Health Insurance Rate Shock-California Obamacare Insurance Exchange Announces Premium Rates

[Scuba]

http://www.forbes.com/sites/rickungar/2013/05/24/unexpected-health-insurance-rate-shock-california-obamacare-insurance-exchange-announces-premium-rates/

For quite some time, I have been predicting that Obamacare would likely mean higher insurance rates in the individual market for the “young immortals” and others under the age of 40. At the same time, my expectation was that those who fall into the older age ranges would benefit greatly as their premium charges would be lowered thanks to the Affordable Care Act.

It is increasingly clear that I had it wrong.

Yesterday, Covered California—the name given to the healthcare exchange created pursuant to the Affordable Care Act that will serve the largest population of insured citizens in the nation—released the premium rates submitted by participating health insurance companies for the three health insurance program categories (bronze, silver and gold) established by the Affordable Care Act, along with the catastrophic policy created for and available to those under the age of 30.

Upon reviewing the data, I was indeed shocked by the proposed premium rates—but not in the way you might expect. The jolt that I was experiencing was not the result of the predicted out-of-control premium costs but the shock of rates far lower than what I expected—even at the lowest end of the age scale.

[Turbineguy]

1. Not to worry,

Fox News will come up with a new lie.

[freshwest]

92. And half the nation will buy it. California was supposed to stay broken!

Dang those sneaky Democrats...

[bluestate10]

191. History repeats. Democrats have a long history of cleaning up republican fiscal messes at

all levels of government. Republicans are better at taking credit for improvements they had nothing to do with and often vigorously opposed.

[freshwest]

204. Very true. There's a graphic for that:

[BrotherIvan]

2. Not my experience

The rate they quoted was over $150 more than what I pay now as an individual (not company-sponsored insurance). Don't know where these numbers are coming from. I have to pay over half my mortgage for something I never use, and if I do try to use it, they deny the charge and I have to pay for it myself. I have a hard time cheering for more of the same.

[SunSeeker]

3. More info please: where do you live, what is your premium and for what insurance?

Those exchange rates are mighty cheap for CA! I currently have Blue Shield HMO coverage through my employer. I pay $1, 757.89 PER MONTH out of my paycheck for my family of 3. And that is AFTER my employer kicks in $1, 402.00 each month.

[Ms. Toad]

5. And the top rate I saw was under $400/month n/t

[SunSeeker]

7. Exactly!! nt

[hunter]

6. My wife and I couldn't get individual insurance, we were uninsurable.

We ran out a COBRA to the bitter end, and my wife had to sign up for the state 'high risk" insurance pool which was oversubscribed. It took several months before she was accepted.

The incomplete high deductible insurance we get now through her work costs more than our mortgage, and there have been several bad years with medical problems that wiped out our savings and destroyed our credit rating.

This was all the consequence of random stuff falling out of the sky that could have happened to anyone.

As far as I can tell, insurance companies do everything they can to shed customers who become expensive.

The U.S. ought to have a national health care system like actual first world nations. Maybe this is an evolutionary step in the right direction, although I tend to think it was a Hail Mary pass to prevent the collapse of the existing health care industry.

[pnwmom]

193. You will no longer be uninsurable, and they won't be able to drop you

for developing any new conditions or to limit annual or lifetime expenditures on you.

[Politicub]

10. You have access to affordable insurance now

That has to count for something.

And you have a really good deal to get that kind of rate on the private market. No one is going to make you change insurers, so just think of Obamacare as being there when you need it

Who is your insurer?

[xtraxritical]

16. I am uninsured now and still will be at those rates.

[flamingdem]

52. Why? Can you qualify for subsidies? nt

[pnwmom]

194. There are subsidies for people with incomes into the 80K range.

Have you looked into that?

[Honeycombe8]

21. Let's have some facts, please...

so we know you're speaking truth as opposed to fearmongering.

What company quoted you? What were the terms of hte policy you were seeking? (deductibe, total out of pocket for year, individual or group or family, did it include dental and mental health, how much for Rx, what were the copays for exams and Rx, etc.).

What was your pior (or current) ins co? What are the terms of that policy? (No two policies have identical terms.)

What is your age, gender, health status, and do you smoke? If you smoke, how much do you smoke, and for how long have you smoked?

Are you in California? Is the company you got the quote from part of the exchange, that the OP article is referring to?

Only when we get the above information can we know how the ACA is affecting your premiums, or IF it is.

[BrotherIvan]

40. You have got to be kidding or delusional or both

You want me to supply my personal medical information to you so you can judge if I'm fearmongering or lying?? Would you like me to post a copy of my medical records for your examination? Are you fucking high?

Here are the numbers, for all of you, I used to pay $185 per month before the ACA. I have Blue Cross of California that I pay independently and have kept it through the years even when I had a salaried job (most of the time I work as an independent contractor). Every 3-6 months since the insurance act passed I have received a letter that my premiums are going up until now I pay $329. On the exchange, the quote was $599 for a commensurate policy with about the same deductable. And no, the calculator did not ask any of the health questions you demanded. That is for ONE person in our two person household.


ETA: now that I have read some of your downthread replies, I don't know why I even bothered taking the time to answer. You are all over here spewing health insurance company talking points and pushing that people should be denied access to care and things like birth control because they aren't medical necessities "rates will go up". WHY do all the cheerleaders always sound like RW trolls? If the Republicans kick out the Tea Party will you please go back?

[intaglio]

47. No, people want you to stop being a troll

Basically you are making a claim unsupported by any fact except your dislike of the ACA and, probably, Americans.

[truedelphi]

91. This person is not a troll. I can attest that

The website that was up and running about a year ago quoted that we would pay as an over the age of 58 couple living in California about 559 bucks a piece.

There would also be a $ 5,000 a year deductible, again for each of us. So that by the time we paid the premiums, 1,118 a month X 12 = 13,416 a year, plus the deductibles, we would have to spend out of pocket some 23,000 and then and only then would the insurer be required to spend a penny on us.

Oh and for what it is worth - there are co-pays!

[Squinch]

102. Is that still in effect? Has it changed since you saw it a year ago?

[truedelphi]

157. That website, which allowed a person a larger and more complete understanding of what was to

Come, has been replaced (apparently) by the website cited in this discussion.

And according to this new website, we will have as our monthly bill a mere $ 102 for the premium. No discussion about where this $ 102 a month is to come from - we don't have it. I have yet to read any article in any newspaper that says that those of us in the 17,000 to 39,000 dollar a year income range are not going to be screwed big time.

So although if the new website quoted here is true, we are only on the tab for $ 102 X 12, then I won't moan too much. Maybe I can babysit on weekends and make that money?

But what worries me is I cannot find anywhere on the new site any discussion of deductibles. And I know there are deductibles being required of almost every insurance holder - and people are really steamed about that.

So if this household still needs to come up with an annual $ 5,000 deductible a piece deductible, plus co-pays, as was detailed in the original website, we will be paying 102 a month X 12 + 10,000 + co-pays before we receive a single penny of help from a Big Insurer. Any couple making under 35,000 a year knows it isn't possible - at least not if you are paying rent at steep prices as we do here in California.

Yet the Obama/Rahm Wellpoint Heath Insurers Guarantee Program has its fans here, so I guess I should just friggin' shut up.

[pnwmom]

197. What level of income will be eligible for the expanded Medicaid program?

Is that all below $17,000 a year?

[truedelphi]

238. After our medical bankruptcy, we were allowed help

here in California, up to about 23K $$ a year. However, the last time we were able to qualify for health insurance, it had an $ 800 a month deductible. And of course, that has to do with Calif. state policies, and the consideration of rent payments being so high.

I have no idea what will happen in California after the 2014 ACA provisions kick in.

I did really like the fact that our household would have gotten help on a per month deductible basis, because if our household has to come up with a $ 5,000 a year deductible before help is given, it means we would probably be dead, since we don't have the $ 5,000. Help being offered after $ 800 as spent seemed like the way to go. (Our years of retirement money was wiped out during the bankruptcy.)

.

[pnwmom]

245. What a nightmare.

I'm truly sorry you had to go through all of that. I hope ACA improves the situation for you.

[intaglio]

114. Then why is a low post count member

making an unproven claim?

[davidthegnome]

198. Seriously?

You're attacking someone's character and credibility simply because they have a post count of under 500? Some of us who have been here for 5-8 years or more have fewer than two thousand. Are we all simply trolls then?

You clearly assert that the poster is a troll, then suggest that the poster probably doesn't like Americans... based on your differing opinions regarding the very controversial ACA... then you have the audacity to attack the poster for not having facts?

Until the ACA is fully realized - until it actually comes into effect for the vast majority of us, I will withhold judgment on it's overall value - but there is plenty of room for debate, for argument, for difference of opinion.

Personally, I think that, as people who are more left of center (generally speaking) we might want to keep "low post count members" around so that they may eventually aspire to that lofty goal of becoming "high post count members". If they are in error, well, that's why we have these "facts", which you mentioned. It would seem that you also did not use them in your attempt to refute the poster's claims.

[hunter]

124. My wife and I pay more than that for insurance and "deductables..."

.... and we often have to fight for what we've supposedly paid for.

Our "deductible" is about $8000.

If we'd had any sense we'd have moved to a first world nation when we were young.

Oh well, live and learn.

[pnwmom]

196. But how can that website account for the government subsidies

for people with household incomes up to the 80K range -- since that would require knowing what a person's taxable income was?

These subsidies will be paid starting next January directly from the govt. to the insurer.

[flamingdem]

64. Yes, I had Blue Cross and it went up every 6 months

Like you reasonable then expensive for not great insurance. Best is to get it through an employer since now Cobra isn't an issue and the exchanges make it easy to get something if you leave or switch jobs.

That said I am unhappy with rates for 60,000 and up earners.

[AllyCat]

83. It's not so good if you are middle class

Last edited Mon May 27, 2013, 01:12 AM - Edit history (1)

I have insurance through my job that used to be good and cheap. Now, the ceo of our place is lowering options and care while increasing the deductible and out of pocket. The rates quoted here would bankrupt my family. Hope it's different for the federal exchange when it comes out. I live under Walker's rule so we get federal.

[LiberalFighter]

128. You have got to be kidding or delusional or both

You use to pay $185 per month? I don't know what type of coverage you have that you only had to pay $185. I seriously doubt it amounted to a hill of beans.

If I had paid for my coverage back in the early 90's it would had been in the $700 to 800 range. And it was in a plan that had everyone covered at a corporation with sites across the country. I believe we had about 600,000 employees not including the retirees at the time.

[flamingdem]

134. I actually know this plan. Someone told me she'd had it forever

It's crappy catastropic insurance and if you got in on it a long time ago it was good up until a couple of years ago when the increases every six months started.

Same plan now is approx. 320 ymmv

[LiberalFighter]

139. Then it is not comparable to most plans??

More of a supplemental like for cancer?

[flamingdem]

141. It's a regular Blue Cross Plan

I think it was called Smart Sense or something. It just had a very large deductible - 8,000 or so. I'm ballparking but she bragged about its low cost and two free visits a year or something. They didn't take new people at that price. They did offer $230 about 1.5 years ago which is now $330 ish. For nothing much, for fear of something like cancer or an accident. So glad those days are over.

[flamingdem]

135. I just defended these numbers below, I know it's true

because I know a woman in her 50s who had it forever at that amount and then increases started.

It's catastrophic insurance, w huge out of pocket / deductible

[pnwmom]

195. The subsidy comes directly from the government so I doubt that the letter

would have addressed that, right?

So the question is how much you would have to pay AFTER the subsidy is accounted for. Your health insurer won't know that because it depends on the income you earn.

[cheapdate]

259. "Every 3-6 months since the insurance act passed...my premiums are going up"

For heaven's sake. Do you think that health insurance rate ONLY suddenly began to increase in March of 2010? Health insurance costs have been sharply increasing every year at a rate much higher than inflation for more than two decades. That's one of the major reasons why Republicans and Democrats recognized it as a major problem that needed to be solved BACK IN 1992!

I've been at the same company for almost 15 years. Our insurance is with Blue Cross of Tennessee. From 1999 to 2009 my premiums DOUBLED -- from around $400 to around $800. They're almost $1,000 today. It didn't START in March 2010 with the passage of the Patient Protection and Affordable Care Act.

Rates will probably CONTINUE to rise, as they have risen steadily FOR THE PAST TWO DECADES.

