Deb, what I said is going to be the case with any conceivable system. The only way to govern a country as diverse as this one is through compromise that is completely satisfactory to no one.

Originally Posted by Brian Rush

Deb, what I said is going to be the case with any conceivable system. The only way to govern a country as diverse as this one is through compromise that is completely satisfactory to no one.

Even if we did away with corporate funding of our politicians?

Originally Posted by Deb C

Even if we did away with corporate funding of our politicians?

Even then, although that would improve things a lot.

Companies face Obamacare preexisting condition fee

Workers will likely end up covering the $63-per-head fee


WASHINGTON (AP) — Your medical plan is facing an unexpected expense, so you probably are, too. It’s a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama’s health care overhaul.
The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.


Employee benefits lawyer Chantel Sheaks calls it a “sleeper issue” with significant financial consequences, particularly for large employers.

“Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it,” said Sheaks, a principal at Buck Consultants, a Xerox subsidiary.

http://www.salon.com/2012/12/10/comp...condition_fee/

Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.

Originally Posted by Deb C

Companies face Obamacare preexisting condition fee

Workers will likely end up covering the $63-per-head fee


WASHINGTON (AP) — Your medical plan is facing an unexpected expense, so you probably are, too. It’s a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama’s health care overhaul.
The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.


Employee benefits lawyer Chantel Sheaks calls it a “sleeper issue” with significant financial consequences, particularly for large employers.

“Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it,” said Sheaks, a principal at Buck Consultants, a Xerox subsidiary.

http://www.salon.com/2012/12/10/comp...condition_fee/

Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.

You're posting this for what reason?

Have you analyzed this and decided that, from a Progressive viewpoint, this is a good or bad thing?

Here's a hint - look up "New Medical Loss Ratio Rule"

Originally Posted by playwrite

You're posting this for what reason?

Have you analyzed this and decided that, from a Progressive viewpoint, this is a good or bad thing?

Education of what's happening behind closed doors is empowerment for the people.

The insurance industry will not give up one thin dime because of now covering preexisting conditions, but the people sure will. CEO's will still get their millions of dollars in salaries, share holders stay happy, while ordinary citizens try and balance their ever weakening budgets.

Originally Posted by Deb C

Education of what's happening behind closed doors is empowerment for the people.

The insurance industry will not give up one thin dime because of now covering preexisting conditions, but the people sure will. CEO's will still get their millions of dollars in salaries, share holders stay happy, while ordinary citizens try and balance their ever weakening budgets.

Under the "New Medical Loss Ratio Rule," the insurance companies have to spend 80% (individual plans) or 85% (group plans) of premiums on actual provided health care. This fee that employers will have to pay (it goes to zero in 4 years) does not change that. The fund is to be administered by HHS to stabilize individual insurance market as it takes on all those previously uninsured; do you really think HHS is going to dole that money out to the insurance companies willy-nilly and risk the market collapsing? You did read that this is being done to avoid having premiums come up with the stabilization funds?

You did notice that this is being paid for by businesses? You did notice that the LARGEST corporations may have to pay "tens of millions?" Before you shed too many tears, do you know how much profit the largest corporations make in a year? Hint, they don't talk about millions - that is chump change.

You did notice that the source of much of the information in the article is from someone with the Xerox CORPORATION?
The corporations that you rail against are pretty smart if not downright sneaky. Do you think that people only on the Right are easily fooled in to doing their bidding?

Health insurance does not equal health care. Forcing people to buy health insurance does not solve a problem. This is simply another one of those "solutions" to a wholly created non-problem that lines the pockets of people who already have a lot of money. And this is what was done in place of actually providing health care, which is what was preached to enact this monstrosity. Bait and switch, and people fall for it every time.

It's very gratifying to watch the so-called progressives come out of their closet into full blown fascism. There was always the tinge of controlling other people to their propaganda, but back when they were still "liberals" it was more opaque. Now we have little tyrants erupting everywhere telling us how great their utopia will be when we are properly enslaved.

