For millions, insurance will cost less than $100/month

[sinkingfeeling]

http://www.usatoday.com/story/news/politics/2013/09/17/100-dollar-premiums-exchanges/2822979/

WASHINGTON — About 6.4 million Americans eligible to buy insurance through the new health exchanges will pay $100 or less a month in premiums because of tax subsidies, according to a Department of Health and Human Services report to be released Tuesday and obtained by USA TODAY.

The report by the HHS office for planning and evaluation said the lower premiums would primarily apply to insurance customers who buy what are called "silver" plans on the exchanges that open Oct. 1.

Although not all of the states nor the federal exchange have announced their rates yet, researchers determined they could estimate payments without that information. As an example, the Affordable Care Act states that someone making 150% of the federal poverty level, or $17,235 a year, would pay 4% of their income — or $57 — for the second-lowest-cost plan. So, that person's subsidy would be the difference between the $57 and the cost of the silver plan in that state.

In the 25 states that have decided to expand Medicaid, 12.4 million uninsured Americans will be eligible to pay less than $100 a month, the report found. People in this group will pay either nothing or a small premium to participate in Medicaid.

[joshcryer]

1. This is why they GOP hates ACA.

And why some wealthy "liberals" hate it too.

[leftstreet]

2. What's the deductible?

[Art_from_Ark]

4. That's a very important question

Another important question is, what, exactly, would this "silver" insurance cover?

[lumberjack_jeff]

27. Silver plans cover all preventative care (but not dental)

Silver plans have an 87% actuarial value, meaning that the plan will cover 87% of all costs experienced by enrollees in a particular population.

http://kff.org/interactive/subsidy-calculator/#income-type=dollars&income=30000&employer-coverage=0&people=3&adult-count=2&adults%5B0%5D%5Bage%5D=21&adults%5B0%5D%5Btobacco%5D=0&adults%5B1%5D%5Bage%5D=21&adults%5B1%5D%5Btobacco%5D=0&child-count=0&child-tobacco=0

[Art_from_Ark]

37. So the silver plan doesn't cover the costs for dental care

or for treating pre-existing conditions?

[lumberjack_jeff]

71. Are you talking to me?

Because what I just posted
a) answered question #1 verbatim. and
b) I thought everyone here already knew that insurers now can't reject applicants because of preexisting conditions. If you are asking if your new insurance will pay for the appendectomy you had when you were 20, then no.

All plans (gold, silver, bronze) will pay for future care despite the fact that you have (heart disease/diabetes/cancer) now.

[Art_from_Ark]

127. The first part of my question was merely asking for confirmation

The second part of my question was in response to your term "preventative care", which to me implies things like check-ups and annual physicals, rather than treatment of a condition that is already known to exist. But you explained that in this post.

I'm still trying to sort all of this out. It sounds much more complicated than the foreign plan that I am currently on, which is as straightforward as can be.

[lumberjack_jeff]

138. You're right about "preventative care" - it does mean checkups and physicals.

They are free of charge to the patient.

But preexisting condition means that the insurer can't reject you as an insured simply because you have a medical history. If you have a medical crisis related to chronic diabetes, the treatment will be covered by your new insurance.

It is arbitrarily complicated, and I'm sorry if I was snappish.

[pnwmom]

76. Of course it covers pre-existing medical conditions (including mental health).

That is one of the main reasons for the law -- that insurers were refusing to cover both.

But in my state there is only dental coverage for children.

[leftstreet]

42. What's the deductible? n/t

[lumberjack_jeff]

69. Depends on the co-pay, which depends on the deductible.

Every plan might have a different methodology so long as it conforms to the 87% actuarial value.

In general, over time, you can expect 87% of your medical expenses to be covered by a silver plan. That is much better than the catastrophic plans which pay only in the most extreme situations.

[L0oniX]

45. Well they don't want poor people to be able to eat so they will die sooner.

[lumberjack_jeff]

72. Yeah, it'd be nice if people could get subsidized dental care too. n/t

[adirondacker]

88. It'd be nice if teeth, eyes and ears were considered the same way as a pecker in Health Care. nt

[totodeinhere]

93. This is certainly better than nothing. But with today's high health care costs having to pay 13%

of the bill for a hospital stay would probably be enough to bankrupt most people. If the plan has catastrophic coverage that might be different and I admit I don't know if it does or not. Last year my mother got a bill for $600,000 for major surgery so if she would have had that plan she would have been stuck for $78,000. Still like I said it is much better than nothing.

Edit - I just read downthread that there is a yearly maximum out of pocket provision that would kick in in a situation like the one I described.