[JDPriestly]

97. Deleted by person posting.

[onlyadream]

108. We have individual insurance thru empire

Well visits are paid as well as 100% hospital, we pay sick visits. For our family of four we pay $425/month. Is this something only for NY?

[SugarShack]

203. You have incredible insurance for healthy people, and I want it.

Unfortunately, I live in FLA and we have some of the most expensive, just like NY.
But we don't have that plan in our state...

[onlyadream]

230. I did a major happy dance when I found it

We were looking at COBRA, $1500/month with crappy, very high deductible ($3500) insurance.

[SunSeeker]

4. Exactly. My brother will finally be able to buy insurance for the first time in his life.

He is middle-aged with a pre-existing condition. This exchange will save his life.

[Che Billy]

8. Oh gawd, how I wish...

...we had a single-payer system. What we have now is a disaster.

[Politicub]

11. How is it a disaster?

The ACA isn't perfect, but millions will reap the benefit. Those who can't afford insurance will get it without cost or offset with a subsidy. Everyone will have access for the first time in American history.

Though I think you're just shoveling a load of crap to be honest with you.

[Bluenorthwest]

15. The law discriminates against millions of same sex couples and families

It is sad to see you dismiss that as 'not perfect'. Such a horrible injustice should create a huge reaction but those of you who are not discriminated against really don't seem to care much about what happens to others.

[Politicub]

20. How does it discriminate?

You are really grasping at straws here.

Do you have health insurance, because many people who want it don't.

Now they will have access. How can this not be a good thing?

[Honeycombe8]

26. Can you cite the provision that prohibits selling ins. to gay people?

I haven't seen it. I would like to read that provision.

[Comrade Grumpy]

25. Because it is a racket. It's lipstick on a pig.

Our healthcare system is gravely distorted by the profit imperative. We need health care reform, not health insurance reform. We need nationalized health care, not this Rube Goldberg system designed to ensure profits for those fucking parasites preying off illness.

I spend more on health insurance than I do on my car payment, my house payment, or food. Not for health care. For health insurance. I give these assholes $8,000 a year, and they still don't want to pay for a shingles vaccine.

I applaud Obama for his tiny first steps, but that's all they are.

[Politicub]

28. Did you read the article, or are you just perpetually negative?

Rates are coming in much lower than expected.

This racket, as you say, is going to mean the difference between life and death or bankruptcy and solvency for some people.

[Comrade Grumpy]

32. The ACA is a band-aid. Our health care system needs radical surgery.

To the extent that the ACA improves things for people, it's a good thing. But our health care system is still fucked, and ACA doesn't really change that.

Our health care system is full of people profiting off misery. And those profits drive our costs sky high.

I have a plan:

1. No-charge health care for everybody paid for by our taxes.
2. Dismantle the parasitical health insurance industry.
3. Nationalize Big Pharma.

[Politicub]

37. A single payer system would be good

But it's not the law right now. I believe we are heading in that direction. Until we get there, the ACA has a lot to like.

But for now - be happy for your fellow Americans who have needed insurance but couldn't find anyone to sell them a policy. Be happy that there are billions of dollars set aside for building health care clinics in all areas of the United States. Think of the woman that will have a lump found in her breast early enough to treat it thanks to free mammograms and preventative care.

To throw the baby out with the bath water demonstrates a profound degree of ignorance.

[Plucketeer]

110. Heh - the thing is....

We could BE THERE - single payer - if this president hadn't sold out to the health insurance industry. We had BOTH houses talking positive about single payer - and the president - who had touted single payer to get folks to vote for him (along with a BUNCH of other forgotten ideas) - took on the attitude: "Well, I mean, ah, IF .... single payer could find it's way to my desk - not that I think it ever will - I suppose I might maybe could sign it. But let's not be hasty here."
Yeah, t'would be HELL to end up with the horse before the cart.

[DCBob]

174. reality check.. the votes were not there for single payer...

end of story.

[Plucketeer]

175. So it's as simple as....

going to the pantry and seeing if there's enough existing votes for something. Hmmmm... I could be wrong, but unless it's a move to name a new post office, nothing gets done without making effort and noise. Neither of which Obama did with respect to Single Payer health care. What stellar leadership.

[DCBob]

176. in many cases it is that simple.

for many in congress, single payer is a non-starter.. no matter how much noise anyone makes.

[Plucketeer]

189. We can make excuses

That's more than the president did. He was elected on talk of single payer - instant stop to the wars, etc., etc. We got rights for gays. While that's important, it does nothing to help the beleagured and scammed citizenry as a whole - the 99%, if you will. I guess as a consolation prize, he's gonna give us the TPP. Then we WILL need health care - especially the expertise of proctologists.

[DCBob]

209. Obama was not elected on single payer promises.. thats absurd.

[Plucketeer]

216. WERE there any promises

or was everything he talked about just plays on words?

[DCBob]

223. see below..

Despite a polarized nation and a largely dysfunctional Congress, President Barack Obama has fulfilled or made substantial progress on 73 percent of the 508 promises he made when he ran for president in 2008.

Those results come from PolitiFact's Obameter, an unprecedented four-year effort to rate the president's campaign promises. The ongoing project by the Tampa Bay Times' fact-checking website reveals that Obama has achieved 47 percent of his promises, earning a rating of Promise Kept. Another 26 percent were partially fulfilled, earning a rating of Compromise.

http://www.tampabay.com/news/politics/national/president-barack-obama-kept-or-moved-forward-on-most-campaign-promises/1271440

[cheapdate]

260. Agree.

My patience is wearing thin for arguments that suggest Obama could defy political reality -- if he only he was good enough, smart enough, or sufficiently committed.

[dionysus]

228. bullshit. sanders said there were less than 10 votes for single payer in the senate...

[Plucketeer]

250. Very well then

be happy with the status quo. Don't push - don't make noise - just be happy with the insurance subsidy setup we were able to make them swallow. Only a few votes - so don't bother bringing it up again. Hell, we're just lucky to be livin' in the greatest country on the planet. SA-LUTE!

[SHRED]

93. not gonna happen

While I agree with your idealism if implemented it would shock our economy wsy too much. The sad truth is that for-profit health and drugs are so intertwined into even retirement portfolios that a slow weaning is necessary to avoid harming millions. I think the ACA while not perfect heads in the correct direction.

[KansDem]

98. I agree...

Our health care system is full of people profiting off misery.

There are what I consider to be five national security issues:

1. Defense
2. Education
3. Environment
4. Energy
5. Health

These concerns should not be left in private hands.

[Honeycombe8]

30. Your post is one of the reasons health care costs have skyrocketed.

The purpose of insurance is not to pay for anything and everything that YOU determine you want, medically speaking. It never was, and it never should be. Ins. companies paying for numerous visits to drs to tell a patient repeatedly, yes, you're having sinus trouble (duh), or whatever, is ridiculous. Paying for things people want but are not medically required, causes costs to increase (birth control pills...what most liberals wanted...but which are not medically required and is not a medical treatment....will cause premiums to go up). I'm not saying these things are not good things, but people who want these things paid for 100% often turn around and complain about health care costs. Well, you can't have it both ways.

Shingles shot is a protection not considered medically necessary. I'll be getting it, though, one day. But ins. IMO is to protect a person from catastrophic costs for treatment, and to get annual exams to catch things early (like mammagram).

If you expect an ins co to pay for everything health care related that you might want, then expect health care costs to be sky high.

[Comrade Grumpy]

34. Well, I didn't get the shingles shot, even though my doctor recommended it.

So, fortunately, the health insurance company's bottom line wasn't hurt. They still have my $8,000 in premiums for the last year to comfort them, too.

I don't want fucking health insurance companies. I want national health care. Our health should not be a for-profit industry.

[BrotherIvan]

42. So the reason insurance costs are so high is because people are getting TOO MUCH care?

Please, enlighten us.

[Squinch]

105. Probably not what the poster was talking about, BUT I think there's some truth in that.

I recently went through the end of life care fiasco with my mother. They kept throwing expensive and unnecessary procedures at her, even though we begged them to stop. (And just to be clear, she DID have the DNR and all the requisite paperwork that should have made that unnecessary, but we learned that those are not sufficient to override the almighty need for unnecessary medical procedures.)

We decided to transfer her to Hospice so we could take her off the machines and end the procedures. But in the ultimate catch 22, they needed a portable version of the machine she was hooked up to so we could transfer her to Hospice to take her off that very machine. But it wasn't readily available, so for 24 hours, they kept her on the machines and continued the painful procedures so they could locate a portable machine that she could be hooked up to in the ambulance to take her to Hospice so we could discontinue the machines and procedures.

One of the most frustrating and eye opening experiences of my life.

[cheapdate]

261. Firstly, it is a fact

that is cited in every reputable, professional analysis of health care costs in the United States that significant money is wasted on unnecessary tests and procedures. This is one of many factors in the high cost of health care in the US.

But that's not really his point, nor was his point that, "the reason insurance costs are so high is because people are getting TOO MUCH care".

What he said was that insurance will NECESSARILY cost more if it must cover a growing list of routine treatments AS WELL AS the cost of major illnesses and injuries.

That is not a controversial statement, nor is it incorrect.

You somehow misinterpreted his obvious meaning.

[BrotherIvan]

43. And since you are an expert on costs

Just so you know, birth control pills cost PENNIES to make and ARE medically necessary for many women. But I guess that is a "liberal" fact you may not get from Fox News.

[Live and Learn]

95. Not to mention how much they save taxpayers

by allowing people to control when and how many kids they have. Birth control pills keep costs down, plain and simple. Viagra, on the other hand....

[xmas74]

202. They are necessary for me.

Without them I would have already had a hysterectomy.

[BrotherIvan]

206. It's hatred of women to say any different

That's denying women basic care based on gender. It's disgusting.

I'm so glad you've found something xmas74 to help you. Health and health care is your right.

[xmas74]

251. I never had a problem until after I had a child.

I've heard so many say they shouldn't have to pay for bc. Without it, I would have a hard time functioning.

[Squinch]

104. Birth control coverage reduces the overall cost of health insurance.

[RILib]

146. what's cheaper Honeycombe8?

Birth control or the birth of a baby?

[noiretextatique]

178. insurance is unnecessary barrier to basic healthcare

and insurance costs are high because they are generally for-profit businesses. they make money by denying services, some of which are indeed medically necesary. and birth control is medically required for some women.

[Demeter]

103. People get unequal treatment, based on what they can afford

and what they can afford is decreased because they will be shelling out tons of money for INSURANCE, which ISN'T healthcare, and not even the promise of healthcare, but more like a lottery ticket with only an occasional winner.

With Universal, Single payer HEALTHCARE, on the other hand....you get what you pay for.

[dflprincess]

187. All it does is require a person to have "coverage" it does nothing to guarantee access to care.

A lot of people will only be able to afford coverage that has out of pockets that are so high that they will still not be able to see a doctor (and the income limits for subsidies are not high enough & bear no relation to what it really costs to live.)

The big winners in this deal are the health insurance companies and the credit card companies as people will continue to use plastic to cover the medical bills they can't avoid. The number of uninsured may drop but the number of underinsured will continue to grow.

[historylovr]

247. +1. nt

[clarice]

277. Right, lets kill the messenger. nt

[clarice]

278. metaphorically of course. nt

[emmadoggy]

14. I agree.

Welcome to DU!

[Scuba]

17. I agree on single-payer, and the disastrous state of our for-profit insurance system ...

... but still feel we're better with the ACA than without. Perhaps the success of the ACA will prompt further movement toward Medicare for All.

[a kennedy]

35. I agree Scuba.....gotta get the door open to begin with and the ACA does that.

It's a first step and I would love single payer also.

[rhett o rick]

89. Yes "it's a first step" has a nice ring but is hollow unless it is followed up with a second

step. Are the Democrats actively working on the second step? Or is that for the next generation?

[bvar22]

46. I would really like to believe that,

but HOW is Mandatory For Profit Health Insurance without a Public Option
going to lead to a Publicly Owned/Government Administered, Cradle to Grave, National Health CARE Plan for every American?

My Tea Leaves say that this is only going to make the Parasitic Health Insurance Industry STRONGER,
and GUARANTEE their Profits for the Ownership Class,
every cent of which is money that will NOT be spent of actual health care.

