Ashamed? Are you implying Iâm a non-productive deadbeat taking advantage of you by participating in the ACA? Pretty broad brush there, Ox.

If it makes you feel better, Iâm paying my premiums under the ACA, and they alone will cost me more than the care I receive this year â unless I suffer some catastrophic health problem, of course. But then, thatâs been true for every single year of my life since Iâve been paying health insurance premiums except one, when I had a surgery 17 years ago. But you know what? In that one year, Iâm sure glad I didnât have to sell my house to pay for that surgery.


----------



## Raeven

notwyse said:


> Raeven....can a person opt out of medicaid and purchase a higher plan? I would guess you could....but it took my application and said I qualify for medicaid and they would contact me. This feels really weird....my income fluctuates wildly...and I fall below poverty level this year....but my assets do not reflect that and it is because of my allowed deductions.


 Iâm not able to offer you much help with respect to how the ACA interacts with Medicaid. The work I do doesnât extend to that part of the law. However, you are always, always free to purchase a private health insurance policy from wherever you wish. Iâd contact an independent personal health insurance broker to find out more about your specific issue, if I were you.


----------



## Raeven

bostonlesley said:


> It's $379/month just for Arcticow...
> what I meant was..the details of the Bronze coverage..what you get for $379/month ..the price varies widely state by state, county by county, but the "plan" doesn't. High co-pays make the $379/month into a much higher figure if you have to actually USE the insurance.
> 
> This ACA was touted as the salvation for all Americans, to insure all and PREVENT losing your assets if you have the misfortune to become ill.
> 
> Have a heart attack with the Bronze Plan and you will have a horrendous hospital bill and out-of-pocket co-pays..you'll still lose your assets and the deadbeats wll lose nothing, and the plan that you USED to have which gave you the same bare bones coverage at $138/month is no longer allowed to be sold.
> 
> Edited to add.the Bronze Plan is a 60-40 plan. In addition to high premiums monthly, and co-pays and deductibles, you get to pay 40% of the medical bills out of your pocket. For the wealthier people who can afford much higher monthly premium, there is of course better coverage. So much for "levelling the playing field"...even if Missouri participated, we make enough $ so that, like most of Missouri middle class, we get screwed with double, triple premiums for bare bones coverage.


 Lesley, all I can say is, the difference between ACâs month-to-month premiums and mine are $142/month. I live in a state where there is no difference in premiums price from county to county and they took the expanded Medicaid funds. Only you and AC can decide if $142/month is worth the potential catastrophic loss of your assets should he suffer a major medical catastrophe (which I hope he doesnât!!). Everyoneâs situation is different, and naturally I donât know what ongoing medical issues AC may have that contribute to spilling you into using your co-pays and meeting your annual deductible. 

Speaking for myself alone, under my new plan I have 3 covered doctor visits per year IN ADDITION TO the preventive care visits â which are all I need, so I will never use the covered visits. I have a $5,000 cap on out-of-pocket expenses, which I will only meet if, again, I suffer a major health problem. Iâm an extremely healthy person for my age, and I get no breaks for that. Conversely, if I were an unhealthy person, I would not be penalized for it. And still, as ouchy as it is to pay $2,844/year for care I will rarely if ever use except in the event of a major illness, it is worthwhile to me to protect my assets.

As I said in my original post and keep saying, not everyone is equally treated out of this legislation, and I assure you, I think it's safe to assume I'm aware that many are unhappy with it. But many of the problems to which people are most strenuously objecting were problems before the ACA. My only point has been, hate it on the basis of the facts, and not the made-up stuff I keep seeing around the forum.


----------



## Raeven

where I want to said:


> Sounds nice but the so did a trip on the Titanic. It is a law that takes from some, who may be less financially able than those it favors, to give a lot to a selected few. The people who end up paying for it are least likely to benefit from it.
> It makes those who get a subsidy happy while angering those who don't yet have to pay. If Medicare is too expensive to be maintained, than this money hog is ten times worst.
> In the process it deranges everyone else's health care for the worse.


 Are you suggesting that no ships should ever be built or used to travel upon the ocean because of that one mishap? Thatâs what it sounds like. Youâre entitled to your opinion, of course, but Iâm not one to throw out the baby with the bathwater. Fix the problems, absolutely. But most of the problems that the ACA was crafted to correct predated the law, and those will need to be fixed in any case if we are to ever have a hope of offering equitable, affordable health care to everyone. This is just MY opinion, of course.

Alternatively, we could just let them die. I guess that's a solution, too.

Costs ARE the problem. But they've been the problem for a very long time. Why is it all so expensive, do you think?


----------



## Raeven

bostonlesley said:


> just FYI, Medicare ( the Fed health program) also refuses to pay for hep vaccines. after I was introduced to sewer water, I needed protection from hepatitis A...each injection of the vaccine cost me $125..so I paid $250 to get the vaccine..the Feds, who make the ACA decisions, don't include the costly vaccines in Medicare, only the el-cheapo ones , while now forcing the insurance carriers under ACA to give them out for free...
> 
> What about the Zoster vaccine? Is ACA going to make the insurors pay for that one???? Medicare doesn't.


Here is a link to what is covered under "Preventive Care."

http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html


And yes, Lesley, that how a doctor refers someone for the test does determine whether or not it is âpreventiveâ in nature. Of course, Iâve seen doctors do that in the reverse to help people out with their insurance companies; i.e., refer someone for a test in such a way that insurance will cover it. Havenât you? As Leslie points out, this is not a problem created by the ACA. It has been a problem for a very long time.


----------



## Raeven

MoonRiver said:


> There seems to be some question about how well Oregon has done. In fact, it sounds like an almost total failure, if the article (3/31/14) is to be believed.
> http://www.politico.com/story/2014/03/obamacare-in-oregon-a-failed-exchange-105189.html


 I can only state my own experience and have done. If others here in Oregon have had a bad one, itâs for them to share it.


----------



## Raeven

bostonlesley said:


> Yet another example of how ACA works in reality..
> 
> A man has no insurance..because his job is 28 hours/week which is Part-time employment so his employer doesn't have to provide insurance.
> 
> He has a need for a $4/month prescription medication..his medical doctor moved out of state, so the man makes an appointment with a new physican. The fee for a "New patient extended visit" is $120.00. The man is required to pay $50 up front by the physician's office and is subsequently billed an additional $70 which he pays when he gets the bill. Total cost out of pocket $120 for the visit and $4 for the prescription medication which has 6 refills.
> 
> ACA mandates that this man obtain health insurance, or pay a fine which the IRS will monitor. The man lives in rural Missouri. There is ONE insuror which provides ACA coverage..one. The least expensive monthly premium is $379.00
> So IF the man signs up for the Bronze Plan under ACA, he pays $379..and then when he sees that new physician, he pays 40 % of the bill=$48, and then the $4 for the medication...so with NO insurance, his out of pocket is
> $124...
> 
> WITH Obamacare, his cost becomes $379 for the month of coverage, plus the deductible of 40%=$48, for a total of $427 plus the $4 for the med=$431...
> 
> 
> or he can pay a yearly fine via the IRS...


 Youâre misstating it. Youâre assuming that person in your example has the same income as you and AC, which you have already made clear by your own example, he cannot â because heâs a part-time person. Further, you are stating that his doctorâs visits MUST require a co-pay. If they are preventive in nature, they will not. The real answer is, it depends.


----------



## Raeven

WV Hillbilly said:


> I wonder how many people know the insurance companies low-balled their premium quotes to entice more customers knowing the government had already agreed to bail them out so they wouldn't lose money .
> In 2015 the premium rates will raise to compensate for the low-balling since the government will no longer be obligated to bail them out . If you think the rates you are getting now are high , just wait !


 I have an idea. Letâs talk about the law as it is currently written and working or not working, and talk about the future when it has happened. As I said in my original post, if it sucks as bad as you all say and believe, it will surely fail â and then you will all be vindicated. 

At this point, what I see is a lot of rhetoric and very few actually intending to discuss. I've posted what I hope is helpful to some. But as I said before, I am not defending or advocating for the legislation. It is what it is. And that's all I'm trying to convey. There's a whole lot of what it isn't being stated around this site.


----------



## Raeven

oneraddad said:


> No Vet's here, huh ?
> 
> I get all my care from the VA and don't have any worries about medical care for the rest of my life.


Sorry, Dad. Didn't mean to leave you out.

None that are speaking up, and good onya. No one deserves it more.


----------



## Oxankle

Raeven; Those who are so proud of the fact that six million people have signed up for ObC should look at the facts; last year there were 45 million people in the US without insurance---why did they all not sign up if this is such a grand program? 

What you will find is that those who signed up first were those with serious medical issues that made them ineligible for private insurance. In short, the most expensive clients that the companies have. After that came those whose costs were lowest. At the same time, the unions and certain other groups were given a pass for this year. All you have to do is read the newspapers to see this.

Oneraddad: Many of us here are vets; those of us lucky enough to have escaped combat injuries are far down on the list of the VA priorities, especially so if we prospered and have other insurance. I have classmates whose only insurance is VA, and I am proud to say that the doctors and nurses of the VA have treated them well. 
My only reports are of the Dallas, Muskogee and Atlanta hospitals--according to friends they are well-run. It is my intent to sign up for VA coverage as I am told that the more applicants they have the better are their chances for funding.


----------



## Guest

I haven't seen Nevada in this discussion , or have I ?


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## Oxankle

Nevada our most liberal member, or Nevada the state?
Ox


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## MoonRiver

The Obamacare fine for not having insurance in 2014 is only $95 per person or 1 percent of income, whichever is greater. So if you make $50,000 that is only $500.

If I was a year younger, I probably would have paid the fine. If something happened during the year, I could always buy insurance then since pre-existing conditions aren't considered. Only problem would be if I required emergency care and I was incapable of getting the application in. I guess the thing to do is have one all ready to submit at a moment's notice and make sure I had a someone with legal authority to submit it.


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## Guest

Oxankle said:


> Nevada our most liberal member, or Nevada the state?
> Ox


The former if you catch my drift .


----------



## Raeven

Oxankle said:


> Raeven; Those who are so proud of the fact that six million people have signed up for ObC should look at the facts; last year there were 45 million people in the US without insurance---why did they all not sign up if this is such a grand program?
> 
> What you will find is that those who signed up first were those with serious medical issues that made them ineligible for private insurance. In short, the most expensive clients that the companies have. After that came those whose costs were lowest. At the same time, the unions and certain other groups were given a pass for this year. All you have to do is read the newspapers to see this.
> 
> Oneraddad: Many of us here are vets; those of us lucky enough to have escaped combat injuries are far down on the list of the VA priorities, especially so if we prospered and have other insurance. I have classmates whose only insurance is VA, and I am proud to say that the doctors and nurses of the VA have treated them well.
> My only reports are of the Dallas, Muskogee and Atlanta hospitals--according to friends they are well-run. It is my intent to sign up for VA coverage as I am told that the more applicants they have the better are their chances for funding.


I didn't say I was proud of the 6 million, and it's incorrect for you to impugn me with that. I merely stated it as a fact to show that in relationship to a country of 315,000,000, there aren't many who have stories to share at this point. Simple math.

And Ox, you sure trust those insurance companies, don't you?

They tell you this stuff, and you just seem to believe it. I strongly urge you to do some research on their profit margins over the past several years. If that doesn't shock you, nothing will. Those profits account for the lion's share of the high costs of health care. There are some mighty well-off shareholders who have powerful motivations for keeping the status quo. And you shouldn't take my word for that -- go check it out for yourself.

To assume that only the sickest people are the ones who can't get insurance and had to sign up for the ACA is to have not examined who is, in fact, signing up. It's true that some have been precluded on the basis of preexisting conditions. But if you hadn't noticed, the definition of 'preexisting conditions' was getting quite broad over the past decade or so.

For myself, I was glad of the option because I am 1) Healthy but like everyone else, can always be vulnerable to a major health issue; 2) Self-employed with no option for group health coverage. I've had great health care coverage all my life and paid dearly for it -- almost never used it -- until my husband died. That put me in a whole new category, and boy, did the health insurance companies have their way with me.

About 9 years ago, I noticed that my hands sometimes went numb in the night when I slept a certain way. I went to see a doc about it. He confirmed I suffer from a moderate case of spinal stenosis, said I might have to have surgery to deal with it if it got worse but to postpone such surgery for as long as I could. So that's what I did. I promptly stopped worrying about it. It hasn't gotten worse, and I don't plan to have any surgery for it unless it gets MUCH worse. No indication at this point that it will. 

However, because I was applying for private insurance 4 years and 10 months after that doctor's visit, I was required to disclose the fact of that visit on my HUGELY INVASIVE application for such insurance, because they required 5 years' worth of my medical history. On the basis of that one doctor's visit, I was determined by Blue Cross to be high risk for regular insurance and they declined to offer me a policy.

At that point, I was made to apply to the Oregon High Risk Pool for private health insurance. Blue Cross -- the same company that had previously declined to offer me a policy -- offered me a policy for $835/month. In all other aspects, I am healthy as the best horse you ever owned.

Well, it didn't take much math to figure out that I could self-insure for much less. So I purchased a catastrophic coverage policy at that point for $514/year (so no one else would have to pay for my health care if I got really sick). HOWEVER, Blue Cross told me that by purchasing catastrophic coverage only, I would be precluded from purchasing regular insurance FROM ANY COMPANY for two years past the expiration date of that policy. So if I had dropped the catastrophic coverage and suffered some huge health failure in that 2-year period, I'd have sacrificed every asset I worked a lifetime for to pay for that health care -- and you WOULD have had to pay for it.

You bet I was glad for the ACA. If you want to characterize me as a "taker" for that, then you go right ahead.

Just one person's story, and everyone has one.


----------



## Guest

but Raeven, how do you think people such as yourself will NOT lose everything you own due to outrageous medical bills under ACA?????? A bill of $250,000 for a cardiac hospital stay with 40 % paid by the patient ..where will someone get that money to pay the bill when they're paying $379/month for the insurance too ??????? Owing a hospital $100,000 costs you your assets...

as you have mentioned several times, many things don't change under ACA.