[lumberjack_jeff]

105. The actuarial value is based on the community.

Most people will have less than 87% of their care in a given year paid by insurance because their medical expenses were modest.

A few people will pay less than 13% of their care out of pocket because they had a hospital stay or an operation or some kind of medical crisis that no one could be reasonably afford.

On average, 87% of the medical costs experienced by the population will be paid by insurance, and as you noted, maximum out of pocket provisions cap the total individual costs.

[pnwmom]

80. That depends on income, since there are both tax credits to lower

the cost of the monthly premium, and tax subsidies to help meet out of pocket costs -- both based on income.

You need to go to your state's exchange to see what your cost would be.

[PowerToThePeople]

3. from the article

As an example, the Affordable Care Act states that someone making 150% of the federal poverty level, or $17,235 a year, would pay 4% of their income — or $57 — for the second-lowest-cost plan

Someone at this level of income does NOT have an extra 57$/Month for insurance (per family member) sitting around.

[DJ13]

5. +1

At that income it should cost 0, with a low deductible.

[Jackpine Radical]

32. $0 with NO deductible, if ya ask me.

Maybe charge $2 a visit if you think people would otherwise abuse the system.

(There are studies showing that people don't abuse the system even when it's free.)

[Hassin Bin Sober]

6. And how do these "tax subsidies" get applied?

If it's at the end of the year they might as well not exist for someone in that income bracket.

[Autumn]

11. I've asked that question several times and have not gotten an answer.

And you are right, if its at the end of the year it's no help at all if one is paying monthly for insurance they can't afford to use.

[PoliticAverse]

77. Actually the tax credit can be paid to the insurance company in advance:

Last edited Tue Sep 17, 2013, 02:51 PM - Edit history (1)

From: http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

Health Insurance Premium Tax Credit

Starting in 2014, individuals and families can take a new premium tax credit to help them afford health insurance coverage purchased through an Affordable Insurance Exchange. The premium tax credit is refundable so taxpayers who have little or no income tax liability can still benefit. The credit also can be paid in advance to a taxpayer’s insurance company to help cover the cost of premiums. On May 18, 2012, the Department of the Treasury and the IRS issued final regulations which provide guidance for individuals who enroll in qualified health plans through Exchanges and claim the premium tax credit, and for Exchanges that make qualified health plans available to individuals and employers. On Jan. 30, 2013, the Department of the Treasury and IRS released final regulations on the premium tax credit affordability test for related individuals. On April 30, 2013, the Department of the Treasury and the IRS issued proposed regulations relating to minimum value of eligible employer-sponsored plans and other rules regarding the premium tax credit. The proposed regulations solicit public comments. Additionally, Notice 2013-41, issued on June 26, 2013, provides information for determining whether or when individuals are considered eligible for coverage under certain Medicaid, Medicare, CHIP, TRICARE, student health or state high risk pool programs. This determination will affect whether the individual is eligible for the premium tax credit. Comments may be submitted electronically, mailed or hand delivered to the IRS. On June 28, 2013, the Department of the Treasury and IRS issued proposed regulations on the new reporting requirements for Exchanges. Comments may be submitted electronically, mailed or hand delivered to the IRS. For more information on the credit, see our questions and answers.

[Autumn]

95. Thanks for that . looking it up now.

[PoliticAverse]

96. You may find this page useful as well..

http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit

[Autumn]

98. That's it. So much easier. Bookmarking this

[llmart]

119. Thanks for the link.....

It was very helpful. I, too, bookmarked it.

As an aside, the 100% poverty level should be raised. No one can live on $11K a year.

[CottonBear]

102. Thank you. n/t

[Autumn Colors]

94. No, you don't have to pay it all up front

I saw a really good explanation of this (which I wish I had bookmarked) because I was worried about that, too.

What I got from it was that the subsidies are based on your estimated income for the coming year. The subsidies are paid directly to the insurance company and you only have to pay your share. At the end of the year when you do your taxes, things get "settled up" based on what your actual income turned out to be. So if the estimate was off you could either owe more or get a tax refund.

[PoliticAverse]

97. This IRS webpage answers questions on the credit...

http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit

[Autumn]

99. Hi Autumn Colors. PoliticAverse posted just what we needed.

[Autumn Colors]

152. Hi!

Ready for the start of autumn in a few days?

[Autumn]

153. More than ready, it's been a long summer.

And when winter hits, I'll be crying for spring.

[CottonBear]

101. I want to know about the tax subsidy too.

I cannot find any info on it on any of the ACA websites or my state websites. I cannot afford an end of year tax rebate. I need an up front subsidy. I would qualify for Medicaid but my idiot governor rejected Medicaid.