If anything, the ACA is a Giant Step toward the Privatization of For Profit Health Care, with the parasitic For Profit Health Insurance Industry
legitimized as the ONLY Gateway to Health Care in America.


So tell me,
What is the next step that will move us toward Medicare for All?

We are going to be STUCK with this for a LONG time.
There will be NO "Fixing it Later".
The ACA actually postpones the opportunity for REAL reform for at least another generation.

[dflprincess]

188. You said it! n/t

[Honeycombe8]

22. I wish I were 18. But reality is, I'm not. Time to move on and work with what we have...

and recognize that 59 is certainly younger than 69. ACA is better than what we had before.

[southernyankeebelle]

51. Che we will get there. It might be a slower process but I have a feeling we will get there.

[flamingdem]

55. Not for millions - and others will get more for the buck

and not be haunted by limits and pre existing conditions

[malaise]

78. That was the hope of the Wingnuts

The opposite is happening

[Politicub]

12. The major provisions of the ACA are almost here

And the end of exclusion based on a pre-existing condition will be consigned to the dustbin of history.

[Bluenorthwest]

18. And another chapter in the history of vicious discrimination against gay people opens....

I'm sorry, but this law excludes my family from being counted as a family. Or as a household. That's fine with you, but of course it happens to others while you get full benefits, rights, tax breaks etc.
Good for you. Congratulations! How wonderful.

[Honeycombe8]

23. Can you cite the provision in the ACA that says what you say it says?

Or are you perhaps talking about some individual ins. company's policies?

[Politicub]

27. If you don't see some positive benefits of this legislation

Then I can't help you.

It's a platform on which to build.

Ad if you haven't noticed, the societal pendulum is swinging toward equal rights. I am part of the gay community and live in Georgia. My husband and I have seen and lived discrimination. But are you aware that because of a federal rule change coming from Obama's HHS we won't be denied visitation rights? Do you care?

And just to clarify, do you think the entire law should be null and void because you say it's discriminatory? I want to know where you stand otherwise I don't see the point in trying to have a reasonable conversation.

[L0oniX]

13. I won't count chickens before they are hatched.

[Honeycombe8]

19. Oh, the naysayers and anti-healthcare reform sky-is-falling folks aren't gonna like this.

It'll be interesting to see all the, "But wait!" naysayer posts and articles, as they search for a dark lining and impending doom in the face of facts. I predict you'll see posts of "That hasn't been MY experience," and "My premium has DOUBLED solely because of Obamacare!" and "I can't even get coverage any more!" None of which will be based on facts or cite any authority or even contain enough information for a reader to discern truthfulness or bogusness.

Time will tell, of course. But this article is based on facts. Facts are pesky things. You just can't argue with them, unless you find people willing to look away from them and base a decision on fearmongering.

[loyalsister]

62. My favorite line from the article..

"With every passing day, the various myths, legends and lies put forward by those with a political axe to grind, TV or radio rating to be raised or vote to be purchased, are falling victim to the facts."

[antigop]

24. I don't consider $1,000/month just for premiums "affordable"

Calculator:

http://www.coveredca.com/calculating_the_cost.html

Number of people in household: 2
Annual income: 63,000
Age of first adult: 55
Age of second adult: 55
Estimated Monthly Silver Plan Premium (without subsidy): $1,026
Estimated tax credit from the government: $0

$1,026 just for premiums --- co-pays, deductibles, coinsurance are IN ADDITION to that.

Run the calculator again with same info, except age of first adult and spouse are 60:

$1249 per month in premiums -- NOT AFFORDABLE.

[Comrade Grumpy]

29. But you haven't factored in the costs...

...of those insurance company executive bonuses.

...of those expensive Manhattan meals for pharmaceutical company executives.

...of paying dividends to the stockholders of for-profit hospitals.

We have to keep the parasitical grub worms fat and happy.

[antigop]

31. Holy moly! $1358 per month age 63 JUST FOR PREMIUMS!!! nt

[woo me with science]

142. +100000

[haele]

149. I've got very good company provided insurance in CA -

And I pay $550 a month in premiums, with my company paying twice as much. True, I have a family plan, but that only added $100 a month to my premium, and $200 to my company.
So, in total, my plan would probably cost around that much if I was carrying the entire amount myself - or more, since I wouldn't have the cost-negotiation my company does with the insurance company.

Insurance costs depends where you live, and what's required to be covered. The California Insurance market is pretty expensive (lots of people but lots of health issues), and due to the higher amount of coverage and regulations on how the insurance company can operate that the state requires (as in, it can't completely be a cut-rate no-service scam for the desperate money-making machine masquerading as "health care insurance" - they do have to provide some service...), they charge more than, say, Montana, Arkansas, or Texas.

Single payer would be far better, and eventually, California will go there.
But for now, this is the best balance between having the taxpayer pay for health-care by emergency room for a large number of people and what was available as "health care insurance" before.

Haele

[antigop]

153. $1358 per month age 63 is JUST FOR PREMIUMS -- that's NOT AFFORDABLE. nt

[haele]

166. A 63-year old single making 60K under the Covered CA "silver" plan pays $679 a month.

Not $1358. For complete coverage that has a few co-pays that are in the median of co-pay costs.
Single 63-year old making $20K a year pays only $85 a month.
Single 63 year old making $40K pays $317 a month.
And there's the federal tax credits, which I haven't figured out yet just in observation for all the categories except for single over $60K; you'd have to go into the various tables to find out what they are.

A couple, with the individual aged 63, spouse 60, and household income is over 60K does end up paying $1305 a month with a federal tax credit of $828 (for two) dropping it down to the equivalent of $475 a month (but you don't get that money until the end of the year). If the spouse is under 60, the premium goes down to $1278, but the credits drop it down to $475.
Add one dependant (child or adult) as covered under the ACA to the couple above, while the up-front premium goes up to $1533, the tax credit increases to drop the cost down to $475 a month. Add another dependent, and it drops down to $405 a month.

A couple (age didn't count when I ran the numbers) with a household income of $36K - pretty much the median income in California - pays $223 a month in premiums after the federal tax credits. Add a child, and the federal tax credits drops the premium down to $157 a month.

The federal tax credits are based on income and members in the household, not age, and are meant to balance out the difference in premiums by age and number of members covered.

Go to the link and find out - if someone is telling you it's still $1358, they're either lying about the CA exchange or they're telling you what the max the insurance companies are going to be able to offer to meet the equivalent care on the open market.

http://www.coveredca.com/calculating_the_cost.html

Now, if we aren't discussing California's plan under the ACA, I apologize for the above comment; that's the problem when there's cross-country discussions.

Having looked at "quotes" from companies, it is clear that free market costs are not affordable to the average person. This is a major problem with the ACA - however - and this is the big "however", no matter what state you live in, there is a federal tax credit in the ACA that even people who's income is up to $60K can get to offset their monthly premiums, so the 63 year old who has been quoted $1358 in a particular state is going to be eligible for some tax credits to offset that cost.
The current ACA system has subsidies and cost containment to attempt to keep medical costs below 12% of their income, which does suck, but is far, far better than what was available before, and if this is going to be an incremental step towards a single payer/rate-administration plan, it is better than what we had seen before.

Before, your only other non-employer-provided based option (disregarding eligibility for Medicare/Medicaid/Tricare/VA) was to suck it up and negotiate with an insurance agent that $1358 a month premium with no federal credits, or go for a cheaper "catastrophic" plan that didn't cover most doctor's visits or lab procedures, or wait until your health got really bad and
A) you suffer through trying to work, take care of "life business" and treat the issue yourself for a period of time until it got to be too much and you (or a family member without coverage) ended up in the emergency room - much worse off and affected for the rest of your life by something that could have been caught early with regular doctor's visits and taken care of relatively inexpensively, or
B) died younger than you would have from something that could have been caught earlier and taken care of, or
C ) ended up bankrupt from treating something in the emergency room that could have been caught earlier and taken care of.

Unfortunately, the ACA is not "health care", it's access to health care, no matter what they call it. And that's another discussion about the values of the electorate and elected lawmakers, and how those values are imposed on the citizens of this country.

Haele

[antigop]

168. it's from the calculator for two people ...the subthread begins here...

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2904304

That's for two people...it's clearly stated in the calculator parameters used.

NO SUBSIDIES in the example.


$1026 for two people age 55, $63,000 annual household income.

Run the calculator again, same parameters except age 63..$1358 for two people age 63.

[RebelOne]

284. If your health is relatively good, try to hold on until

you are 65 and qualify for Medicare. I have Medicare and the premium is only $105 a month.

[antigop]

285. your health may be "relatively good" one day, and "really bad" the next. Holding off until Medicare

doesn't prevent you from a financial catastrophe if you should get sick or have an accident before you qualify for Medicare.

Why would someone think that just because they are healthy today, they will automatically be healthy tomorrow?

[dkf]

33. They are affordable in a sick world where your health premiums are similar to your mortgage

And exceed your car payment for which you may receive no benefit whatsoever if you don't get sick.

[Turbineguy]

36. If you dont't get sick

you reap the benefit of not being sick. It's an insurance pool.

But yes, if as a society we thought that being healthy was a social good then things would be different.

[Politicub]

38. Not being sick is its own reward

Your health is your most valuable thing. The ACA will help more people be healthy.

[dkf]

39. We are the cause of our health problems.

Infectious diseases are mostly under control. It's our habits that are now killing us, what we eat and our lack of activity. And if we are too poor to eat healthily maybe its because the health premiums are eating our paychecks.

[hunter]

67. Not always. Sometimes random shit really does happen.

Sometimes you have an accident and they can't repair you "good as new." Sometimes you inherit a bad mix of genes. Sometimes your mom gets the flu or something while she is pregnant with you and it messes you up. Maybe chicken pox messed up your lungs before there was a vaccine. Look at most type II diabetes people, many of them are from ethnic backgrounds where certain genetic characteristics helped them survive irregular, unpredictable times of famine and bad weather, but prove harmful when high calorie food sources and adequate winter and summer shelter are available.

If the problem is as you say it is, does that mean you support a universal health care system supported by taxes and "free" to all? That would be a surprise coming from dkf...

Personally I think the health insurance industry ought to be nationalized and incorporated into some sort of single payer or entirely socialist health care system. At the same time I would examine the industry's records for evidence of malfeasance of the sort that broke existing laws and killed people. I'm sure we could find a few highly paid executives to put on trial.

[Jennicut]

73. I am type 1 diabetic.

I had no control over my pancreas deciding to stop making insulin around the around the age of 30. Some people really don't have any control over their health. Sometimes, life just happens. Most of us with autoimmune diseases feel like our bodies betray us. If I had millions , I would poor it into research on autoimmune diseases like type 1 diabetes, celiac disease, lupus, scleroderma, MS, etc. There really is no reason people get these diseases aside from some of it being genetics.

[CountAllVotes]

84. genetics; yes

I agree with your statement. I also strongly believe that many of these diseases such as the ones you name are from living on a very sick planet.

It is these same individuals that find relatives with the same problem(s).

For it are these people and their relations that are indeed experiencing the pain of the earth.

Sad, sick world. Many are dying too soon. Unexplainable in many cases ... rapid onset and sudden death.

And there is nothing that can be done or will be done for one reason:

BIG PHARMA makes loads off of these people. What does medicine do for them other than experiment? Nothing much otherwise ... no help or anything reasonable like that!

and ...

Who cares as long as the conditions that you mention exist? They are not contagious, so forget these losers eh?

[dkf]

90. I have a hunch the research is going to find that it's something we are doing.

We just don't understand it yet. The way we've bastardized the production of food, and the amount of anti-biotics in the food chain are playing havoc with our auto immune systems.

I keep telling people I wish we would be putting a whole lot of research into medicine instead of paying so much for our health care system. Only a government that needs to pay for health services sees an advantage in solving diseases whereas any for profit corporation's wet dream is a lifelong customer that will LOSE HIS LIFE if he can't pay for their services.

I see things like this: Engineered Gut Bacteria Reverse Type 1 Diabetes in Experimental Mice

http://www.genengnews.com/gen-news-highlights/engineered-gut-bacteria-reverse-type-1-diabetes-in-experimental-mice/81246608/

Then I see things like this: Fecal Transplants: The FDA Steps In

http://www.wired.com/wiredscience/2013/05/fecal-transplants-fda/

I'm not sure I trust the US Government to do this properly either.