The DIFFERENCE is that right now, this minute, we don't have a monthly bill of $379/month for Arcticow..if, God forbid, he had a whopping hospital bill of $250,000, we'd have to make SOME kind of payment happen or, indeed, lose our shirts..this does NOT change if you're Middle class and owe "only" $100,000....

there is NO CHANGE in risk of losing the farm...but there IS a change in taking an additional $379/month for the privilege of still risking everything you own.


----------



## Terri in WV

Raeven said:


> Lesley, all I can say is, the difference between ACâs month-to-month premiums and mine are $142/month. I live in a state where there is no difference in premiums price from county to county and they took the expanded Medicaid funds. Only you and AC can decide if $142/month is worth the potential catastrophic loss of your assets should he suffer a major medical catastrophe (which I hope he doesnât!!). Everyoneâs situation is different, and naturally I donât know what ongoing medical issues AC may have that contribute to spilling you into using your co-pays and meeting your annual deductible.
> 
> Speaking for myself alone, under my new plan I have 3 covered doctor visits per year IN ADDITION TO the preventive care visits â which are all I need, so I will never use the covered visits. I have a $5,000 cap on out-of-pocket expenses, which I will only meet if, again, I suffer a major health problem. Iâm an extremely healthy person for my age, and I get no breaks for that. Conversely, if I were an unhealthy person, I would not be penalized for it. And still, as ouchy as it is to pay $2,844/year for care I will rarely if ever use except in the event of a major illness, it is worthwhile to me to protect my assets.
> 
> As I said in my original post and keep saying, not everyone is equally treated out of this legislation, and I assure you, I think it's safe to assume I'm aware that many are unhappy with it. But many of the problems to which people are most strenuously objecting were problems before the ACA. My only point has been, hate it on the basis of the facts, and not the made-up stuff I keep seeing around the forum.


What you are getting is what I would actually consider affordable. It seems that you are very much in the minority.

Correct me if I'm wrong, but it has been my understanding that if one takes the subsidy then they can have their assets recouped for said subsidy. So, how are you protecting your assets with insurance by accepting the subsidy?


----------



## Terri in WV

bostonlesley said:


> but Raeven, how do you think people such as yourself will NOT lose everything you own due to outrageous medical bills under ACA?????? A bill of $250,000 for a cardiac hospital stay with 40 % paid by the patient ..where will someone get that money to pay the bill when they're paying $379/month for the insurance too ??????? Owing a hospital $100,000 costs you your assets...
> 
> as you have mentioned several times, many things don't change under ACA.
> 
> The DIFFERENCE is that right now, this minute, we don't have a monthly bill of $379/month for Arcticow..if, God forbid, he had a whopping hospital bill of $250,000, we'd have to make SOME kind of payment happen or, indeed, lose our shirts..this does NOT change if you're Middle class and owe "only" $100,000....
> 
> there is NO CHANGE in risk of losing the farm...but there IS a change in taking an additional $379/month for the privilege of still risking everything you own.


Exactly! I can't see paying for the privilege to pay my own medical bills and still be faced with losing everything anyway.


----------



## painterswife

bostonlesley said:


> but Raeven, how do you think people such as yourself will NOT lose everything you own due to outrageous medical bills under ACA?????? A bill of $250,000 for a cardiac hospital stay with 40 % paid by the patient ..where will someone get that money to pay the bill when they're paying $379/month for the insurance too ??????? Owing a hospital $100,000 costs you your assets...
> 
> as you have mentioned several times, many things don't change under ACA.
> 
> The DIFFERENCE is that right now, this minute, we don't have a monthly bill of $379/month for Arcticow..if, God forbid, he had a whopping hospital bill of $250,000, we'd have to make SOME kind of payment happen or, indeed, lose our shirts..this does NOT change if you're Middle class and owe "only" $100,000....
> 
> there is NO CHANGE in risk of losing the farm...but there IS a change in taking an additional $379/month for the privilege of still risking everything you own.


How would you ever owe a hospital that if you have insurance?


----------



## arcticow

I don't believe the baby needed bathed in this water at all, if the true objective is to have a clean baby... But yes, I favor throwing out this polluted water. And the either or argument of Dem. V. Rep. is part of the problem. A growing number of conservatives will opt out of this for a third viewpoint that gets past the same old same old, and deals with the problems instead of arguing.


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## MoonRiver

arcticow said:


> I don't believe the baby needed bathed in this water at all, if the true objective is to have a clean baby... But yes, I favor throwing out this polluted water. And the either or argument of Dem. V. Rep. is part of the problem. A growing number of conservatives will opt out of this for a third viewpoint that gets past the same old same old, and deals with the problems instead of arguing.


And all we did was exchange state controlled insurance programs for a federal government controlled insurance program. People blame the insurance companies when the state governments, federal government, or both were to blame for the mess.


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## Terri in WV

painterswife said:


> How would you ever owe a hospital that if you have insurance?


Very easily:

$250,000
-$12,600(deductible)
=$237,000
-60%(insurance pay out)
=$94,960

$94,960
+$12,600
=out of pocket expenses of $107,560 not counting monthly premiums.

One might as well opt out, because I don't know of anyone that could pay that.


----------



## painterswife

Terri in WV said:


> Very easily:
> 
> $250,000
> -$12,600(deductible)
> =$237,000
> -60%(insurance pay out)
> =$94,960
> 
> $94,960
> +$12,600
> =out of pocket expenses of $107,560 not counting monthly premiums.
> 
> One might as well opt out, because I don't know of anyone that could pay that.


What is you out of pocket cap? I don't believe that there is insurance allowed that will require you pay that 94600.00


----------



## Guest

Lordy Mercy. All this info is only a click away.

The federal cost-sharing subsidies essentially increase the insurance company's share of covered benefits, resulting in reduced out-of-pocket spending for lower-income consumers. A family of four whose income is between 100 and 150 percent of the federal poverty level ($23,550 to $35,325) will be responsible for paying 6 percent of covered expenses out-of-pocket compared with the 30 percent that a family not getting subsidized coverage would owe in a silver plan. A family with an income between 150 and 200 percent of the poverty level ($35,325 to $47,100) will be responsible for 13 percent of expenses, and one with an income between 200 and 250 percent of the poverty level will be responsible for 27 percent ($47,100 to $58,875). 

In addition, people who earn 250 percent of the federal poverty level or less will also have their maximum out-of-pocket spending capped at lower levels than will be the case for others who buy plans on the exchange. In 2014, the out-of-pocket limits for most plans will be $6,350 for an individual and $12,700 for a family. But people who qualify for cost-sharing subsidies will see their maximum out-of-pocket spending capped at $2,250 or $4,500 for single or family coverage, respectively, if their incomes are less than 200 percent of the poverty level, and $5,200 or $10,400 if their incomes are between 200 and 250 percent of poverty. 

http://www.kaiserhealthnews.org/fea...chelle-andrews-on-cost-sharing-subsidies.aspx


----------



## painterswife

Terri in WV said:


> Very easily:
> 
> $250,000
> -$12,600(deductible)
> =$237,000
> -60%(insurance pay out)
> =$94,960
> 
> $94,960
> +$12,600
> =out of pocket expenses of $107,560 not counting monthly premiums.
> 
> One might as well opt out, because I don't know of anyone that could pay that.


I don't believe you have the facts at all. This is exactly why this thread was started. Too much mis information is being spread.


----------



## Raeven

Lesley, I agree with you. Cost, cost, cost. THAT is the fundamental problem. The question I keep seeing people avoiding is... WHY? Why have the costs risen so much?

That question really bugged me over the past several years. In my work, I interact with many different companies of many different types. Every year, every one of them was facing rising costs for health care coverage. This dates back to long before the ACA. Increases of more than 20% a year were not uncommon. 

So I started doing some digging. I really didn't care where my research led.

What I learned was, PROFITS in health care are soaring. I mean, profits like you can't believe. 

How come no one cares about that?

My understanding of how the ACA is intended to work is stated below. *There is NO GUARANTEE this is how it WILL work:*

Three main areas of high cost were identified. I'll name each and then share my understanding of what is meant to be done about it.

*1) Profits for health care providers, including insurance companies*. Today, because of the ACA, profits are held to 20% -- and that figure must also include administrative costs. This provides incentives for administrative costs to become more efficient, because what the companies save in those costs can become profit. My understanding is that profit will be more severely limited as time goes on. Just that one step reduced average profits of health insurance companies by HALF. That meant that before this restriction, someone was putting 40% (nearly half!) of every dollar spent on health care in his or her pocket -- because either you or one of your loved ones got sick. Maybe this doesn't shock you, but it sure shocked me.

Think those companies have any incentive to see this law fail? LOL, or succeed? Either way, heads they win, tails we lose. They'd rather see it fail, but they're protected even if it doesn't. THAT is why I'm not a huge fan.

*2) Efficiency in shared information.* This is not "sexy," but it was identified as a huge contributor to increased costs. Example: Your GP refers you for an MRI, looks at the results and decides you should see a specialist. You go to the specialist, who, not having access to the files and records resultant from the first MRI, refers you for a second one. Huge duplication of effort and costs. The ACA requires medical providers to standardize their methods of sharing information. The goal is to eliminate all this duplication and waste within the system. It's a huge system and there is a lot of pain being felt to comply with this requirement, especially by smaller providers. Once it's done, it's done. That's the idea, anyway.

*3) End-of-life care.* This, too, is huge. Studies show that the most expenditure for health cares come in the last year of life. Here's where "death panels" become an issue. Someone is deciding at what point there is a diminishing value for providing care. Example: Colonoscopies done after age 50 and before age 70 save more lives for the investment of cost than they kill. After age 70, there is a diminishing return on lives saved in relationship to cost for the procedure. Cancers detected at that age are slow-growing and aren't likely to be what kills you. Plus, the older you get, the thinner the walls of the colon are, so there is a much higher chance that you'll be harmed by the procedure more than helped by it. So age 70 is the cut-off for a pay-out by Medicare.

But people shouldn't think they didn't have "death panels" deciding this stuff for them prior to the ACA. They did. Insurance companies were deciding whether or not you got the treatment you sought. Difference is, THEIR motive was profit -- not your health and well being.

Over time, the idea is that costs will come down and subsidies can be eliminated so that the premiums paid will equal actual costs of care. Pretty big gamble, especially with a profit motive still built in. So we'll see.

And let me just add, if we ever get single-payer, universal health care, meaning a system like Medicare for all which I personally advocate, then I'll be out of a job. So I really am willing to put my money where my mouth is on this issue. (I think I'm pretty safe.)


----------



## Oxankle

Painterswife: This is how insurance works; they cover some things, some they do not. Some cover up to a limit (that is one thing ObC removes, no limit now) and some have big co-pays. If your co-pay is 40% and you have a big bill you will be broke, bankrupt, almost at once.

Now; Raeven quotes insurance profits at 40%---I have no idea where she got that figure. In all states health insurors are regulated entities. No regulatory board will permit that kind of profit. I own a dozen or so shares of Prudential--I had a policy with them when they went private and the shares were my part of the pie. Those shares pay about 2 to 3 percent per annum and are worth about $75 or so each. A far cry from the 40% Raeven asserts. Blue Cross operates all over the country and is highly regulated--show me where they earn 40% on their premiums. 

The simple fact is that people who had no insurance either did not need/want it or could not afford it. Those who did not want/need it still don't want/need it. Those who could not afford it are now either getting a slice of taxpayer money to cover their costs OR the subsidy is too small to help---we've heard a lot of that here.

Even if the subsidies work, the money must come from somewhere. Where will it come from????? Guess who gets to fork that money over? The poor working stiff who pays taxes, plus your share of the tax on real estate transfers, and so on down the line.


----------



## painterswife

Oxankle said:


> Painterswife: This is how insurance works; they cover some things, some they do not. Some cover up to a limit (that is one thing ObC removes, no limit now) and some have big co-pays. If your co-pay is 40% and you have a big bill you will be broke, bankrupt, almost at once.
> 
> Now; Raeven quotes insurance profits at 40%---I have no idea where she got that figure. In all states health insurors are regulated entities. No regulatory board will permit that kind of profit. I own a dozen or so shares of Prudential--I had a policy with them when they went private and the shares were my part of the pie. Those shares pay about 2 to 3 percent per annum and are worth about $75 or so each. A far cry from the 40% Raeven asserts. Blue Cross operates all over the country and is highly regulated--show me where they earn 40% on their premiums.
> 
> The simple fact is that people who had no insurance either did not need/want it or could not afford it. Those who did not want/need it still don't want/need it. Those who could not afford it are now either getting a slice of taxpayer money to cover their costs OR the subsidy is too small to help---we've heard a lot of that here.
> 
> Even if the subsidies work, the money must come from somewhere. Where will it come from????? Guess who gets to fork that money over? The poor working stiff who pays taxes, plus your share of the tax on real estate transfers, and so on down the line.


Out of pocket limits cap the copay. Show me an insurance policy that does not have one. Show me the facts.


----------



## Raeven

Terri in WV said:


> What you are getting is what I would actually consider affordable. It seems that you are very much in the minority.


LOL, well, I certainly am on THIS board! It's too early for actual statistics. Mine -- or anyone else's.



Terri in WV said:


> Correct me if I'm wrong, but it has been my understanding that if one takes the subsidy then they can have their assets recouped for said subsidy. So, how are you protecting your assets with insurance by accepting the subsidy?


Only to the extent that you understated your assets to determine your subsidy. I mentioned this in my original post, to calculate the subsidy carefully. I took only 70% of mine based on my income from the prior year. Since I'm self-employed, that figure will vary. But here's how it will work:

I estimated my subsidy, reduced it by 30% and applied it to my premiums. If I earn more than I based my subsidy on, I will be taxed for the difference. If I can't pay that tax, then it would be subject to collection same as any other unpaid Federal tax. Since I underused my subsidy, I should receive the difference as a credit on my 2014 tax return. So I think even if my earnings were predictable and reportable by W-2, I'd underuse my subsidy by at least 10%. Kind of like estimating how many exemptions to take during your work year for tax withholdings.