[PoliticAverse]

120. It's available as a paid upfront directly to the insurance providers tax credit.

See: http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit

[CottonBear]

145. Thank you so much! n/t

[Boudica the Lyoness]

9. You are so right

It must be hard for those who have never been poor to understand $57/month is a lot of money if you only have $1,436/month to live on!

[Daniel537]

25. Indeed it is.

Most people will scoff at $57 and say anybody can afford it, so just stop whining. I can tell they've never had to walk a day in the shoes of the working poor.

[BuelahWitch]

33. That $1436 is before taxes

More like $1200 take home, or less. And yes $57 is a hell of a lot of money to throw in a hole every month if the deductible is too high for you to use your "insurance."

[cbdo2007]

19. How does this work in countries that have universal health care? Do lower income people not pay for

it out of their income???

[Boudica the Lyoness]

121. In the UK people don't 'buy' health insurance

like they do here in the US. Nobody has to pay a penny in insurance premiums, deductibles, co-pay etc. Everything is paid for from taxes. If you don't have any income, you still get top-notch healthcare for 'free'. It's a wonderful system and the healthcare is better than in the US. Doctors are held accountable for their patients health.

I have lived in both England and the US and have family members in both countries who, like me, have seen plenty of doctors and have been hospitalized.

[cbdo2007]

141. That's what I'm asking - what is the tax % people pay for the universal health care??

Do poor people pay the same % as rich people??

It isn't "free" and many people are paying much more than they would be under our current system. That's why I'm wondering. If we're ever going to be a "universal" or "single payer" health care country, the next big fight is going to be cost with people who think it's "free" being shocked they actually have to pay thousands of dollars per year for it.

[lumberjack_jeff]

29. They don't have $600 for rent either.

But rent, food, and medical care are still needs.

[PowerToThePeople]

31. correct.

[pnwmom]

81. It wouldn't be $57 per family member because that number is based

on a single person household.

[SoCalDem]

85. But they may still get injured or sick, and then they will be on the hook

for THOUSANDS of dollars....and years of being hounded by collection agencies..

perhaps a burner cell phone AND health care insurance might be a plan for them..

I'm pretty sure that MOST people could come up with $57 ..Truly destitute people will qualify for free ..

It's too bad we do not have universal healthcare for all, but until that happens we have to deal with thing the way they are..or will be..

[uponit7771]

122. +1

[former9thward]

7. The Devil is in the details.

What is the deductible and what does the plan cover? If someone thinks that people making $17k a year are going to be happy about paying a new $57 a month bill they are very out of touch with reality.

[JoePhilly]

10. Clearly the ACA sucks. We just need to figure out why.

[leftstreet]

12. It entrenches for-profit insurance companies. Duh n/t

[JoePhilly]

13. Sure, it entrenched something that was already entreched.

Now its double entrenched.

[leftstreet]

16. Insurance payments have always been mandated?

I didn't know that

[JoePhilly]

18. I get the sense there's lots of stuff you don't know.

[leftstreet]

20. What's the deductible again?

[tridim]

34. And caps their profits at 20%, forever.

Which has resulted in my premiums dropping about 50% in the past few months.

Horrors.

[leftstreet]

41. I don't think you understand the MLR

A little research might help

[lumberjack_jeff]

107. True, profits will be capped at a small percentage of the 20% max MLR.

[Mojorabbit]

103. Is there a cap on premium prices year to year? nt

[PoliticAverse]

147. No. There's a cap on profits (medical loss ratio). n/t

[Mojorabbit]

149. I was afraid that would be the answer. Thank you

In Florida we might have a problem down the road then. That is not counting all the others we have here.
I cannot fathom what kind of person would cause so much harm to their fellow men for ideology esp when it comes to health.

"Congressman Joe Garcia sent a letter yesterday to Florida's legislative leaders urging them to return the insurance regulator's authority to approve health insurance rate hikes, which Senate Bill 1842 removed for two years.

Read more here: http://miamiherald.typepad.com/health/2013/08/letters-urge-legislature-to-reinstate-insurance-regulators-rate-oversight.html#storylink=cpy

[Ms. Toad]

151. It does't matter what state laws say -

Health insurance ratios are governed by the ACA, and since quite a few overcharged their customers once they figured up the numbers at the end of the year, $500 million in premium refunds were made in 2012 (2013 refunds are not yet available).

[Nuclear Unicorn]

110. Actually, it caps the amount they can spend on things other than medical services

That means their admin costs and whatnot. Any profits have to be realized after their overhead has been paid out of the 20%.

