Obamacare. Is it working?

[SkyDekker 1,122]

JohnnyMarko

*********It will fail because we are simply forcing people to buy insurance they cannot afford. Not enough regulation of the actual prices or the controls to keep costs in check.

Can confirm. My plan through the Colorado Exchange keeps going up and up, and the crazy premiums + high out of pocket actually keeps me from going to the doctor if I need to.

I said it in another thread, but Colorado is going to vote on a single payer system next year. I haven't read enough about how it will work or the numbers or how it will effect my costs, so I'm not for or against it yet.


My premiums have gone up year after year since long before the ACA became law. It's not a new phenomenon.

$158.26 to $173.25 a month is a big jump for someone in my financial situation. For a shit plan I don't see why I need to pay and extra $15 a month this coming year.

Around here if you cannot afford a couple of dollars a month, you are just too lazy to work harder.

Of course that is different when it comes to Obamacare, in that case it is Obama's fault. Unless you are an immigrant, then you are likely illegal and should go back to whatever hellhole you came from.

[rehmwa 2]

JohnnyMarko

$158.26 to $173.25 a month is a big jump for someone in my financial situation. For a shit plan I don't see why I need to pay and extra $15 a month this coming year.

Well, you likely had bad coverage before. Now, you are compliant in case you get pregnant.

So it's a win...

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[turtlespeed 212]

tkhayes

Perhaps you could expand on the solution you propose might work because it is nowhere to be found in the right wing charters and doctrines

Dissolve Obama care and widen Medicare.

Regulate percentage of BILLING AND CHARGES, and audit the books like they do with the SEC.

There is no reason a single pill for pain in hospital should cost 50 bucks.

Regulate down the charges allowed and pay providers on performance reviews.

Oooooooooh, maybe we could implement the "common core" standards to the medical field. THAT would be a doctor I would run away from.

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[normiss 622]

Free smoking cessation assistance and "free" annual physicals!

[JohnnyMarko 1]

SkyDekker

Around here if you cannot afford a couple of dollars a month, you are just too lazy to work harder.

I don't know how you pulled my work ethic into this, but okay. I don't have any assistance from my employer with health care. I pay everything out of pocket. I've had several raises but income isn't very equal to cost of living "around here". Sure, I could move. But I love it here so I'm going to make it work. I can cut back on other expenses to afford the measly $15 hike, but I'd rather put that somewhere else.

SkyDekker

Of course that is different when it comes to Obamacare, in that case it is Obama's fault. Unless you are an immigrant, then you are likely illegal and should go back to whatever hellhole you came from.

I never said it was Obama's fault.

[tkhayes 126]

Quote

Dissolve Obama care and widen Medicare.

And merge the VA, Medicare and Medicaid into one. If you are going to hand out free healthcare, you can do it in one agency.

Raise the ages for young, lower the ages for elderly, adjust the tax base to pay for it.

Next year, do the same. In 5 years or less, we have universal healthcare for everyone. Leave the private system and insurance companies in place, expand the VA Hospital/Doctor/Care network to cover Medicare and Medicaid patients.

But EVERYONE pays into the system through taxes, even if you use the private system.

If you are filthy rich, you are getting your private healthcare anyway, if you are anyone else, most likely you go to the got run hospitals and the govt paid-for doctors. Govt controls the prices and has the right to negotiate with drug companies doctors, and other hospitals to adjust the prices of everything.

Tort laws get reform to reduce lawsuits.

What's the more likely outcome? We build a fourth agency to oversee the other 3 agencies, fuck it all up by spending another trillion dollars to offer exactly what we had before, which is shitty healthcare for half of America. And no healthcare for millions.

[FreefallingCari 0]

I'm curious as to the amount the ACA reimburses (about same as Medicaid, according to your post) vs. the amount that Medicare pays. I use a doctor/practice that doesn't accept ACA coverage, but the great majority of their practice is old folks on Medicare.

As a Nurse, and someone well versed in insurance, I just want to touch base on what you just stated.

The ACA is not some magical insurance. The insurance offered on the ACA Marketplace is the exact same plan off of the Marketplace. Doctors offices accept some insurance, and decline others.
Ex: Gynecologist X takes my insurance, but Gynecologist Y does not accept my plan. A person who purchases my plan ON the marketplace has the exact same plan as I do, they just happen to receive a subsidy to cover their monthly premium or their deductible. That is it.

I use individual health insurance, and I have preferred this over employer offered coverage. I have been with BCBSNC for 15 years on the individual market. When the ACA change happened, I simply picked a plan from the new structure. You know, the Bronze, silver, gold, and platinum metal offerings.