Why do so many people preach their own enslavement? They never think that all this garbage is going to apply to them as well, do they? It's always the evil other that will be harmed, not us good people. What do you think the result of viewing other human beings as evil enemies will always be?

That's progressivism- a sociopathic cult. And the results are starting to come in even now, if you're paying attention.

Originally Posted by playwrite

Under the "New Medical Loss Ratio Rule," the insurance companies have to spend 80% (individual plans) or 85% (group plans) of premiums on actual provided health care. This fee that employers will have to pay (it goes to zero in 4 years) does not change that. The fund is to be administered by HHS to stabilize individual insurance market as it takes on all those previously uninsured; do you really think HHS is going to dole that money out to the insurance companies willy-nilly and risk the market collapsing? You did read that this is being done to avoid having premiums come up with the stabilization funds?

You did notice that this is being paid for by businesses? You did notice that the LARGEST corporations may have to pay "tens of millions?" Before you shed too many tears, do you know how much profit the largest corporations make in a year? Hint, they don't talk about millions - that is chump change.

You did notice that the source of much of the information in the article is from someone with the Xerox CORPORATION?
The corporations that you rail against are pretty smart if not downright sneaky. Do you think that people only on the Right are easily fooled in to doing their bidding?

So it's fair to let the larger insurance corporations that can afford the 80% loss medical ratio to gain even more power?

Medical Insurance Companies Find Healthcare Reform Loopholes

Author : Tom Carolan



While the new legislation has sanctions against insurers that impose any 'unreasonable premium increase'. They run the risk of being prevented from participating in the central insurance marketplace and having low sales.The new law is also eating into insurance companies' profit margin by requiring at least an 80% medical loss ratio. This means that their profit cannot exceed 20% of the value of the premiums that it charges it customers. This requirement may be difficult to fulfill on the part of the insurers, especially if they are dealing with certain individuals or small businesses.Insurers' concern over this feature has prompted them to ask for exemptions. They pointed out that the medical loss ratio requirement can cause an increase in premium costs, as well as a significant disturbance of the health insurance market and industry as a whole.


The new laws make it difficult for a provider of so-called bottom-dweller plans to do business. These plans are usually aimed at healthy young individuals, but do not provide adequate protection when policyholders become ill. This is a good thing in the long run, but as these providers pull out of the market, there should be viable alternatives in place. Politicians have vested interest in making the new laws a success. They may find themselves voted out of office if the health care legislation they supported made health care more expensive rather than more affordable. Big name health insurance companies usually take the blame as politicians try to curb criticism pointed at them.Lawmakers believe that health insurance companies like Aetna and UnitedHealthcare stand to make huge profits as health insurance becomes required.

Originally Posted by Seattleblue

Health insurance does not equal health care.

True, but it does provide access to health care. Imagine being diagnosed with a second stage cancer -- serious, but very treatable -- but not having the means to pay for the chemotherapy and other treatments involved...

Originally Posted by Deb C

So it's fair to let the larger insurance corporations that can afford the 80% loss medical ratio to gain even more power?

Medical Insurance Companies Find Healthcare Reform Loopholes

Author : Tom Carolan



While the new legislation has sanctions against insurers that impose any 'unreasonable premium increase'. They run the risk of being prevented from participating in the central insurance marketplace and having low sales.The new law is also eating into insurance companies' profit margin by requiring at least an 80% medical loss ratio. This means that their profit cannot exceed 20% of the value of the premiums that it charges it customers. This requirement may be difficult to fulfill on the part of the insurers, especially if they are dealing with certain individuals or small businesses.Insurers' concern over this feature has prompted them to ask for exemptions. They pointed out that the medical loss ratio requirement can cause an increase in premium costs, as well as a significant disturbance of the health insurance market and industry as a whole.