[former9thward]

14. The ACA is simply rearranging the deck chairs on the Titanic.

The U.S. health care system is fundamentally broken and only a single payer system will bring some measure of sanity to it.

[JoePhilly]

17. So when the titanic hit that iceberg, since their weren't enough life boats ...

they should have destroyed all of the other lifeboats.

Great analogy you have there.

[former9thward]

21. Its a perfect analogy.

Though not in the warped way you applied it. The ACA will provide limited help to a very limited amount of people. But most will continue to drown in the health care bureaucracy and health care costs. Every single poll has shown the majority of people oppose the ACA and that number will only grow as it is implemented next year.

[JoePhilly]

26. Think of Single Payer as the RMS Carpathia.

btw ... I love your use of the RW talking point that the "majority of people oppose the ACA".

Most of those who oppose it are right wingers who think the ACA goes to far. Ironically, they like to count YOU among their numbers.

Then, there are the few on the left would prefer everyone drown rather than take the progress provided by the ACA and build on it.

And here, you count those right winger nut jobs among your opposition numbers.

Classic.

[former9thward]

35. The majority of people in the U.S. are right wingers?

If I thought that was true I would get out of politics and find a hobby. I don't think that however. Are the unions right wingers? First I've heard of that but I see all sorts of "facts" asserted on DU everyday that I and no one else knew.

[JoePhilly]

54. The majority of those who oppose the ACA are right wingers, yes.

I did not say that the majority of Americans are right wingers.

[former9thward]

62. Is the AFL-CIO a right wing organization?

[L0oniX]

44. I don't see why we should help sociopath heath insurance corporations. They are preditors.

[JoePhilly]

55. Doing nothing is a much better plan.

[L0oniX]

65. Single payer is the only moral plan.

[SunSeeker]

79. No. It is immoral to let 45,000 die each year waiting for single payer that never comes.

The ACA, as imperfect as it is, saves lives and provides health coverage to 30 million Americans that don't have it now. Enacting the ACA was the moral choice under the circumstances that existed. We did not have the votes for single payer.

[Bigredhunk]

111. Bingo!

Agree with Sunseeker & Joe Philly. It's imperfect, but it's a step in the right direction. Do you really think Obama could've had single payer if he just went for it harder?? I want single payer too, but huge leaps like that aren't done overnight. My guess is people will be happy with the ACA and we'll move to the left from there.

As far as the ACA being unpopular, how much $$ was spent on a disinformation campaign against it? One of the two US senators from my friggin' state was out there touting "death panels" and "pull the plug on grandma." It's no coincidence that you have morons going to sign up for the ACA in KY, being very happy about it, and then saying something like, "I just hope they don't make me get Obamacare." It's the same crowd who says "Keep the goverment out of health care...and keep your hands off my social security!" Also, it was one of the main issues for Obama vs Robme, and Obama won the election decisively. Can't be that unpopular or people would've put him out.

Everybody on the right is against it because they'll always hate everything Obama does. The others who hate it (a large majority at any rate) believe all the lies about it. As it rolls out and people start to see the benefits, I'm betting popular opinion on it will change.

[L0oniX]

114. Ok then let them pay to stay alive because that is moral. n/t

[SunSeeker]

118. Medicare will be expanded to cover those who can't pay. But you will always find something to hate.

Apparently you prefer the way things were, with 45,000 people dying each year for lack of coverage. How dare Obama!

[L0oniX]

128. Being overly optimistic is your thing ...I'll count my chickens after they are hatched. n/t

[area51]

131. I think you mean Medicaid

and not every state will enact the expansion of Medicaid.

Also, it's 100,000 people dying each year due to lack of health care.

GingrichCare will not stop this, nor will it stop medical bankruptcies. But you knew that.

[Cal Carpenter]

23. It's more like having paid to reserve a spot in a lifeboat

but not being able to pay the extra fee to actually get into the lifeboat when the ship starts sinking.

Insurance does not equate to HEALTH CARE, and what people need is HEALTH CARE, not insurance.

[Daniel537]

28. Exactly.

People keep conflating insurance with actual care, which anybody who has had to deal with the insurance industry can tell you is just not so.

[Daniel537]

22. I agree, but unfortunately there just isn't the will among the D.C. elite to do this right now.

Insurance companies have deep pockets, and they make sure to keep politicians fat and happy. We can only hope the ACA becomes a pathway to single payer at this point, but i'm not holding my breath.

[RC]

106. ACA was designed to keep Single payer from happening.

Health insurance companies wrote most of the ACA. Either where it was birth, in the Right-wing Heritage Center, or in the Congressional committee, where the lobbyists out numbered the bought off congress critters that were supposed to be writing it.