BCBSNC, and other companies, offer the exact same plans on and off of the marketplace. Again, I am trying to stress that the Marketplace is not some magical insurance that no doctor accepts. The company itself, BCBS, Coventry, United healthcare, etc, all contract with physicians as to what they provide. The government does not actually have any involvement with this, it is the insurance companies.

So, person with *Cari* Plan, that is me, Can see ABC doctor, and reimbursement is XYZ. Someone who purchased Cari Plan on the Marketplace can see ABC doctor too, and their reimbursement is XYZ too.

Your doctor accepts insurance, and it could be that your doctor just so happens NOT to accept the insurance COMPANIES or PLANS on the ACA.

I have BCBSNC Blue Value Plan. My doctor does not accept BCBSNC Blue Local. BOTH plans are offered on the ACA Marketplace, both can be purchased off of the Marketplace, but doctors are able to choose which plans and designs they accept.

:)

Skydiver Survivor; Battling Breast Cancer one jump at a time. DX June 19th 2014
I have been jumping since October 5th 2013.
https://pinkribbonskydiver.wordpress.com/

[FreefallingCari 0]

***There is no reason a single pill for pain in hospital should cost 50 bucks.

Yes there is, to *some* extent. I am a Nurse, so they have to pay the Nurse's wages. They have some overhead costs which must be taken into account. Now, with this being stated, the markup of 500% IS insane.

Everything is market up because ER use in the Hospital is one of the biggest drains on their resources.

Ex: I cannot tell you how many times a week that we have women come to an ER for a fucking pregnancy test. They do this because they know we will give them one, and then it is standard protocol to give an ultrasound. **Remember, we cannot turn anyone away!
Dollar tree has a pregnancy tests for 1$. Planned Parenthood gives them out for free... ** But the ER is FREE if I do not pay my bill, or I have the medicaid card. Planned Parenthood accepts medicaid, so do family planning clinics, but people want their test NOW, and they want it for FREE.

Oh, and allergy sufferers come to the ER too. Seasonal, stuffy nose, cold symptoms, with no fever or complications.

ER should be able to turn people away if their vital signs are stable, and they are not experiencing an EMERGENCY.

Skydiver Survivor; Battling Breast Cancer one jump at a time. DX June 19th 2014
I have been jumping since October 5th 2013.
https://pinkribbonskydiver.wordpress.com/

[Stumpy 256]

Cari - I'm interested - do you run a triage system?

In most of the countries I have lived in sure, I COULD go to the ER for a sniffle, or (if I was a woman) a pregnancy test, but given that they are usually full of people bleeding, or needing limbs reattached and so on, I'd be sitting there a LONG time so would probably give up and go somewhere else!

Never try to eat more than you can lift

[ryoder 1,384]

FreefallingCari

A person who purchases my plan ON the marketplace has the exact same plan as I do, they just happen to receive a subsidy to cover their monthly premium or their deductible.

They don't receive a subsidy unless their income is below a certain level, and depending on the level, the subsidy is pro-rated. Also, they may not get a subsidy, but depending on their annual income, they may get a partial tax credit when they file income taxes for the year.

I got no subsidy the first year I used ACA, and I am still fighting with the IRS over the tax credit.

"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

[Bolas 5]

Stumpy

Cari - I'm interested - do you run a triage system?

In most of the countries I have lived in sure, I COULD go to the ER for a sniffle, or (if I was a woman) a pregnancy test, but given that they are usually full of people bleeding, or needing limbs reattached and so on, I'd be sitting there a LONG time so would probably give up and go somewhere else!

You're assuming these people pulling this stunt don't have something better to do...

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[SkyDekker 1,122]

JohnnyMarko

***

Around here if you cannot afford a couple of dollars a month, you are just too lazy to work harder.

I don't know how you pulled my work ethic into this, but okay. I don't have any assistance from my employer with health care. I pay everything out of pocket. I've had several raises but income isn't very equal to cost of living "around here". Sure, I could move. But I love it here so I'm going to make it work. I can cut back on other expenses to afford the measly $15 hike, but I'd rather put that somewhere else.

SkyDekker

Of course that is different when it comes to Obamacare, in that case it is Obama's fault. Unless you are an immigrant, then you are likely illegal and should go back to whatever hellhole you came from.

I never said it was Obama's fault.

My post wasn't aimed at you specifically. I though the "Around here" would have made that clear.

[headoverheels 291]

That may be true in NC, but here in California, I can assure you that most/all of the providers I use will not accept any insurance obtained through the state exchange.