[Scuba]

74. That statement is just so you, overlooking the pollutants and poisons that are killing us.

[drm604]

125. This is simply not true.

Yes, some are to blame for their health problems but many, possibly most, are not.

I am not to blame for the chronic problems that hit me at 15 and have plagued and impoverished me my whole life. At that age I did not drink or smoke (and still don't) and I was physically active.

[MannyGoldstein]

179. Did you know that the oft-recommended low salt diet kills people?

http://www.nytimes.com/2013/05/15/health/panel-finds-no-benefit-in-sharply-restricting-sodium.html?pagewanted=all&_r=0

That's actually been demonstrated many times, yet the diet scolds won't stop their "common sense" (i.e., unproven) scolding to eat less salt. So people get unhealthy by trying to get healthy.

Same goes with weight, fat and meat consumption, and all kinds of other stuff. Lots of scolding, little evidence.

"God heals, the physician takes the fees" - Ben Franklin

[BrotherIvan]

41. EXACTLY! Thank you

All the shills on here have no idea what they're talking about. They are obviously not Californians but just want to jump up and down and push the latest cheerleading line. It's pure crap. These rates are not only not affordable, they are ridiculous. And according to the cheerleaders on here, you shouldn't use that insurance either for things like visits to the doctor or birth control because then the rates will go up.

So we're all supposed to be so happy we are paying thousands per year to predatory companies for something we can't use! The ACA may improve some small things but it still traps us in the most broken healthcare system in the modern world.

[Skittles]

44. and that is the INDRODUCTORY price

imagine the price after a few years

[LWolf]

45. Neither do I. nt

[flamingdem]

54. Do you qualify for subsidies? nt

[antigop]

56. my post: Estimated tax credit from the government: $0 nt

those aren't my statistics --- I'm just pointing out how unaffordable the premiums are.

[flamingdem]

57. Now I see what you mean. It's not a great deal for middle to upper middle class

It's better for those earning less. It is much better insurance of course but if one doesn't use it, my case, then it's too expensive still.

bummer.

[antigop]

60. and the middle to upper class are going to hate it for that reason.

They will feel they are getting stiffed when other people are getting insurance much cheaper.

[flamingdem]

63. The numbers will show that they are mostly covered at work

Maybe they should have been more vocal during the process.

I clearly remember those with work insurance not giving a crap about people who were struggling with insurance.
Republicans mostly, but some dems too

[antigop]

69. People get laid off, especially older workers

They will not have affordable insurance.

[OKNancy]

107. If they got laid off, they wouldn't have the income and would qualify for lower rates and subsidies

you are trying very hard to pour cold water on the very real benefits of the ACA.

[antigop]

115. the rates for 2014 will be based on your 2013 income.

If you get laid off in 2013 and have no income in 2014, you have to come up with the premiums for 2014 WHEN YOU HAVE NO JOB.

[BuelahWitch]

180. That's what I want to know

What happens if you lose a good paying job you had the year before and you have to take a job that pays much less. Are the premiums going to be adjusted for emergencies or will we be stuck until the next year?

[Godhumor]

253. Loss of job counts as a life event for Covered CA

In which case, current situation takes precedent over previous. In other words, no, you don't keep paying your previous while employed premium.

[antigop]

281. it depends upon what happens to an older person who loses his/her job

She/he may have to retire due to no job prospects. Some people do get pensions and may start receiving them.

[antigop]

116. Face it...older people get screwed by the PPACA due to age rating. nt

[OKNancy]

118. not if they have a modest income

We will save about $500.00 per month

[antigop]

120. $1026 per month for two people w/ income $63000 IS NOT AFFORDABLE-- I don't care what your age is.

That's just for premiums --- for the silver level... You have to pay copays/coinsurance/deductibles in ADDITION TO THE PREMIUM if you require medical attention.

You have to look at the max out of pocket in addition to the premiums.

[woo me with science]

130. Thank you. nt

[dumbcat]

72. But wasn't that the whole point?

That poorer people would finally have medical insurance, and the better off would have higher premiums to cover them? Isn't that what a progressive system is supposed to do, or am I missing something?

[antigop]

77. it's not "progressive"

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2905522

[Flatulo]

140. ACA looks like it's going to make a new class of poor people. Those with a living income who don't

qualify for heavy subsidies will be spending half their after-tax income on health insurance, and only if they're not unfortunate enough to get sick. If they get sick, the copays will wipe them out.

[Turbineguy]

132. The great part happens

when you don't catch some disease because somebody near you could not afford to see a doctor. This is not like a casino.

[woo me with science]

70. No, it's not affordable. It's a fucking racket.

The whole purpose of the ACA was the mandate. It was a fucking scam to entrench the bloodsucking health insurance middlemen into our health care system and ensure that every single American is forced to feed their racket.

The people defending this are the very same people who defend every single outrage by the corporatists who have hijacked this country. They defend indefinite imprisonment of human beings without due process. They defend slaughter of innocents by drone and the President's ability to murder at will. They defend austerity budgets and cutting critical social safety nets. They defend corporate authoritarians in our schools, and they defend sending our jobs off to other countries. They defend ANYTHING that benefits the one percent. They spend their time at this site insulting and lecturing "liberals" and spewing right-wing talking points. They are not Democrats, except in name.

They are a cancer in our party. Our party has been hijacked by Wall Street, and they pay good money for constant, insulting propaganda to tell us that the siphon in our pockets is a GOOD thing.

How long do we tolerate this garbage? How long?

[antigop]

71. just read some of the replies on this thread. nt

[hunter]

76. But when you find yourself between that rock and a hard place, it's still better than what we had.

Ask any "uninsurable" person who has no health insurance, anyone who has faced a COBRA they can't pay because they are too sick to work, or anyone who has run out a COBRA.

As wretched as this is, it's an improvement.

Sometimes the difference between a "F" and a "D" grade is important.

I give "Obamacare" a "D-" but that's a marked improvement from the "F-" kill it with fire our existing healthcare system deserves.

The most remarkable thing about healthcare in the USA is that even people with excellent insurance and/or wealth can get incredibly inappropriate, expensive, and sometimes deadly health care. Sociopathic doctors who are only motivated by money are going to target the very wealthy; you are much less likely to find them working the local free clinic or middle class HMO.

[woo me with science]

79. No, because it *entrenches* the for-profit system.

Last edited Mon May 27, 2013, 02:32 PM - Edit history (3)

They will fix it later. This is the mantra we are always fed. But the promised "fixes" and "improvements" NEVER happen.

You have to understand what has happened here. We did not get this "D-minus" plan because nothing else was possible. At the time of the negotiations, the country polled heavily in favor of a public option. It would not have been difficult to rally the country to pressure for something better than this, if Obama and corporate Democrats had wanted to do so. It would not have been hard to design a plan that focused on the aspects of health care delivery that REALLY needed fixing: cost control. They didn't. Obama did not fight for a public option. There are no serious cost controls in this plan, and there never were, which is something that does not happen accidentally. Obama chose to make backroom deals with the health insurance companies, because this administration is corporatist and has been corporatist since the day they got into office. If you tune out all the propaganda and simply look clearly at what is being DONE, over and over again, you will see that what we got was entirely consistent with every other decision this administration has made in the corporate arena. The corporate Democrats did not push for something better, because what we got was precisely the goal: a sop for the One Percent.

We are on a road of austerity budgets and Social Security cuts. We are on the road to privatized schools. We are on the road to the Keystone pipeline. We are on the road to the Trans-Pacific job and wage killing agreement. And we have a brand spanking new health insurance program that mandates the purchase of an obscenely overpriced product that vast numbers of Americans still will not be able to afford to use.

They are not working on our behalf. That is a truth that people need to get their heads out of their nether regions and face. We have a broad, systemic problem of corporate money in our government and in our elections, and both parties are working for corporate interests, not ours. This plan is an ironically named insult to and assault on Americans. There is no serious affordability here at all, nor any serious plan to provide affordability, and there never was. The point of the plan is, was, and has always been The Mandate: a captured market for an obscenely overpriced corporate scam of middlemen and thieves.

[hunter]

85. I don't think it's sustainable.

They've cut in half the straw that will break their camel's back.

It's a temporary patch.

The machines they have built become brittle.

[CountAllVotes]

88. thank you my friend

I'm glad I'm not alone in my thoughts regarding this enormous pig of a scam that only the very few, the desperate ones, will find themselves to be the final victim of in the end.

It reminds me of so many other things I'm seeing these days, from long-term care plans that some of the wealthier folk out there have been paying for and all of a sudden, it goes insolvent with doubled premiums, alas becoming un-affordable for them as they age. File a class-action lawsuit they propose? WTF? Why don't they DO SOMETHING? Some have been paying into this SCAM for as long as 30 years only to find they are shyte outta luck on this deal -- perhaps $40K in the hole on this "deal" ... a "deal" for those that could afford it, yes even they too are beginning to feel that little *pinch*.

This is but ONE example of how many other scenarios just like this?

Same thing here is the way I see this new B.S. deal. A lot of $$$ for what exactly? And, pray tell, what if you don't have that 1K a month for "it", whatever "it" is?

Fact is, I don't trust these suckers one damn bit and it is a treacherous pig of a scam I must agree.

Greed rules and Wall Street and the corporations are the thankless masters of we the servants of the United States of America. Don't you just love this unique form of dare I say it ... FASCISM?

[Bozvotros]

112. I hate to admit it but I think you're right.

Living in America under Obama is a little like being an abused spouse who sheds her psychopathic mate and marries someone who no longer punches her in the face and molests her children. At first you're happy things aren't so brutal. You don't even care that he told you a lot of lies and hangs out with some of your ex's old friends. And, OK, sure, he fenced some of your jewelry for meth and booze and new clothes but he talks so sweet to you.

Believe me, I am not someone who thinks it would have made no difference if we would have elected McRomney or any other stooge the Repugs would have run. With the Pugs in the White House and the House and kind old Harry Reid standing between us and full fascism, I am giving the nod to fascism 10 to 1. But Obama has continued to disappoint and finally really irritate me. I am sick of having to compromise and capitulate to these sick fucks running the con game that is American politics. I am tired of being told to wait for things that should have come long ago or that this screwing is less harsh than the one we could have got or that something is better than nothing.

We are at war all right but it isn't with Al Qaida and the Muslims. (Good band name... I doubt it is taken.)

[lhooq]

136. Time will tell ...

how affordable the PPACA is. For me (income < 100% FPL, residing in Florida, a state not expanding Medicaid), health insurance is as unaffordable as ever and that won't change any time soon. No subsidies for me, because I make too little!

Anyway, woo me with science makes a cogent argument that the PPACA entrenches the for-profit system and that that's the main intent of the law. One point not said but I'll say it: from where did the individual mandate originate? From the Heritage Foundation, in the early 1990s, as part of their response to the Bill and Hillary Clinton health plan proposed in '93. Go figure.

[Skittles]

201. excellent post

[ohiosmith]

109. This post was alerted on. The jury voted 4/2 to let it stand.

AUTOMATED MESSAGE: Results of your Jury Service

At Mon May 27, 2013, 09:30 AM an alert was sent on the following post:

No, it's not affordable. It's a fucking racket.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2905411

REASON FOR ALERT:

This post is disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate. (See <a href="http://www.democraticunderground.com/?com=aboutus#communitystandards" target="_blank">Community Standards</a>.)

ALERTER'S COMMENTS:

The whole purpose of the ACA: "It was a fucking scam" "the President's ability to murder at will." Anyone who supports the ACA is a "cancer in our party".

What the fuck? Is this really Democratic Underground? When you go so far beyond constructive criticism that you start posting freeperish attacks on a sitting Democratic President, the Democratic party, and members of DU...maybe it's time to take a break. This is incredibly over-the-top and inappropriate.

You served on a randomly-selected Jury of DU members which reviewed this post. The review was completed at Mon May 27, 2013, 09:40 AM, and the Jury voted 2-4 to LEAVE IT.

Juror #1 voted to HIDE IT and said: No explanation given
Juror #2 voted to LEAVE IT ALONE and said: No explanation given
Juror #3 voted to LEAVE IT ALONE and said: It's not a "freeperish" attack. It's a left of center attack that embodies the opinion of many Democrats. Leave the post.
Juror #4 voted to LEAVE IT ALONE and said: Not only is there nothing wrong with the post per DU's Community 'Suggestions' it is also agreed with by many members here. You don't like their points? Tough... they are totally valid.
Juror #5 voted to HIDE IT and said: Language is inappropriate and verbally abusive to fellow Democrats.
Juror #6 voted to LEAVE IT ALONE and said: Many in the party have concerns about ACA -- though admittedly not to this degree. I don't think this rises to "hide" level.