[PowerToThePeople]

24. I am on board with single payer too. n/t

[pnwmom]

86. The ACA is the best chance we have now TOWARD single payer,

because of its system of waivers starting in 2017 for states like Vermont that want to initiate their own single payer.

The best way to make sure this happens is to support the ACA in staying alive till then.

http://www.dailykos.com/story/2013/07/30/1226609/-Single-Payer-movement-in-the-era-of-Obamacare

[former9thward]

87. I am in favor of states moving forward on the issue.

Different states may have different programs and people can view the different results and determine what is best. At the Congressional level I think the ACA will stop single payer for at least a generation. Every time it comes up people will say "we have just started with the ACA. Let's see how it works out over the next few years."

[pnwmom]

89. If the ACA FAILS we can be sure single payer won't be allowed to proceed anywhere.

With ACA, we have a chance to start state by state.

[Whisp]

15. we should just trash the whole thing.

after all, Boehner and the Boys want to do it, so it's got to be the right thing to do!



It will get worse, there is still time for out and out PANIC here over ACA implementation.

[Le Taz Hot]

48. Why don't you try and address

some of the concerns upthread? The answer to that is there is NO answer so you and your cohort here are reduced to ridiculing posters with legitimate concerns. How cliché this all is.

[Whisp]

50. oh, The Concerns....

yes yes, we must address the Concerns.

I am concerned about people that will finally be able to get some help with health care, I am not so concerned about people who are raging against it like BoehnerHeads.

[Le Taz Hot]

51. Wow!

"Concerns. "

I'm just gonna let that one sit there all by itself.

[leftstreet]

53. They won't have 'concerns' until they lose their good coverage

Obamacare attempts to change this dynamic. Under the law, health plans that cost over $10,200 for an individual or $27,500 for a family will have to pay an excise tax of 40 percent on every dollar that they exceed that cutoff beginning in 2018. As Jonathan Gruber, an MIT economics professor who helped design the law, explained to the New York Times, the tax is meant to reorient the way that employers approach their workers’ health problems and their associated costs. “It’s focusing employers on cost control, not slashing,” said Gruber.
http://thinkprogress.org/health/2013/05/28/2064441/employers-obamacare-cut-wasteful-spending/

9: What is a “Cadillac Health Plan”?

The PPACA imposes a 40 percent excise tax on “Cadillac” health insurance plans. This new tax will apply to health plans valued in excess of $10,200 for individuals and $27,500 for families. Those thresholds will grow annually by inflation plus 1 percent. The tax takes effect in 2018.
http://www.cpehr.com/affordable-care-act-obamacare-for-business

How Obamacare Is Encouraging Employers To Cut Wasteful Spending And Promote Workers’ Health

By Sy Mukherjee on May 28, 2013 at 4:05 pm

In an effort to cut wasteful U.S. medical spending, certain employers will be scaling back expensive health plans available to their employees and encouraging workers to pursue more preventative and ongoing primary care. The move is being prompted by Obamacare provisions that encourage a more cost-sensitive and efficient approach to Americans’ health care than the status quo.

Recently-released government data shows that Americans’ medical bills are completely random, with some hospitals charging as much as $100,000 more for the same services performed at other facilities. In turn, that drives up the costs of many private health plans, and increases companies’ spending on employer-sponsored insurance.

Obamacare attempts to change this dynamic. Under the law, health plans that cost over $10,200 for an individual or $27,500 for a family will have to pay an excise tax of 40 percent on every dollar that they exceed that cutoff beginning in 2018. As Jonathan Gruber, an MIT economics professor who helped design the law, explained to the New York Times, the tax is meant to reorient the way that employers approach their workers’ health problems and their associated costs. “It’s focusing employers on cost control, not slashing,” said Gruber.

Companies aren’t waiting until 2018 to shift their health care models. Some are increasing their use of high-deductible health plans (HDHPs) — which charge workers low monthly premiums but high annual deductibles — in an effort to raise employees’ awareness of how much their health care consumption costs.

http://thinkprogress.org/health/2013/05/28/2064441/employers-obamacare-cut-wasteful-spending/

But by then, Obama (and Hillary) will be out of office, so the Democrats don't care

[Le Taz Hot]

59. 2014 is the year "Obamacare" comes into affect

(for the suckers, er, consumers, at least -- not for employers, they have a pass for another year) and there are going to be WAY too many people that don't benefit from ACA and, in fact, will actually be worse off. This is going to play negatively for the Democrats in the 2014 election because there will be too many people falling through cracks the size of Chicago.

