October 16, 2013

My ACA health care sign up, part two.

I detailed my application experience here:

http://www.democraticunderground.com/10023777148

Given the interest folks have in understanding the process, some may be interested in fuller details.

After I finished the process with Marketplace I received an email from Health Net and on 10/10 received a letter of welcome.

Today I went on the site and they confirmed the following details.

Gold/HMO Cost is $ 757 per month (for wife and I, soon to turn 60) living in AZ.

After the subsidy we pay $ 444. (If our income changes subsidy could go down.)

Here are the coverage details:

Deductible: None
General copay: 20%
Out of pocket limit: $ 6,000 individual, $ 12,000 couple
Limit on plan payout: none
Referral needed for specialist?: No
Primary care visit: $ 30
Specialist care visit: $ 60
Preventative: None
Generic Drugs: $ 20
Preferred brand drugs: $ 50
Surgery: 30%
Emergency room: $ 150/visit
Ambulance: none
Hospital: $ 500/stay
Eye/glasses: no charge

They include a couple of examples in coverage:

Having a baby: $ 7,540 cost, patient pays $ 1,200
Managing diabetes: $ 5,400 cost patient pays $ 1,520

I understand that many are still struggling with the national website (although reports are that the state sites are working much better).

Some people are having frustrations verifying and uploading documents. You might have better luck walking into one of the clinics that have been set up to assist people in signing up.

You can find the nearest bricks and mortar site here: https://localhelp.healthcare.gov/

I misread the instructions on the insurance companies website so I called their website and we figured it out together.

They were surprised that I had already gotten a letter (in fact I got it last week).

I am sure that there are cases of hiccups but in my case the transfer of file information from the ACA Marketplace to the insurance company was actually the smoothest part of the process.

Now I am only awaiting payment instructions and will be covered Jan 1st.

Good luck.

October 14, 2013

WSJ/NYT/WP On Sunday Senate Democrats go on offensive "reverse the sequester"

Last Monday I predicted that nothing would happen until the DJI hit 14199:

http://www.democraticunderground.com/10023751580

This Morning I said that the strategy would be Deadlock Sunday, Sell off Monday, Clear CR Tuesday.

http://www.democraticunderground.com/10023840286

Now in an obvious and organized leak to the three main pillars of the establishment press Democratic Senators have indicated that Sunday was not only deadlocked but in fact the Democrats have gone on the offensive and want Sequestering cuts done away with.

Tomorrow is a holiday but the markets are open. Conventional thinking by the talking heads is that light trading and not much will happen. Light trading also means that if there are aggressive sellers and no buyers that the indexes will sink, and fast. even or especially in light traffic. If they think they have a day to get their profits out, it will accelerate.

It seems to me that the Democrats are willing to apply the kerosene.

This will lead to a near unanimous Senate resolution for a long term fix.

The House will have to bring it to the floor and 50 Republicans will use the cover of the markets and the Senate to pass the legislation WITHOUT AMENDMENT.

These tactics will never be used again.

No negotiation, no compromise and no fig leaf.


http://www.democraticunderground.com/10023840286

October 13, 2013

Social Security and Medicare and the question of mandated reductions

This is not meant to argue any particular policy suggestion for Social Security or Medicare but simply to add to the information available.

Reading various discussions about Social Security it appears that some are not aware that both SS and Medicare are on the path to draconian cuts in benefits as required by law.

The trustees are required to issue annual reports on the solvency of the fund where they project the ability to pay based on balance, interest revenue and payments. If it reaches a point of technical insolvency (expected expenditures exceed expected revenues) then benefits are automatically cut.

Currently the trustees project that will happen in 2033 when benefits would be automatically reduced by 25%

The report is prepared by the Office of the Chief Actuary

This year's summary in full here:

http://www.ssa.gov/oact/trsum/

Full report here

http://www.ssa.gov/oact/tr/2013/index.html

Again not arguing for any particularly policy simply pointing out, if no changes are made mandatory draconian changes will be automatically triggered by the law itself and the same is true for Medicare.

October 13, 2013

On health care the US is no longer a moral outlier

I was asked to give a presentation as part of a panel discussion on the PPACA. Pretty much old hat for people at DU. What I find interesting is the extreme curiosity that people have about it. There were several stories that were similar to mine and a number of people in the audience were having verification problems, which I hope visiting the local signup locations will help. People who want to find a local physical location to sign up can go here:

https://localhelp.healthcare.gov/



Anyway here are my notes, again nothing really new for DUers who are the best informed people you will meet:



Before getting in the details of what I have found in applying for the Patient Protection and Affordable Care Act I would like to spend a moment on the larger issue of what happened on October1st, 2013. It is something I have been talking with people in different countries about for the last 34 years.