The new laws make it difficult for a provider of so-called bottom-dweller plans to do business. These plans are usually aimed at healthy young individuals, but do not provide adequate protection when policyholders become ill. This is a good thing in the long run, but as these providers pull out of the market, there should be viable alternatives in place. Politicians have vested interest in making the new laws a success. They may find themselves voted out of office if the health care legislation they supported made health care more expensive rather than more affordable. Big name health insurance companies usually take the blame as politicians try to curb criticism pointed at them.Lawmakers believe that health insurance companies like Aetna and UnitedHealthcare stand to make huge profits as health insurance becomes required.

I think you're going to have to work a little harder to make the link between exemptions and "more power." What you have here doesn't even qualify as "a stretch," it makes no inference whatsoever.

Originally Posted by Deb C

No one quibbles over this.

However, if one thinks that is THE issue stopping single payer or the public option, then that person has no idea what is going on -
-which pretty much means that person has no idea how to get what they want when it comes to health care policies.

- brought to you by Obamacare -

http://theincidentaleconomist.com/wo...ption-edition/

Reality: Red State Option Edition

More than half of the states challenged the ACA in various suits; they ultimately prevailed only in finding the Medicaid expansion unconstitutionally coercive. Justice Roberts’ opinion made the Medicaid adult expansion to 138% FPL optional on a state-by-state basis (the Red State Option).

Yesterday, Arizona’s Governor stopped pointing her finger and joined the Medicaid expansion. Pundits expressed shock, but no one should be surprised. Most of the plaintiff states will ultimately follow suit, for two reasons: politics & money. First, in most counties, the local hospital is one of the largest employers and these hospitals want the Medicaid expansion. The political pressure will be intense, well-connected, and local. Second, the federal match rate is indeed generous. It is hard to justify turning down such largess. But as the plaintiff states jump on ship voluntarily, it undermines their prior claims of unconstitutional coercion.

Meanwhile, in Oklahoma, the Governor is sticking to her guns. 200,000 Oklahomans will lose (or fail to obtain) coverage as a result. The state authorized $500,000 for a consultant to study options to cover these people. Will the report recommend the expansion?

F-in Arizona???? And the Okies on the ropes?

I realize these report of Obamacare reducing actual suffering are much less interesting that bashing Evil Barry, but one can always ignore these reports if that's your thing.

Originally Posted by playwrite

I realize these report of Obamacare reducing actual suffering are much less interesting that bashing Evil Barry, but one can always ignore these reports if that's your thing.

Oh, as a resident of the Washington, DC area, I always find it great fun to bash Marion Barry.

Recently, after taking a good look at the details of the ACA and its SCOTUS ruling, I'm making a prediction on what the long-term result will be for the healthcare industry.

First, the so-called "individual mandate" is a mandate only in that there is a penalty (ruled to be a tax) levied on those who do not purchase insurance; as written in the ACA there are no criminal penalties for not carrying insurance (and the IRS can't even put you in jail for not paying the penalty, nor can they use many of the tactics they can usually use for tax evaders; as has been discussed the main way they have at enforcing it is withholding refunds). Furthermore, the opinion in NFIB vs. Sebelius did uphold the penalty in its current form but indicated that any significant strengthening of it (i.e. attaching criminal penalties as some early Obamacare drafts did have, or raising the amount of the "tax" by a significant amount) would call its constitutionality back into question (paraphrasing what Roberts said given that a person can choose between insurance and the tax without the above sanctions it's acceptable, but if it were a crime to go without health insurance or the penalty were so high there would be no realistic choice the penalty would likely be deemed unconstitutional). Basically what the ACA drafters were hoping for was creating a social stigma against those who can afford health insurance but opt out of buying it; so far that hasn't happened (in fact in many red states it's done the opposite in creating a stigma against those who support Obamacare).