----------



## where I want to

Raeven said:


> Are you suggesting that no ships should ever be built or used to travel upon the ocean because of that one mishap? Thatâs what it sounds like. Youâre entitled to your opinion, of course, but Iâm not one to throw out the baby with the bathwater. Fix the problems, absolutely. But most of the problems that the ACA was crafted to correct predated the law, and those will need to be fixed in any case if we are to ever have a hope of offering equitable, affordable health care to everyone. This is just MY opinion, of course.
> 
> Alternatively, we could just let them die. I guess that's a solution, too.
> 
> Costs ARE the problem. But they've been the problem for a very long time. Why is it all so expensive, do you think?


No- just that learning from experience that not everything is as first touted. To grow beyond being fascinated and beguiled by glitter.

It is so expensive in large part because a provider knows to the dime how much can be wrung out of the system. So, whether it actually costs that much or not, that will be the price. 

There were some checks on that reality made known by the drops in charges given to the self-payers. Now, why those checks are going to be gone. Costs will certainly go up but will be disguised by covered by taxes in part. 

Costs will go up because they can. True before Obamacare but so much more likely post obamacare.


----------



## Raeven

Terri in WV said:


> Very easily:
> 
> $250,000
> -$12,600(deductible)
> =$237,000
> -60%(insurance pay out)
> =$94,960
> 
> $94,960
> +$12,600
> =out of pocket expenses of $107,560 not counting monthly premiums.
> 
> One might as well opt out, because I don't know of anyone that could pay that.


Terri, my out-of-pocket costs are CAPPED at $5,000. I believe they are for all the plans. Maybe that is the information you don't have. True also for Arcticow. In all instances, you can call the insurance company you are/were planning to use and ask them directly about the caps.


----------



## Oxankle

Raeven: Baloney; I am 82 years old. My insuror is Blue Cross. I have had two of those procedures done in the past 7 years. Under ObC I could not get even one.
Certain cancers, slow growing, are best left to benign neglect. Others not so. I want my doctor to decide which, not some penny-pinching bureaucrat. 

It is true that some of the elitists in this country want the insurance industry killed and a single-payer, European-style, substituted. Look at England, where for a time they paid hospitals a premium for quick end-of-life procedures. Hospitals were literally killing old people until the public got wind of it.

An acquaintance, in Canada, had to give up a visit here because a long-needed procedure was scheduled for the time when she had planned the trip.--She could not afford to re-schedule because of the long wait time. So much for government health care.


----------



## Raeven

Hey, Ox -- I pay taxes, too. A lot of them. And they go lots of places I'd rather they didn't.


----------



## Terri in WV

I stand corrected and am doing this to myself right now...:bash:

My figures are all wrong, but I imagine many were doing the same thing as I, so I'll leave my brain burp there for all to see. :smack

The out of pocket cap for family(in my case) is $12,600. With the bronze plan I'd still be paying out over $21,700 in monthly premiums and caps if something major were to happen. Which, in my case, would still be a hardship, but not quite as much as my previous flawed figuring.


----------



## Raeven

Oxankle said:


> Raeven: Baloney; I am 82 years old. My insuror is Blue Cross. I have had two of those procedures done in the past 7 years. Under ObC I could not get even one.


PREVENTIVE procedures would no longer be covered. For other purposes such as you described, they would be. Same point Lesley made in an earlier post. You need to draw this distinction. Under the ACA, those procedures would be covered same as with your insurance.


----------



## Raeven

Terri in WV said:


> I stand corrected and am doing this to myself right now...:bash:
> 
> My figures are all wrong, but I imagine many were doing the same thing as I, so I'll leave my brain burp there for all to see. :smack
> 
> The out of pocket cap for family(in my case) is $12,600. With the bronze plan I'd still be paying out over $21,700 in monthly premiums and caps if something major were to happen. Which, in my case, would still be a hardship, but not quite as much as my previous flawed figuring.


No need to :bash: .  There is so much bad information out there, and the law IS complicated.


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## Oxankle

Painters wife: I don't think I mentioned caps. Some policies had lifetime caps in the past--that is one of the few good things about ObC, no more caps. I also know that there are yearly out-of-pocket caps, catastrophic illness caps. I've not read the details of the several ObC policies so cannot comment there. 

My point is that someone, the taxpayer, has to cover those subsidies for the people who get them.


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## Terri in WV

Thanks for the reprieve Rae, but me posting my idiocy doesn't help the matter.


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## haypoint

There is a very serious problem with Health Care Insurance, but it isn't ACA. The real problem is half the working people expect to buy Health Insurance for $200 a month that will fund their knee replacements at $40,000 each, bypass surgery for $60,000, three different medications, at $200 a bottle, each month and fund your physical therapist. The other half of the working people are healthy, never goes to the doctor and doesn't need or want to throw their money into a pile that others benefit from. 
The old and unemployed are already covered by Medicare and Medacaid. The very rich do not need insurance, they can pay their medical bills no matter how high.
The Math doesn't work. It can't.


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## Raeven

Terri in WV said:


> Thanks for the reprieve Rae, but me posting my idiocy doesn't help the matter.


ROFL, I didn't mean to make it sound like a reprieve.. I am so sorry if that seemed condescending!! Last thing I meant.

If it makes you feel any better, this whole thread is my personal :bash: ....


----------



## sidepasser

Then there are the rest of us who pay for our policies and do not fall under the ACA..

I have to pay 20% of whatever the bill is..
maximum ins. payments are capped at 1M per incident. I have a 1,000 deductible. 

My co-pays are 30.00 to a reg. doctor; 40.00 to a specialist and tests are various from 150 for a MRI to 100 for radiology. I haven't asked about other tests yet.

So if I were like my DH who was in a freak accident when we were married before he passed away; he racked up 982,000 in one hospital and another 300,000 at the second hospital including his rehabilitation. Ins. payed 80%. 

Fortunately we were at a hospital that gets tons of donations and they had a fund and they wrote off the 250,000+ that would have been owed as the 20%. Oh and it wasn't a taxpayer funded thing, private donors established the fund and contributed to it annually for those like us that were "working poor".

I now have BCBSA and Tri-Care. Still have co-pays and deductibles. I pay for my premiums through work, DH pays for our Tri-Care.


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## Terri in WV

I didn't take it as condescending at all! More as a very nice opt out for my flawed figuring.


----------



## where I want to

Raeven said:


> PREVENTIVE procedures would no longer be covered. For other purposes such as you described, they would be. Same point Lesley made in an earlier post. You need to draw this distinction. Under the ACA, those procedures would be covered same as with your insurance.


Not quite. This is part of glitter. Obamacare mandates what must be included in policies- not only in subsidized plans but in all plans otherwise the extra taxes. So, since it also demands affordability, there is a squeeze. That squeeze is mostly manafested now as limited networks. Much more than policies used to have. I once could shop around to find the policy that covered the most of what I felt would be needed for me and less coverage where I was unlikely to need it. Now, since any policy must include much of what I don't need, I can't do that. If I wish to avoid paying a lot more, I can only do that by finding policies that limit their network. And that may very well limit my ability to get treatment.
Obamacare's promise is that you'll have insurance that has no lifetime limits or pre-existing condition limits. It did not promise that you will be able to find a provider to accept it.
And for rural people especially, that could kill you.


----------



## Raeven

where I want to said:


> Not quite. This is part of glitter. Obamacare mandates what must be included in policies- not only in subsidized plans but in all plans otherwise the extra taxes. So, since it also demands affordability, there is a squeeze. That squeeze is mostly manafested now as limited networks. Much more than policies used to have. I once could shop around to find the policy that covered the most of what I felt would be needed for me and less coverage where I was unlikely to need it. Now, since any policy must include much of what I don't need, I can't do that. If I wish to avoid paying a lot more, I can only do that by finding policies that limit their network. And that may very well limit my ability to get treatment.
> Obamacare's promise is that you'll have insurance that has no lifetime limits or pre-existing condition limits. It did not promise that you will be able to find a provider to accept it.
> And for rural people especially, that could kill you.


Our experiences are so different. I am rural, too and must travel at least 60 miles round trip for any care.

I went from having a choice of one provider to quite a number of providers, and a choice of 49 plans. All my doctors participate in the plan I chose.

Affordability was a problem before the ACA and continues to be the major one.


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## Oxankle

I will leave this discussion with one last point. I worked for 37 years for modest pay so that I could support my family, save a $ or two and carry health insurance for myself, my wife and children. 

At 72 years of age my wife was found to have pulmonary fibrosis; the doctor told us to expect her to live two more years. Blue cross paid about $50 grand per year, plus hospitalizations, plus rehab, plus ambulances, plus all her other meds, for a medication that kept her alive for almost five years. 

A younger brother was diagnosed with the same disease a couple of years later. Treated by the VA, where doctors DO have to consider costs, he was told he was not a candidate for treatment my wife received. He lived almost two years after diagnosis.

If I were an accountant balancing costs against benefits I would have to say that the VA was right. But I am not an accountant, and I paid for the insurance we had, and dammit I do not want an accountant making life or death decisions for me.
Ox


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## Raeven

Oxankle said:


> I will leave this discussion with one last point. I worked for 37 years for modest pay so that I could support my family, save a $ or two and carry health insurance for myself, my wife and children.
> 
> At 72 years of age my wife was found to have pulmonary fibrosis; the doctor told us to expect her to live two more years. Blue cross paid about $50 grand per year, plus hospitalizations, plus rehab, plus ambulances, plus all her other meds, for a medication that kept her alive for almost five years.
> 
> A younger brother was diagnosed with the same disease a couple of years later. Treated by the VA, where doctors DO have to consider costs, he was told he was not a candidate for treatment my wife received. He lived almost two years after diagnosis.
> 
> If I were an accountant balancing costs against benefits I would have to say that the VA was right. But I am not an accountant, and I paid for the insurance we had, and dammit I do not want an accountant making life or death decisions for me.
> Ox


I'm sorry for your losses, I truly am.

Things changed a lot in health care in the 10 years from when you were 72 to now, when you are 82. They changed for everyone, and not for the better. I understand you want to tie the decision re your brother to a hard-hearted accountant, and I'm not in a position to refute that. Nor am I interested in doing it one way or another. But it is just possible that different decisions were made for reasons other than only cost. No way to know, unfortunately. I would hate it for you -- and all of us -- if they were.

A big part of the problem is perception: When it's MY mother who needs care, then it's "reasonable and prudent care." When it's YOUR mother who needs care, then it's a "wasteful and shameful expenditure of taxpayer dollars." Of course I don't really think this, I hope you understand my point.

I have repeatedly said, I am far from sure this scheme will work or that it is the best approach to solving our issues with health care. But it is what we have, and people should evaluate their feelings about it based on accurate information to the greatest extent possible. I never said I had all the answers... but I do understand the law pretty well. It's the misinformation I have repeatedly seen on this site that caused me to post. The anger over it does not come as a surprise.


----------



## rkintn

Oxankle said:


> Oneraddad: Many of us here are vets; those of us lucky enough to have escaped combat injuries are far down on the list of the VA priorities, especially so if we prospered and have other insurance. I have classmates whose only insurance is VA, and I am proud to say that the doctors and nurses of the VA have treated them well.
> My only reports are of the Dallas, Muskogee and Atlanta hospitals--according to friends they are well-run. It is my intent to sign up for VA coverage as I am told that the more applicants they have the better are their chances for funding.



I have VA health benefits. The Marion, IL hospital is wonderful. I am not too find of Memphis or nashville's facilities. The community bases outpatient clinics are nice as well. I've til yet to have a problem being seen or receiving care thru any VA facility I've gone to.


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## Guest

Well, nobody wants to see what's really behind the curtain, but this is the actuality: The cost of medical care is beyond the reach of average people. The cost of insurance is beyond the reach of average people. There are about 10 times too many people on earth anyway. Everybody is going to die. The lucky ones won't be sick, or at least not for long. Regardless of what you see on CNBC, the economy, at the personal level, for most people has not recovered, and is not likely too. The 50's are gone, the 60's are gone. We're at a point where we are just going to have to suck it up. Either pay up big time for insurance, or take your chances without. Although I did not vote for the president, he was no worse choice than the other party's candidate. I think he's doing like the rest of us, trying to help. Although I find him to be somebody I'd probably not have as a friend, still, he's doing the best he can. 

When I was a kid, I got my tonsils removed for 5 or 10 bucks. Broke arms, all that stuff. Less than a day's pay. My oldest daughter's birth, the pregnancy, doctor visits, delivery, everything was either $200 or $250, I think. Was a long time ago, I could be wrong. 1975, I paid a surgeon $200 for a hernia repair surgery. 2 weeks pay, I guess. Still, that's all history. There is no easy cure, no quick fix. We can't go back. The future will be much worse than the past. Until mankind learns to quit reproducing madly, quit fighting about everything, live life like it means something, and accept the end when it comes. 

Once a person accepts that sickness and death are part of life, maybe they can start living it like it has meaning. It's hard to watch your loved ones get sick and die, but that's just the way it is. Be glad you were here.


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## haypoint

Seems no one that spends under $299 a month on their health care is willing to pay $300 in health insurance. But at the same time, plenty of folks want coverage that will pay out a million in medical care as long as they can get it for $300 a month. Sorry but that's about 270 years of premiums.


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## Terri in WV

Rae, I think you're very brave to attempt this again after the other day.  Thank you. It has helped me to correct some of my thinking.

After my experience year ago, I'm still gun shy about the max caps though. I know that they have ways around it that can leave one on the hook for huge bills. 

In my case, we had good insurance with a cap of $5,000. I had to go into the hospital and my son was born 10 weeks premature. I begged everyone that walked into my room to please call my insurance. Apparently no one did as we were left with over $100,000 in bills(I quit counting when it got to that). The insurance reduced our coverage from 100% to 60% and the hospital refused to acknowledge their part in not getting paid. I was hounded almost daily with threats of court and losing everything. All because the lack of one phone call.


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## Raeven

Perfectly said, zong, in my opinion. Everyone's got to live with one foot in the future and one foot in the present. Personally, I find it to be like standing on two separate pieces of ice in the middle of the ocean these days.


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## Raeven

Terri in WV said:


> Rae, I think you're very brave to attempt this again after the other day.  Thank you. It has helped me to correct some of my thinking.
> 
> After my experience year ago, I'm still gun shy about the max caps though. I know that they have ways around it that can leave one on the hook for huge bills.
> 
> In my case, we had good insurance with a cap of $5,000. I had to go into the hospital and my son was born 10 weeks premature. I begged everyone that walked into my room to please call my insurance. Apparently no one did as we were left with over $100,000 in bills(I quit counting when it got to that). The insurance reduced our coverage from 100% to 60% and the hospital refused to acknowledge their part in not getting paid. I was hounded almost daily with threats of court and losing everything. All because the lack of one phone call.


