View Full Version : So what do you think that future of the ACA might be?
gimmethesimplelife
11-15-13, 11:58pm
I bring this topic up as it seems today that 39 Democrats sided with Republicans in supporting legislation that seemingly goes against the spirit of the ACA, and today we have Mr. Obama backpedalling on his signature legislation. I am not here this time to support or criticize ObamaCare - those who post on this topic all know where we all stand.
What strikes me at this point is that this legislation has had more twists and turns in the plot than a Mexican telenovela - for those who have never seen a Mexican soap opera, they typically last only four to five months and have numerous completely over the top twists and turns in the plot - more so than American ones do. I really am wondering now what the final outcome/form of the ACA will be? It is seeming to be possibly taking new forms of late and at this point it seems like it may be beyond the Democrat's ability to control it.
So what do you'all think of the future of the ACA? I personally find the numbers of those who have enrolled to be a huge disappointment BUT I do take some hope in the fact that the one area that the ACA seems to be working well is in the states that have expanded Medicaid - those enrollment numbers for Medicaid make me take heart as I know what a relief it will be to so many people at that end of the income scale to actually have their lives worth insurance.
Other than that, I'm thinking Mexican telenovela on this law at the moment. Rob
I'm thinking of moving to a country that can manage to actually do this sort of thing correctly.
iris lilies
11-16-13, 1:24am
I'm thinking of moving to a country that can manage to actually do this sort of thing correctly.
I listened to the President's press conference yesterday. He is talking about you, bae. You are only 5% of the population, the "individual market." According to the President:
1) there is constant churning in this market
2) It's not very stable or reliable
3)People have a lot of complaints about [your] product.
unstated, but heavily implied: you need to be grateful for the Prez getting you out of that deal.
Here's the full speech and his faux apology is about 18:00 to 20:00 into it. He seems to be saying that when he told people that they could keep their insurance, it was only the 5% in the individual market that he was speaking to. Employers who are dropping plans right and left leaving their employees out there without coverage are not addressed in his mea culpa. At least, not in the section I watched.
http://www.youtube.com/watch?v=rhPTEEHnUY0
iris lilies
11-16-13, 1:30am
I bring this topic up as it seems today that 39 Democrats sided with Republicans in supporting legislation that seemingly goes against the spirit of the ACA, and today we have Mr. Obama backpedalling on his signature legislation. I am not here this time to support or criticize ObamaCare - those who post on this topic often know where we all stand.
What strikes me at this point is that this legislation has had more twists and turns in the plot than a Mexican telenovela - for those who have never seen a Mexican soap opera, they typically last only four to five months and have numerous completely over the top twists and turns in the plot - more so that American ones do. I really am wondering now what the final outcome/form of the ACA will be? It is seeming to be possibly taking new forms of late and at this point it seems like it may be beyond the Democrat's ability to control it.
So what do you'all think of the future of the ACA? I personally find the numbers of those who have enrolled to be a huge disappointment BUT I do take some hope in the fact that the one area that the ACA seems to be working well is in the states that have expanded Medicaid - those enrollment numbers for Medicaid make me take heart as I know what a relief it will be to so many people at that end of the income scale to actually have their lives worth insurance.
Other than that, I'm thinking Mexican telenovela on this law at the moment. Rob
That's funny! I don't watch Mexican tv productions, but maybe it is like.
It's not nearly as exciting, though, as the 2000 Presidential election with all of those twists and turns, court decisions, recounts, hanging chads, and the Florida Sec of State's sexy mama press conferences.
ApatheticNoMore
11-16-13, 1:50am
Why the country can't even get this halfway right probably has to do with the money and corruption in the whole political process. It might not be so cool that congress is entirely bought and sold. I mean even short of universal coverage we can't EVEN get drug prices like the rest of the world has, which you think would at least be included in any decent healthcare reform bill. Why? Pharmaceutical companies give too much money to our government.
What will happen, well they could just keep the parts people don't hate: mostly the laws regarding preexisting conditions, and expanded medicaid, add some things that have a better chance of working like re-importation of drugs and lowering the Medicare age (even if not till age zero). But instead we'll probably be stuck with this for awhile.
gimmethesimplelife
11-16-13, 2:02am
That's funny! I don't watch Mexican tv productions, but maybe it is like.