Thank you very much for participating in our Jury system, and we hope you will be able to participate again in the future.

[Flatulo]

113. I have to agree with you there brother. Same thing here in MA with our Romneycare.

The first year the rates weren't too bad, but still high. For the next few years we saw shocking increases. Unless you're destitute with no income, in which case you'll qualify for a fully subsidized Commonwealth Care plan, these policies will consume 50% or more of your after tax income. When you add in the copays, there's nothing left to live on.

Health insurance is bankrupting us. It's only going to get worse.

[lhooq]

137. Score one for Romneycare!

Reading

Unless you're destitute with no income, in which case you'll qualify for a fully subsidized Commonwealth Care plan,

fills me with envy.

In contrast, with the PPACA, if you're destitute, then you're supposed to be picked up by expanded Medicaid. But many states, including big ones like TX and FL, are not expanding Medicaid. Thus, if you are destitute, well then you better hope to get on hospital charity care, use the county health department, or figure bankruptcy is how you will discard any large medical bills. Romney's Commonwealth Care plan does not sound that bad, after all.

Hey, I'm just joking, well, sort of ...

[Journeyman]

94. Thanks for the link. . .

[OKNancy]

106. are you purposefully leaving out something to prove a point

I went to your link and put in your figures... You left off some important information.

[URL=.html][IMG][/IMG][/URL]

Editing to add: I just read that the income is adjusted gross income.... $475.00 per month for a couple with an adjusted gross of $60,000 is doable under almost any circumstance.

[antigop]

119. go back and read my post..nt

[haele]

177. It's the jump from $62K - $63K , the "drop out". At $62K, it's $491.

The difference is that you now are netting after taxes over $4100 a month, and the electorate feels that you're now making enough to handle paying up to a quarter of your monthly net income on health care and not hurt to much, because you can still deduct half of those costs on your income taxes when they're due.
You should be able to get back as much as $6K a year on your taxes above that amount. It's not right, but that's what they thought they could promote just to get 40% of the citizenry at the lower economic scale out of emergency room health care.

I would have rather seen them put the drop-out at $90K - especially in California, where people can be attempting to pay off both student loans and mortgages up to $3500/$4000 with a net of $5500 a month of income.

So, the upshot is that if your household income is under $63K, the ACA is much cheaper than anything you can get on the market. After that, you're stuck with market costs.
I'll agree, it's not comfortable for those who have a household income around or above $63K; but luckily for some in that category, if you have a dependent (which adds significant costs to a household) you do get the tax credit applied.

It's very affordable for those who are on the margins, who are eligible for EIC, and who don't usually have a job that gives them health coverage.
Unfortunately, a lot of us - probably around 10% of this country - who are just above that line, but not well-off enough that $1K a month is disposable income, it still stings.

But this is what it comes down to for me:
Single Payer - vs. - Health insurance/health access plans/ACA -vs.- Health insurance/health access plans with no ACA in place.
It's not "ACA" vs paycheck. It's access to health care that doesn't depend so much on the whims of insurance companies and the cost is somewhat regulated more fairly.

What I pay now in a health-care premium from my employer-provided insurance for just me and my spouse (if we were both 55) is 2/3 the cost of what it would be under Covered CA, and our Aetna plan is considered comparable to most.
If we were both 55 and had a household income of $63,000 right at, the CA plan would be only $300 a month more than what we pay now, and give us the same benefits we have now.
If I lost my job, I would have to come up with over $1450 a month while on unemployment or doing part-time work to pay for COBRA to keep a continuance of a comparable insurance we have now until I could get another employer-provided insurance plan - if they had one.
Right now, we would be paying significantly less between the CA plan/my employer's plan with up to a household income of $62,000. Frankly, if I wasn't so close to the 55 age level, and our combined household income wasn't well within $10K of the upper level with a potential to go up this year, I would definitely consider going with Covered CA for ten years or so vice the employer plan and hope to transition into single payer that way. If I didn't have health care, I'd go ahead and suck it up.

I've gone the emergency-room health care plan route in the past, and as I get older, there are more things going wrong; I can afford the bills I have now, I couldn't if I didn't have health insurance to cover most of the costs I'd be facing without it.
So I see it this way - if I had to, $1K a month in premiums is cheap when the insurance company is "negotiating down" an additional monthly average of $2400 in medical costs due to chronic problems (some thanks to that period of "emergency room health care", others due to age).
Last year without health insurance, out of pocket for both me and my spouse would have been $57,653 for basic treatment of chronic health issues.
Not counting any of the emergency/urgent care visits - which came up to an additional $80K plus, according to the statements from my insurance company. $10 for an anti-nausea pill. $112 for an IV rig. $75 for the CNA to draw blood. $700+ for labs (bills for which kept coming in for 3 months afterwards) $1,200 for a 2-hour "room" stay at the Urgent Care. $220 for the follow-up doctor visit.

The main problem with the ACA and all of the exchanges is that it isn't single payer. And so, we get hung up on the term "affordable" - which single payer would be marginally more so.
The hope is that, like Social Security and Medicare, is that the ACA builds a framework to become a single payer or cost-regulated system that is truly affordable and mostly out of hedge fund manager and CEO hands.
And honestly, as bad as it might look now, it looks as if this hope is possible - especially as these state exchanges will work for the majority of their populations.

Haele

[antigop]

182. As Judge Judy says,....

Well, you know, what she says. Nice try.

This will be unaffordable for lots of older pre-Medicare people who do not qualify for subsidies.

[haele]

184. Allrighty then, just toss it all out and start over.

I can wait, I have insurance through my company. At least for the next three years or so.
Scrap it all, spit in the eye of the people who run the insurance and health care lobbies.

I don't care about myself, I can be a martyr - I'm not afraid to die (I am afraid of being disabled, though), I've done without health care at times in my life, been living in a van eating raman noodles poor before, and don't mind at all if I become crippled or develop something undetected because I've got all my quarters for full disability and a number to a disability lawyer if I need it. Now that I'm 50+, even less of a problem...I can wait until I start collecting early SS and Medicare, so long as they haven't f**d that up.
That's me.

Of course, I'll say the above until I get laid off, and am stuck with a truly un-affordable COBRA plan ($2K+ a month just for myself and my chronically ill spouse, $3K if we add the dependent grandchild that's covered under my current health care, as of 2011 when I last sat down with the benefits person).
Choose between $2K - $3K a month on the market or what the ACA gives me and my household - $1200 a month, $515 a month if we can include the grandkid. Guess what I choose?
Now that it's "We" instead of "Me" - What we had before ACA was un-affordable to me and to anyone else who was taking care of someone with serious or chronic health problems.
My disabled spouse can't go without health care, and neither can my stepdaughter (dependent under 25) and her baby (the other dependent) that we have custody of.

Nor will most of my neighbors, now lining up to sign on to Covered CA, who will go back to hoping not to get sick and treat themselves with OTC's until they have to go to the emergency room.

I know the for-profit health care system in this country sucks any number of scatological body parts.
I'm just happy some people who didn't have access to anything other than emergency room health care now have access to health care.
I'm pissed it's not single payer, that it doesn't make health care affordable for all of us, but at least some people will get it, and perhaps not die of undiagnosed cervical cancer in the emergency room before she's 55 and leave three kids and a husband, the way the working family across the street from me ended up last year.

You see, it's all about the hostages to fate, the family members, and how many hostages people are willing to give up. If I didn't have anyone that needed health care, I'd probably be just as strident about the financial/medical death panels and the incremental destruction of the middle class.
"How dare they call themselves affordable charging a couple over fifty-five $1300 for health care...." Really, they should have called it "Regulated Health Care Access Act" and stopped pretending to be affordable. It's not affordable (compared to Medicare?) if you have a pre-tax household income of $63K a year and/or are midway through 50 - which is about 25% of California.

I know they're playing one level of the working class people against the other. It's Jay Gould all over again. "I can hire one half of the working class to kill off the other half"...

We can do better, and I'm looking long out - hoping a very flawed ACA is just part of the incremental process that will be revised and re-tooled, just like Social Security, just like Medicare, just like the VA, just like all the other programs that go up and down depending on the whims of the electorate.
We've also got a really shitty value system in this country where people are judged on the money they make, and until we as an electorate take to the streets to change that, and take back the media in the process, we're not going to advance beyond where we are now, where those with the most money get to play gotcha with those with less, and turn us each against the other.

Got a problem with the ACA - vote. Agitate. Push. Move to change the morals and values of this country.

Because there are serious gaps, because it doesn't benefit you and me (except in extremis) it needs to be re-tooled. So many good programs over the years - education, civil rights, health care, financial reform - died because they were scrapped for being politically imperfect, a waste of time and money, instead of being re-tooled to fit the problem they were addressing.

Haele

[antigop]

185. I didn't say it didn't benefit me -- I don't live in CA. But the CA rates screw older pre-Medicare

retirees and workers who have to purchase off the exchange and don't qualify for subsidies.

And they are going to be livid when they find out how badly they are getting screwed when they see how much cheaper the rates (with subsidies) are for other people.

You can try and spin this all you want, but ACCESS means nothing if you can't AFFORD it.

[dflprincess]

190. And the Silver PLan has a $2000 deductible

and a maximum out of pocket of $6,400 for a single, $12,800 for a family.

The "Platinum" plan has no deductible but still has a max out of pocket of $4,000 (single) and $8,000 family.

The Gold plan has no deductible but the out of pockets are still $6,400/$12,800.

The Bronze plan has a $5,000 deductible and the out of pockets are $6,400/$12,800.

I can't find anything that calculates the premiums for the Bronze, Gold or Platinum plans.

http://www.coveredca.com/PDFs/English/CoveredCA-HealthPlanBenefitsComparisonChart.pdf

No word on how any of these plans will actually improve access to care when you can't afford the out of pocket.

[antigop]

192. exactly what I have tried to get across...ACCESS means nothing if you CAN'T AFFORD the

premiums and/or you can't afford to get sick.

Thank you.

[dflprincess]

199. I've been beating that drum for a long time and many don't seem to get it.

I can only guess that they have really, really good insurance or enough cash to cover all their out of pockets.

[antigop]

200. You are correct -- many don't seem to get it...until it happens to them. Thank you. nt

[Ruby the Liberal]

50. Holy Crap!!

That is about HALF the cost of my monthly COBRA in 2009, and about half of what Vermont is estimating for their exchange.

Calculator: http://www.coveredca.com/calculating_the_cost.html

[flamingdem]

53. Oops - ACA does seem to favor lower income

and that is a problem.

Ideally it will lead to lower rates in the future for everyone

[Ruby the Liberal]

58. Thats what I am hoping - a few states taking the lead

and showing how it can work in practice.

My state is going with the Fed exchange to start. I call that a victory over the GOP when GOP states defer to the fed on this.

[flamingdem]

61. They are hammering middle class earners but that group is covered

through work most of the time.

If a single makes a low end salary 20-30 that's a sweet spot for subsidies - 85 a month and great coverage.

However 50-60 grand makes the monthly more than what I was paying, catastrophic but since I rarely use it.. my issue is cost. I can't pay $500 a month. Just on principle, I'm tired of those rates when I rarely use it.

[antigop]

66. A lot of people lose their jobs and don't have insurance. nt

[antigop]

59. no, I doubt it will lead to lower rates. Dream on. nt

[flamingdem]

65. this might lead people to

hide income if they are independents

[antigop]

68. How an additional $1,000 in income can cost you $6,420 more in premiums

See example:

http://www.democraticunderground.com/10022905392

[antigop]

75. Should a 50-year-old w/ $46000 income pay the same as a 50 yo making $500,000?

Run the scenarios on the calculator

Each will pay $411 -- no subsidy.

Once you reach $46,000 the subsidies go away and the premium stays at $411 for a 50 year old regardless of income above $46,000.