Oh, Terri, that's awful. I've heard a lot of those stories, I'm afraid.  I am so sorry.

I understand why you are gun shy, completely. I understand why zong won't get any medical care whatsoever. We're all products of our own personal value judgments and experiences over a lifetime.

With respect to getting "permission" from insurance companies under the ACA, I don't believe that is any longer an issue except in getting care "out of network," which shouldn't happen unless you are traveling. That's one of the rough edges they really need to work out. 

Were I in your position, here is what I would do: Decide which plan will work best for you. Then call the insurance company directly and ask them every single question you have. They should be able to provide you with a copy of the policy, its limitations and requirements on the spot. Mine did.

So far as I can tell, I don't need to get permission to do anything so long as I use in-network providers. I guess I will still worry that I don't suffer something awful when I travel, but at least I don't have to worry anymore if I suffer a slip and fall around my place.

As for being brave, well, thanks.  I'm QUITE sure only a few would characterize it that way!! But I am glad if even only one person was helped to understand it better and make a more informed decision -- whatever that decision is. And I am equally glad that the discussion has remained civil and respectful, even though this is a very, very emotional issue. But thanks again. 

Lastly, I am grateful for the moderators who have allowed the thread to proceed as it will. I have a renewed appreciation for them that I have failed to express up to now. Thanks to both Terri and Shrek.


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## Terri in WV

Thanks for the advice Rae. Right now it's kind of moot for me though. The deadline's today, although I have read of extensions. I'm in Ky right now and can't see signing up here, as I have a contract on a house in WV. So...until I find out where I'm going to plant us, I'm holding off on anything.

Okay, so not brave. How about a glutten for punishment? ound:


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## SimplerTimez

Terri in WV said:


> <snip>
> Okay, so not brave. How about a gluten for punishment? ound:


Hopefully you aren't gluten intolerant :spinsmiley:

************
So many excellent points made, particularly about costs re: zong's post.

Insurance costs (home/auto/health/life) comprise nearly 25% of my gross income. :shrug:

Yet we have to have them. I certainly don't mind my taxes going for VA or Medicare/Medicaid. But the costs are crazy, and income has not gone up like the costs of medical care has, nor like insurance costs. So much is broken, even if the ACA was a stellar plan, it isn't going to fix the underlying issues. I'm at least hoping it will open the dialogue to begin repairing the real issues.

Some doctors are forming cash co-ops, which seems to be a viable possibility, and circumventing the insurance brouhaha all around. 

I've paid for health insurance for years and years, and yet have seen a doctor twice in the last ten years, once, as required by my employer for a physical. I guess I'm back paying for those three babies that I had 

And I second the even handedness of the mods here, thank you.

~ST


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## Guest

painterswife said:


> How would you ever owe a hospital that if you have insurance?


Because the Bronze Plan from Obamacare is a 60-40 barebones coverage insurance plan...theplan pays 60% and you pay 40%..Medicare is an 80-20 plan.


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## Raeven

But what about the out-of-pocket cap? Have you determined if there is or isn't one? All the plans I examined had an out-of-pocket cap as zong described in his post #108. There's even a calculator. Hope this helps!!


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## arcticow

Blue Cross is the ONE ACA provider in MO. Same company as most employers use. When and if I decide to spend for coverage, I will look elsewhere. Have never been fond of BC, was covered by them for awhile. Just got a full-time job, finally. If I choose no insurance, I will pay the PENALTY for not doing what O wants. Just stop pretending it's anything other than punishment for not going along...


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## Raeven

AC, I'm pretending no such thing. A penalty is a penalty, and I've never called it anything else. Sorry you feel that way. And I hope you have good, acceptable coverage through your new employer.


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## arcticow

Rae, that was not directed toward you, but to the good folks who describe it as a tax. I am considering investigating one of the Christian self-coverage co-ops. Like the idea of physicians' can co-ops also...


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## Raeven

Thanks for clarifying, AC. When I thought it came from you, it felt like a slap -- which if I deserved it, fair enough! In that instance, just didn't think I did. 

I agree, it is not a tax. It is a penalty, and it is going to get worse in each successive year.

We have a number of physician's cooperatives here in my area. I looked into joining one and decided that I didn't need their services enough to merit purchasing into one. That said, I think they're a great option. Doctors want to get back to the practice of medicine; patients want to get back to the business of having a direct relationship with their physicians.


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## elkhound

this makes me so mad i am going to pull a zong/bryn/elkhound....i am going fishing(elk) tomorrow...drink me a shot of wine(zong) and whittle me a spoon(bryon) while i wait on a fish to bite.

i always feel better after cooking a fish on the river bank and watching the green water flow by.


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## Guest

Raevan, you are correct..mea culpa..even the BronzePlan has an out of pocket annual cap. $12,500...

I spent the past 2 hours researching what is available in my part of the world..
a single insurance company provides Obamacare for this part of rural Missouri..and has an annual out-of-pocket deductible of $5600...here's how it works for those Americans who happen to be 56 and older.

Monthly premium for an individual is no longer quoted as $379 (from December), but is now $555/month and only guaranteed to be that amount in 2014. This monthly premium is for the Bronze Plan. Silver and Gold plan premiums are higher.

The plan pays nothing at all until you have paid $5,600 (in ADDITION to the monthly premiums!). Then it pays as follows:
Physician visits for an illness,..you pay $15 co-pay
Specialist visits..you pay $75 co-pay
Out Patient Procedures..you pay 30% of the charges
In-patient( hospital admission),you pay $500 plus 30% of the charges.

So the totals are as follows:
$6,624/year in premiums
then an additional $5600 out of pocket in that calendar year, before the insurance company pays a dime of expenses....

That's $12,224 every year.
I don't know anyone who has an extra $12,224 in income to pay for healthcare BEFORE they get any return . 
Now AFTER you've paid out $6624 in premiums, and $5600 deductible, you still have another $6,900 out of pocket each year before you hit that cap of $12,500 ..


To recap:
that's $6624 in premiums
and $5600 in deductible before the insuror pays a dime..
$12,224 spent..
and THEN before you reach that yearly cap,you get to spend another $6,900.
that's a grand total of $19,124 from your bank account if you become seriously ill in one calendar year..anybody on this forum have that kind of cash laying around??? God bless you if the answer is "yes"..


What happens when the person cannot work and therefore can no longer pay the extra $555/month, not to mention the $5600 ? Where is the safety net to keep that now-sick person from losing the farm?
Obamacare was touted as the safety net..I don't see one..please explain.


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## Raeven

Lesley, wow. You've done a lot of homework. That's great information, even if not particularly encouraging.

Honestly, I'm not sure if they've worked it out that far, re mid-year changes. It's pretty fly-by-the-seat-of-your-pants at this stage. Here's what I THINK will happen, but don't quote me on this, because I've received no official guidance at all.

If you fail to pay your premiums, then you would become subject to the penalty that would be assessed at the end of the year. Or... would you? You complied within the time frame, and you would have suffered what we in the biz refer to as a Life Status Change (loss of job or work hours), which has always been a bona fide reason to effect a change in coverage. Would the reduction in income then throw you into Medicaid eligibility?

It's a great question, and I will spend some time trying to find out. Because now I'm curious, too.

I sure agree that under the Bronze plan as you outline it for your area, paying your penalty and taking your chances looks a lot more attractive than the option available. Were there any doctors' visits included in that Plan? Just wondering if the insurance company assumes ANY of the expense other than preventive care under the circumstances you outlined...? Any? Bueller?

I can't help but wonder, too, how different it might have been if your state had taken the expanded Medicaid funds. Maybe none, but maybe some. Not sure that's something that can be learned.

Thanks very much for the time and effort you've spent. It's eye opening to see how the ACA is impacting folks in other areas, for sure. I'm glad to learn there is at least a cap for out-of-pocket, even if not terribly "affordable."


----------



## Guest

Missouri Medicaid is only available for:

Single people who have children or are pregnant and their income is below poverty level per each Missouri County..

or..

Missourians who are 100% disabled according to the Social Security Administration..

Immigrants who are designated as refugees.


and, no..not a dime paid until the annual deductible is reached..


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## arcticow

I strongly suspect that it would be cheaper, but not much. Reward for falling in line with O's Big Idea... So we are punished for standing up to him... All the states that defied him...


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## SimplerTimez

Another link, that shows the prices of all plans, and my state, showed all deductibles, co-insurance percentages and max out of pocket. 

Plus the sidebars have a lot of information as well.

http://www.valuepenguin.com/ppaca/exchanges

~ST


----------



## no really

Gonna post a quick one here, limited internet time where I am.. Cancelled my insurance yesterday... got a notice for a conference call about an hour ago from head of the company! Have only had dealings with him a couple of times as he is in the UK head office. 

He stated he understood why we (the group he was speaking to) declined the coverage and offered us the opportunity to transfer to the foreign offices, wow. He said he would be available to help in any capacity he could and had instructed HR to provide some info to us on options.

Funny thing is as he was closing the call he said that due to the excellent work ethic we had he was giving us a raise. It was a little more than what the company contribution to our insurance would have been. 

Supper time here got to eat before it's all gone :banana:


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## sidepasser

A person does not have to be traveling to be "out of network" when seeing a doctor. My daughter had a severe asthma situation and had to see a specialist. Said specialist was in our town but out of our network.

Insurance would cover but at "out of network" prices. Out of network applies to any doctor who is not a participant within an insurance company's "network of doctors" who have agreed to participate and accept what the insurance company offers as payment. There are many doctors who are members of say "Aetna insurance company" network but not BCBS, etc.

Make sure that ANY doctor within your area, specialists you may see, etc. are within the chosen insurance company's network. Otherwise, you will pay out of network co-pays or not be covered at all (depending upon your insurance company).

Here is an article which may explain it better than I did:

http://www.getinsured.com/answers/are-the-costs-of-out-of-network-providers-covered-under-the-aca/
*Know the limits*

_In the past, many insurance companies required prior authorization for guaranteed payment of out-of-network emergency care. Now that&#8217;s no longer the case (with the exception of some of the &#8220;grandfathered plans&#8221. Nor can an insurance company charge you a higher co-pay or coinsurance for emergency hospital care.

*Other out-of-network services are a different story. One way insurers try to keep premiums more affordable is by limiting provider networks and restricting any out-of-network services that aren&#8217;t related to true emergencies. So, your insurance plan can ask for prior authorization before allowing you to see an out-of-network provider. And they may still limit payment, or refuse coverage altogether, for any non-emergency services from out-of-network providers. 
Some plan providers are honoring more liberal out-of-network policies on existing plans for a limited time. Most will switch to more restrictive policies by 2015. *
_
- See more at: http://www.getinsured.com/answers/a...s-covered-under-the-aca/#sthash.1GqMThDi.dpuf


http://www.getinsured.com/answers/a...s-covered-under-the-aca/#sthash.1GqMThDi.dpuf


----------



## Cookie2

Okay, here is my objection to Obamacare and thoughts on medical insurance and the high cost of medical care ...

~ Obamacare did some good (pre-existing conditions, lifetime caps, etc) and a lot of bad (mandated tax, loss of personal freedom, loss of privacy, etc).

~ I firmly believe that the givernment has over-stepped their bounds in creating a law that has no basis in the US Constitution. While there are lots of great reasons for having health insurance (or any insurance for that matter), a federal mandate to buy an optional product is not the role of government.

~ Approximately 100 years of Progressive laws have gotten us to this point. Creating more Progressive laws aren't solving the problem. As soon as Congress allowed citizens to pay for employer-supplied medical insurance premiums with pre-tax dollars but refused to give the same tax break to individuals paying for their own insurance, the whole system began to crumble.

~ Why are medical care costs so high? Because medical providers can charge that much. Frankly, they are encouraged to charge that much because of the tax code. Obamacare did NOTHING to fix this problem. Here it is in a nutshell: If a doctor charges a patient $100, the insurance company may have negotiated to pay the doctor $40, the insurance company will tell the patient to pay $20 and the doctor will be told by the insurance company to "write off" $40. What is that "write off"? It is a tax write-off. NO OTHER BUSINESS GETS THIS WRITE-OFF. If you are an electrician and you give your customer a bill for $100 and the customer's homeowner's insurance cuts you a $40 check for the work then the customer pays you $20 but refuses to pay you any more, you can't write off the remaining $40 from your taxes. You do have to go through an elaborate process of trying to collect on your 'bad debt' and eventually you might be able to take a bad debt deduction but you can't just charge whatever you want and automatically write off whatever the customer doesn't pay you. Anyway, medical providers are encouraged by tax laws to increase their tax write-offs because every dollar in write-offs reduces the taxes they have to pay on their profits.

I have an appointment and need to go ... more later.


----------



## painterswife

I agree. Health Insurance should be either before tax or after tax but the same for every person.


----------



## Raeven

sidepasser said:


> A person does not have to be traveling to be "out of network" when seeing a doctor. My daughter had a severe asthma situation and had to see a specialist. Said specialist was in our town but out of our network.
> 
> Insurance would cover but at "out of network" prices. Out of network applies to any doctor who is not a participant within an insurance company's "network of doctors" who have agreed to participate and accept what the insurance company offers as payment. There are many doctors who are members of say "Aetna insurance company" network but not BCBS, etc.
> 
> Make sure that ANY doctor within your area, specialists you may see, etc. are within the chosen insurance company's network. Otherwise, you will pay out of network co-pays or not be covered at all (depending upon your insurance company).


 sidepasserâ¦ thanks. Good clarification. When I was speaking about being out-of-network when I travel, I was referring solely to my own personal situation, as that is when it would come up for me â not to how plans available through the ACA work in general. Youâll note I stated in my original post that folks need to be careful to pick a plan that includes their regular doctors, etc. and to make sure those are all in-network. But it canât be stated too often, and your links place helpful emphasis on that.

Thanks again for taking the time to research and post. Itâs so easy to create confusion with all this, even when weâre trying hard not to.