[DougH 270]

Have to find a source, it was quoted on NPR, but there was in the range of 2 million individuals that signed up for insurance under the ACA that had to drop the coverage due to cost of premiums and deductibles.

That isn't a great result.

"The restraining order says you're only allowed to touch me in freefall"
=P

[okalb 78]

headoverheels

That may be true in NC, but here in California, I can assure you that most/all of the providers I use will not accept any insurance obtained through the state exchange.

What insurance company is your policy through?

Time flies like an arrow....fruit flies like a banana

[headoverheels 291]

okalb

***That may be true in NC, but here in California, I can assure you that most/all of the providers I use will not accept any insurance obtained through the state exchange.

What insurance company is your policy through?

My insurance is though Anthem, provided by my employer. If I got a plan though the state exchange, provided by Anthem, I would not have coverage to use any of the 5 MDs I've used in the past year, and possibly not the surgery center or anesthesiologists. I could certainly still pay cash with the state exchange Anthem plan, and get partially reimbursed by the insurance, but I wouldn't have the protection of negotiated rates. e.g., the surgery center billed over $14k for ~30 minutes of theater time and preop/recovery, and was allowed $2.3k by Anthem, since they accept my non-state exchange Anthem plan.

[FreefallingCari 0]

Yes we do have a triage system, but it is insane to visit an ER because you do not want to pay 1$ for a pregnancy test elsewhere.

I believe some people should be allowed to be turned away.

Here in the US, our ER's are not typically filled with trauma unless it is in specific areas. Our common patients have asthma flare ups, which is 100% understandable, or patients with the Flu, colds, or sniffles.

My ER had a LOT of homeless people and a few "frequent fliers" who came in 2-4 times a week because they were 'in pain'. We HAD to see them, but they are not given always given pain meds unless there is trauma or something specific.

Skydiver Survivor; Battling Breast Cancer one jump at a time. DX June 19th 2014
I have been jumping since October 5th 2013.
https://pinkribbonskydiver.wordpress.com/

[FreefallingCari 0]

Correct, subsidy requires specific qualifications. I figured that would have been implied , but I should have made it clear. :)

People have had such an easy time with the subsidy, but the IRS tax credit issue seems to be a problem. This is from what I am told by various people. Anecdotal, but it is my experience.


For everyone, or whomever.
People do not have to purchase individual coverage through the marketplace, they can also purchase directly through the insurer if they will not be eligible for a subsidy.

Skydiver Survivor; Battling Breast Cancer one jump at a time. DX June 19th 2014
I have been jumping since October 5th 2013.
https://pinkribbonskydiver.wordpress.com/

[FreefallingCari 0]

Quote

My insurance is though Anthem, provided by my employer. If I got a plan though the state exchange, provided by Anthem, I would not have coverage to use any of the 5 MDs I've used in the past year, and possibly not the surgery center or anesthesiologists. I could certainly still pay cash with the state exchange Anthem plan, and get partially reimbursed by the insurance, but I wouldn't have the protection of negotiated rates. e.g., the surgery center billed over $14k for ~30 minutes of theater time and preop/recovery, and was allowed $2.3k by Anthem, since they accept my non-state exchange Anthem plan.

This is an easy one. Employer offered coverage is different than 100% individual coverage. Anthem for employers is going to cover specific doctors. Just like BCBSNC employer plans will. I do not have an employer plan, I own my plan, it is individual.

Now, if you had to use the marketplace because you qualify for a subsidy, and lost employer coverage, there would be a plan which can suit you.

For what it is worth, I learned to do insurance billing when a coworker went out sick. All insurance policies, to my knowledge, allow for "negotiated rates". You may have a deductible to meet, etc.. But you can choose your plans and deductibles.

I am referring to the individuals which the ACA is attempting to cover, and those are INDIVIDUALS.

Skydiver Survivor; Battling Breast Cancer one jump at a time. DX June 19th 2014
I have been jumping since October 5th 2013.
https://pinkribbonskydiver.wordpress.com/

[headoverheels 291]

FreefallingCari

Quote

My insurance is though Anthem, provided by my employer. If I got a plan though the state exchange, provided by Anthem, I would not have coverage to use any of the 5 MDs I've used in the past year, and possibly not the surgery center or anesthesiologists. I could certainly still pay cash with the state exchange Anthem plan, and get partially reimbursed by the insurance, but I wouldn't have the protection of negotiated rates. e.g., the surgery center billed over $14k for ~30 minutes of theater time and preop/recovery, and was allowed $2.3k by Anthem, since they accept my non-state exchange Anthem plan.