It's not nearly as exciting, though, as the 2000 Presidential election with all of those twists and turns, court decisions, recounts, hanging chads, and the Florida Sec of State's sexy mama press conferences.I gotta agree with you, IL. The Prez elections in 2000 - there was some good political drama there with all kinds of twists and turns. Rob
gimmethesimplelife
11-16-13, 2:21am
I listened to the President's press conference yesterday. He is talking about you, bae. You are only 5% of the population, the "individual market." According to the President:
1) there is constant churning in this market
2) It's not very stable or reliable
3)People have a lot of complaints about [your] product.
unstated, but heavily implied: you need to be grateful for the Prez getting you out of that deal.
Here's the full speech and his faux apology is about 18:00 to 20:00 into it. He seems to be saying that when he told people that they could keep their insurance, it was only the 5% in the individual market that he was speaking to. Employers who are dropping plans right and left leaving their employees out there without coverage are not addressed in his mea culpa. At least, not in the section I watched.
http://www.youtube.com/watch?v=rhPTEEHnUY0Thanks for posting this, IL. I had not heard it or seen it. I see the points he makes and I agree with them (and I admit here I am not in that 5% audience, and if I were, yes, I might see things differently). To me the points he makes between 18:00 and 20:00 make sense BUT I would agree that it is a faux apology - it is more an explanation and no real heartfelt apology at all. Again, I understand my POV comes from someone who stands to gain - at least to start with - due to the ACA. (if it remains intact in it's current form, anyway....which my gut is telling me is debatable) Rob
I listened to the President's press conference yesterday. He is talking about you, bae. You are only 5% of the population, the "individual market." According to the President:
1) there is constant churning in this market
2) It's not very stable or reliable
3)People have a lot of complaints about [your] product.
unstated, but heavily implied: you need to be grateful for the Prez getting you out of that deal.
Gee, thanks. I've had essentially the same policy, with the same company, for a dozen years. It has met my needs, at a cost I found fine.
It's now gone.
I hope this changes.
Luckily, Canada is only 2 miles away.
gimmethesimplelife
11-16-13, 2:23am
Gee, thanks. I've had essentially the same policy, with the same company, for a dozen years. It has met my needs, at a cost I found fine.
It's now gone.
I hope this changes.
Luckily, Canada is only 2 miles away.I'm intrigued. Do you go to Canada for health care, if I may ask, or do you intend to in the future? I'm just curious as to your reference to Canada as it does have universal health care - not the American model of care. Rob
I'm intrigued. Do you go to Canada for health care, if I may ask, or do you intend to in the future? I'm just curious as to your reference to Canada as it does have universal health care - not the American model of care. Rob
I was thinking of simply moving there. If I'm going to have to live in a place where the government is involved in my healthcare, I'd rather trust the Canucks to get it right.
catherine
11-16-13, 7:55am
It seems like the deals Obama made to insurance companies that put them in the driver's seat in order to get Obamacare a reality, such as mandating HC for everyone, and raising rates to enable high-risk people to get full coverage, has backfired. That was the part that I didn't like. As much as I believe in affordable health care for everyone, it became affordable for a few and unaffordable for many. ANM, you're right, it's probably because he had to sell his soul to the insurance industry.
I don't know what will happen now, but it feels like unless there's a miracle, it may get put on hiatus or shelved. If it gets shelved, the insurance companies are not going to be happy after the millions they've spent setting up their side of the deal. Wouldn't it be great if it wound up forcing the insurance companies to lower their rates for individuals as a better alternative to shutting down the plan altogether?
ACA has already brought about some highly-critical, irreversible changes: Even Republicans are standing up and declaring that they will protect ACA's Guaranteed Issue provisions, even as they attempt to repeal the rest of it. No longer will insurance pools exclude those with preexisting conditions. No longer will insurance pools exclude those who have exceeded a lifetime cap. And since the Republicans tried to use the "death panels" idiocy in their original objections to ACA, we're not going to see any efforts to cut the legs out of Guaranteed Issue from that angle.