----------



## Raeven

Cookie2 said:


> Okay, here is my objection to Obamacare and thoughts on medical insurance and the high cost of medical care ...
> 
> ~ Obamacare did some good (pre-existing conditions, lifetime caps, etc) and a lot of bad (mandated tax, loss of personal freedom, loss of privacy, etc).
> 
> ~ I firmly believe that the givernment has over-stepped their bounds in creating a law that has no basis in the US Constitution. While there are lots of great reasons for having health insurance (or any insurance for that matter), a federal mandate to buy an optional product is not the role of government.
> 
> ~ Approximately 100 years of Progressive laws have gotten us to this point. Creating more Progressive laws aren't solving the problem. As soon as Congress allowed citizens to pay for employer-supplied medical insurance premiums with pre-tax dollars but refused to give the same tax break to individuals paying for their own insurance, the whole system began to crumble.
> 
> ~ Why are medical care costs so high? Because medical providers can charge that much. Frankly, they are encouraged to charge that much because of the tax code. Obamacare did NOTHING to fix this problem. Here it is in a nutshell: If a doctor charges a patient $100, the insurance company may have negotiated to pay the doctor $40, the insurance company will tell the patient to pay $20 and the doctor will be told by the insurance company to "write off" $40. What is that "write off"? It is a tax write-off. NO OTHER BUSINESS GETS THIS WRITE-OFF. If you are an electrician and you give your customer a bill for $100 and the customer's homeowner's insurance cuts you a $40 check for the work then the customer pays you $20 but refuses to pay you any more, you can't write off the remaining $40 from your taxes. You do have to go through an elaborate process of trying to collect on your 'bad debt' and eventually you might be able to take a bad debt deduction but you can't just charge whatever you want and automatically write off whatever the customer doesn't pay you. Anyway, medical providers are encouraged by tax laws to increase their tax write-offs because every dollar in write-offs reduces the taxes they have to pay on their profits.
> 
> I have an appointment and need to go ... more later.


 Cookie2â¦ Itâs impossible to separate the politics from the policy in this discussion, isnât it? How we approach a solution to our health care systemâs problems is driven by our own ideologies.

You hit the nail on the head when you said that the reason medical providers can charge so much is *because they can. And why is that?* Because health care, and particularly emergency health care, does not lend itself readily to a capitalist model. When you need care, you need it. There is no opportunity for you to negotiate with the ambulance service that picked you up to take you to the hospital to determine if they are the best choice for you. The hospital will work to save your life without going through a haggling process to determine if you both can arrive at a fair price for their services. You *might* be able to negotiate somewhat after the fact, but any capitalist knows that is a weak position, indeed. You are essentially, at that point, a beggar.

I completely agree with you about the tax breaks in the tax code for medical providers. I bang on the insurance companies the most re their profits, but non-profit hospitals are making out like bandits, too, owing to the tax breaks they get for their status as non-profits. Itâs funny, isnât it, how ânon-profitâ hospitals can be so wealthy? Check out the salaries for those hospitalsâ administrators. Yikes. And donât get me started on pharmaceutical companies. What kind of health care system could we have, I wonder, if we removed the profit motive from it?

Iâve read often that something between 50-64% of all bankruptcies filed in this country were due to costs from an unforeseen medical crisis in the family. Terri in WVâs story earlier in this thread shows how readily costs spiraled out of control for her, although she did not file for bankruptcy. And while I sympathize with Boston Lesleyâs and Arcticowâs point re the unaffordability of the ACA in their particular situation, I would also make the point that, personally, should I be faced with an unforeseen medical crisis, Iâd rather be on the hook for $12,224 than for hundreds of thousands of dollars at the end of it all. But thatâs a decision thatâs left to each individual to make.

I realize that the most obvious objection to the ACA is the fact that it is not optional â and also that itâs too expensive for many. I suspect that if such a scheme had been introduced but was only going to cost each family, say, $100/month, there would be much grumbling but far less outrage. But then, getting sick isnât optional, either. I feel strongly we need to work hard on getting costs down.

I do know this: The system we had was unsustainable. I have said many times in this thread that I am not acting as an advocate for the ACA and Iâm truly not a big fan. I have serious doubts as to whether or not it can work. But change had to start somewhere. I wish it hadnât been with this legislation, but it was.

Thanks for your comments.


----------



## Twp.Tom

Thank You All, for sharing your knowledge, and views on this thread, especially You Rae*, for starting it! We should all be informed of what is REALLY going on around us. I don't know if this is a thread drift- but a friend of mine, just stated this, and I wanted to share: 
"If money is speech, and free speech is an inalienable right of all Americans (and the domestic and foreign owned corporations they allow to exist),
then are the poor among us enslaved by poverty and through chance or lack of action somehow less deserving of that right? Should their voice rightly be drowned out on the public square?

We seem to have a high tolerance for the deliberate misleading of the public that is increasing becoming part of every significant political camp..."


----------



## where I want to

Re: caps on out-of-pocket. That is not a cap on all the costs you might pay. It is the caps of coinsurance and deductibles. If the insurance does not cover a service or provider, that does not go to figuring whether you have met the cap. Just as the out-of-network provider can charge more than the amount used to determine the basic reimbursement level for figuring the percentage they pay.
For instance, if you need to go out of network for care and that provider charges $1000 for their services, while an in-network provider is contractually limited to $500, you will not only pay the extra $500 of charges but that extra $500 does not count in out of pocket limits either. 
For people living in a city, that is usually not a serious issue due to access to so may providers. For rural people it can be a horrible problem. Heaven forbid you ever have a rare or difficult illness that requires you to travel out of network because there are no local providers.


----------



## Raeven

where I want to said:


> Re: caps on out-of-pocket. That is not a cap on all the costs you might pay. It is the caps of coinsurance and deductibles. If the insurance does not cover a service or provider, that does not go to figuring whether you have met the cap. Just as the out-of-network provider can charge more than the amount used to determine the basic reimbursement level for figuring the percentage they pay.
> For instance, if you need to go out of network for care and that provider charges $1000 for their services, while an in-network provider is contractually limited to $500, you will not only pay the extra $500 of charges but that extra $500 does not count in out of pocket limits either.
> For people living in a city, that is usually not a serious issue due to access to so may providers. For rural people it can be a horrible problem. Heaven forbid you ever have a rare or difficult illness that requires you to travel out of network because there are no local providers.


WIWT, that appears to be true, based on articles I've read, and it's a problem that must be addressed. However, the ACA was not the cause of this problem. It only highlighted a problem that already existed. I wish we could hear more actual experiences from people who have either signed up through the ACA or who nearly did but then changed their minds because of encountering these issues.

I say that because I, too, live rural. It's a *minimum* 60-mile round trip for me to access *any* medical care, and further if I need emergency care. But I knew that when I moved out here. I didn't expect them to build a hospital 15 minutes away just for me (and I am very sure they won't!). I think if I suffered from a rare or difficult illness, I would need to make some hard decisions about where I chose to live. I would have been faced with those same decisions had the ACA not been enacted.

The *only* exclusion of service on the plan I purchased through the ACA is gastric bypass surgery, so long as I use in-network providers. But again, exclusions of coverage -- AND using out-of-network providers -- are problems that existed prior to the enactment of the ACA. They were not caused by the ACA. Again, if others have a different *actual* experience, I would really appreciate them posting about it.

Thanks for your comments.


----------



## Raeven

Twp.Tom said:


> Thank You All, for sharing your knowledge, and views on this thread, especially You Rae*, for starting it! We should all be informed of what is REALLY going on around us. I don't know if this is a thread drift- but a friend of mine, just stated this, and I wanted to share:
> "If money is speech, and free speech is an inalienable right of all Americans (and the domestic and foreign owned corporations they allow to exist),
> then are the poor among us enslaved by poverty and through chance or lack of action somehow less deserving of that right? Should their voice rightly be drowned out on the public square?
> 
> We seem to have a high tolerance for the deliberate misleading of the public that is increasing becoming part of every significant political camp..."


Tom, thank you, you made my day. I had to learn about the ACA whether I wanted to or not, and in response to all the inaccurate information floating around, I felt compelled to share what I know and what I personally experienced.

In response to your "thread drift," which doesn't bother me in the least so long as it remains respectful, and it has: I think what your friend said is spot on. He, like me, will likely be dismayed by the Supreme Court decision rendered this morning that removed the limit on how much money can be contributed by people to campaigns and causes. Under Citizens United, the definition of "people," of course, was expanded to include corporations. And now, not only can they contribute with a veil of anonymity... they can contribute an *unlimited* amount of funds.

I don't like to leave the impression that only the "poor" are using the ACA, because it is simply not true. Certainly some people were denied access to coverage because they are poor. But many have been denied access to coverage because, like me, they are small business owners, or they work for a small business owner who does not offer health insurance.

One of the things I like best about the ACA is that it truly addresses portability of coverage for the first time ever. I don't know about you, but I know a lot of people -- and in a past life was one myself -- who hung on to a job I wanted to leave because of health care benefits that I wasn't sure I could replace. This impediment also acted as a damper on me to become self-employed. Those limitations are now removed, and I think that is great.

One thing I am very curious about and plan to research is, what happens if you move to another state mid-year? Can you opt into another plan that is overseen by your new state? Or are you required to remain "in-network" through the end of the calendar year? That's not workable, obviously. When I find out, I'll post what I learn.

Thanks again, Tom, for saying such nice things. But true credit belongs to everyone here who posted respectfully, even if passionately and with anger. There's a lot to be angry about -- I get that. But all have been outstanding in abiding by the rules set in this sub-forum, and I am most grateful for it. Thanks to you all, too.


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## where I want to

No obamacare did not cause the problem but it did encode it into the general population's choice. I made the choice to find insurance that I could still afford because I looked for one that had virtually no network- all doctors were equally covered. I could afford such a policy because I was willing to accept less coverage on other aspects.
But obamacare removed that ability to pick a plan that works for your situation. It standardized coverage based on the government's opinion of what was good for me and deprives me of exercising another opinion.
I was caught like that once and it almost killed me. I hate the idea of being killed for the sake of cheaper insurance for others.


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## Oxankle

"I don't like to leave the impression that only the "poor" are using the ACA, because it is simply not true. Certainly some people were denied access to coverage because they are poor. But many have been denied access to coverage because, like me, they are small business owners, or they work for a small business owner who does not offer health insurance."

Raeven; that is illogical. If these people were not too "poor" to buy insurance for themselves why did they not buy it? Why did they wait for the taxpayer to pay part of their insurance? Private insurance has always been available to all comers.

I don't hold any grudge against those who had preexisting conditions that barred them from private insurance, and I think that the government long ago should have let health insurance companies compete across state lines.

What chaps my heinie is adding another facet to our already overlarded welfare state.
Ox


----------



## Raeven

Oxankle said:


> "I don't like to leave the impression that only the "poor" are using the ACA, because it is simply not true. Certainly some people were denied access to coverage because they are poor. But many have been denied access to coverage because, like me, they are small business owners, or they work for a small business owner who does not offer health insurance."
> 
> Raeven; that is illogical. If these people were not too "poor" to buy insurance for themselves why did they not buy it? Why did they wait for the taxpayer to pay part of their insurance? Private insurance has always been available to all comers.
> 
> I don't hold any grudge against those who had preexisting conditions that barred them from private insurance, and I think that the government long ago should have let health insurance companies compete across state lines.
> 
> What chaps my heinie is adding another facet to our already overlarded welfare state.
> Ox


You know, that sounds really good, but it shows a couple of things: First, you haven't read most of what I've posted here, at least not closely; and second, that you aren't aware of what's been going on over the past few years for a lot of us who are self-employed or employed by other small business owners.

I am not poor by much of anyone's definition. Nor am I unhealthy. I AM self-employed. But as I have said at least twice in this thread previously, I was still characterized as having a "preexisting condition" and therefore "high risk" by Blue Cross. At that time before the ACA, they were the only game in town. There were no other providers. Sure, they'd sell me a policy. For $835/month. That meant that for premiums alone -- not counting co-pays and deductibles -- I would have been paying more than $10,000/year for private insurance I would hardly use. I COULD have paid that, but what kind of idiot would pay those premiums when self-insuring would cost me around $500/year, absent a catastrophic event? That's about how much I spend annually for doctors' visits paying cash. To that cost, I added a catastrophic coverage plan that cost an additional $516/year. So my total cost to self-insure with catastrophic coverage was $1,016 annually. Versus $10,020 annually. Get it now?

That's why I didn't buy their private insurance, and that's why a lot of people I personally knew didn't buy it. I knew MANY people who had been similarly characterized as "high risk," despite few if any real health issues, and based on reasons as stupid as mine was. They, too, chose to not pay those ridiculous private insurance premiums. And they were not poor. Just not eligible for group health coverage and not stupid.

I am very glad you have insurance coverage that works well for you. Many in this country did not.

ALL taxpayers, including me, are paying for uninsured people who need medical care. You're ALREADY paying for it. So am I. I am now paying nearly three times what I paid last year, and it will likely by far exceed my use of the health care system. That's what insurance IS -- a balancing of risk. I'm sorry you don't understand that. I know you want to see it the way you see it, and I see it differently. I think we're just going to have to agree to disagree on the best approach.

By the way, what IS your approach? I'd love to hear it.


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## where I want to

Raeven said:


> You know, that sounds really good, but it shows a couple of things: First, you haven't read most of what I've posted here, at least not closely; and second, that you aren't aware of what's been going on over the past few years for a lot of us who are self-employed or employed by other small business owners.
> 
> That's why I didn't buy their private insurance, and that's why a lot of people I personally knew didn't buy it. I knew MANY people who had been similarly characterized as "high risk," despite few if any real health issues, and based on reasons as stupid as mine was. They, too, chose to not pay those ridiculous private insurance premiums. And they were not poor. Just not eligible for group health coverage and not stupid.
> 
> I am very glad you have insurance coverage that works well for you. Many in this country did not.
> 
> ALL taxpayers, including me, are paying for uninsured people who need medical care. You're ALREADY paying for it. So am I. I am now paying nearly three times what I paid last year, and it will likely by far exceed my use of the health care system. That's what insurance IS -- a balancing of risk. I'm sorry you don't understand that. I know you want to see it the way you see it, and I see it differently. I think we're just going to have to agree to disagree on the best approach.
> 
> By the way, what IS your approach? I'd love to hear it.


