Awesome.Originally Posted by puzzld
"So is Obamacare hurting all Americans? Of course not, just the teeny-tiny bunch of die-hard conservatives who will refuse to be helped. "
Awesome.
"So is Obamacare hurting all Americans? Of course not, just the teeny-tiny bunch of die-hard conservatives who will refuse to be helped. "
OK, well I received the termination letter and it looks like I am going to have to pay more. I have a policy with Assurant which does not meet the demands of the ACA. This is starting to suck.
Details?
I hope the next step in healthcare reform is to bring down the cost of healthcare. It's $185 to see my family practice doc. My husband got 5 stitches in his palm and it cost $5000.
I worked 35 years in healthcare. They redecorated the doctors lounge and imported antique stained glass windows that became skylights in the lounge. They spent a million dollars and installed a full size capuccinno machines. All leather furniture and big screen tv's. For fuck's sake they don't live there...they grab a cup of coffee between surgeries and make a few phone calls. Even the docs were embarrassed by the excess. This was when the hospital was a non profit, they are now a for profit hospital. The hospital I worked for bought up the majority of physician practices. They also bought land...lots of it, surrounding the hospital. They recently built a woman's hospital out in the boonies, where the rich people live.
I know medical equipment and hospital beds don't come cheap and I have to say the last time I was in the hospital I had the best bed ever and State of the art equipment and monitoring. Every nurse on staff has to have a bs in nursing and then continue college after being hired. The hospital reimburses staff 100% for college and really, obnoxiously pushes/forces people to get their masters. They don't hire LPN's unless it's the home health care program they bought up. They also own a private college. To me, it seems a bit over the top. I chose to quit working when they moved L&D to the new women's facility. Part of the reason is, they wanted me to go to New Mexico and spend 3 weeks taking some stupid course to become certified as a medical secretary. You would think that working in the field for 30+ years would make you a fucking expert at your job..lol It seems they want every single person working there to be educated to the max, which is a good thing, but in the larger scope of things not really necessary. I was admitted to intensive care. I had my first real bout of atrial fibrillation, which in itself isn't life threatening, but does increase your risk of a stroke. I think I could have been treated in a general medical floor or a cardiac floor. I'm thinking they had some empty beds in ICU and I have great insurance.
There was a time when health care was affordable. I have my bills from when my first child was born, even accounting for inflation, it was a cost that could have been dealt with without insurance by making payments for a couple years. With all the improvements to the facility and all the staff having masters degrees and being certified in their field, the infant mortality rate has gone up. The rate of hospital acquired infections has decreased slightly. The costs far outweigh the benefits.
My husband has excellant health insurance through his job. He works for a major cereal company and we pay nothing for our insurance. We have no co-pays, deductables or premiums. %100 free and yet, your breakfast cereal is affordable and the ceo's rake in million dollar bonuses every year. Elizabeth Warren advocates raising the minimum wage to $10.10/hr. She says it increases her cost of a #6 at burger king by 4 cents. I would think add affordable insurance in there too and the cost to the happy meal would be minimal. When companies sponser a gymnastics team and then pay a million bucks to put a winner on a box of wheaties...;I think they certainly can afford insurance. I also had an experimental device used in my neck a few years back. Our insurance didn't blink an eye, it was covered 100% and the manufacturer of the device paid me a few hundred dollars to be in a study of the device.
As I get the details I'll post them. It looks like I am going to fall outside of the subsidies by a bit and that I will have to buy more coverage. We've had trouble with the website thing so far.
I'm wondering if the pricing will level out once there is broader participation.
I buy my insurance privately with no help from my company. Coverage for me, the wife and 6 year old.
I will keep you updated is I get the exact details.
theoretically the coverage should get cheaper when more people are covered. this is a general principle of any insurance, the more people covered the less risk, therefore, the lower the premiums. it will be interesting to see if this happens, but i believe that it will and is a big part of why i support a single payer system.
i'm sorry your insurance dropped you, but i still believe that is purely a sign of greed. the companies can't make the $$$ they want to so instead of becoming 'affordable' they're choosing to drop people instead. how is that ethical business practice? it's throwing it in all our faces that profit is more important than the people you're covering.
did you say before you got a refund from your insurer because it was 'too' expensive by ACA standards?
we also won't really know what the tax 'credits' (i don't think they're true credits?) or breaks look like under the ACA.
Yeah I was with Assurant on family coverage, when I had the issue with my job dumping last November my coverage lapsed. In that interim we received a reimbursement check. A few months ago I put the wife on the mission of finding us new coverage, and we ended up by chance with Assurant again on an even lesser coverage plan but something I can afford out of pocket. We still have coverage, and the letter said something to the effect that the plan we have doesn't meet the minimum standards for the ACA. We only get 2 doctors visits a year, etc. So as far as I know I can keep it until january? We've been attempting to get on the healthcare market without success, but not sure last time she had a chance to try.