ACA's Age Rating provision is similar in that it aims to keep the added risk associated with growing older from making health coverage unaffordable. My hope is the fact that folks in that age range and those approaching that age range will have the political power to safeguard that provision. The fact that we've heard so little about it gives me some hope in that regard, though it is important to keep in mind that this provision is the one that goes hand-in-glove with the individual mandate. What's important here is to make that link very clear: Attacks on the individual mandate are attacks on older, pre-Medicare Americans in the same way that privatization of Social Security is an attack on older Americans (in general).
ACA's Medical Loss Ratio provision has actually already been in effect for long-enough that some folks are going to be receiving their second rebate checks soon. I think it is possible that some back-door negotiating could undercut that provision - a give-back to the insurance industry in return for supporting some other change - but unless it is an even exchange from the subscribers' standpoint, expect that any attack on Medical Loss Ratio to come with a very substantial cost on those who support it.
ACA's Essential Benefits provision is, and will always be, a matter of contention and it'll go back and forth as do all things in our nation. It is a shame that right-wingers cannot see past their obstinacy and see Essential Benefits for what it is: Their best path to something they said they wanted, i.e., selling insurance across state boundaries. Of course, it is possible that right-wingers never really wanted what they claimed they wanted, and instead really just wanted the right for states to treat their own poor citizens like crap, and be able to export that crappy treatment across state lines. Regardless, I believe we'll see Essential Benefit change every time there is a change in Congress and the White House, adjusting to whichever side is currently riding high.
Which basically leaves the exchanges and the subsidies, i.e., those things (along with the individual mandate) that folks ignorant about ACA think are the entirety of ACA. We've already seen cycles in our lifetime where socially conscious partisans prevail in bringing about some measure of justice for the poor only to have the downside of the cycle result in taking those measures away (Pell Grants, for example - though let's be clear - education, as worthy as it is, is far less critical than health). It is not possible to predict whether self-focus or social consciousness will be the long-term trend, but at least over the last 350 years that trend has been toward the latter. However, we could be entering a new Dark Age - who knows?
I have been a supporter of Obama through the years, but this could be the end of our relationship. When all is said and done there may be a happy ending, but the entire roll-out has been a demonstration of incompetence and deception. It is truly sad as this could have been a landmark move forward if handled correctly. Now, even if the people who could not afford insurance or had pre-existing conditions end up happy campers the blundered roll-out will not be forgotten and will cloud or overshadow any benefits. I can only imagine the fiasco if the young and healthy decide not to enroll and the entire program flops. I am embarrassed by our government in totality.
In the Shields and Brooks discussion last night they said this could well be "the end of liberal government". http://www.pbs.org/newshour/bb/politics/july-dec13/shieldsbrooks_11-15.html
Of course people have short term memories. Remember only two years ago the main issue was the economy. When things go well, they seem to be forgotten quickly.
iris lilies
11-16-13, 12:43pm
...but the entire roll-out has been a demonstration of incompetence and deception... .
I am happy to participate in your watershed moment.
Mine came as a result of forced intimacy with the local Housing Authority, puppets of the feds, where every lie, incompetant act and supercilious bureaucrat you could imagine was part of the game. I live a couple of blocks from public housing. People in our neighborhood were always recruited to participate in the planning meetings for the multi-year project that razed the public housing towers of the 1960's and their internal rot in order to build another project that cost the taxpayers billions.
I voted Democrat until I saw what federal government really could produce: the 21st century version of same old drug pushers, unwed baby mamas and homicides. Gosh, the time I put into that project! But most importantly, I was a fool, a trusting fool.
On the bright side, I always think that these interactions with HUD as well as other push-backs against threats from the city and state helped to shape our neighborhood in being the strong take-no-prisoners place that we are. You threaten us baby, and you have a force to contend with.
But yes, now I vote Republican after seeing up close and long term how incompetent and misguided are gooberment do-gooders are. A pox on them.
I was actually surprised that the ACA got as far as it did. The Clintons had started to address health care and backed off when they saw what a political hand grenade it was. It turned out ACA didn't change or improve my situation whatsoever, so my interest in any undoing of it that might arise is purely academic, except that I dare hope this may mean less drama over the budget in January.
ApatheticNoMore
11-16-13, 2:33pm
In the Shields and Brooks discussion last night they said this could well be "the end of liberal government".
of course it's not liberal government. Liberal government would have been single payer, no insurance companies. It may have worked and it may not have (though really at least it has a track record - both other countries and Medicare). It might be some compromise between liberal government and being owned by pharma, hospitals and the insurance companies but is any such compromise really possible? And never even mind liberal government is even good centrist government possible in those situations?