Exactly 34 years ago today I was on a remote border island in Indonesia and after work my colleagues and I were talking about American health insurance. I was Chief of Operations of refugee resettlement for ICEM the agency that would resettle more than a million people from South East Asia.

It was as close to MASH as you could imagine including a rather unconventional corp of bored and zany doctors. We worked 14 hours a day on Tanjung Penang Island trying to accelerate the out processing of 100,000 boat people. Then we would go over to the tables in the town square eat noodles, drink beer and amuse ourselves. With no radio or TV we were left to our own devices.

In the group there were doctors from Australia, Canada, Switzerland and the Nordic countries. One of the games we played was when there would be an American staffer or official visiting I would set up the evening by asking “How is Congress doing on reforming health care”. The ‘Mark’ would make some comment that would always end with “ well we have the best health care system in the world”.

The rest of the night would be spent watching these doctors refute every myth about socialized medicine and socialized health insurance and dissect the unwitting American before your eyes. Now these doctors were from all different political backgrounds and most of them quite conservative but they all liked their system. They were smart and would slowly and skillfully disembowel the hapless traveler.

The Coup de Grace would come when one of the doctors would say “Bob lets put all of the myths and misinformation aside and please answer this one question, ‘ Bob how can any wealthy developed country advance the proposition that only those with money should be able to access health care from a moral perspective. How do you justify it morally Bob?.” Que the Australian doctor “Right get your hand off it Bob, don’t be a bongo you are a few Kangaroos loose in the top paddock”.

The most important thing that happened on October 1st, 2013 is that the US crossed a moral line and joined all of the other developed countries saying that everyone in the US deserved affordable access to health care.

That is the headline and it is a big deal.

Up until 14 years ago I was able to use the best plans in the market. I made a transition and now was self employed and because of an obscure ear condition that had no treatment costs was still considered uninsurable, defying all logic.

When President Obama introduced the PPACA I was disappointed because I was hoping that I would be getting a single payer universal plan like the ones my colleagues talked about 34 years ago. The more I read, including things like a ceiling on the medical loss ratio and evolving away from ‘fee for services’ the more I liked it.

I was uplifted last year when nearly 13 million Americans received more than a billion dollars in refunds because their insurance companies were found to have exceeded the 20% Medical Loss Ratio. I was amused that Texas was the largest recipient of refunds and wondered if those Texas politicians who rail against Obamacare want their citizens to return those overpayments back to the insurance companies.

When Oct 1st came I felt that it was finally my turn and I got on the healthcare.gov website.

My wife and I simply wanted some basic coverage that would save us from a catastrophic event. I simply wanted to end the day thinking “if my wife or I get cancer or have a heart attack please give us a chance to fight and not live the rest of our life in staggering debt.”

In 1999 we faced one of those moments when my wife had stomach aches and we went into the doctor who said “you will need to stay the night and tomorrow you are going to have a hysterectomy. You have multiple large ovarian cysts and we are worried that if any of them become transient they will cause a cardiac event”.

We were glad that we had been paying for the most expensive medical plans in the market and we asked the doctor what would happen while we waited for the paperwork to be finished. A clerk came in and said that we were denied. My wife and I were now shocked and the Doctor said “I will handle it”.

He had the clerk return the call to the insurance adjuster. He started in a small voice “I am curious what medical school you went to. Oh? Because I went to Harvard and did post graduate work at John Hopkins and sit on the National Board for Board Certified Gynecologists and I found your reasoning completely devoid of any medical reasoning whatsoever. (now in a booming voice) “what city do you live in, because I am going to discharge this woman now and if a cyst breaks off and she has a heart attack I am going to fly to that city and make a deposition with the prosecuting attorney charging you with manslaughter. Oh its approved, thank you”.

He told me he had to threaten Manslaughter about 3 times a month to get something approved.

Now we just wanted to make sure that if we had one of those events we wouldn’t spend the rest of our lives in debt.

To make matters worse two years ago I picked up a new hobby: diabetes, not as much fun as advertised.

It took me two days to finally get my account opened. In the beginning the site was down a lot or not working properly. It took me 45 minutes to get somebody to answer my call or respond to the live chat function.

But late at night on the third day I got through. The pages are well constructed and don’t require much information. When I got through to the third page we had a problem with my wife’s verification. We know why, they have added an additional letter to her name on her green card so it didn’t surprise us.

We couldn’t call through to Experian as it was past office hours.

The next day we got in and the verification issue had been resolved.

They asked if we wanted to go directly to the Market Place or see if we qualified for a subsidy. I never have qualified for any government benefit and wasn’t going to waste my time but I decided ‘what the hell’ and pushed the button.