I took one look at what our premiums would be and burst out laughing. $1,000+ a month for 2 people, no subsidies and a $12,000 a year deductible. And we DON'T make a lot of money by California standards. We'll be paying the penalty -- it's WAY cheaper.

[leftstreet]

60. 2018 for the excise tax on good employer plans

I agree with your post though

[antigop]

117. older people making over 400% FPL really get nailed. I've tried to explain this over and over.

So glad you posted this, Le Taz.

A couple making one penny over 400% FPL will not get subsidies. Add to that the deductible/ max OOP if you happen to get sick -- IT'S NOT AFFORDABLE.

And 400% FPL for a couple, especially living in California, isn't exactly living high on the hog.

Cue the "But you get a gaggle of tax breaks" posts....countdown ...3...2...1

[Hestia]

142. If my math is correct, 400% over FPL is $69,000 +. At that pay level, most people

have medical insurance through their employer as one of their benefits. Those that are contractors or consultants appear to be hit hard. But at that level, don't they already have medical insurance? I can't see someone having to pay $1,000 more per month (was that the quote) when we've seen reports that the state exchange has lowered premiums.

The Union Medical Insurance Pools have not been approved by HHS for some crazy reason, and they are supposed to be fantastic plans (I guess they would be the Cadillac plans, but if they can afford them, why penalize them? I've had a Cadillac plan before, used it, and didn't come out having to bankrupt myself over the bills.) That one major reason the Unions are not behind it - along with guaranteed customer service jobs, and others, have to stay in the US. I cannot figure out why HHS would jerk the Unions around like this, since they were instrumental in getting Obama elected in the first place. Screw with them, and all Democrats will not be able to automatically assume their support in elections here on out.


Walgreens, IBM Retirees, et al will get their own exchange, which pretty much appears to be inline with the HHS exchanges, just with another administrator, which on the face of it, they are going along just not with the state exchanges. Whatever helps upper management & BOD sleep at night.

[Mojorabbit]

150. A ton of self employed people might fit into that box.

We do. We need insurance so we will pay it. We can afford it but my husband has a preexisting and we have been unable to buy insurance for years so I will take the opportunity gladly. I am worried though that a lot of people will not be able to pay that kind of money per month. It is a lot.

[lumberjack_jeff]

30. I work with someone making $17k a year.

She's very happy that she's going to be able to get insurance. Having a stroke last year and being unable to find a primary care doctor who will take her without insurance, sucks.

[former9thward]

36. If she had a stroke any emergency room is required to take her without insurance.

That aside if it works out for her I am happy for her. We will see what the $17k-$25k crowd thinks after a year.

[Stargazer99]

56. Emergency rooms charge more than an insured person

to the very working poor that are the least able to foot full charge bill
Charity care you say? You've not been out in the field of reality have you?
That crap that the Republicans gaslighted the general public with that
all you have to do is go to the emergency room...was a smoke job to all
those never put in that position so the general public thinks the poor and
working poor are taken care of....what a laugh!

[lumberjack_jeff]

67. The emergency room isn't the issue. The issue is primary care so they can observe.

They gave her meds when she had the stroke. It's important that she receive follow up visits to validate that the meds are working.

Sheesh.

[former9thward]

70. I hope the ACA does well for her.

[lumberjack_jeff]

73. It can't be worse than being uninsured. n/t

[tabasco]

78. Yes, that's a much better system

"Just go to the emergency room"

[pnwmom]

82. But they will still bill you afterwards, and charge you MORE than if you had insurance.n/t

[former9thward]

90. Don't pay the bill.

Let them sue (which they don't) and if/when in court challenge them to justify every item. Easy to win that one.

[pnwmom]

91. No, not easy to win. You would need to pay for an attorney.

And most people would rather not have the black mark on their credit.

[L0oniX]

43. Earning 17k in NYC is not the same as 17k in Holland Mi.

[lumberjack_jeff]

68. Sure it is.

The bus ticket from NYC to Holland Mi is the same price as the reverse trip.

[uponit7771]

123. Good point also...

[roamer65]

126. If she's from MI...

she will now get very subsidized private insurance, or very low or no cost Medicaid. With our passing of Medicaid expansion, it will be hard not to have health insurance.

[maddezmom]

116. You seem really angry

[Precisely]

8. Money they don't have

and won't have to spend on actual health care.

It's a start.