By the way the states could eventually try single payer if they wanted to. ACA and many people's premiums rising and insurance company policies that don't cover anything, I mean our healthcare system is going to be pretty bad, so why not? Vermont plans single payer for 2017 and I hope they get their crack at it. And while I don't think it's going to happen immediately in California (bankrupt state is bankrupt afterall) other states are better positioned.
I would like to see the absolute end to greed-driven health care, but I suppose that's too much to hope for. Insurance agencies and Pharma have an iron-handed grip on the system, and they're not about to give that up.
So what do you'all think of the future of the ACA? I'm not sure. Right now its suffering from the shock of ideology crashing into reality. It's architect's have been damaged by the growing realization that they lied about affordability and portability as well as the realization that the President seems to believe that he can simply ignore the elements of his own law that prove to be inconvenient, thereby putting the fairness of any law in jeopardy. It also highlights the level of ineptitude of this administration that even its most hard core apologists find difficult to ignore
The ACA has always been, and will continue to be, a bad law. Right now the tide seems to be rising against it as people see its destructive power, and we haven't even gotten to the stage where the employer mandate will have negative effects on a much larger demographic.
My gut feeling is that it has done long term harm to progressive politics in this country, which is a good thing IMHO.
I think everyone should chill and let the ACA get up and running. Let's revisit this in a year or so and then see how it's working.
iris lilies
11-16-13, 9:09pm
I think everyone should chill and let the ACA get up and running. Let's revisit this in a year or so and then see how it's working.
What exactly does "chill" mean if one is without insurance? Does it mean tral laa tra laa I'll worry about that tomorrow, or--?
I think everyone should chill and let the ACA get up and running. Let's revisit this in a year or so and then see how it's working.
Alot of my friends that are low middle income have had their medical insurance cancelled, either individual plans or through their employers. They all have said that the ACA plans are unaffordable for them - either they can't afford the payments for them, or if they go with the cheaper plans (which are not cheap, by the way) then they can't afford the deductibles... What are they supposed to do? Chill - and see how it goes in a year or so, when they have health problems of their own and kids that get sick....nevermind the occasional car wreck or cancer scare that may come up. They should just chill - HUH????
There is nothing about ACA that makes people who previously could afford reasonable healthcare suddenly become unable to afford reasonable healthcare. There are probably other considerations in their lives that they're not sharing with you, such as how affording healthcare now means being unable to afford some other, discretionary spending that they want to engage in. There is a lot of resentment that the compromise doesn't make rich people pay for it all and that as a result folks just over the poverty line are forced to redirect money associated with some of their elective expenses to pay for reasonable healthcare.
goldensmom
11-17-13, 7:58am
I think everyone should chill and let the ACA get up and running. Let's revisit this in a year or so and then see how it's working.
Okey-dokey (speaking for a friend) while I’m chillin’, whose going to pay for my chemo treatments, high insurance premiums and deductable (already checked it out) of an alternative insurance after my affordable, employer group health insurance had been cancelled?
There is nothing about ACA that makes people who previously could afford reasonable healthcare suddenly become unable to afford reasonable healthcare. There are probably other considerations in their lives that they're not sharing with you, such as how affording healthcare now means being unable to afford some other, discretionary spending that they want to engage in. There is a lot of resentment that the compromise doesn't make rich people pay for it all and that as a result folks just over the poverty line are forced to redirect money associated with some of their elective expenses to pay for reasonable healthcare.
+1
Alot of my friends that are low middle income have had their medical insurance cancelled, either individual plans or through their employers. They all have said that the ACA plans are unaffordable for them - either they can't afford the payments for them, or if they go with the cheaper plans (which are not cheap, by the way) then they can't afford the deductibles... What are they supposed to do? Chill - and see how it goes in a year or so, when they have health problems of their own and kids that get sick....nevermind the occasional car wreck or cancer scare that may come up. They should just chill - HUH????
This is the result of having for-profit insurers as middle-men in health insurance. ACA is the bastard political child of that demand. If all of these people had banded together to insist that congress pass single payer, we wouldn't be in this situation. In the meantime they can direct that outrage to Sen. Max Baucus who refused to let single payer even be considered.