Seems like if I get coverage now, I'll probably pay more than if I'm able to stick it out as participation grows. Like it might be better to sue the benefits I'm already paying for as long as I can. From this vantage point, it looks like I will have to buy a plan with more traditional coverage that will be more expensive.
No, they are being dropped because their current policies don't comply with Obamacare's regulations. From the LA Times article on the prev. page:
Obamacare did nothing to address what's wrong with our current for-profit, fee for service health care system. All it did was to force everyone to buy insurance, and mandate that insurance must cover everyone for everything, forever, no limits. The young and healthy will pay more to cover the old and sick.Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage.
uhhhh, yeah, thanks for the bold print because satan knows i lack basic reading comprehension skills.
can you explain what regulations they aren't complying with? with links, pretty please? and not something from a biased news source?
i'm pretty sure the pricing is a big part of what they're refusing to comply with. a huge part of the ACA is to make insurance "affordable" (catchy name, huh?) buy including things like caps on how much you will pay out of pocket and creating tax breaks based on your income. which is why PCP got a refund check from this insurance company in the first place.
The LA Times is a biased news source?uhhhh, yeah, thanks for the bold print because satan knows i lack basic reading comprehension skills.
can you explain what regulations they aren't complying with? with links, pretty please? and not something from a biased news source?
i'm pretty sure the pricing is a big part of what they're refusing to comply with. a huge part of the ACA is to make insurance "affordable" (catchy name, huh?) buy including things like caps on how much you will pay out of pocket and creating tax breaks based on your income. which is why PCP got a refund check from this insurance company in the first place.
And, bolding to emphasize what part of a quote is being referred to is pretty standard..nothing to get insulted about.
but you still didn't answer my question. what regulations are they refusing to conform to? i'd put money on it that their failure to comply has to do with cutting into their profits.The LA Times is a biased news source?
And, bolding to emphasize what part of a quote is being referred to is pretty standard..nothing to get insulted about.
The people who are losing coverage are losing coverage that was largely useless. Didn't cover any of the preventive stuff. High deductible, high copay, drop you if you so much as sneezed. For the most part they aren't losing anything that was worth having... but I understand the angst over having to pay more for better coverage, especially if you've been healthy and don't think you need coverage at all.
This whole meme of the young and healthy will have to pay more for the old and sick does ring true to a point. But the one thing I can guarantee is this. Even if you're young and healthy now, you won't stay that way for long, especially if you don't do the simple preventative things. And I can assure you we all pay more than our share for young, formerly healthy people that end up in the emergency room, or who end up qualifying for medicaid for themselves and their kids after they neglect their routine maintenance.
the ACA regulations:but you still didn't answer my question. what regulations are they refusing to conform to? i'd put money on it that their failure to comply has to do with cutting into their profits.
What is 'a qualifying plan,' according to the ACA?
A 'qualifying plan' is one that provides the essential insurance benefits, which include emergency services, hospitalizations, laboratory services, maternity care, mental health and substance abuse treatment, outpatient or ambulatory care, pediatric care, prescription drugs, preventive care, rehabilitative and habilitative (helping maintain daily functioning) services and vision and dental care for children, according to www.obamacarefacts.com. Starting in 2014, the ACA largely requires individual plans to provide the aforementioned essential health benefits and cover pre-existing conditions. The law also limits how much premiums can vary based on age.
What will happen if my plan doesn't meet ACA standards?
Current health care policy holders whose policies don't meet ACA standards will receive a letter from their insurance carrier, stating that their plan will change or be mapped into a plan mandated by Obamacare effective Jan. 1, 2014, according to Grotenhuis marketing vice-president Valerie Cramer, who works a special health care reform support center for insurance agents.
http://www.thedailynews.cc/2013/10/1...able-care-act/
Last edited by *crickets*; 10-29-2013 at 01:24 PM.
thank you. sounds like junk policies that insurance companies probably make a killing off of since they don't even cover ED or preventative care.
i had a plan while i was uninsured that just covered major medical alone and i think it was around $89/month for me. i dropped it a few months back. it would have covered a hospital stay, a broken bone, and i think maybe it covered a few measly dollars if i landed in the emergency room.
Maybe some were useless but not all. There was a woman interviewed on CNN today who was happy with her insurance plan that was cancelled, and she said the one she will be forced to buy is more expensive and not better. And there are millions more in the same predicament.