Obamacare did not make health insurance cheaper- it made more expensive but simply shifted the costs to people who are not getting an advantage of it.. But subsidies are not the only thing it did- it created requirements for businesses and for the people receiving those business related insurance policies. It created reductions in Medicare reimbursements, thereby making it harder for those people to get coverage and actually raised the taxes paying for those benefits at the same time. Worst it let the government get their hand into detailing who gets what treatments. This will only get worse. 

So your problem was solved at the expense of the multiple times of people who have lost out. And at the cost of having government having an ever expanding control over people's actual life. They have no established a right to say what treatments are cover and what best practices are- all subject to lobbying by those who do not concern themselves with my wellbeing. 

Would you have been happy to take a tax deduction for the cost of your health insurance? That is the net effect of employer insurance. I would have been happy to pay more for insurance to have the government require no life time limits or preexisting condition exclusions. Or for them to negotiate better coverage for some groups. 
But the moment the government has the right to tell me what treatment I am allowed seek and makes ever more convoluted and byzantine paperwork that I will be unable to resolve before their denials of treatment kill me, I can't think that your advantage is enough for me to have lost so much.


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## Raeven

where I want to said:


> Obamacare did not make health insurance cheaper- it made more expensive but simply shifted the costs to people who are not getting an advantage of it.. But subsidies are not the only thing it did- it created requirements for businesses and for the people receiving those business related insurance policies. It created reductions in Medicare reimbursements, thereby making it harder for those people to get coverage and actually raised the taxes paying for those benefits at the same time. Worst it let the government get their hand into detailing who gets what treatments. This will only get worse.


First off, I never said it made insurance cheaper. I understand well that costs remain high. *What have I said repeatedly throughout this thread? Costs are the fundamental problem with health care. Understanding why costs are high and fixing those issues is central to solving the problem*. It will take time. The subsidies are meant to make the insurance premiums affordable while costs are reduced, and though for some that has not worked out to be as affordable as they would like or feel they can afford, they do make it affordable for others. Of course it is unsustainable over the long term if no reduction in costs are realized.

I haven't seen where it has made it harder for people with Medicare to get coverage. Medicare IS coverage. If what you meant to say was that it has made it harder for those folks to get CARE because payments have been reduced to Medicare providers and some providers no longer take Medicare patients, then yes, that has happened. Those people can still get care, though they may have to make some changes to have it. And in the meantime, a lot of people who had *no* access to health care before have it now. Perfect? By no means. But it's a start.

You may be right, the scheme may not work. I have allowed for that throughout this discussion. I have also allowed that there may be better solutions to the problem. I haven't heard one yet. I've actively looked for the plan of the opposition. Crickets. Perhaps you can point me to it if you have a link.

As for the government having a hand in who gets treatments, that's a philosophical difference we have. Me, I'd prefer to leave it to a knowledgeable, impartial board of medical people whose goal is a fair, equitable determination about what is reasonable care. You, you're comfortable with a board of insurance company bean counters to make those decisions. Remember, their goal is profit.

Do you think there is ever a point at which it becomes untenable to provide medical care? If so, when? Or should it all be completely unlimited under any and all circumstances? And who pays for that?

Some have said we should know when it's our time to die, and honestly, I agree with that. But lots of people don't and won't. What's your view on this?



where I want to said:


> So your problem was solved at the expense of the multiple times of people who have lost out. And at the cost of having government having an ever expanding control over people's actual life. They have no established a right to say what treatments are cover and what best practices are- all subject to lobbying by those who do not concern themselves with my wellbeing.


Are you sincerely trying to say that you and everyone else in the whole country have sacrificed so I can have medical care? I have spelled out my own numbers many times here, and you'll just have to show me how that's true. I'm not only covering my own, but someone else's, too. Yours, maybe? That's just how insurance works. Unfortunately in this country, up to now, insurance companies have done an amazing job of privatizing their profits and socializing their risks. Pretty slick -- and we let them get away with it.



where I want to said:


> Would you have been happy to take a tax deduction for the cost of your health insurance? That is the net effect of employer insurance. I would have been happy to pay more for insurance to have the government require no life time limits or preexisting condition exclusions. Or for them to negotiate better coverage for some groups.
> But the moment the government has the right to tell me what treatment I am allowed seek and makes ever more convoluted and byzantine paperwork that I will be unable to resolve before their denials of treatment kill me, I can't think that your advantage is enough for me to have lost so much.


Please share what treatment you have been actively denied as a direct result of the ACA. I really want to know that. PM me if you prefer to not post it publicly. I have shared specifics in this thread about my own medical history, which is not something I do lightly -- but you speak only in general terms, and it is impossible to discuss your situation in an informed way without knowing all the facts. I am genuinely interested to know.


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## Guest

I deluged my elected officials with the following "plan"..never got a single reply from either party members..not one..

Expand Medicaid to provide a bare bones product as an OPTION to everyone on a sliding scale basis..make only $7/hour? Pay $25/month premium for family coverage. Working but only part-time and making $15/hour? Pay $50/month premium. County/City health clinics set up shop again, offering preventive care, primary care, health classes, vaccinations. 

Visit the ER, have no insurance and haven't yet signed up for this? Sign up to participate, pay your monthly premium for 3 months or be billed at 100%.

As a tax payor, I'd much prefer helping people who are helping themselves as best they can..

Medicaid is already in place for all 50 states..why reinvent the wheel for everyone when the target WAS the 15 million uninsured?????


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## Raeven

Lesley, it's nice to hear some meaningful suggestions of other ways this might have been implemented. Thank you. In my opinion, your suggestions (not surprisingly!) have a lot of good merit.


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## where I want to

Semi-double post


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## where I want to

You're right that some doctors, especially specialists, refuse patients. That is why I signed up with a practice including a number of doctors because the last time I needed a new doctor, when the one I had left the area, I had called every doctor I heard was accepting new patients to be told that they were not accepting new Medicare patients. Then some one mentioned a new doctor coming and I called the day he got there. He at least for awhile, was accepting anyone. Since he was in a group practice, I was just passed to the incoming replacement when he left.
Not exactly a good way to choose a doctor. But better than having none.
And that is a huge problem in our area. Because we have such a high percentage of medicaid and medicare patients, getting doctors to come is hard. They can make so much more with private insurance as opposed to the lower level of reimbursement the government mandates.
And I have no option to shop around for a better insurance as once on medicare or even simply being eligible for medicare, every other private policy makes their reimbursement dependent on medicare approval. Medicare doesn't approve, neither will a private policy.
There is another thread going on about the convoluted rules of medicare -
http://www.homesteadingtoday.com/specialty-forums/politics/512315-you-can-thank-mr-obama.html



One of the awful flaws of being stuck with medicare is that, if a doctor wants to charge more than 114% of the amount that medicare approves, and many specialists do, than he is legally barred from asking for payment unless both you and the doctor sign a contract agreeing that neither of you will bill medicare for the charge. That means that you can't even get the amount medicare would pay - you get zip. If the doctor is willing to do it in the first place.
And as the government pinches reimbursement rates, more and more doctors will choose not to bother with those patients. 
Obamacare includes a new panel to decide what procedures medicare will cover. They will not ask my opinion on their choices. And they have changed or eliminated from coverage several medications and procedures already. There have been a couple of posts here about the loss of coverage for some meds under medicare, even though this was the best judgement of the person's doctor.
I have not yet been on medicare long enough to personally have a problem, although I've heard lots of complaints from others about medicare not covering things they did a couple of years ago. But I once found myself in a position like medicare where I could not get insurance to cover seeing a specialist yet the specialist would not see me without insurance. I was stuck a whole year getting sicker and sicker until I was able to get insurance that was acceptable. It is a position I never wanted to be in again. Yet here I am.


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## Tommyice

WIWT I found out with my surgery last year that just because the doctor is in a group doesn't mean they all accept the same insurance. My first surgery involved a colon resectioning and the creation of an ileostomy. The surgeon that created the stoma for the ileostomy was in my plan but the surgeon who performed the resectioning wasn't. The both of them, along with a third surgeon who assisted during my reversal of the ileostomy, were all in practice together--their own group. So that is something a patient needs to confirm when they look at a group practice.


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## where I want to

Tommyice said:


> WIWT I found out with my surgery last year that just because the doctor is in a group doesn't mean they all accept the same insurance. My first surgery involved a colon resectioning and the creation of an ileostomy. The surgeon that created the stoma for the ileostomy was in my plan but the surgeon who performed the resectioning wasn't. The both of them, along with a third surgeon who assisted during my reversal of the ileostomy, were all in practice together--their own group. So that is something a patient needs to confirm when they look at a group practice.


I've run into that too in a local hospital where many of the emergency room doctors aren't participating in various insurance plans but no one tells you which is which. They stitch you up and reem you out later when you start getting billed. One of the awful results of limited networks.


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## painterswife

where I want to said:


> I've run into that too in a local hospital where many of the emergency room doctors aren't participating in various insurance plans but no one tells you which is which. They stitch you up and reem you out later when you start getting billed. One of the awful results of limited networks.


Networks is one of the problems that should have been addresses with the ACA. You should never have to worry about your insurance covering you just because you were closer to one hospital or crossed a state line. If they cover a "broken leg" where you live then they should cover in anywhere in the US.


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## where I want to

painterswife said:


> Networks is one of the problems that should have been addresses with the ACA. You should never have to worry about your insurance covering you just because you were closer to one hospital or crossed a state line. If they cover a "broken leg" where you live then they should cover in anywhere in the US.


Would have been a plus but that is the way insurance companies decided to meet the obamacare mandate of affordability.


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## painterswife

where I want to said:


> Would have been a plus but that is the way insurance companies decided to meet the obamacare mandate of affordability.


No, that was in place before the ACA, nothing new.


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## where I want to

painterswife said:


> No, that was in place before the ACA, nothing new.


There were insurances that had limited networks but there were also insurances that did not. There were choices out there for people who needed specific benefits and could do without others. That is one of the messes that were created by Obamacare- the government decided what was good and drove the others away. Having been caught by a limited network, I found one that was nationwide. It cost more and return less but it gave me freedom. It's gone now.
For people who didn't buy insurance before ocare, this is all one big wonderful law that got them insurance at low prices. But for many more people, it screwed things up royally. So if you are not on of the favored few, you would see all the damage and none of the benefit.


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## painterswife

where I want to said:


> There were insurances that had limited networks but there were also insurances that did not. There were choices out there for people who needed specific benefits and could do without others. That is one of the messes that were created by Obamacare- the government decided what was good and drove the others away. Having been caught by a limited network, I found one that was nationwide. It cost more and return less but it gave me freedom. It's gone now.
> For people who didn't buy insurance before ocare, this is all one big wonderful law that got them insurance at low prices. But for many more people, it screwed things up royally. So if you are not on of the favored few, you would see all the damage and none of the benefit.


I still have the same choices with regards to networks. No change here. I am not one of the favored few either.


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## L.A.

WOW !! Tobacco users beware !!!

Wyoming is expensive anyway for coverage,,but GEEZE,,,,
My cost would have been $250/Good Silver plan,,,With tobacco,,,$360/lowest cost plan available,,,,:grit:

Just can't afford it,,Please just fine me.

Why are states prices & policies so different yet the penalties are the same,,,,discrimination !!

Lord,,I know I ain't suppose to hate,,,,but I hate this,,,,:whistlin:


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## Oxankle

It appears to me that the majority of us are not pleased with ObC. Let's just express our opinion where it counts come November.


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## L.A.

Hmmm,,,,What's the difference between tobacco use and pre existing condition????


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## Guest

L.A. said:


> Hmmm,,,,What's the difference between tobacco use and pre existing condition????


an extra $500/month


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## Jim-mi

The older lady who does the blood work at the local village health clinic, told me that she is already facing the "death panel" formed by the aca.
Her elderly failing husband is being denied procedures. Beth (her name) has been in the medical business for a whole lot of years, She is a very trusted dedicated employ.
She has been working "later" in life to take care of her husband.
She and I are on the same political page and over time had many discussions about the sorry state of affairs of this aca. So I know she is not blowing smoke when I hear her talk about those flaming idiots who recommend throwing her husband . ."Under the bus" . . . . . . Too old to get such and such treatment . .etc. etc.
Yes of course I have read about money's spent on the elderly . . but who the hell are they, the flaming idiot death panel, to decide when "to pull the plug" on ANY person..........
Regardless of what ever bloated figure you are forced to pay it is just totally wrong what has been put into this criminal **law** called aca

Poo poo my post if you wish, . . . .but just wait till it happens to your loved ones.


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## Raeven

Oxankle said:


> It appears to me that the majority of us are not pleased with ObC. Let's just express our opinion where it counts come November.


 Exactly why I did hope to keep the thread focused on factual information only. Interestingly, it was your first post that overtly moved the thread in a political direction, Ox. 

I appreciate the futility of attempting to discuss this issue without politics entering into it, because how one approaches the solution is driven by ideology. So I guess you wanted to talk about politics until you didn&#8217;t. 

Still, I agree &#8211; we all have to make our choices come November. So I would much prefer to keep the discussion on factual information about the ACA rather than argue politics with anyone here. Think I haven&#8217;t noticed that mine are different than most of the other HT members?  I have no need to change anyone&#8217;s mind in that respect and have attempted best I can to keep away from those aspects of the discussion. I&#8217;ll debate politics if you want, but that was never the point of this thread. And there&#8217;s a whole forum on this site where we can have those discussions. Personally, I would consider it a waste of time.


----------



## Raeven

Jim-mi said:


> The older lady who does the blood work at the local village health clinic, told me that she is already facing the "death panel" formed by the aca.
> Her elderly failing husband is being denied procedures. Beth (her name) has been in the medical business for a whole lot of years, She is a very trusted dedicated employ.
> She has been working "later" in life to take care of her husband.
> She and I are on the same political page and over time had many discussions about the sorry state of affairs of this aca. So I know she is not blowing smoke when I hear her talk about those flaming idiots who recommend throwing her husband . ."Under the bus" . . . . . . Too old to get such and such treatment . .etc. etc.
> Yes of course I have read about money's spent on the elderly . . but who the hell are they, the flaming idiot death panel, to decide when "to pull the plug" on ANY person..........
> Regardless of what ever bloated figure you are forced to pay it is just totally wrong what has been put into this criminal **law** called aca
> 
> Poo poo my post if you wish, . . . .but just wait till it happens to your loved ones.