And yes, I have insurance through my employer and guess what, my deductibles are way up too.
This is the result of having for-profit insurers as middle-men in health insurance. ACA is the bastard political child of that demand. If all of these people had banded together to insist that congress pass single payer, we wouldn't be in this situation. In the meantime they can direct that outrage to Sen. Max Baucus who refused to let single payer even be considered.
And yes, I have insurance through my employer and guess what, my deductibles are way up too.
+1 - for all the problems of Medicare, I don't see many people for just getting rid of it and throwing the elderly back on the insurance market (except for maybe the pro voucher folks).
I've been watching my employer chip away at health benefits long before ACA came along.
flowerseverywhere
11-17-13, 11:33am
I would like to see the absolute end to greed-driven health care, but I suppose that's too much to hope for. Insurance agencies and Pharma have an iron-handed grip on the system, and they're not about to give that up.but we let them have this grip. How many people work hard to lower their cholesterol and blood pressure without a pill? I know someone who has an incurable cancer and has endured 7 months of expensive chemotherapy that leaves them pretty much either on the toilet or in bed. I am not sure why. And those ads for electric chairs that claim they can get your insurance to cover. Don't you think the decision should be in the hands of the physicians, not the companies? Poor health claims many victims, people who have tried to live a healthy life that get cancer, or have heart attacks etc. But taking responsibility to be as healthy as possible would go a long way to lowering our costs.
The law will have to be revised, but I can't see us going back to caps and pre-existing conditions excluding you from getting coverage. I do feel very bad for people who have had their greedy employers see this as a way out of providing the benefit of group health insurance to their employees and retirees that they made promises to.
ApatheticNoMore
11-17-13, 1:45pm
Well see I see the need for people to pay more and more of their income for necessities as a bad thing (one could make a very good argument about prices should include more externalities but that has nothing to do with the ACA, those prices are high due to rent seeking period and I'm not so keen on "prices should include abundant rent seeking"). Overall I think making basic necessities cost more disempowers people, it makes them more and more dependent on more and more income just for mere survival - basically it enslaves them to the need to earn lots of income almost always working for others all the more - how on earth is that ever going to put working people in a good bargaining position?
Of course the ACA is a mixed bag in that regard as some people are getting better deals on health insurance or for those in a narrow range it may help them in self-employment, and yes this is so even though many of the ACA policies aren't of very good quality (high deductables, small networks etc.). What it also seems to be doing is eliminating the option of getting high quality healthcare plans for all but the super rich, PPOs going away, and everyone will be on HMOs with narrow networks, that don't pay out of network, with high deductables, etc..
Noone really wants all these crummy insurance plan "choices", what one wants is healthcare that one can actually afford to use, not to fear bankruptcy from medical bills, etc., but if you have an insurance market and you basically eliminate or make entirely unaffordable the few choices that *some* people had that may have been better at actually assuring this (reasonable deductible, wide network like PPOs etc.) then their health care situation is worse.
Well see I see the need for people to pay more and more of their income for necessities as a bad thingThe status quo (the most vulnerable in society being precluded from life-saving healthcare such as necessary cancer treatment) was unacceptable, and the alternative (the costs of addressing the essential needs of the most vulnerable paid in a more progressive manner) was not politically viable. It's kind of pointless to bring up the concern you raised without factoring in the rest of the reality.
There is nothing about ACA that makes people who previously could afford reasonable healthcare suddenly become unable to afford reasonable healthcare. There are probably other considerations in their lives that they're not sharing with you, such as how affording healthcare now means being unable to afford some other, discretionary spending that they want to engage in. There is a lot of resentment that the compromise doesn't make rich people pay for it all and that as a result folks just over the poverty line are forced to redirect money associated with some of their elective expenses to pay for reasonable healthcare.
Like they can't pay for their mortgage now or groceries or heat, etc. because they no longer have an employer that is paying a portion of their health insurance. And for those that have lost their individual plans they paid for all themselves there is a HUGE increase in the amount of payments for the ACA plans in comparison, or a HUGE deductible that is unaffordable for them when purchasing the cheapest plan offered.