[Keefer]

38. I have 4 distinctly different heart problems.

My 2 cardiologists told me "no more work." I am receiving SSI and Medicaid right now. In December, SSDI starts, which means I lose Medicaid. SS rules are that once SSDI kicks in, I have a 2 year wait before I am eligible for Medicare. (Retroactive to May, 2013.) What am I supposed to do? $57 a month is a lot of money. Plus the deductibles for doctors, specialists, and 13 different prescriptions every month. I can't live for 2 years without medication. On top of all that, one of my cardiologists wants me to have a defibrillator implanted. What happens if it can't be done before Medicaid ends? What do I do for 2 years worth of check-ups and battery changes? This whole thing has me worried 24 hours a day, and is more than likely adding stress I don't need, with my heart the way it is.

[Stargazer99]

58. It the Republican plan to make the general public ignorant

as to what really happens to lower income people

[ileus]

39. I look forward to switching

A 100 buck a month premium would save me 250.

[L0oniX]

40. So does that cover "everything"? No co-pays? No drug costs? It may be tough enough...

for some of our poor to even get to a treatment center other than walking ...which will be tough for the disabled. The UK pays for transportation = good. I just have serious doubts about this whole thing and I expect huge problems. it should have been single payer like Obama spoke of while on his first campaign trail ...and yea I hear him say it ...live at a rally.

[pnwmom]

83. That depends on income -- there are subsidies based on income that lower out-of-pocket costs too.

[lancer78]

46. Just checked my silver plan

My unsubsidized amount I have to pay is $493 / year. I can either pay that all at once or split it up monthly. My maximum yearly out of pocket expenses is $2,250 and I have a guaranteed 94% actuarial value. This is all based on a $300/week salary. The deductible is a little high for me, but I know I could always buy a little co-insurance for that.

[leftstreet]

47. What's the deductible?

You say it's 'a little high'

[lancer78]

49. It is $2,250 n/t

[leftstreet]

52. HOLY SHIT !!

That's outrageous

[lancer78]

64. Sorry.

Made a mistake, that is max out of pocket per year. my deductible will be about a fourth of that.

[Hoyt]

75. That low max out-of-pocket is a big deal. If you need expensive care, it is not likely to be denied

because you can't pay the deductible. I cannot imagine many hospitals turning a patient away for a $250,000 transplant because they don't have the first $2,250.

I could see someone being denied relatively minor care, or not being able to pay for relatively inexpensive meds -- but that is something fixable.

I think ACA is a big step forward, despite some issues. It was the best we were going to get at the time.

[pnwmom]

84. My daughter had a trip to the emergency room for a broken finger tip

and it cost more than $5,000.

To put this into perspective.

[Zorra]

57. Basic ACA Resource Guide

http://www.democraticunderground.com/11429688

[NCTraveler]

61. Question about the subsidy.

Is it paid out to the individual at the end of the year when taxes are done? Does the individual have to come out of pocket and then wait until the end of the year to be reimbursed?

[Autumn]

100. PoliticAverse gave me this link up thread

http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-the-Premium-Tax-Credit

[NCTraveler]

109. Thank you for sharing that.

Very helpful.

[Liberal_Stalwart71]

63. I would ask everyone to use Wendell Potter's site. Not only do I think he's an

American hero, he puts Obamacare in plain English, making it easier to understand:

http://www.publicintegrity.org/2013/09/09/13355/benefits-obamacare-simplest-terms

Again, the ACA is not perfect, but I think it can be improved and I do think it's a good start towards the public option, which coincidentially, I and every single federal government employee, including members of Congress and their families, have.

Note: Our public option isn't *exactly* like the bills that were proposed several years ago, but the public option concept is the same.

------

Check out Wendell Potter's site, please. He answers a lot of questions that many of you are posing here.

[Hoyt]

74. Potter does some good things nowadays, but, fact is, he got rich screwing people.

I give him credit for repenting.

[Liberal_Stalwart71]

92. Yes, he got rich screwing people, but like David Brock, he has more than made up

for it. He has dedicated his entire life doing right by us.

What he's doing now is amazing. Check out his site if you can.

[dem in texas]

66. Right Wing Posers Get off this board!

The ACA may not be perfect, but it is much needed and a step in the right direction. Yes, there are some glitches in it and it will need some "nips and tucks" once it goes into effect, but this plan is needed by many, many people. I have a daughter who lost her job and was paying for her medical insurance under the Cobra plan, it was running her a little over $300 a month and had high deductibles and poor coverage. She is paying off a hospital bill for an appendix operation that her insurance only partially covered. She had to drop the insurance last month because she is having such a hard time financially. Her big worry now is finding a job and keeping her house from foreclosure. She has been able to pick up some odd jobs and part-time work I am keeping my fingers crossed that she does not get sick before the ACA insurance kicks in.