What does this mean? Right now to the average person all of this talk about mandates, penalties, exchanges, subsidies, etc. is largely theoretical since no one has seen it put to use in practice (and leads to a lot of misunderstanding about the law, such as that even people in poverty who can't afford insurance without assistance will be penalized which isn't true). Come 2014 (unless they delay the implementation of the exchanges, which is a real possibility considering the lack of progress made so far in getting everything ready) we'll start seeing how that all works, and so far many of the tactics that have been discussed only in hypothetical settings (like lowering your withholding so the IRS can't confiscate your refund) will start to circulate among the general population once they're applied in RL settings.

Many of us have asked whether this will be good or bad for the insurance companies' spreadsheets. My prediction: Boom in the short term, bust over the long term. In 2014 (or whatever the first year is if delayed) the insurance companies will see many new customers, mainly from two groups: those who now have subsides from the government allowing them to buy coverage they couldn't afford before, and "freeloaders" who have been convinced under the "mandate" to buy coverage. Simultaneously, the ban against not covering those with pre-existing conditions goes into effect. While most in the first group will represent a long-term uptick for the companies, it's a different story for the second group. They (as well as some who currently have insurance but now understand it may be beneficial to proceed as I'm about to discuss) will likely learn sooner or later that it may very well be beneficial NOT to have insurance. For most the penalty-tax will be less than the insurance and will opt to go that route instead. But what about if they get sick without insurance? Well, given that you cannot be denied insurance because of pre-existing conditions, you can simply wait until you need it and then sign up for insurance. This will eventually lead to an unsustainable situation for the private insurance market (and is indeed what many liberals were hoping for) that the government has limited options (thanks to the ruling limiting the magnitude of any penalties for not having insurance) to combat. This will once again pit a liberal vs. conservative fight on what to do. What many conservatives will fight against (but what will help preserve the private insurance market, even if it's in name only with all the government regulations) is making a new "penalty" where if you opt out of private insurance you'll be forced to purchase a government-run plan (which is as constitutional as the Medicare taxes taken out of your paycheck) rather than a mere "tax" that's to many a fraction of typical insurance costs (basically a public option that's mandatory if you don't have other insurance). If the Right fights that out it will lead to many insurance companies going bankrupt being forced to take on all these sick folks without healthier people contributing, which will lead to what they (conservatives) have dreaded the most all along: the only insurance plan surviving being government-run single-payer (once again being 100% constitutional).

Remember, it's not so much the mandates the Right was (and is still) trying to gut judicially (after all they're the ones who came up with the idea), but rather seeking to strike down the whole ACA by removing components important to its functionality.

Originally Posted by Kelly85

Many of us have asked whether this will be good or bad for the insurance companies' spreadsheets. My prediction: Boom in the short term, bust over the long term. In 2014 (or whatever the first year is if delayed) the insurance companies will see many new customers, mainly from two groups: those who now have subsides from the government allowing them to buy coverage they couldn't afford before, and "freeloaders" who have been convinced under the "mandate" to buy coverage. Simultaneously, the ban against not covering those with pre-existing conditions goes into effect. While most in the first group will represent a long-term uptick for the companies, it's a different story for the second group. They (as well as some who currently have insurance but now understand it may be beneficial to proceed as I'm about to discuss) will likely learn sooner or later that it may very well be beneficial NOT to have insurance. For most the penalty-tax will be less than the insurance and will opt to go that route instead. But what about if they get sick without insurance? Well, given that you cannot be denied insurance because of pre-existing conditions, you can simply wait until you need it and then sign up for insurance. This will eventually lead to an unsustainable situation for the private insurance market (and is indeed what many liberals were hoping for) that the government has limited options (thanks to the ruling limiting the magnitude of any penalties for not having insurance) to combat. This will once again pit a liberal vs. conservative fight on what to do. What many conservatives will fight against (but what will help preserve the private insurance market, even if it's in name only with all the government regulations) is making a new "penalty" where if you opt out of private insurance you'll be forced to purchase a government-run plan (which is as constitutional as the Medicare taxes taken out of your paycheck) rather than a mere "tax" that's to many a fraction of typical insurance costs (basically a public option that's mandatory if you don't have other insurance). If the Right fights that out it will lead to many insurance companies going bankrupt being forced to take on all these sick folks without healthier people contributing, which will lead to what they (conservatives) have dreaded the most all along: the only insurance plan surviving being government-run single-payer (once again being 100% constitutional).