It's not a meme or myth, it's a fact:This whole meme of the young and healthy will have to pay more for the old and sick does ring true to a point. But the one thing I can guarantee is this. Even if you're young and healthy now, you won't stay that way for long, especially if you don't do the simple preventative things. And I can assure you we all pay more than our share for young, formerly healthy people that end up in the emergency room, or who end up qualifying for medicaid for themselves and their kids after they neglect their routine maintenance.
A number of factors are driving up rates. In a report this year, consultants hired by the state said the influx of sicker patients as a result of guaranteed coverage was the biggest single reason for higher premiums. Bob Cosway, a principal and consulting actuary at Milliman Inc. in San Diego, estimated that the average individual premium in 2014 will rise 27% because of that difference alone. (from the article I quoted earlier.)
This is not true. I chose less expensive coverage that had few doctor's visits but did cover me if something hardcore happened. It had decent prescription etc too.
Second statement-Totally true.
Now that this is in effect, I no longer have input. Um, with Medicaid you get free vasectomies.
That's all I got.
I would be willing to bet that if something catastrophic had happened, say cancer or some chronic disease, you'd have found the holes in the coverage soon enough. At least that's been the experience of people I know.
Yeah, catastrophic insurance is usually intended for car accidents,not long term ailments like cancer. And even with those, there is a cap eventually.
Conservatives are expressing shock and outrage that the Obama administration knew that many people in the individual insurance market would not be able to keep their plans once the Affordable Care Act took effect. Such shock is not surprising; overblown outrage is the stock and trade of conservative politics these days.
But here's what conservatives won't tell you, lest it undermine their theatrics: Many insurance plans are shutting down because they don't meet the higher bar of quality benefits required under Obamacare, and of those people who lose access to their plans, many will pay less and all will have better and more comprehensive options.
Also, with a few exceptions, no one is really noting that this point isn't quite news. In 2010, the fact that certain insurance plans would not be grandfathered into Obamacare because of their inadequate coverage was widely covered by the press. It was a given, after all that, if standards for health insurance were going to be raised in America -- a good thing -- then some plans that don't meet the bar would no longer be available. One could blame this on the Affordable Care Act, or alternatively, one could blame this on insurance companies for providing such substandard care in the first place.
Here's what this boils down to:
Will some people lose their current insurance? Yes.
Will these same folks lose health insurance coverage? No.
They will all have access to better plans and in many cases pay less because of expanded options and tax credits.
This whole kerfuffle ignores that insurance plans were changing all the time and premiums were skyrocketing pre-Obamacare. Suddenly, a whole range of bad behavior on the part of insurance companies is blamed on the Affordable Care Act. It's just like employers trying to shaft their workers by cutting hours and benefits and blaming it on the Affordable Care Act, even though employer mandate provisions don't take effect for another year.
Trying to blame Obamacare for every problem in the private insurance market is paradoxical: The whole reason for passing the Affordable Care Act was to fix what's broken with private insurance
If we as a nation object to the inherent and deeper flaws within the private health insurance system in America, then we should embrace a single-payer system. But instead, because conservatives were so wed to propping up the private insurance market, we got Obamacare. It's disingenuous to turn around and point fingers at Obamacare for faults that have always been -- and will always be -- pervasive in private health insurance.
The Affordable Care Act prevents some of the worst abuses of the private insurance market and makes coverage overall more inclusive and affordable. It doesn't fundamentally alter the private market equation -- and incentives to cut corners and care.
I know Republicans love their manufactured outrage, as much as they loved it back in September 2010, when Republican Sen. Mike Enzi cited the same 40% to 67% numbers for those expected to lose plans that NBC now reports as "new news." But the fact remains that about 80% of Americans get their health insurance either from their employers or from a program like Medicare, and that won't change at all under the Affordable Care Act.
Millions more are uninsured and will be thrilled to have access to affordable insurance at subsidized rates. This saves us all money, because the cost of their emergency room care isn't offloaded onto the rest of us in rising premiums. What we're focused on now is the small sliver of Americans who, like myself, get insurance through the individual market. Some of us will see our current plans disappear, but all of us will see our plans upgraded -- with many becoming more affordable.
When it comes to President Obama and his policies, conservatives have a steady supply of manufactured shock. But improving the quality and affordability of health insurance for all Americans and providing real facts along the way, that's an important accomplishment.
http://www.cnn.com/2013/10/29/opinio...html?hpt=hp_t4
When FOX contributors are complaining ‘Too Many People Are Going to Get Health Care’ (Dr. Marc Siegel on Hannity) then you know that the ACA must be good thing.
kerfuffle
MEDICARE FOR ALL!
http://www.msnbc.com/msnbc/cut-rate-...-cut-rate-care
Millions will lose their old health plans under Obamacare?and most will come out ahead.