[Indykatie]

80. ACA Is and Will Continue to Be Good For Millions of Americans

Is it Perfect? No but it's a great start. The combination of the subsidies and elimination of pre-existing limitations along make this a huge win for many. The unlimited preventive care paid at 100% coupled with no cost contraceptives makes ACA very attractive especially to women. These basic features will be found in all the Exchange plans under ACA. Many companies such as the one I work for have already implemented many of ACA provisions such as children covered to age 26, unlimited preventive care, free contraceptives and unlimited lifetime benefits. Those who continue to whine and complain about the ACA and claim to see no good in the law are either totally uninformed or just out to troll in my opinion. Many of the complainers would never accept anything less than Single Payer and that's an unrealistic benchmark. ACA will also force Employers to cap contributions for their plans to a level required by law. I urge everyone to go to an independent site such as the Kaiser Foundation (KFF.org) and educate yourself on the provisions of the ACA so you will know when you are being fed misinformation including erroneous statements being made here on DU where I would expect commenters to have a better grasp of the legislation. My big worry is around implementation. I worry that some States will not feel motivated to get it right preferring instead to have something else to criticize the President about.

[antigop]

81. excuse me...I am very well versed in the ACA. nt

[antigop]

82. $1026 per month for two people w/ income $63000 IS NOT AFFORDABLE.

nt

[ProSense]

86. You are

"$1026 per month for two people w/ income $63000 IS NOT AFFORDABLE."

...spreading misleading information.

The fact is the premium you're citing is based on the age rating and doesn not apply to any couple earning $63,000. There are also other factors to consider.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2905988

[ProSense]

87. Actually,

"Should a 50-year-old w/ $46000 income pay the same as a 50 yo making $500,000?"

...that's what happens now because anyone not eligilbe for Medicaid has to pay the same as someone earning $500,000.

The ACA changes that and makes the wealthy pay more via additional taxes on ordinary and investment income.

Employers already take out 7.65 percent of workers’ wages to support the elderly and disabled. Of that, 1.45 percent goes toward paying Medicare’s hospital bills. Obamacare increases the Medicare hospital tax by 0.9 percent, beginning in 2013, for anyone who earns more than $200,000 ($250,000 for joint filers). It also creates a new, 3.8 percent tax on investment income, setting income thresholds at the same $200,000 and $250,000 levels mentioned above. Taken together, those two provisions are expected to generate $210.2 billion over the next decade.

http://www.democraticunderground.com/10022078875

[slipslidingaway]

96. Time will tell ...

remember two thirds of medical bankruptcies were people who had insurance.

You never know what happens when a serious illness makes an appearance.

[Scuba]

99. One of our national shames. Thanks for reminding us of that.

[slipslidingaway]

252. The shame is the ACA will do nothing to alleviate the bankruptcies ...

it will help some people receive care no doubt, but many people will find that having insurance can come at a high cost. Two-thirds of the medical bankruptcies were people with decent insurance.

[Scuba]

255. Agreed, the ACA is far from ideal. Still, it will help many.

[madville]

111. Still possible with these plans

These are all 60/40, 70/30, 80/20 type plans, the family out of pockret annual cap is around $12,000, who has that laying around?

[antigop]

117. that's my point. It's not just the PREMIUMS...it's the copays/coinsurance/deductibles

if you need medical attention.

[slipslidingaway]

254. Exactly and we're living it now with a high annual out of pocket maximum...

for the past few years. You can maybe do this once or twice, but after awhile it takes a toll.

slipslidingaway (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:11 PM
Original message

If you have HC insurance what is your annual out of pocket maximum?
Ours is over 11,000 and that differs from the annual deductible which is about 2500.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x8667267#8667333

[hue]

100. Why do You think Repukes voted so vehemently against ACA? It's going to be one of the best things..

that ever happened to the US folks!
The Repukes fear success for our President & the Dems.

[madville]

101. Individual rates are $300-400 a month

I imagine family rates will be $800-1200. That's for the Silver plan which is 70/30, the insurance pays 70% of the bill and the insured pays 30%, anything major will still throw most people into medical debt.

[antigop]

121. that's what people need to look at -- it's not just the premiums --- it's the max out of pocket...

in addition to the premiums.

[hunter]

138. These days I'm very cheerful and friendly about medical debt.

Maybe I end up living on the streets but I pity those poor under-paid drones at the collection agencies.

Sorry, I've got no money today and my credit rating is in the toilet. Now what?

[antigop]

122. Even With the Affordable Care Act, Health Insurance Coverage Remains Unaffordable for Many

http://truth-out.org/news/item/14019-even-with-the-affordable-care-act-health-insurance-coverage-remains-unaffordable-for-many

Any hopes that large employers would be penalized for failing to offer affordable insurance coverage to the spouses and dependent children of their employees under the Patient Protection and Affordable Care Act (ACA) were recently dashed by a proposed interpretation of the law from the Obama Administration.

The interpretation, which was released by the Internal Revenue Service (IRS) late last month in the form of a proposed rule, related to the “Employer Shared Responsibility Provision” of the ACA, popularly known as the employer mandate. That provision provides that larger employers (those with more than 50 employees) offer insurance coverage not only to their employees, but to the “dependents” of those employees as well. If these employers fail to offer “affordable” coverage, they may be subject to monetary penalties.

But the IRS’s definition of dependents in the proposed rule excludes the spouses of employees, regardless of whether the spouse is employed.

[antigop]

123. Employers Eye Bare-Bones Health Plans Under New Law

http://finance.yahoo.com/news/employers-eye-bare-bones-health-030600026.html

Employers are increasingly recognizing they may be able to avoid certain penalties under the federal health law by offering very limited plans that can lack key benefits such as hospital coverage.

Benefits advisers and insurance brokers—bucking a commonly held expectation that the law would broadly enrich benefits—are pitching these low-benefit plans around the country. They cover minimal requirements such as preventive services, but often little more. Some of the plans wouldn't cover surgery, X-rays or prenatal care at all. Others will be paired with limited packages to cover additional services, for instance, $100 a day for a hospital visit.

Federal officials say this type of plan, in concept, would appear to qualify as acceptable minimum coverage under the law, and let most employers avoid an across-the-workforce $2,000-per-worker penalty for firms that offer nothing. Employers could still face other penalties they anticipate would be far less costly.

It is unclear how many employers will adopt the strategy, but a handful of companies have signed on and an industry is sprouting around the tactic. More than a dozen brokers and benefit-administrators in 10 states said they were discussing the strategy with their clients.

"There had to be a way out" of the penalty for employers with low-wage workers, said Todd Dorton, a consultant and broker for Gallagher Benefit Services Inc., a unit of Arthur J. Gallagher & Co., who has enrolled several employers in the limited plans.

Pan-American Life Insurance Group Inc. has promoted a package including bare-bones plans, according to brokers in California, Kansas and other states and company documents. Carlo Mulvenna, an executive at New Orleans-based Pan-American, confirmed the firm is developing these types of products, and said it would adjust them as regulators clarify the law.

[woo me with science]

133. ^^^^^^^ Here we go. ^^^^^^^

[nadinbrzezinski]

148. It is despicable .

But those workers have no care otherwise, or an emergency room

This is the half fix hunter alluded to. The system will still collapse...so either they fix it...(in this political environment not very likely) or it collapses.

There is a third way...the strikes in those sectors become national, the unions get members, and healthcare (as in good health care) is part of it.

I feel it in my bones, the bed the elite is feathering will not end well for them.

[antigop]

152. and we have cheerleaders cheering about how great this is. nt

[antigop]

154. nadin, what they have done is a classic "divide and conquer"....

Some people will get advantages, a lot won't due to loopholes and corporations trying to get by on the cheap.

The ones who come out ahead won't have a lot of sympathy for those who are disadvantaged.

It's a classic "I got mine -- screw you" attitude.

And it was played perfectly...that's why I don't share your optimism.

[cbdo2007]

155. This is good, it will begin the move of health insurance from employers to individual....

Companies who offer bear-bones plans will have to pay more to compete with bigger companies, or even better, it will begin a trend away from our employers offering health insurance as part of the package for regular people and put everything on the exchanges.

[antigop]

156. I don't think you understood the article. I would suggest you re-read it. nt

[cbdo2007]

159. Understood it just fine actually. Thanks!

[antigop]

160. no, I don't think you did based on your response. nt

[cbdo2007]

161. I'm pretty sure you didn't get my response. Maybe reread it and have a cup of

coffee and talk it over with your dinner party friends this weekend and maybe it will make sense to you in some divine enlightenment.

[antigop]

162. Please re-read it so you understand what it is saying. nt

[cbdo2007]

163. Please do some research, perhaps the Google machine or the Wikipedia

on the computer there and maybe that will help point you in the right direction.

Happy to help Bro!

[antigop]

164. I don't need to do research...I read the article and understood what it said. nt

[cbdo2007]

165. I don't think so. nt

[antigop]

167. well, it's your choice... you can misinterpret the article or you can go back and re-read it and

understand what it is saying.

[cbdo2007]

169. Thank you for the permission to have a choice. I grant you permission to have a choice as well

to reread my post or continue to misunderstand it as well. OMG, what if we both reread and now understand what the other is saying, but we'll both still be on opposite sides. Far out man!

[antigop]

170. well, I see you've made your choice. nt

[cbdo2007]

171. I see you've made your choice as well.

I hope your time misinterpreting my post was well spent.

[antigop]

172. I wasn't misinterpreting anything...you need to understand what the article says. nt

[cbdo2007]

173. I understood it, that's why I responded. nt

[antigop]

181. But your post shows you really didn't understand it. Sorry. No need to keep this up.

nt

[cbdo2007]

210. I understood it just fine. Unfortunately you didn't understand my response and make the connection

to your post.


Good day Sir!

[WorseBeforeBetter]

271. Some NC employers cut worker hours to avoid cost of health care reform

....

While many businesses are scaling back work hours to keep part-timers out of the company insurance plan, others are not hiring so as not to cross the 50-employee definition for large employers – the federal threshold for having to insure full-time employees. Still other businesses are mulling the option of scotching company health coverage altogether and paying a federal fine instead.

....

It’s expected that some will opt for the fines. Nancy Adams, owner of Piggly Wiggly grocery stores in Sanford and in Broadway, said that’s one option under consideration for her business. The $2,000-per-worker fine would apply to just five full-time employees at the two Piggly Wiggly stores, amounting to $10,000 a year, she said, because the law exempts the first 30 workers from the fine.

Adams said the company would save considerably and likely give workers a $2-an-hour pay raise to help them buy individual policies on a health care exchange. Such exchanges, created by the Affordable Care Act, are designed for those who buy coverage on their own.

Adams’ grocery business has 86 employees and currently provides insurance to 31 of them at a cost of about $120,000 a year. Insuring all those who work at least 30 hours would raise the cost to about $165,000, she said.

“We don’t have the pockets to pay an extra $45,000 for health insurance,” Adams said. “It’s huge.”

http://www.newsobserver.com/2013/06/01/2932880/some-nc-employers-cut-worker-hours.html#storylink=cpy

Cutting hours, not hiring and/or dropping coverage completely? Those are *good* things!

[graham4anything]

126. President Obama's plan already saves me $19,200 OUT OF POCKET. with NO lifetime cap, and

no exclusion for any prior.

One company in NJ started a few months early and allowed me to switch from AETNA where I was up to $3000 a MONTH
with a 15% coming in may ($3450 a MONTH).

Right off the bat I save 50% on the 3000 (or 65% on the 3450 it would have been).

Then it is now going to be 70/30 INSTEAD of 50/50.

100% THANKS to President Obama.

It was NOT possible May 2012.
It is possible in NJ May 2013

And it is and did make Teddy Kennedy happy that there was forward movement.

Thank you and God Blessed us with both President Obama and thank you Jerry Brown.

[mzmolly]

129. Great to read this!

[antigop]

131. I wouldn't call $1500/month "affordable". And what is the max out of pocket in addition

to the premiums?

[Ms. Toad]

143. Those are the current rates -

Not the rates that will be in effect after the market exchanges and subsidies kick in at the beginning of 2014.

I believe California is the only one which has announced rates and subsidies so far for 2014. The premiums ranged from $17 to $365, with the out of pocket max ranging from ~$2000 to ~$6000 (all depending on income). That is the mid-level plan.

[antigop]

144. I know they are the current rates....the poster was touting how "great" they were. nt

[antigop]

145. I wouldn't call the CA PPACA rates "affordable".

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2904304

You need to run the calculator to get estimates for CA PPACA. They are NOT AFFORDABLE for some -- especially older pre-Medicare people who don't qualify for subsidies.