I spent most of this day at a hospital. Most people I spoke with were talking about the changes they have seen in their insurance premiums this new year. Many spoke about their and co-pays and out of pocket expenses sky rocketing. For instance, last year, one lady paid $10 a month for eye drops for her glaucoma. This year, it's $200 a month. She's on a fixed income. Now she's thinking about not using the drops.

The other situation that many don't understand, is that there are no restrictions on what the insurance industry can charge regarding a person's age.

Another situation is that the larger insurance corporations will edge out the smaller ones. Kind of like what Walmart does to small businesses when they roar into their town.

While there will be a few pluses with ACA, the insurance industry will be the biggest winners.

Originally Posted by Kelly85

Recently, after taking a good look at the details of the ACA and its SCOTUS ruling, I'm making a prediction on what the long-term result will be for the healthcare industry.

First, the so-called "individual mandate" is a mandate only in that there is a penalty (ruled to be a tax) levied on those who do not purchase insurance; as written in the ACA there are no criminal penalties for not carrying insurance (and the IRS can't even put you in jail for not paying the penalty, nor can they use many of the tactics they can usually use for tax evaders; as has been discussed the main way they have at enforcing it is withholding refunds). Furthermore, the opinion in NFIB vs. Sebelius did uphold the penalty in its current form but indicated that any significant strengthening of it (i.e. attaching criminal penalties as some early Obamacare drafts did have, or raising the amount of the "tax" by a significant amount) would call its constitutionality back into question (paraphrasing what Roberts said given that a person can choose between insurance and the tax without the above sanctions it's acceptable, but if it were a crime to go without health insurance or the penalty were so high there would be no realistic choice the penalty would likely be deemed unconstitutional). Basically what the ACA drafters were hoping for was creating a social stigma against those who can afford health insurance but opt out of buying it; so far that hasn't happened (in fact in many red states it's done the opposite in creating a stigma against those who support Obamacare).

What does this mean? Right now to the average person all of this talk about mandates, penalties, exchanges, subsidies, etc. is largely theoretical since no one has seen it put to use in practice (and leads to a lot of misunderstanding about the law, such as that even people in poverty who can't afford insurance without assistance will be penalized which isn't true). Come 2014 (unless they delay the implementation of the exchanges, which is a real possibility considering the lack of progress made so far in getting everything ready) we'll start seeing how that all works, and so far many of the tactics that have been discussed only in hypothetical settings (like lowering your withholding so the IRS can't confiscate your refund) will start to circulate among the general population once they're applied in RL settings.

Many of us have asked whether this will be good or bad for the insurance companies' spreadsheets. My prediction: Boom in the short term, bust over the long term. In 2014 (or whatever the first year is if delayed) the insurance companies will see many new customers, mainly from two groups: those who now have subsides from the government allowing them to buy coverage they couldn't afford before, and "freeloaders" who have been convinced under the "mandate" to buy coverage. Simultaneously, the ban against not covering those with pre-existing conditions goes into effect. While most in the first group will represent a long-term uptick for the companies, it's a different story for the second group. They (as well as some who currently have insurance but now understand it may be beneficial to proceed as I'm about to discuss) will likely learn sooner or later that it may very well be beneficial NOT to have insurance. For most the penalty-tax will be less than the insurance and will opt to go that route instead. But what about if they get sick without insurance? Well, given that you cannot be denied insurance because of pre-existing conditions, you can simply wait until you need it and then sign up for insurance. This will eventually lead to an unsustainable situation for the private insurance market (and is indeed what many liberals were hoping for) that the government has limited options (thanks to the ruling limiting the magnitude of any penalties for not having insurance) to combat. This will once again pit a liberal vs. conservative fight on what to do. What many conservatives will fight against (but what will help preserve the private insurance market, even if it's in name only with all the government regulations) is making a new "penalty" where if you opt out of private insurance you'll be forced to purchase a government-run plan (which is as constitutional as the Medicare taxes taken out of your paycheck) rather than a mere "tax" that's to many a fraction of typical insurance costs (basically a public option that's mandatory if you don't have other insurance). If the Right fights that out it will lead to many insurance companies going bankrupt being forced to take on all these sick folks without healthier people contributing, which will lead to what they (conservatives) have dreaded the most all along: the only insurance plan surviving being government-run single-payer (once again being 100% constitutional).