 Jim-mi, you and I have a mutual respect between us that is hard won, and I have no wish to jeopardize that. I donât doubt your village lady friendâs perception. It may be 100% accurate, but I have no way to assess that. She and I would have to have an in-depth discussion about it. Factually speaking, I can tell you that health insurance companies have *always* had âdeath panels.â Surely you have heard tales â or experienced such incidents yourself â of health insurance companies determining which treatments they will cover and which they will not? So this is nothing new.

I would pose to you the very same question as I put to WIWT (that so far has gone unanswered): Is there any point at which you feel that medical care should be withheld? Or do you feel that care should be unlimited, regardless of the cost of it, no matter how pointless if the patient is adjudged terminal? Is there ever any limit?

I really have a tough time reconciling the points of view that on the one hand, the ACA is costing too much but on the other hand, no care should ever be withheld, no matter how much it costs and no matter how pointless it is to render it.

I have tried very hard to not "poo poo" anyone's posts, and I'm sorry if you think otherwise. I have learned from this discussion. I try to learn from every discussion -- else what's the point of having one?

As for whether or not it has happened to my loved onesâ¦ why do you assume it hasnât?


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## Guest

I have noticed, especially in other subforums, that the very people who are already benefiting from the system, social security, SSDI, medicare, VA benefits, etc are the ones most vehemently opposed to others benefiting. What's that about? I got mine, the rest of you can drop dead?? I paid into the system too, in more ways than I care to remember. That don't make me a sacred cow. Regular, pre-Obama insurance, you pay in, you *may* collect a lot more than you put in. Or *may* collect nothing. Same with social security, if I'd died last year, I would not have gotten one cent of the money I paid into the system. Why is nobody crying about all the people that buy insurance and don't get to use it, or the people who pay into SS and never get to collect? And before anybody complains about Obamacare is mandated, that's not actually true, you can opt out. SS and medicare is mandated, why no complaining about that? Oh, I forget, too many of the complainer mentality are benefiting..


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## where I want to

Raeven said:


> And if you were one of the favored few within the old system, you could just ignore the ones who had no options. Different side of the same coin.
> 
> Iâm beginning to suspect your plan was one that didnât meet the âminimum standardsâ test. Do you know if that was the case?
> 
> Itâs been repeatedly said on this thread by me and others that one of the problems the ACA must work out is the in-network/out-of-network issues. I guess weâll see if they do that or not. I think they have to.
> 
> May I just point out that, if I recall correctly, both you and Ox had strenuous objections to the ACA because it cut certain aspects of Medicare and Medicaid? Those are both single payer systems, to which I believe each of you have indicated your opposition. Isnât that kind of wanting to have it both ways? You can complain about single payer, yet you participate in systems of health care that are exactly the same thing? Iâm just trying to grasp how this rationale works.
> 
> Another thing I would mention is that you said that, to date, you have had no problems with your care under the ACA. If/when you do, I hope you will make sure to share that information. Equally, I think it would be only fair to share it if you donât have any problems going forward.
> 
> There is no âone-size-fits-allâ approach to the ACA. As I have said before, I went from having ONE available provider (Blue Cross) to having 49 different plans to choose from through a number of different providers. They all had to *compete* to join our state exchange. As a result, our costs went down. A lot. I should think you would appreciate that, if the pure capitalism model suits your world view.


Almost no one had no options at all. I got mine by chosing to work at a job that did not pay well, along with other negatives, to have good health benefits. 
And you keep dismissing all the statements of problems with ocare as they do not effect your particular joy in coverage. If you chose differently then you had the benefits and liabilities of that choice. Or should have.
Unlike my previous ability to gain some independence, I have no choice about being under medicare. Because I am retired. I no longer have the ability to go back and not retire. And my chances of getting my old health insurance back with any job i could now get are zero. There are no- mind you notice- no choices for me regarding health care. All private policies are directly tied to medicare. No medicare, no insurance at all. And the government has all the rights to chose what care will be covered- even if it kills me by regulation.
So, everything that ocare has done to "reign in medicare costs" (Obamaspeak for take money from that program to fund other's free and reduced premium insurance) has a direct effect on my ability to get providers to give me their service. I am in competition for services with all those people who have the benefit of the money removed from medicare to lower their premiums and offer the providers higher reimbursement with much less red tape than medicare offers.
It is simple to understand that some have been really screwed over by obamacare- it's just not palatable for those who have done really well under ocare to acknowledge that their benefit has come at serious cost to others.


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## Raeven

Some food for thought, and a situation that highlights the many competing challenges of fixing our broken health care system:

_"Sovaldi, a new hepatitis C treatment, can cure up to 90 percent of patients within three months. There's just one problem: The drug costs $1,000 a day. That price tag has thrown the biotechnology world into turmoil, as lawmakers and insurance companies complain that Sovaldi's maker is trying to milk desperate patients."_

http://www.cbsnews.com/news/1000-a-day-miracle-drug-shocks-us-health-care-system/

The whole article is worth a read.


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## where I want to

Raeven said:


> Some food for thought, and a situation that highlights the many competing challenges of fixing our broken health care system:
> 
> _"Sovaldi, a new hepatitis C treatment, can cure up to 90 percent of patients within three months. There's just one problem: The drug costs $1,000 a day. That price tag has thrown the biotechnology world into turmoil, as lawmakers and insurance companies complain that Sovaldi's maker is trying to milk desperate patients."_
> 
> http://www.cbsnews.com/news/1000-a-day-miracle-drug-shocks-us-health-care-system/
> 
> The whole article is worth a read.


That's a thread already going on in GC.


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## Raeven

where I want to said:


> Almost no one had no options at all. I got mine by chosing to work at a job that did not pay well, along with other negatives, to have good health benefits.
> And you keep dismissing all the statements of problems with ocare as they do not effect your particular joy in coverage. If you chose differently then you had the benefits and liabilities of that choice. Or should have.
> Unlike my previous ability to gain some independence, I have no choice about being under medicare. Because I am retired. I no longer have the ability to go back and not retire. And my chances of getting my old health insurance back with any job i could now get are zero. There are no- mind you notice- no choices for me regarding health care. All private policies are directly tied to medicare. No medicare, no insurance at all. And the government has all the rights to chose what care will be covered- even if it kills me by regulation.
> So, everything that ocare has done to "reign in medicare costs" (Obamaspeak for take money from that program to fund other's free and reduced premium insurance) has a direct effect on my ability to get providers to give me their service. I am in competition for services with all those people who have the benefit of the money removed from medicare to lower their premiums and offer the providers higher reimbursement with much less red tape than medicare offers.
> It is simple to understand that some have been really screwed over by obamacare- it's just not palatable for those who have done really well under ocare to acknowledge that their benefit has come at serious cost to others.


My husband, too, took a job exclusively for the health care benefits, when he arrived here from Australia. I could never really explain to him in a way he could understand why that was the case here in the States. He came from a commonwealth country where health care is free to everyone. Our system just didn't make sense to him. But he did it all the same.

I have benefited under the ACA, never denied that. But your assertion that it has come at your expense is somewhat misleading. There has been great success in advancing the notion that Medicare has been "cut" to fund the ACA. Here is a more accurate explanation of how that has actually happened and the reasoning behind it: http://www.politifact.com/truth-o-m...ays-obamacare-cuts-money-medicare-and-senior/

You may disagree with the reasoning behind it, and I am not minimizing the actual consequences you feel you have suffered. However, to assert that there has been a direct cut of Medicare to fund the ACA is simply untrue. The reality is far more nuanced.


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## Terri in WV

Raeven said:


> .
> 
> I am not poor by much of anyone's definition. Nor am I unhealthy. I AM self-employed. But as I have said at least twice in this thread previously, I was still characterized as having a "preexisting condition" and therefore "high risk" by Blue Cross. At that time before the ACA, they were the only game in town. There were no other providers. Sure, they'd sell me a policy. For $835/month. That meant that for premiums alone -- not counting co-pays and deductibles -- I would have been paying more than $10,000/year for private insurance I would hardly use. I COULD have paid that, but what kind of idiot would pay those premiums when self-insuring would cost me around $500/year, absent a catastrophic event? That's about how much I spend annually for doctors' visits paying cash. To that cost, I added a catastrophic coverage plan that cost an additional $516/year. So my total cost to self-insure with catastrophic coverage was $1,016 annually. Versus $10,020 annually. Get it now?
> 
> That's why I didn't buy their private insurance, and that's why a lot of people I personally knew didn't buy it. I knew MANY people who had been similarly characterized as "high risk," despite few if any real health issues, and based on reasons as stupid as mine was. They, too, chose to not pay those ridiculous private insurance premiums. And they were not poor. Just not eligible for group health coverage and not stupid.


There are a lot of people now that are in the same position you were in then. We are being forced, by law, to pay ridiculous insurance premiums on something we may rarely use. For many, unlike in your case, we are given a "choice" between many cost prohibitive insurances. I would jump on the chance to self insure with catastrophic coverage for $1,016 a year, as I'm sure many would.

I am now going to be one of those idiots that pay $10,000+ a year for catastrophic coverage. So, does it make me less of an idiot now that it's the ACA?


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## Raeven

where I want to said:


> It is quite clear that your definition is that the government, with your agreement, should decide who is not worth the expense. I'd say those who have paid for their insurance should have priority but in truth I think that the people involved are the ones with their doctors who decide.
> My father made that choice not to get treatment. But it was his choice.
> You make it sound like this is simple. It is not. It is rarely clear what is exactly going to happen. Would you deny a hip surgery that would give a 90 year old a comfortable two more years or let them writh in agony for those two years? Or would you yank the feeding tube so spouse could have the privilege of watching their partner of 60 years slowly starve? Or brain surgery for an old person that costs but could even return them to function?
> Just because they are old does not mean their life has no value.


No, not simple at all. That IS my point. And I have never said otherwise. These are horrible, difficult choices. I sure hated having profit be the motivator for making them.


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## Raeven

Terri in WV said:


> There are a lot of people now that are in the same position you were in then. We are being forced, by law, to pay ridiculous insurance premiums on something we may rarely use. For many, unlike in your case, we are given a "choice" between many cost prohibitive insurances. I would jump on the chance to self insure with catastrophic coverage for $1,016 a year, as I'm sure many would.
> 
> I am now going to be one of those idiots that pay $10,000+ a year for catastrophic coverage. So, does it make me less of an idiot now that it's the ACA?


How many people are you covering? I'm just covering me. I'll bet it's relative.


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## where I want to

Raeven said:


> You may disagree with the reasoning behind it, and I am not minimizing the actual consequences you feel you have suffered. However, to assert that there has been a direct cut of Medicare to fund the ACA is simply untrue. The reality is far more nuanced.


Agreement has nothing to do with it- it is in black and white in the law. It specifically calls for panels that removed the decision from the doctor and patient to form recommendations as to what would be covered and what not. It specifically called for reining in medicare reimbursements by this method along with capping the amount. 
It has not done this with the obamacare mandated insurances. So who do you think is going to pay for this?


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## where I want to

Raeven said:


> No, not simple at all. That IS my point. And I have never said otherwise. These are horrible, difficult choices. I sure hated having profit be the motivator for making them.


I hate the government to make the choices. With commercial insurance, I saved my life by getting a different policy. I'm now stuck at the mercy of the inflexible government.


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## Raeven

where I want to said:


> Agreement has nothing to do with it- it is in black and white in the law. It specifically calls for panels that removed the decision from the doctor and patient to form recommendations as to what would be covered and what not. It specifically called for reining in medicare reimbursements by this method along with capping the amount.
> It has not done this with the obamacare mandated insurances. So who do you think is going to pay for this?


It's obvious you hate the law and I have never said anyone shouldn't. I have said that if you're going to hate it, at least hate it on the basis of the facts. As Ox said, you'll get your chance to indicate your displeasure in November.

Here are some facts about the IPAB: http://en.wikipedia.org/wiki/Independent_Payment_Advisory_Board

You can decide if this is better or worse than who was making these decisions previously. Just understand that they were being made already.


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## Oxankle

"My husband, too, took a job exclusively for the health care benefits, when he arrived here from Australia. I could never really explain to him in a way he could understand why that was the case here in the States. He came from a commonwealth country where health care is free."

Again, this defies logic. Nothing is free. If you do not pay for your health care someone else has to pay. You have already mentioned the subsidy you get---where do you think that money comes from?

There will always be poor among us---I have no hesitation in approving the spending of public monies for the widow, the lame and the blind who cannot do more for themselves than try. 

Where I object is taxing the public to extend free anything to the woman who unwisely gets herself pregnant at sixteen, drops out of school and becomes a welfare ward. I object to paying welfare to the lout who ignores his studies, learns nothing of use to the world and shows up at every bar in town instead of taking his meager earnings home to his family. I object to paying the bills of illegal immigrants while millionaire labor contractors complain that the public is not sufficiently accommodating them. 
More than anything I object to people who think that the world owes them a living just because they exist. Obc is just another of those freebies extorted from the working class by those who vote for any politician who promises more from the public treasury.


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## Terri in WV

It'd cover myself and 3 kids. Our ages are 11, 12, 14, and 50. My total outlay has been less than $1,000 a year, because we are healthy.

If I stay in Ky, it will cost me a minimum of $9,117.24 annually in premiums. If I move to WV the minimum will be $9,385.80.


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## Raeven

Terri in WV said:


> It'd cover myself and 3 kids. Our ages are 11, 12, 14, and 50. My total outlay has been less than $1,000 a year, because we are healthy.
> 
> If I stay in Ky, it will cost me a minimum of $9,117.24 annually in premiums. If I move to WV the minimum will be $9,385.80.


I'll understand if you don't want to offer specifics on the public forum, but I'm curious if you carried insurance during the time your costs were under $1,000 a year? Or were those costs due to self-insuring and paying out of your own pocket only when you or family members needed medical care?