This is an easy one. Employer offered coverage is different than 100% individual coverage. Anthem for employers is going to cover specific doctors. Just like BCBSNC employer plans will. I do not have an employer plan, I own my plan, it is individual.

Now, if you had to use the marketplace because you qualify for a subsidy, and lost employer coverage, there would be a plan which can suit you.

For what it is worth, I learned to do insurance billing when a coworker went out sick. All insurance policies, to my knowledge, allow for "negotiated rates". You may have a deductible to meet, etc.. But you can choose your plans and deductibles.

I am referring to the individuals which the ACA is attempting to cover, and those are INDIVIDUALS.

I don't know whether you don't understand what I am saying, or whether I don't understand you.

With my employer plan, I have NEVER found a medical provider which doesn't take it. I don't have to have a referral, I don't have to see my primary care doctor before a specialist.

Those same MDs will not take ANY insurance provided though the same insurers (e.g.Anthem), if it is insurance obtained through the state exchange. I haven't pressed them on that, since I have other insurance, but I have seen the sign at the check-in desk, and have been told that over the phone when making an appointment with a new doctor.

My understanding (maybe out of date) is that NC uses the federal exchange. Here, we have a state exchange which also negotiated rates for services.

[ryoder 1,384]

FreefallingCari

People have had such an easy time with the subsidy, but the IRS tax credit issue seems to be a problem. This is from what I am told by various people. Anecdotal, but it is my experience.

Well, that is discouraging; I thought my problem was triggered by a mistake the CO ACA office made: It sent out 1095-A's for both my dental and medical policies. So I filed my income tax using the combined totals.

Shortly afterward, the CO ACA office informed me the dental 1095-A should not have been generated. So what did the IRS do? It ignored the medical 1095-A and used only the dental 1095-A, (which of course was a tiny fraction of the premiums).

So I sent a letter to the IRS explaining the mistake. They ignored it.

Finally in exasperation, I refiled my 2014 taxes. So now I am being audited, and had to submit yet another copy of the 1095-A which I already sent them. Still waiting for their response.

"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

[winsor 186]

No.

Anyone who expects Obamacare to be viable would do well to study arithmetic (not a required subject at Harvard Law). Running the numbers is enlightening.

[tkhayes 126]

Quote

Hillary's only other option will be to impose price controls on the health care industry. She's recently taken to demonizing drug companies but, notes Roy, they account for only 12 percent of health care costs. The real "savings" that could lower the price of coverage would be from going after doctor and hospital reimbursement, but that would be the political equivalent of stepping on a land mine.

the article makes this sound like it is a bad thing. YES, this is EXACTLY what needs to happen. the doctors, hospitals, drugs and such need to be REGULATED insofar as price structure goes. that is part of the solution.

The reason the insurance company might ,eave the exchanges is that they are getting raked by the hospitals with ridiculous charges that they have to pay because they are an insurance company.

First step might be that they all need to publish their prices for every procedure, every task, every piece of equipment. period. These all vary depending on how good the insurance is and how many people they had to serve for nothing that day.

My hip replacement estimated at $42K for the hospital for 2 days. I stayed one day and they billed $90K to BCBS, BCBS paid $56K. My insurance company got ripped off by the hospital, but even the insurance company does not give a fuck becuase the rates will go up to cover that eventually.

If you want a free market system, one of the the first things that needs to happen is the providers need to publish their rates. for everyone and everything. one giant list. The codes already exist, it is how things are billed today.

Then consumers could actually 'shop'. And so could insurance companies.

[cvfd1399 0]

Well let's regulate car prices then too. If it has 4 wheels and 2 doors its 10,000 if it has 4 doors thats 20,000. Doesn't matter the quality of material, the craftsmanship, or the features, its a flat price.

Fuck Lexus for making a car out of better materials with better craftsmanship that led to a higher price.

[tkhayes 126]

I never said regulate all prices to the 'same level'. I said publish the prices, and some cost controls obviously need to be in place (regulation). I even advocated for a public/private system so that special doctor can in fact charge 10 times whatever the next guy wants if he/she chooses to.

Cars are not required for life or death. cars are not a human right that cannot be done without. cars are apples and oranges to healthcare. Most countries in the world now acccept healthcare as a basic human requirement, the USA has a long way to go in that regard.


I guess your health insurance is therefore reasonable, the prices are not going up and you're completely satisfied with it, right? You do not wish to see ANYTHING change ever because the system is so perfect for you and everyone that you know and/or care about?