Remember, it's not so much the mandates the Right was (and is still) trying to gut judicially (after all they're the ones who came up with the idea), but rather seeking to strike down the whole ACA by removing components important to its functionality.

I see a few problems with your scenario coming to fruition, at least in the manner you outlined.

The CBO gives the maximum number of those who will choose to pay the penalty rather than the insurance at 4 million. I think its doubtful out of 315 million people that is enough to bring the whole system down.

These 4 million people will have to be very careful to never overestimate their taxes and have their refund taken. Moreover, while the IRS cannot aggressively seek the penalty itself, it is unclear whether that applies to the penalty and interest for unpaid taxes - raising the imperative of never overestimating one's tax withholding. Further this group will be under constant duress every time they come in contact with health providers. For example, "freeloader rates" will likely become considerable higher than subsidized insured rates due to 180 degree cultural turnaround on how people will think about these freeloaders. And if the freeloader decides to take the insurance at the time it is needed, there is the real possibility that the clever insurance company will find a way to insist on something more than just the first monthly payment - they're likely going to make it difficult for you to "opt back out" for at least a year. The hassle factor will start to weigh on the group, couple that with the subsidies (remember those are available up for people making up to $80k per year) and pretty much, with time, the 4 million is going to dwindle down to those who should be eligible for Darwin Awards.

As you noted, the initial 4 million will likely consist primarily of young people (with the occasional anarchist or t-bagger thrown in here and there). Not really much of a political block and one that would likely consist of people with very different primary political issues. As time progresses, and those who clearly benefit from Obamacare and those who discover the world does not end, much of the power behind its opposition will vanish. When that happens, unfortunately, the insurance companies will make their move and get their GOP friends to actually impose the penalty on the diminishing 4 million, likely in some subtle way since most of the Dems will just look the other way.

As with what you presented, this is all speculation. We're just going to wait and see what happens. Either way, with the Medicaid Expansion and the subsidies, the needle has been moved toward universal care; we're now dealing at the margins.

Life disruptions from high out-of-pocket health expenditures

http://www.pnhp.org/news/2013/januar...h-expenditures

Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures



Comment about the above article:

How well will the Affordable Care Act address these problems? First, the design of the essential health benefits required of the plans, although fairly broad, allows important benefits to be excluded as long as there is token representation of each general category of benefits. Also most exchange plans will penalize patients for obtaining care outside of their networks - again impairing affordability and access to important services that may be available only outside of the networks.Probably the most significant disruptive element in the exchange plans is that most people will be enrolled in plans with either 60 or 70 percent actuarial value. Most of the plans will achieve these low actuarial values by requiring high deductibles and perhaps co-payments or coinsurance - some of the very tools that result in the disruptions described in today's article.

Although the Affordable Care Act does provide subsidies for both premiums and out-of-pocket expenses, for many individuals these subsidies will not be adequate to prevent the disruptions described.


Many nations with far lower total health care costs than ours are able to provide comprehensive health care for everyone - with first dollar coverage! They do not need to use disruptive out-of-pocket cost sharing to keep their level of spending sustainable. It is no secret how they do it. So why do our policy makers seem to want to keep it a secret here in the Unites States?