I raise this question because the reason that $1,016/year didn't look so good to me is, prior to the ACA I would have paid for all *preventive care* out of pocket. So instead, I avoided getting such care. I didn't get physicals, lab work, EKGs, nothing. Like you and your family, I am fortunately very healthy and didn't need such care -- *as far as I knew.* I was glad to verify I AM that healthy, which is why paying nearly three times as much now is preferable to me than taking the bare bones coverage that was all that was available under the old system. I am appreciative to have access to preventive care again.

As far as your premiums, you're paying less per person than I am. And unless I suffer a major medical issue, I'll pay more in premiums than my preventive care would have cost to pay for it myself. So no free lunch here. And clearly, no free lunch for you, either!


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## Jim-mi

First let me say that in my post when I said "poo-poo . . and loved ones" . .that was intended as a broad sweep of the brush and NOT specifically pointed at Raeven . .sorry if it was wrongly taken.
Yes the lady (Beth) surprised me when she brought up the "death panel" thing while she was with drawing my blood.. I did not initiate the subject. Heck when someone is going to do blood work or needles on me I have to turn away and shield my view of such activitys . .I HATE needles . . . . .any way, after she brought up the subject I deemed it best not to ask for specifics . . . . .so I know not any particulars. Just the way she said it I darn well know that she was hoping for some kind of intervention and was being denied it. . . . .meaning a sooner demise of her husband....

But I will be very vocal about "When is it time to quit" . . this should be one of those heart wrenching discussions with an on the scene physician involving the at hand data . . . . .And NOT be dictated by some far off uncaring yea-hoos . . .whose main interest is the almighty dollar. . . . . . .Each and every case is different.
I am very fortunate that after my accident, the Orthopedic Dr. called in four different Dr's to consult about saving my leg or amputating. 
I really do think that today the stupid bean counters would say . . Far and away cheaper to cut the leg off.......And no amount of discussion is going to change my mind other wise.................

Yes it is far better to attempt discussion of this contemptuous subject than to fling darts at each other....

PS I should have added my accident happened just before the aca was rammed down our throats.


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## Raeven

Jim-mi said:


> First let me say that in my post when I said "poo-poo . . and loved ones" . .that was intended as a broad sweep of the brush and NOT specifically pointed at Raeven . .sorry if it was wrongly taken.
> Yes the lady (Beth) surprised me when she brought up the "death panel" thing while she was with drawing my blood.. I did not initiate the subject. Heck when someone is going to do blood work or needles on me I have to turn away and shield my view of such activitys . .I HATE needles . . . . .any way, after she brought up the subject I deemed it best not to ask for specifics . . . . .so I know not any particulars. Just the way she said it I darn well know that she was hoping for some kind of intervention and was being denied it. . . . .meaning a sooner demise of her husband....
> 
> But I will be very vocal about "When is it time to quit" . . this should be one of those heart wrenching discussions with an on the scene physician involving the at hand data . . . . .And NOT be dictated by some far off uncaring yea-hoos . . .whose main interest is the almighty dollar. . . . . . .Each and every case is different.
> I am very fortunate that after my accident, the Orthopedic Dr. called in four different Dr's to consult about saving my leg or amputating.
> I really do think that today the stupid bean counters would say . . Far and away cheaper to cut the leg off.......And no amount of discussion is going to change my mind other wise.................
> 
> Yes it is far better to attempt discussion of this contemptuous subject than to fling darts at each other....


Thanks very much for your clarification, Jim. It means a lot to me.


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## viggie

No worries. It's a political construct, so it really can't be divorced from our political views. Just how it is.

And yes, I know for a fact it was the ACA based on discussions and the timing, as well as the official reason for the 7% across the board layoff.


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## Raeven

viggie said:


> No worries. It's a political construct, so it really can't be divorced from our political views. Just how it is.
> 
> And yes, I know for a fact it was the ACA based on discussions and the timing, as well as the official reason for the 7% across the board layoff.


If I owe you an apology, then you have it, unequivocally. I'm sorry. Your observation about it being a political construct is well taken, for sure.


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## Belfrybat

For heaven's sake, Viggie, cool it! YOU are the one trying to make this into a political argument, not Raeven, and as far as I can see no one else is trying to pull this thread down to General Chat levels -- just you. Yes, you have a right to your feelings, but again and again Raeven has tried to keep the level to facts, and you seem determined to undermine that. 

I've read the whole thread, and Raeven was up-front in her attempts to keep it off political footing and to try to explain the facts of the new law to the best of her ability. And until you took over the argument, she was pretty much successful. 

Most of the folks here don't like the law. I don't like it either (probably for different reasons than you), but whether we like it or not, it's important to try to understand what is actually is and not what the rumours say it is. I think it was nice of Raeven to try to explain some of it as objectively as possible. Just because we don't like something is no reason to not try and understand what is *now the law*. Will it be the law 5 years from now? Who knows, and frankly I don't care. What I do care about is the importance of having it explained as objectively as possible. And as far as I am concerned Raeven has attempted to do that and you are attempting to derail her at every turn.

Raeven, might I suggest you no longer respond to Viggie -- it does nothing but derail the conversation that was going on. I appreciate what you've tried to do and I appreciate your generosity in attempting to defuse the bomb he keeps wanting to light. I think we would all benefit if you could just ignore his comments so the conversation can get back on track, if that is even possible at this point.


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## Raeven

Belfrybat... it's kind of you to take up on my behalf, and I am grateful to hear that in the opinion of some, at least, I have accomplished what I have tried hard to do. But I do also appreciate viggie's point of view, given all she has endured as a result of this legislation. Her perspective is a valid one and although I have winced at her anger directed toward me, I am sympathetic to her situation. I am also happy to hear her point of view. I won't ignore her. She has important things to say, same as anyone in this thread, and if we were all required to speak in a certain way to be heard, then a lot of information would go begging. 

I love your tagline. I wish more felt the same. Thank you, again.


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## Terri in WV

Rae, I won't go into our preventive care as I'm in agreement with zong, that this looks like it's starting to head south. 

I would like to thank you for starting this and being able to give informed information about how the ACA works. 

As you've said, it is what it is, and we will all have to work with it to the best of our ability. And I believe, that no matter where any of us stands on the issue, we are all in for a very bumpy ride until this gets sorted out. 

I didn't sign up for anything, because of the potential move. I know that there will be a penalty(or whatever it may be called) for that. If you happen to know the details of how signing up in the future works(or doesn't), I'd very much appreciate hearing it. Publicly or privately, it doesn't matter as I value your opinion.


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## Jim-mi

Because the political wheels turn so confoundedly slow and the hacks in DC seem to know every which way to pontificate about an issue . . .but not how to solve it. . .--We--best listen to a person like Raeven so as to get many pointers about how to get along with this very nasty **law**.....
.Quite obviously I am more than a bit unhappy about aca

So instead of shooting the messenger (Raeven), . .aim your salvo's toward the politico scumbags who are responsible for this mess . .. . . .


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## Cookie2

Raeven said:


> Cookie2â¦ Itâs impossible to separate the politics from the policy in this discussion, isnât it? How we approach a solution to our health care systemâs problems is driven by our own ideologies.
> 
> ~ I wasn't talking about politics. I was writing about the tax code and the US Constitution. I believe this "health care system's problems" were created by laws that weren't fixed - nor even addressed! - in the writing of the Obamacare law. Obamacare just makes the situation worse. I agree that our approach differs and differs dramatically. Too many people believe that it is government's role to fix the problem. I say it is government's role to pass laws repealing the previously created laws that made this problem, then get out of the way!
> 
> You hit the nail on the head when you said that the reason medical providers can charge so much is because they can. And why is that?
> 
> ~ As I stated before, they can and do because the current tax code encourages them to. Also, there are laws and/or practices that say that a doctor won't (or can't) advertise. Ever notice how you never see doctors with ads in the newspaper with "this month a 20% discount on all bladder surgeries - normally $1000, now just $800". Slowly we're getting to the point where some clinics will give you a price sheet if you ask for one ($50 for a 15 minute appointment, for instance) and some will run specials (my daughter's pediatrician ran a "back to school special" of $25 cash as long as you didn't expect them to submit to insurance) and there are now concierge doctors that advertise their services. As to ambulances, I used to live in an area where you could be an ambulance service annual member for $75. If you needed an ambulance, even a Life Flight, you got the service for a greatly reduced price. I believe if we let true market forces work ... you really could compare medical providers based on price and benefits, then we'd see a reduction in some costs.
> 
> 
> I bang on the insurance companies the most re their profits, but non-profit hospitals are making out like bandits, too, owing to the tax breaks they get for their status as non-profits. Itâs funny, isnât it, how ânon-profitâ hospitals can be so wealthy?
> 
> ~ I refuse to get into a discussion berating businesses for being successful.
> 
> Iâve read often that something between 50-64% of all bankruptcies filed in this country were due to costs from an unforeseen medical crisis in the family.
> 
> ~ Wrong statistic! over 50% of all bankruptcies filed in this country are due to MEDICAL DEBT - unforeseen or otherwise.


My objections to Obamacare include everything I mentioned in my previous post plus the fact that the "affordable" portion of the plan is that it is welfare and nothing more. The 'subsidy' is welfare. The 'tax' is to help fund that welfare.

In summary: The federal government caused the problem (with decades of Progressive policies and laws) and now the federal government has passed yet another law making matters worse.


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## Raeven

I think it's obvious we are no longer discussing the specific requirements of the legislation as it was enacted, and I'm not going to be drawn into further political debates about it. Anyone who has a specific question, please feel free to PM me. If I can provide an answer, I will be happy to do so. Thanks to everyone who participated in the discussion with the understanding that it was about the law itself, and not the politics that attended it.

If the mods determine it is best to close this thread as it devolves into a political cat fight, then I agree it is for the best.


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## L.A.

Is it time yet???

Come On!!! You said there would be Ice Cream,,

I think I just pack up my Government penalty fine and go out to the barn,,,,

I've got my own Ice Cream stashed behind the horse meds,,,,,

:sing:


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## Guest

Raeven said:


> I think it's obvious we are no longer discussing the specific requirements of the legislation as it was enacted, and I'm not going to be drawn into further political debates about it. Anyone who has a specific question, please feel free to PM me. If I can provide an answer, I will be happy to do so. Thanks to everyone who participated in the discussion with the understanding that it was about the law itself, and not the politics that attended it.
> 
> If the mods determine it is best to close this thread as it devolves into a political cat fight, then I agree it is for the best.


Way past time !!!


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## Guest

Just my own 2 cents..

Is there ever a need to withhold medical/surgical care from anyone regardless of cost?

No. The instant that it becomes OK, we enter another world of ethics..the infant born with severe heart disease...some people would euthanize him becaue the cost of the surgical repair is too high.. the 95 year old woman who still takes her sailboat out on the Chesapeake who now has pneumonia..some people would deny her treatment because of her age..
the 60 year old farmer with liver failure ..transplant denied because he's too old and near retirement age anyway..

I believe in the sanctity of life..the "life ethos" if you will..when a life is judged to be "unworthy of saving", civilization is diminished.


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## Jim-mi

Which is a huge part of the aca nonsense.
From all that I am getting the "death panel" actions will be greatly exacerbated by the bean counters . .. . . .
Absolutely . .the "life ethos". . .shall not be judged by a far off "panel" of idiots.


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## Raeven

Fact:

There are no âdeath panels.â Did you read the link I posted earlier, re the Independent Payment Advisory Board? http://en.wikipedia.org/wiki/Independent_Payment_Advisory_Board

*That is the only board that was created by the ACA*. IPAB is tasked with developing specific proposals to bring the net growth in *Medicare* spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015.

With regard to IPAB's recommendations, the law says "The proposal *shall not include any recommendation to ration health care*, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria."

Any exclusion for coverage anyone is suffering under Medicare predated the ACA.


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## Guest

Please address what effect obamacare has on people that has medicare advantage plans .


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## where I want to

Raeven said:


> Fact:
> 
> There are no âdeath panels.â Did you read the link I posted earlier, re the Independent Payment Advisory Board? http://en.wikipedia.org/wiki/Independent_Payment_Advisory_Board
> 
> *That is the only board that was created by the ACA*. IPAB is tasked with developing specific proposals to bring the net growth in *Medicare* spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015.
> 
> With regard to IPAB's recommendations, the law says "The proposal *shall not include any recommendation to ration health care*, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria."
> 
> Any exclusion for coverage anyone is suffering under Medicare predated the ACA.


I think subsidized obamacare enrollees should have a panel to bring in their costs into line with target levels too. After all, medicare at least had tax provisions to cover most of it's cost while obamacare subsidies are sheer expense.
This is and always was like Obama's promises- he promises benefits will not change but he will arrange that ever decreasing numbers of providers will give their services due to the amount of effort needed to prove that services are really needed that gains them so little in return.

Since it's so wonderful, you should share it too.


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## Raeven

WV Hillbilly said:


> Please address what effect obamacare has on people that has medicare advantage plans .


I thought you wanted me to shut up. 

Seriously, that's information that exceeds the scope of my knowledge of the law. My work does not extend to Medicare coverage or the various Part plans, so I have no details on the law's impact on those plans, if any.


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## Belfrybat

I don't know of any impact the ACA has directly on Medicare Advantage programs, but I did read earlier today that the Advantage programs will be given more money in 2015. Or depending on which article I read, less of a cut. A couple of years ago there was talk about them being done away with as it costs more for them to provide services than traditional Medicare -- as I remember it at the time it was like $10-15 more a month. But apparently that tide has turned and they will continue to be funded. 
http://www.washingtonpost.com/busin...d92462-bea0-11e3-9ee7-02c1e10a03f0_story.html


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## where I want to

According to the article you cite-

"The government has paid insurers who run Medicare Advantage plans more per enrollee than the cost of care for people with traditional Medicare coverage. But that is being scaled back in part to help pay for the overhaul, the massive federal law that aims to provide insurance for millions of uninsured people.

UnitedHealth Group Inc. is the nationâs largest provider of the coverage. Its CEO, Stephen Hemsley, told analysts earlier this year that 2014 reimbursement was cut about 6.7 percent, and a similar cut for 2015 would be âextraordinarily disruptive.â"

It says the program has been cut to fund Obamacare, that this years cut is expected to be less. The insurance companies responded to the cuts by restricting networks, etc.. So why woukd anyone think that it hasn't effected Medicare enrollees negatively?


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