For a president who has spent five years fighting for health care reform, this should be a blissful moment. Insurance exchanges have opened in all 50 states, more governors are embracing the historic expansion of health care for the poor, and Obamacare?s fiercest congressional opponents have neutered themselves with their government shutdown.
Instead, the administration is slogging through one of the toughest weeks since the Affordable Care Act was signed into law three years ago. Health and Human Services Secretary Kathleen Sebelius faces a congressional interrogation Wednesday for the troubled rollout of the government?s online insurance marketplace. And as the president speaks Wednesday at Boston?s Faneuil Hall, he faces yet another political mess, this one over the cancellation of millions of individual insurance plans that don?t meet the ACA?s minimum standards for coverage.
This latest political storm blew in last weekend, when media outlets started reporting that many people who buy their health coverage directly from insurance companies will have to switch plans in 2014. Their old policies don?t cover the essential health benefits the law requires, so they must now shop for new ones that do. Some people will face higher premiums as a result.
The president has never explained this. He persists in claiming the Affordable Care Act won?t force anyone to switch insurance policies. ?If you like your health plan, you will be able to keep your health plan,? he says, ignoring the fact that the health care law could invalidate a quarter of the 14 million individual health policies Americans now hold.
But as critics excoriate the administration for misleading the public, here?s a point to bear in mind. The affected consumers aren?t getting ripped off. Most will get more for care their money under the new system than they ever could have hoped for under the old.
The Affordable Care Act was designed not just to expand insurance coverage but to protect consumers who buy it. Compared to people who get group coverage through their jobs, folks seeking individual health policies have long had a raw deal. Those with pre-existing health conditions have either been denied coverage or charged prohibitive rates, and those deemed insurable have gotten plans with high deductibles and limited coverage. On average, plans sold on the individual market covered just 60% of their subscribers? medical costs in 2010, researchers reported in Health Affairs last year, while group plans covered 83%. In addition to other fees and copays, the average individual subscriber paid a $2,858 annual deductible?nearly four times the $751 that group plans charged.
To correct these distortions, the health care law requires that products sold as health insurance offer the buyer a minimum level of financial protection. Specifically, the law identifies 10 essential health benefits?ranging from maternity care to lab tests and prescription drugs?that all plans must cover as of January 1, 2014. It also limits the sums that insured people can be charged out-of-pocket for their care. Policies sold before March 23, 2010, are exempt from the law, but most of those have been replaced by newer plans that still fall short of the new benchmarks. Studies suggest that half to three-quarters of current individual plans no longer pass muster. Many individual subscribers have switched from one substandard plan to another during the past three years, so their current ones won?t be grandfathered in.
Hence the frustration. ?All we?ve been hearing the last three years is, if you like your policy you can keep it,? LA real estate agent Deborah Cavallaro told the Los Angeles Times. ?I?m infuriated because I was lied to.?
Cavallaro received a notice from Anthem Blue Cross this month, saying her cut-rate policy was being canceled because it didn?t meet even the lowest of the four coverage levels that insurers can offer in the new health care exchanges (bronze, silver, gold and platinum). The company said she could get a bronze plan for $484 per month?an increase of about $190. ?I just won?t have health insurance because I can?t pay this increase,? she told the paper.
But for every Deborah Cavallaro, there is probably at least one Judith Goss. Goss is a Michigan retail worker who got an inexpensive ?mini-med? policy while working at Talbots and kept it going for $65 a month after losing her job. ?I was aware that it wasn?t a great plan,? she told Consumer Reports last year, ?but I wasn?t concerned because I wasn?t sick.?
When she did get sick?with breast cancer?she quickly surpassed her plan?s four-figure annual spending limits and ended up postponing treatment while she scrounged for $30,000 to cover her bills. As White House spokesman Joshua Earnest says, ?Those cheap individual policies seem like a great deal until you actually have to use them.?
Real health insurance would have cost Goss more up front. Thanks to the Affordable Care Act, that kind of coverage is now available?at subsidized rates?through a health care exchange. The law effectively discounts premium prices for people earning up to four times the federal poverty wage ($45,960 for an individual, $94,200 for a family of four). And according to the Kaiser Family Foundation, nearly half of the 14 million Americans now insured through the individual market will qualify for subsidies when they enroll in qualified plans through the exchanges.
A shift of such magnitude was always bound to make waves. The Obama administration could have smoothed them by explaining?early and often?what consumers stand to gain from higher health care standards. The president?s ?keep your plan? promises look misinformed or even dishonest now that the revolution is here. But while Obama may suffer politically, consumers are still getting a good deal. Some may pay more for coverage, but they?ll be buying real security.
https://www.healthcare.gov/glossary/...alth-benefits/
A set of health care service categories that must be covered by certain plans, starting in 2014.
The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Reply With Quote