Most of these friends are just scraping by and don't have any for discretionary spending. They live extremely modestly. They are all from my MS support group, so as you can imagine we have a lot of medical expenses in our lives.... ACA is unaffordable for them, although I guess they won't be denied coverage for a pre-existing condition, but that doesn't help much if you can't afford the payments or the deductible. I guess I am the lucky one, being just poor enough and on SS disability, which qualifies me for government help. But this ACA is going to break some of my friends.... I was hoping this would be a good thing for all. I sat and looked at the choice of ACA coverage plans with one of my friends a few days ago and it is so disheartening for this low middle income group that borders on poverty....
Like they can't pay for their mortgage now or groceries or heat, etc.No: Like they cannot afford a nice vacation or a new television.
Most of these friends are just scraping by and don't have any for discretionary spending. If your characterizations of their status are accurate and comprehensive, then ACA will be a net positive for them, despite claims to the contrary.
While everyone is complaining about the cost of insurance. Why arnt' they addressing the cost to the insurance company's? How much are the hospital's and health care workers making? How much do doctors and nurses in socialist country's make?
The ACA doesn't do anything to address the cost of healthcare as far as I know, except increase it by adding additional taxes to medical devices. Do they not think that that cost is simply going to be passed on.
As usual, this is the place where I ask why we really need insurance at all? Its a given that people need health care, but why do we need the middle men who are little more than economic bullies to both the consumers and the medical providers. When the ACA really morphs into the Affordable Care Act rather than the Affordable Insurance Act it will be a lot easier for this tax payer to support. As it sits compelling several million more citizens to become customers of an already bloated insurance industry under the threat of economic sanction is counter to my view of how it should be administered. I believe there are some other people out there with similar feelings. When Congress inevitably kicks this can out past the 2016 elections it is possible this objection could be heard and the current version of the ACA will become a footnote just above the one for "Hilarycare". I just hope someone smarter than me is able to come up with a plan that actually helps people in need of care more than it focuses on throwing mud on the opposition's plan. Big dreams...
JaneV2.0
11-18-13, 11:53am
Bravo, Gregg!
As usual, this is the place where I ask why we really need insurance at all? Its a given that people need health care, but why do we need the middle men who are little more than economic bullies to both the consumers and the medical providers. When the ACA really morphs into the Affordable Care Act rather than the Affordable Insurance Act it will be a lot easier for this tax payer to support. As it sits compelling several million more citizens to become customers of an already bloated insurance industry under the threat of economic sanction is counter to my view of how it should be administered. I believe there are some other people out there with similar feelings. When Congress inevitably kicks this can out past the 2016 elections it is possible this objection could be heard and the current version of the ACA will become a footnote just above the one for "Hilarycare". I just hope someone smarter than me is able to come up with a plan that actually helps people in need of care more than it focuses on throwing mud on the opposition's plan. Big dreams...
But then what would all those people that work in the health insurance industry do? And what did you expect when the act was put together behind closed doors with the insurance industry writing it up? Even Nancy didn't know what was in it.
As usual, this is the place where I ask why we really need insurance at all? Its a given that people need health care, but why do we need the middle men who are little more than economic bullies to both the consumers and the medical providers. When the ACA really morphs into the Affordable Care Act rather than the Affordable Insurance Act it will be a lot easier for this tax payer to support. As it sits compelling several million more citizens to become customers of an already bloated insurance industry under the threat of economic sanction is counter to my view of how it should be administered. I believe there are some other people out there with similar feelings. When Congress inevitably kicks this can out past the 2016 elections it is possible this objection could be heard and the current version of the ACA will become a footnote just above the one for "Hilarycare". I just hope someone smarter than me is able to come up with a plan that actually helps people in need of care more than it focuses on throwing mud on the opposition's plan. Big dreams...
Well, if we didn't have insurance who would negotiate for the rates that are paid to the medical profession. Isn't it the insurance industry that is the check and balance for the monopoly that the medical industry holds over us? And without the insurance industry maybe the government would have to regulate the medical industry, which doesn't seem like it would have popular support in today's political environment.
I do like the concept, but it raises some questions.
But then what would all those people that work in the health insurance industry do? And what did you expect when the act was put together behind closed doors with the insurance industry writing it up? Even Nancy didn't know what was in it.