Originally Posted by Deb C

Life disruptions from high out-of-pocket health expenditures

http://www.pnhp.org/news/2013/januar...h-expenditures

Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures



Comment about the above article:

How well will the Affordable Care Act address these problems? First, the design of the essential health benefits required of the plans, although fairly broad, allows important benefits to be excluded as long as there is token representation of each general category of benefits. Also most exchange plans will penalize patients for obtaining care outside of their networks - again impairing affordability and access to important services that may be available only outside of the networks.Probably the most significant disruptive element in the exchange plans is that most people will be enrolled in plans with either 60 or 70 percent penalize patients for obtaining care outside of their networks - again impairing affordability and access to important services . Most of the plans will achieve these low actuarial values by requiring high deductibles and perhaps co-payments or coinsurance - some of the very tools that result in the disruptions described in today's article.

Although the Affordable Care Act does provide subsidies for both premiums and out-of-pocket expenses, for many individuals these subsidies will not be adequate to prevent the disruptions described.


Many nations with far lower total health care costs than ours are able to provide comprehensive health care for everyone - with first dollar coverage! They do not need to use disruptive out-of-pocket cost sharing to keep their level of spending sustainable. It is no secret how they do it. So why do our policy makers seem to want to keep it a secret here in the Unites States? .

Let's take a little bit more critical look at the comment piece.

Just exactly what analysis leads to the assertion that the plans design "allows important benefits to be excluded as long as there is token representation of each general category of benefits."? It's one thing to say a plan assumes only 100 brain tumors in a population of 1 million; it's a total different thing to suggest the plan will not cover the 101st brain tumor in the group if it should arise. Which is it? Do you know?


As in regard to the "penalize patients for obtaining care outside of their networks - again impairing affordability and access to important services," I get the "access" part (no big news there under any plan and that would include Medicare whereby a lot of specialist do not take Medicare patients) but what’s up with the "impairing affordability" piece???? Anyone with the least experience in dealing with health insurance understands that going outside of network providers is nearly ALWAYS more expensive.


In regard to "actuarial values," I would bet that 99% of people had never heard of the term, at least in the context of health insurance, before the ACA and probable that's moved down to maybe 98% since its enactment. For those who don't know what "actuarial values (AV)" means here is a good description -

http://yourhealthsecurity.org/wordpr...consumers2.pdf

One of the key objectives of the ACA was to get people to better understand their insurance coverage benefits/costs. It has been very obscured and that tends to lead to people not getting their money's worth. It's not perfect but getting ALL insurance plans to provide their AV for comparison purposes in the exchanges will put people a lot more in charge of what level of insurance they want for themselves given their own unique situation and tolerance for risk.

Moreover, if you look at the link, you will see that those who were least likely to afford insurance before ACA will not only get subsidies, but will have much higher AV coverage. Those not eligible for subsidies (e.g. family of 4 making over $88K per year) tend to be fully capable of deciding what level of AV they are willing to pay for.

It should be noted that Medicare, the Nation’s single payer for those over 65, has an AV of 74% that makes it comparable to a ACA Sliver Plan, and likely the coverage those being subsidized will get –
http://www.kff.org/medicare/upload/7768-02.pdf

Finally, this - "Most of the plans will achieve these low actuarial values by requiring high deductibles and perhaps co-payments or coinsurance"

First, it's a misdirection to say "most." The level of coverage, the AV, the deductibles, copayments, coinsurance are ALL spelt out for people to decide what they want. What will be "most" is what most people decide is best for them with and without the subsidies.