[JPZenger]

104. Buf if employee's costs paid by employer, no subsidies available for spouse and children

One facet of the health care reform process has left millions of families with unaffordable insurance costs. If a person's employer pays most of the costs of the employee's coverage, then that employee is not eligible to receive subsidies through the health care exchange to cover insurance costs for their spouse and kids. This assumes that is it possible for the employee to have spouse and kids covered by the employer's plan. It does not matter how much that employee has to pay to cover their spouse and kids, there still is no subsidy.

[RebelOne]

108. Well, maybe my Medicare payments will be reduced.

I already pay $105 a month, and that is a lot of money considering my SS check is only $1400 a month.

[SCantiGOP]

112. kick the hell out of this

2 members of my family (over whom I have no control) have no insurance but won't get off their asses and do the necessary up-front work to get coverage. Very, very frustrating.

[Spitfire of ATJ]

113. At one point a typical middle class family of four heath care plan cost around $1,200 a month.

[roamer65]

125. Good news for those in MI

We are going to pass Medicaid expansion...yay!

[freshwest]

129. What a blessing for so many. Thanks, sinkingfeeling.

[KennedyBrothers]

130. Will 2012 incomes be used to determine subsidy?

If a single person made, say, $35,000 in 2012, is that what will be used to determine the subsidy?

[B Calm]

132. It's not so cheap for a couple who want to retire at age 62.

[n2doc]

133. Shame the Minimum wage couldn't be raised to cover this

at least for those stuck in min wage jobs.

[santroy79]

134. seems unfair

glad those making less are getting Ins. for $57 a month but Im paying way more then that through my employer even if you account how much more Im making. Plus its worse Ins. I should have the option to leave my employer Ins and sign up through the ACA

[BainsBane]

135. You do, or you will as soon as the exchanges are set up

but your insurance plan at work will also improve since ACA sets guidelines on what insurance plans will have to offer.

[santroy79]

136. Ins I have meets it already

But it only covers 80%.

[bread_and_roses]

137. For millions making 150% poverty, $57 mo is unaffordable

Just who are we kidding here? Here's the Living Wage calculation for Broome County, NY - where I live - from MIT

http://livingwage.mit.edu/counties/36007

Notice that the food allowance for 1 is approx $8.00 per day. Been to the grocery store lately? The monthly estimation for health care is $122 mo, but that would have to include eyecare (don't need glasses!), dental (don't get a toothache!), any ordinary OTC products - aspirin and such - as well as physician, prescriptions, etc.

If one needs clothes (even at thrift store prices - and what about underwear? socks?) or shoes (harder at thrift store) or light bulbs or dish detergent, or clean clothes (laundromat), or wants an internet connection that all has to come out of the $72 "other" category. As well as any recreation (forget a movie).

The above is barely - maybe - manageable with no recreation, no dental/eye problems, no unexpected expenses, no presents for anyone for b'days or holidays ...

Affordable. Right.

[MindMover]

139. When you are making 17 grand a year, any amount whether it is 100 or 57 a month is a lot of money ..

So again I say this whole plan is just welfare for insurance companies ....

[OKNancy]

140. Please note: income is ADJUSTED gross income

for most people. It is labeled as Modified adjusted gross, but for most this is the same as adjusted gross.
This will make a big difference when you calculate what premiums might be.

I like this calculator. http://laborcenter.berkeley.edu/healthpolicy/calculator/

For my husband, premiums will go from $600.00 per month to $150.00 per month ( I will be on Medicare in Jan so I won't need it)

[LittleGirl]

143. spouse came home yesterday

and said he got an email that our company provided (self insured) healthcare costs are going up next year and so are the deductibles. We pay close to 200 a month for premiums (just us two) and our deductibles for in-network and out of network are in the low thousands. He said that spouses that work and are using this companies' plan will be penalized (charged a fee) for not getting health care at their own employer. (I thought that odd considering some spouses probably work part-time or aren't eligible for health care at their employer). Who knows anymore????

I wondered out loud if the company is hoping to have their employees go outside of the company and get their own healthcare in the exchanges.

My spouse and I agree, we need to get single payer in this country and pound it louder than the GOP.

[Scurrilous]

144. K & R

[grahamhgreen]

146. That's still 640 million a month! Public Option Now

[madrchsod]

148. my medicare is around 100 a month

drug plan is a few bucks more. medicare pays out 80-100% depending on the treatment. free wellness check up each year,full integration of my records with all my doctors,and other stuff i never got on private insurance. oh yes,i have received the finest of care in a "church run" healthcare system and was not turned down for any procedure.

hospitals like medicare for at least one reason. they know actually what they will be paid by medicare for each procedure and they know they will be paid at a certain date.