I have to admit I've grown weary of the "what would all the displaced workers do" reasoning for avoiding changing turgid systems. That's especially true of government, but also insurance, healthcare, defense, agriculture and several other industries so swollen by fat government subsidies that they no longer have any kind of competitive sensibilities. The world changes. Workers will continue to be replaced by automation with or without the ACAs of the world. They will find new industries just like when steam put row boats out of business. To be responsible we need to cushion the blow, not avoid it.
Well, if we didn't have insurance who would negotiate for the rates that are paid to the medical profession. Isn't it the insurance industry that is the check and balance for the monopoly that the medical industry holds over us? And without the insurance industry maybe the government would have to regulate the medical industry, which doesn't seem like it would have popular support in today's political environment.
If the insurance industry is our only advocate, we're $*#ed.
I do like the concept, but it raises some questions.
The glory of armchair quarterbacking, I get to toss statements like that on the mat and let someone else propose solutions! :moon:
There is nothing about ACA that makes people who previously could afford reasonable healthcare suddenly become unable to afford reasonable healthcare. There are probably other considerations in their lives that they're not sharing with you, such as how affording healthcare now means being unable to afford some other, discretionary spending that they want to engage in. There is a lot of resentment that the compromise doesn't make rich people pay for it all and that as a result folks just over the poverty line are forced to redirect money associated with some of their elective expenses to pay for reasonable healthcare. If your income is below $16K (or $33K for a family of 4), have assets over $2K or so, and you live in one of the 30 plus states that did not expand Medicaid, then you do not qualify for subsidies or Medicaid. And if you have been buying your own low cost plan for approx. $100 - $200/month with approx. $4k deductible, and then have a 3 fold or more increase in premiums and a much higher deductible due to Obamacare mandates, that can mean you will have to pay 1/3 - 1/2 or more of your monthly salary to have medical coverage . I would say that would effect a lot of people a great deal. Even those with employer coverage who are low income are seeing rates rise for both their portion as well as their employees portion due to the changes. And because of some weird quirks in wording of the ACA, it is often difficult for many low income people who have employer medical coverage to get subsidies.
From the NY Times:
"When Income Is Too Low for Subsidies
Q: It seems that if a person or family that does not qualify for the states’ Medicaid program and earns too little to qualify for a subsidies they will have to pay the full insurance price or have no coverage. I thought the ACA was set up to protect these people. Is this really right or did I not understand the answer? –emjay, N.J.
Q. I read your article and was a little disconcerted by the Q&A related to people who had too much money to qualify for Medicaid and too little to qualify for subsidies on the exchange and will have to pay full price for coverage offered on the exchanges. This was a revelation to me, because I thought the Affordable Care Act was intended to provide coverage to this specific group, who likely are the uninsured working poor. How can you earn too little to qualify for a subsidy? Aren’t these the very people who need a subsidy? And what % of the population does this gap represent? What do they do for medical care? Am I missing something here? –Ellen Einiger, New York, NY.
A. You both understood the issue correctly. In my original column, I explained that the Obama administration’s health care law aimed to expand Medicaid so that everyone under age 65 would qualify if they earned up to 138 percent of the federal poverty level (that’s about $16,000 for an individual and $32,500 for a family of four in 2014). But the Supreme Court ruled in June that the decision to expand Medicaid is up to the states — and only 26 states have decided to move forward, according to the Kaiser Family Foundation.
So now, people may find themselves in an unfortunate situation: they may not be eligible for Medicaid and they may earn too little to qualify for subsidies on the exchange. More specifically, if you can’t get Medicaid and your income is below 100 percent of the poverty level, you will not be eligible for financial assistance on the exchange.
States like Texas and Louisiana have chosen not to expand their Medicaid program, even though the federal government will reimburse the full cost of the program for the first three years (and 90 percent of the cost thereafter), according to a spokeswoman from the Department of Health and Human Services. If you want your state to expand the program, you can tell your state governor and representatives in Congress (though many of them have made their opposition clear). A non-participating state can opt in at any time, the spokeswoman added.
It’s hard to say precisely how many people fall into this coverage gap. There are an estimated 7 million uninsured adults under age 65 with incomes below the poverty level living in states that have decided not to expand their Medicaid programs, according to Kaiser. (Most people over 65 are eligible for Medicare).