[mzmolly]

276. I guess you'd have to define affordable?

And, calculate how long one has to make payments on health care expenses etc.

Affordable to me is being able to keep a home/family afloat.

[antigop]

279. Still haven't posted the percentage I asked for, did you? nt

[mzmolly]

147. Ask the OP your questions. I'm applauding "progress" not

perfection.

[antigop]

150. oh, brother...$36,000 to $18,000/yr -- yeah, that's just peachy.

And if there's a $20,000 deductible you are worse off if something happens.

It's not just the premiums -- it's the deductibles/copays/coinsurance in addition.

[mzmolly]

219. Nope.

[antigop]

225. Nope what? Who can afford $18000 in premiums as graham4anything is paying today? nt

[mzmolly]

239. Nope. G4A

hasn't incurred the expenses you suggest, he/she has. This is your boo hoo, worst case scenario, based upon inaccurate calculations, figure.

[antigop]

241. And you have to be able to handle premiums+ max op if you want to be covered. nt

[mzmolly]

243. No you don't.

You can pay the small tax penalty and wait until you have a pre-existing, costly condition to enroll.

[antigop]

249. No you can't do that...have to enroll during enrollment period

to prevent that very scenario. You don't want people waiting until they need medical attention...everyone needs to be paying into the system especially when they are healthy.

And you may need to go to the emergency room --- so you need to be covered BEFORE it happens.

You can only enroll outside the open enrollment period under special circumstances...

http://www.kaiserhealthnews.org/stories/2011/july/11/health-insurance-exchange-regulations-released.aspx

Such enrollment periods are designed to encourage people to sign up for coverage right away, rather than waiting until they become ill. That’s important because in 2014, not only does the law require nearly all Americans to carry coverage, it also requires insurers to take all applicants, even those with medical conditions.

To give people time to understand the exchanges and make their choices, the initial open enrollment period will begin Oct. 1, 2013 and run through Feb. 28, 2014. In subsequent years, open enrollment will run from Oct. 15 to Dec. 7. People will be able to purchase insurance outside of open enrollment under specific circumstances, such as when adding a child by birth or adoption, or in cases where they lose employer coverage or coverage through a spouse.

[mzmolly]

262. An article from 2011? Here try this:

http://www.pcip.ca.gov/Home/default.aspx

[antigop]

265. Did you read your own article? That's the high risk pool, not the exchange. nt

[mzmolly]

267. Did you read what I replied

to? That's the category someone who did not purchase insurance and has a pre-existing condition would be in.

[antigop]

268. The high risk pool GOES AWAY once the exchanges are up and running.

If you have a pre-existing condition, you cannot pay the penalty and then jump into the exchanges if you get a pre-existing condition. You have to enroll in the exchanges during the open enrollment period, with the exception of special conditions like marriage, loss of job, change of job.

That's the way it works.

FROM THE ARTICLE YOU POSTED:

The California PCIP program was to last until December 31, 2013, when the national health reform begins. After that date, there is no need for high risk pools, because federal rules do not allow insurers to reject persons with pre-existing conditions or charge them higher rates than those without such conditions.

[mzmolly]

270. Regardless, you can't be denied coverage

for having a pre-existing condition. (This, per your own snip.)

[antigop]

273. I never said you can't be denied coverage. But you have to be able to PAY

the premiums/deductibles/copays/max out of pocket.

[mzmolly]

274. Or, pay for hospital stays, testing, cancer treatment

sans insurance ... as in prior to the home saving/life saving/savings saving legislation you're bitching about.

[antigop]

151. you don't even know if it's "progress" or not if you don't know the max out of pocket. You were the

one claiming "progress".

[graham4anything]

208. Best benefit to me is-WE WERE FREE TO CHANGE now in 2013.WE WERE NOT FREE in 2012(or prior).

We finally were free to change companies and not be blocked because of preexisting conditions.
Prior to this spring, we were NOT free to do so. It was impossible.

Are you saying it's better I pay $3450 a MONTH than now that I pay $1500 a month?
So are you saying it is a bad thing to pay less?(shaking my head in disbelief).

btw, it's 70/30 NOW instead of 50/50 before, meaning I save even more NOW than last year or the 20 years before
and so then total of $5000 more between deductible/out of pocket and then everything is ZERO dollars from my end.

Now. So let's recap
20 STRAIGHT YEARS OF self employment and not company paid,(then the short period of COBRA)-
every year a 15% rise-
the past 12 months were on AETNA-
$3000x12=36000 plus 7500=$43500.
Meaning an out of pocket with my new plan this year at other company of $20,500

However, THEY(AETNA) were about to up it in May2013 to $3450 a month
which was
$3450x12=$41,400 plus $7500=$48900
meaning NOW I save $25900 a YEAR.

TODAY thanks to being able to switch and NOT being restricted like we were last year due to preexisting-
$1500 x12= $18000 premium plus $5000=$23000 on my end out of pocket.
Then-(prior to may 2013)

and the $25,900 a year can pay for my families food/electric/gas/cable/internet/phone bill for the entire year, with if I so desired, two full vacations on top of it, just from the savings out of pocket that prior to a few months ago, I was NOT able to do.
BECAUSE PRIOR TO A FEW MONTHS AGO- I COULD NOT SWITCH BECAUSE THE PRIOR MEDICAL CONDITIONS WOULD NOT ALLOW IT.

AND I HAVE NO LIFETIME CAP.

The only thing relevant to the conversation is nothing but-what we are paying as self-employed in just a small(family)group.
Because it is just TWO options to have GOOD coverage at the higher price, or the lower price.
Any other thing is a distraction to that.

Thank you President Obama.
Thank you for those in California, Jerry Brown for leading the way.

Where California, and NY and NJ go (plus some others), go the nation.
And California is leading the way. What an amazing turnaround.

Can one imagine what would have happened to California had Meg Whitman defeated Jerry Brown.
The choice was and is clear which way is the correct way to go.

I will pick Jerry Brown or Barack Obama over any republican or pseudo republican(tea,libertarian/3rd party) 100% of the time
Because there is NO denying how great it can be if the entire country would follow along moving forward quickly.

[antigop]

211. and how many people can afford $1500/month + max op? That's the point. Just because YOU can.

You were paying $3450/month for premiums prior.

Obviously, if you can pay $3450/month, your income must be pretty decent.
Thank you for proving the point that the people who are happy with the PPACA are people with high(er) incomes who can afford high premiums +max OP.

[graham4anything]

213. One has to have insurance. One has to make choices on WHAT IS AVAILABLE today, not 20 yrs from now

and your thesis is 100% wrong.

Your argument is bogus in that if YOU got a major illness without insurance at all, you would either have to give up 100% of ones belongings or just never bother to pay the bill.

Insurance was NEVER meant to pay for the flu or a cold, or elective surgery at all.

It is for catastrophic illness.

IMHO
and I don't know your age, so I won't assume you are in the younger years of us all.
But as one gets older, one gets some sort of need of having insurance for a big $$$ illness.

BTW-it is why the so called "48 ounce soda discussion" was so important.
Saving calories and sugar now, saves $$$bigtime later on in doctors bills.

And I didn't have the luxury of 20 years of having a big company pay 90% of my premiums, a benefit that is a workers tax free
benefit, and one which most people don't realize is such a big deal.
Now, when the companies are taking it away, people are starting to realize what self-employed have known for decades and decades.

Yet for 20 straight years, my $$$ went up 15% til this year my out of pocket was a 50%-65% savings.

And one makes choices about spending.
But you don't have anything which to base your statement above. so NO it is NOT obvious what you said.
I could have a zero income for all you know.
I would re-mortgage my house though(one I paid off in the 1980s fully,), to have my health insurance.
I would NEVER consider NOT having insurance.

and wishes don't make other types come true.

Thank God for President Obama and Gov. Brown.
And Thank God for Teddy Kennedy working decades on this issue
And, yes, Thank God for Hillary and Bill in trying.

NOBODY else has done squat since LBJ. NOBODY. Not Bush Not Reagan Not W Not Jeb. NOBODY.
It was an issue no republican has done anything about nationwide.

they should stop obstructing it.
We already would have had a single payer had Hillary's ideas gone through in 1993 that the rightwing scare team stopped.

To think that it would be better to have defeated the President's plan and then not do nothing for 20 more years is well,
NO sorry, I myself don't know anyone who thinks that who knows the facts out there "in the real world, real facts, not bad
soundbyte world".

[antigop]

214. yes, be thankful you are still getting gouged....just not as much. HOORAY! nt

[graham4anything]

217. Thank God for President Obama,Sen. Kennedy Gov. Brown and future Pres. Hillary for moving us forward

(note as of this moment I looked and counted 51 replies by you.
I won't change your mind.

Thank God for President Obama, Gov. Brown and future President Hillary Clinton for moving us forward since 1992
when 100% of the time, republicans have attempted to keep us from NOT being able to change,
and 100% of the time, republicans moving us backward.
ZERO thanks to the republicans in congress, house.

The choice is obvious. And the republicans are still doing this.

and note, I looked and counted on this thread and saw 51 of the exact same replies from you on this thread.
51 of them as of the time I counted.

please note- I will NOT be making any more replies to you as obviously will keep making your response.

I made mine.

Over and out.

and btw, Justice Roberts for whatever reason in his mind, got it 100% correct and it is the law of the land.

[antigop]

229. I keep asking the question because NO ONE has been able to claim $1026 for two people on a $63000

income in CA is AFFORDABLE, especially combined with the max out-of-pocket.

[mzmolly]

236. Here. You must have missed this?

http://www.forbes.com/sites/rickungar/2013/05/24/unexpected-health-insurance-rate-shock-california-obamacare-insurance-exchange-announces-premium-rates/

[antigop]

215. and I'll ask the question again...how many people can afford $1500/month +max OP?

YOU obviously can since you were able to pay $3450/month + max op.

Thanks for proving the point.

[mzmolly]

220. Are you reiterating that a small percentage of Americans

will pay the top rates you quote? Seems so.

[antigop]

226. I'm reiterating that the rates are NOT affordable -- especially for older pre-Medicare who do not

qualify for subsidies,

and the max out of pocket ($11,900 for families) is unaffordable for LOTS of people.

Max out-of-pocket is paid IN ADDITION to premiums.

[mzmolly]

231. $11,900 applies to those at incomes above 400% of the poverty level.

And, that figure is the max. vs the bottomless pit that was the max pre-legislation.

400% of the poverty level = a family of four making 94,200 (AGI) - annually.

http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html

[antigop]

234. Did you even look at the example I referenced?

I'm not talking about a family of four --- the example is for 2 people, age 55.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2904304

[graham4anything]

221. California & $200 that is the important numbers.

California is going to set the standard for the nation
sooner rather than later if the repubs are voted out of office

I can move to California and get the $200
the argument shouldn't even be on my numbers, but on the $200

and I personally would give up my cell phoneS and my computer internet and my tv and cable to purchase insurance
as insurance is a lot more important than my cable tv

Thank God for President Obama, Gov. Brown and those moving FORWARD, not making excuses to keep us back.

[mzmolly]

222. Hear hear!

[antigop]

227. hear, hear? Who can afford what graham4anything is paying now? nt

[mzmolly]

232. G4A

can apparently.

[antigop]

240. yep....evidently...but most people would not be able to afford that. nt

[mzmolly]

242. Most people who are working and making that kind of income

are employed by someone who provides insurance. Those that are self-employed, are getting a reduction in costs, along with the a gaggle of tax breaks they take advantage of before their AGI is calculated.

[antigop]

244. g4A is self-employed, per his/her post. nt

h

[mzmolly]

246. Awesome! The perfect candidate for the savings touted.

[antigop]

256. we are talking about TWO PEOPLE with a COMBINED INCOME of $63000. Got it?

NO, I guess not.

[mzmolly]

263. A combined AGI of 63,000.

Yep, I get it.

[antigop]

266. Now figure out the % of what you are paying in premiums + your max out of pocket.

Because THAT'S what a couple will have to plan for.

Include the "gaggle of tax breaks" in your calculation.

NET: It's STILL NOT AFFORDABLE for a couple age 55-64.

[mzmolly]

269. Define affordable?

If two older people with no children at home, can't live on 63,000 less the max medical expense you're concerned about, then the country is in great trouble.

> The 2011 Median Income of US households was $50,054 per annum.

http://en.wikipedia.org/wiki/Household_income_in_the_United_States

Many families of two live on much less than 50K, annually. Many larger families do too.