Second, it is the deductable that reduces the amount of coverage provided to a TOTAL GROUP of people by their insurance - that is what the AV measures. And most people in the group will not even get the stated AV coverage! That's because most people, thank God, generally do not get seriously ill enough to use the deductible. Yes, PREVIOUS to the ACA, there were poor people that could be seriously ill and not seek health care because of (for them) a high deductable. However, with ACA there is the Medicaid Expansion that takes the most likely group of people in this situation out of that predicament (that’s why every Progressive should be interested in getting individual states to accept the expansion; hello, Florida!). In addition, the subsidies take out what should be the rest of those who had been in such a predicament. For those not being subsided? If you are making over $88K, you or one of your kids get seriously ill but you don't seek health care because of the deductable... well, you're a candidate for the Darwin Awards.

Right now my favorite Democrat is Congresswoman Jan Schakowsky of Illinois, who is prepared to revive the public option.

A Democrat who actually has a sense of priorities!

That's rare indeed in these feverish days of "Pin The Tail On The Second Amendment."

"Insurance is a Bet"
Health Insurance is Not Healthcare

by JP SOTTILE
Insurance companies make a simple wager with you each time you sign a policy. They are betting that, over the life of the policy, they will pay out less to you and your beneficiaries than you will pay them.
Insurance companies of all kinds make tidy profits on this simple wager. If they don’t, sometimes the government will bail them out.

Either way, insurance is still just a bet. And in America, we do not have a healthcare system. We have a health insurance industry.

That industry has been one of the most profitable sectors of the economy for well over a decade. But costs skyrocketed and care suffered. We heard horror stories about rationed care, denied procedures and corporate bureaucracies run amok. Ironically, these were the horror stories we were supposed to hear if the government took the reigns of the “best healthcare system in the world.”

So, instead of a single-payer healthcare system, we got The Affordable Care Act—aka Obamacare. Instead of retiring the health insurance industry and its actuarial tables and profit margins and wagers, Obama “saved” the health insurance industry and enshrined it in perpetuity as the “Health Insurance-Industrial Complex.”

http://www.counterpunch.org/2013/01/...ot-healthcare/

Originally Posted by Deb C

"Insurance is a Bet"
Health Insurance is Not Healthcare

by JP SOTTILE
Insurance companies make a simple wager with you each time you sign a policy. They are betting that, over the life of the policy, they will pay out less to you and your beneficiaries than you will pay them.
Insurance companies of all kinds make tidy profits on this simple wager. If they don’t, sometimes the government will bail them out.

Either way, insurance is still just a bet. And in America, we do not have a healthcare system. We have a health insurance industry.

That industry has been one of the most profitable sectors of the economy for well over a decade. But costs skyrocketed and care suffered. We heard horror stories about rationed care, denied procedures and corporate bureaucracies run amok. Ironically, these were the horror stories we were supposed to hear if the government took the reigns of the “best healthcare system in the world.”

So, instead of a single-payer healthcare system, we got The Affordable Care Act—aka Obamacare. Instead of retiring the health insurance industry and its actuarial tables and profit margins and wagers, Obama “saved” the health insurance industry and enshrined it in perpetuity as the “Health Insurance-Industrial Complex.”

http://www.counterpunch.org/2013/01/...ot-healthcare/

Although I am not a fan the ACA does make a single payer plan more attractive. Perhaps that was the real goal all along.

I need to vent just a little bit...

My fiancee had some swelling & pain in a finger so she went to the campus clinic. The nurse freaks out and assumes some kind of infection, so they start running some blood tests. No signs of infection so they take her over to the local hospital for an X Ray and insist on an MRI (ouch).

Anyway, it's a little stress fracture and the recommended "treatment" was that she should try to avoid using it for a while.

The bill? Well, the doctors have already collected $2,000 from the insurance company, and they want another $600 from us because $2,000 isn't enough! $2600 to say "Don't use your finger for a while!"

So... this is why having insurance doesn't fix a damn thing that is wrong with our medical system, and this is why voters aren't exactly thrilled with the ACA.

Ok. End rant. Back to writing a nice "no way in hell" letter to the doctor.

This article says that ACA will reduce costs for most people, and those for whom it doesn't, will get more for their money.

http://www.newrepublic.com/article/1...very-shocking#