But that’s an imperfect estimate: It includes some uninsured adults who are eligible for their state’s current Medicaid program but who are not enrolled, a Kaiser spokesman explained, as well as some undocumented immigrants who would not be eligible for coverage under an expanded program even if their state were to go forward with one.
People in this situation should find out what services may be available through their local community health centers. "
If the insurance industry is our only advocate, we're $*#ed.
The glory of armchair quarterbacking, I get to toss statements like that on the mat and let someone else propose solutions! :moon:
I suppose in a free market economy we could pay what the market would bare. There would always the miracle of capitalism - credit. I suppose for a procedure like heart by-pass surgery requiring highly skilled workers and expensive equipment the banks would be willing to loan money to a person with a good down payment, collateral, and demonstrable income. Of course the risk of default would be high and require a high interest rate.
I suppose in a free market economy we could pay what the market would bare. There would always the miracle of capitalism - credit.
Seems to me there are many other solutions available. For instance, non-profit insurance cooperatives/risk sharing pools or social-based solutions such as the Amish use, or subscription medical services, or ....
ApatheticNoMore
11-18-13, 4:22pm
The Medicaid thing, it's curious the Republicans and Obama are all in a rush to pass something that will appear to help those with cancelled policies (it probably won't do much) but helping those inadvertently falling between the cracks of subsidies and Medicaid in verious states neither seems particularly concerned even with the appearance of doing something.
Seems to me there are many other solutions available. For instance, non-profit insurance cooperatives/risk sharing pools or social-based solutions such as the Amish use, or subscription medical services, or ....
I do like the Amish concept where medical treatment is paid for by contributions from the community.
I do like the Amish concept where medical treatment is paid for by contributions from the community.
First requirement there is "community". I expect (just my opinion) the Amish would not turn away from a phrase like "it takes a village".
If your income is below $16K (or $33K for a family of 4), have assets over $2K or so, and you live in one of the 30 plus states that did not expand Medicaid, then you do not qualify for subsidies or Medicaid.That should be fixed.
The Medicaid thing, it's curious the Republicans and Obama are all in a rush to pass something that will appear to help those with cancelled policies (it probably won't do much) but helping those inadvertently falling between the cracks of subsidies and Medicaid in verious states neither seems particularly concerned even with the appearance of doing something.At this point, that is going to have to be addressed at the state level.
No: Like they cannot afford a nice vacation or a new television.
If your characterizations of their status are accurate and comprehensive, then ACA will be a net positive for them, despite claims to the contrary.
Please reread my previous post and try and really pay attention this time. Then read Spartana's post. And maybe, just maybe you'll "get it". *sigh*
I read your message just fine. I understood Spartana's post just fine. I disagree with your conclusions. Read that over a few times and "just maybe you'll get it". *sigh*
The Medicaid thing, it's curious the Republicans and Obama are all in a rush to pass something that will appear to help those with cancelled policies (it probably won't do much) but helping those inadvertently falling between the cracks of subsidies and Medicaid in verious states neither seems particularly concerned even with the appearance of doing something. Yes I also wondered about that - once again the truelly poor are left to fall into the cracks while those with higher incomes can reap the benefits even after they max out their 401Ks, 457's, IRA's and other tax deferred things that allow them to lower their incomes to qualify for subsidies.
Personally I just don't know why Obama doesn't take the Medicaid option off the table completely (and leave the states out of it completely) and just offer subsidies (based on a sliding scale) to all income earners. Although that may still be too expensive for some low income earners to afford even basic medical care even if 100% of the premiums were covered due to very high deductibles, co-pays and co-insurance. But as it is now that is the case for those borderline low income people. Those who make just under $16K and live in expanded Medicaid states can get 100% free coverage with no premiums, no deductible, no co-pays and no co-insurance. Whereas a person making just above that cut off limit will have very large out-of-pocket expenses if they need to be treated even if most or all of their monthly premiums were covered by the subsidies. I guess that would be a pretty darn big incentive to keep one's income under 138% of poverty level so they can get totally free medical coverage - or stay unemployed or retire early on a low income and just be on Medicaid instead of working since there are no assets counted.
And btw, I just heard that - at least in Calif - that the states insurance regulators won't allow an extention of those lower cost policies that have been cancelled by longer than March 31, 2014 even if the feds approve longer extensions.=. That may happen in other states as well so even if the feds do get extentions passed, your state may not allow that.
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