[antigop]

272. You are looking at the median for US --- median for CA is higher

http://www.deptofnumbers.com/income/california/

We are talking about the rates in CALIFORNIA.

I noticed you didn't post the percentage of income, did you?

[mzmolly]

275. I notice you're not talking about what things are/were like

for Californians who are ill, prior to the legislation?

What percentage of income is currently charged for health care expenses? .. One might work a LIFETIME and not be able to afford treatment for a car accident, pre HCR. In fact, the amount you're complaining about would be spent in a few short days in most local hospitals.

-- The average price of an inpatient stay rose to $20,858 in 2009 from $15,063 in 2005. The average price of an outpatient visit rose to $728 in 2009 from $505 in 2005. Overall, California acute care hospitals last year collected $28.7 billion from non-governmental sources, principally people who get coverage through their employers. That was a 37 percent increase from 2005, when hospitals were paid $20.9 billion.

http://www.kaiserhealthnews.org/stories/2010/october/17/california-hospital-costs.aspx

[antigop]

280. because that's not the point...

http://www.nationofchange.org/health-care-s-forgotten-crisis-part-1-families-can-t-afford-medical-care-1370096051

It's STILL UNAFFORDABLE.

[mzmolly]

287. The heck it isn't. Your continued assertions that

Last edited Sat Jun 8, 2013, 01:59 AM - Edit history (1)

X is "not affordable" are not actually meaningful. What is meaningful is the life changing, life saving legislation.

[antigop]

289. Read the link...I'm not the only one saying it's STILL NOT AFFORDABLE. nt

[antigop]

292. if you CAN'T AFFORD it, it doesn't buy you anything. nt

[antigop]

283. Still haven't figured out the percentage, have you? nt

[mzmolly]

286. It's not possible unless one knows the monthly payment amount

and the number of years involved in a payment plan. Got that info?

[antigop]

291. You were the one raving about the tax breaks. So--what's the percentage of income

paid by premiums and copays/deductibles/coinsurance/max out of pocket?

[mzmolly]

293. Over how many

years?

[antigop]

296. You can't spread the premiums over years... they have to be paid each month. nt

[mzmolly]

299. The monthly AGI for the couple you noted is $5,250.00

The monthly premium (according to oldish data) is $1107, which is about 22% of the monthly income. If one includes payments for out of pocket expenses, this may bring the total to about 25% of adjusted gross income. Contrast this to the average person who has insurance through an employer and you'll likely see a similar percentage. And if you contrast either of these scenarios, to those without insurance where costs of care had no limitations you'd get a better understanding of why the legislation was so important.



Progress...

[mzmolly]

218. I do know - as I'm familiar with the legislation.

You apparently, are not?



The legislation limits out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums. (Depending upon income.) The legislation also expanded Medicaid.

[antigop]

224. I'm very familiar with the legislation -- but you weren't following the thread

graham4anything's post #126
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2908567

mentioned how his rates TODAY decreased but he/she did not mention what his/her max out of pocket is. The $18,000 rates were his rates TODAY, NOT necessarily the rates under the PPACA that goes into effect Jan 1, 2014.

His rates could have gone down simply by switching to a higher deductible/larger max out of pocket.

graham4anything touted how much his rates decreased --- you called it "progress' --- without knowing what graham4anything's max out-of-pocket is THIS YEAR.

btw -- your chart shows the problems of the PPACA:

1) The subsidies end at 400% of the FPL and older pre-Medicare people get screwed
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2904304

Run the calculator for ages 55-64 with an income above 400%FPL.
$1026 for premiums for two people on a $63,000 income in California is NOT AFFORDABLE, especially when you look at the max out of pocket they will have to pay IN ADDITION to the $1026 premiums.


2) The max out-of-pocket is $11,900 for families -- that's IN ADDITION to the premiums.

[mzmolly]

233. Average premiums in Cali are $323 post leg. Now, you tell me what your couple paid prior to the

legislation. That is, if they could even get coverage.

As you know, the fictional couple you note, would have been disqualified if either of them had a health condition. One short stay in the hospital might have meant losing their home.

Also, your worst case scenario isn't panning out:

For all the negative chatter about how including older and sicker Americans in the health insurance pools would drive up the price for younger participants in the pool less likely to be ill, what we are now seeing in states like California is that the desire on the part of the health insurance companies to increase market share—thanks to the large influx of customers as a result of Obamacare—is driving prices downward.

That is precisely what the President said would happen.

“The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.”

The actual costs?

Kliff continues, “On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium. For the 2.6 million Californians who will receive federal subsidies, the price is a good deal less expensive…”

Unexpected Health Insurance Rate Shock-California Obamacare Insurance Exchange Announces Premium Rates

[antigop]

235. Average means nothing....look at the calculator... run the scenarios...two people ages 55 -64.

making $63,000 Total.

Empty nesters -- pre-Medicare -- get screwed.

[mzmolly]

237. The calculator = worst case scenario and was based upon inaccurate predictions.

Read the article I posted.

http://www.forbes.com/sites/rickungar/2013/05/24/unexpected-health-insurance-rate-shock-california-obamacare-insurance-exchange-announces-premium-rates/

[antigop]

257. Evidently you need to read the article and understand what it says. n t

[antigop]

258. the calculator is NOT the "worst case" scenario. nt

[mzmolly]

264. It's based upon old

data. Newer info >>>>>>>>>>>> http://www.californiahealthline.org/articles/2013/6/3/editorial-says-covered-calif-rates-better-than-expected.aspx

[antigop]

282. no, the article doesn't say that. Go back and read it, please. nt

[mzmolly]

288. "Editorial Says Covered Calif. Rates Better Than Expected"

Ah, yeah it does.

[antigop]

290. It doesn't say that the rates on the Covered CA website are incorrect. nt

[mzmolly]

294. The article is new - the rates

are old.

[antigop]

295. it doesn't say that.. pls go back and read it. nt

[antigop]

297. Look...I'm done with this. You seem to refuse to read what you even post.

You posted an article about the high risk pool and didn't seem to know it went away on Jan. 1, 2014 even though it was stated in the article you posted.

You posted median income for the US when the thread clearly mentioned rates in CA.

Now you claim that the rates on Covered CA website are wrong...when that's NOT what the article you posted said.

Look, if you want to believe that over $1,000/month with a max OOP/deductible/coinsurance for a couple in CA age 55 $63,000 income are AFFORDABLE, you can believe whatever you want. Many people on this thread agree with me and I posted an article that backs me up.

For someone with a chronic condition, the max OOP/deductible can easily be reached EACH YEAR.

You can continue to be a cheerleader, but a lot of DUers know how bad it is going to be to force people to purchase something they can't afford.

Just check out the medical bankruptcy rates in Massachusetts.....

I'm done. I can't continue a conversation with someone who doesn't seem to read what is posted.

[mzmolly]

300. I knew the HR pool went away because it's no longer needed.

I'm fine using the California median income amount you noted. That still means the couple you are concerned about makes more than the average family in Cali.

The article I posted indicated that rates are better than anticipated. The Cali calculator, is an ESTIMATION based upon older data.

Look, if you want to believe that over $1,000/month with a max OOP/deductible/coinsurance for a couple in CA age 55 $63,000 income are AFFORDABLE, you can believe whatever you want. Many people on this thread agree with me and I posted an article that backs me up.

What I believe is that many, if not most Americans/Californians are living on less than the income you claim one can't live on.

That said, I am not indicating that the legislation is perfect. I support a single payer system. I hope this legislation was a step in that direction.

[antigop]

301. for the last time...READ. THE. ARTICLE. It doesn't say COVERED CA is based upon older data.

It does NOT say that.

It does NOT say that.

IT. DOES. NOT. SAY. THAT.

[mzmolly]

302. You misunderstand.

I did not say the article made the claim you question. The calculator for covered CA is using statewide averages in cost - which are improving per the article.

[freshwest]

205. +1. I know people who are breathing much easier on account of this.

[still_one]

127. They first put out a calculator several months ago which miscalculated

the premiums higher

The calculator has subsequently been fixed, and the premiums are less or the same based on ones income

[maidensandiego]

158. I ♥ my AFH n.k.a O-Care !

I really do get so TIRED of folks whining about the "Affordable Health Care" Act. Because THAT'S .... exactly what it's named. All this labeling it " Obamacare "...is soooooo annoying . And the POTUS thought the same as well when it was voted the Law of the Land...but even he has realized... ONCE AGAIN.....that people fall right into the game plan of labeling someting that will make automatic CRITICS.....cringe like the ignorant people that they ARE !!!! Just let them hear the word "Obamacare"..and it turns into " Oh No. Woe is Me. OOOOOOOMG...what am I gonna do ? This is Socialism. This is wrong. This is gonna kill jobs. This is gonna create Death Panels. OOOOOOMG. What do I do ?" This is the STUPIDITY of the followers of the these Repugnant Republicans too. I wish only that our Demcratic Leaders... would start to peddle this sound bite on very show and every city they visit. "Hey AMERICA. If it's good enough for the state of MASS. Then it's good enough for the MASSES across these United States !"

Thank you for shedding the light on some of the mis-information that's been and is STILL....being PEDDLED !!!!! My employer pays his employees medical & dental insurance plans [has over 500 employees], and we the employee pay for any spouse and dependants. I have a 23yrold son , who I pay $150 a month for [not bad] who's had 2 incidents since I signed him up in 2010.

One bill was for a broken hand, Total Bill = $1283.00...my portion $35 for co-pay and $15 my portion of the bill. The other incident was for stitches in his hand. Total Bill $295.00 my portion $35 for co-pay and $15.00 my portion of the bill. I would say for $50 out of pocket on each of those incidents...I'm a pretty darn HAPPY CAMPER with my Affordable Health Care Plan [Kaiser Permanente] ☺

[NiteOwll]

183. I get it....If you're being gouged right now

with 15K+ in premiums and $10K+ in deductibles or can't get insurance at all, you think this is a godsend. Which I'm happy for. It's no fun to go without insurance. I know, we did it for 2 years.

If our family had to go an exchange like this, we would be seriously hurting. We could never come up with an extra $500 a month in premiums with a $2K deductible and higher copays. These rates seem completely unreasonable. I don't know who comes up with the calculator but not everyone has the same budget and situation. Some of us were hit hard by 2+ year layoffs and we are still digging our way out.

[antigop]

186. Sorry to hear that, NiteOWll. I agree -- it's not just the premiums. It's the copays, coinsurance

and deductibles you have to pay in addition to the premiums if you need medical attention.

[antigop]

212. NiteOwll...case in point....

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2915664

Poster claims he/she was paying $3450/month...now paying $1500/month.

So he/she thinks the PPACA is a "godsend".

[davidthegnome]

207. Too confusing.

The Affordable Care Act is what they're calling it - but you'd have to be a legal expert or someone possessed of the patience of a saint to read all the way through it, to really understand all the particulars. I don't understand them - and won't pretend to. I'll wait until this begins to effect me and those around me, I'll judge the affordable care act by the effect it has on my life, and on the lives of those I know.

What I will say is that it makes me uneasy. It makes me uneasy because it is a legal mandate, forcing people to buy insurance, whether they want it (or will ever use it) or not. I understand the reasoning for it and the need for reform, but this particular reform makes me uneasy. It would have been wonderful to have a public option, or single payer - or even some kind of reform that was laid out in simple language that punks like me with only a year of college could understand.

It makes me uneasy, because so much of the arrangements, from my understanding, were agreed to behind closed doors. It makes me uneasy because I don't understand it. It makes me uneasy because it's been promoted, argued about - and ultimately will be implemented by - the same sort of people who already have complete health coverage, the best in the Country. People who rarely if ever have to worry about paying their bills, feeding their families, or breaking a leg and being unable to work.

What most often strikes me as being bizarre in this age of super PACs, is that our elected representatives have so very little in common with the people they are supposed to represent. Somehow, I just don't think that THEY understand what it's like to be an average American, a working class American, a poor American. If they did, I believe they would fight far harder for a Nation that is clearly ready for something resembling a public option, or single payer system.

[WinkyDink]

248. My health-care coverage (Capital Blue Cross/Group. PA.) just INCREASED $17/mo = $204/yr more.

So much for REDUCED RATES.

[markiv]

298. my rates have doubled since it passed nt