They had warned me that I may need to provide them with all kinds of W2s, 1099s and tax figures. When I pushed the button, none of that happened.

It instantly came back with a $ 3600 subsidy. Last year was a little unusual for me, I spent part of the year moving to Tucson so I had lower than average income and a lot of write offs.

But I was stunned. Even though I had read everything I could about the Act including the Senate bill I had no idea that we would qualify with an adjust gross income of about $ 40,000.

That took us to a page that showed us the range for the Bronze, Silver, Gold and Platinum plans. We had expected to just get the cheapest Bronze plan.

Instead we went for a Gold plan that has the following:

1) Free preventative
2) Low copays, Dr. visit $ 17.
3) Covers 80% of all costs
4) Maximum out of pocket $ 10,000
5) No deductible.

Hundreds of doctors are on the plan. The cost is $ 750 but after the subsidy we only pay $ 444.

For a couple approaching 60 with diabetes in the family this was stunning.

There have been a lot of distractions because of the mechanics and legitimate stories about the gliches. I also understand that others may not get the benefit I did or may need even more assistance. Here is what I see as being lost in the media:

1) The US is no longer the moral outlier among developed countries when it comes to our health insurance system. It is the policy of the government that everyone have access to affordable health care.

2) For the first time people can apply for a government benefit or subsidy and (when the system is working) get an instant statement of what that benefit is. You don’t wait for someone to process your application and get back to you in 3 months, an instant answer comes back in seconds.

3) The structure and nature of the subsidies are much larger than anything I have seen in the media.

I know that a lot of people are frustrated and concerned and I simply would like to encourage you to stick with it, use the call center and the live talk option and all the resources to get the maximum benefit.

October 12, 2013

Matt Taibbi: Its up to the Democrats to save the Republicans from Ted Cruz

http://www.rollingstone.com/politics/blogs/taibblog/democrats-must-stop-ted-cruzs-hollywood-ending-20131011

Taibbi is smarter than the average reporter but he also maintains a "Democrats are only marginally different than Republicans" patronizing tone which drives him to some particularly unfortunate points.

If you really don't think that there is difference between the two then it isn't the least important that one strategy is absolutely defeated.

So as we approach a completely manufactured crises between one party that wants to govern and one party that wants to perpetually renegotiate and institute policy through the prospect of financial collapse he thinks it is up to the Democrats to find some way (and he just hopes we find it) to save the Republicans the way out.



How about this Taibbi, why not lay the blame and the responsibility at the feet of those that are the ones that are most responsible, Tea Party Radicals, whimpy Republican moderates, Wall Street leaders watching from the bleachers and all of the hand maidens in the media who, like yourself minimize the real differences between two completely different political philosophies.

No compromise, no negotiations and no fig leaves.

If we do 'help' the Republicans, Mr. Taibbi, only one thing for certain is known for sure:

They will do it again, and again, and again.

If a mentally unstable person has a gun you don't take the gun and take out some of the ammunition. You take away the gun.

October 10, 2013

Chumming for sharks, the media turns on the GOP

The President has been dicing and slicing the Republican idiocy and leaving the parts in the water. Now the media sees the "jaw dropping" change in the polls.

For those of us watching it hour by hour you will have just noticed that the media has now turned. It now feels almost Watergate like (for the old folks).

You will see the media growing more and more hostile, especially with these silly little pressers where they answer only one question and then run away after going over their talking points with shaky voices.

Boehner is about to face a shitstorm, including open hostility from Wall Street.

You can feel the change. Democrats are united AND relaxed. The media senses a wounded animal and now with the peoples anger quantified have started hunting the bastards down.

October 8, 2013

US Bankers to Rand Paul: You are an idiot.

Rand Paul went on MTP and stated that as the income of the federal government was greater each month than the scheduled bond payments that there was no possibility of a default and that the President was "irresponsible" to suggest that was the case:

Reuters is carrying this report from the banking industry that would appear to a) answer Mr. Paul directly on point and b) consider that point beyond idiocy:



How far have Republican legislators fallen in the moral matrix?

If you go down to the lowest rung of amoral bankers you would then have to look downward into a cavern the size of the Grand Canyon and then in a little speck way down there, you would find House Republicans.

Not only should these people not be in any position to legislate or offer an opinion on anything more substantial than the likelihood of rain, I don't think they should be given driver's licenses.

October 8, 2013

Top U.S. bankers warn against prioritizing interest payments: WSJ

Source: Reuters

(Reuters) - Top U.S. bankers have warned the Obama administration and Republican lawmakers that any move to pay interest on debt before obligations such as Social Security and payments to veterans would pose severe risks to financial markets and the economy, the Wall Street Journal reported.

Some lawmakers think prioritizing interest payments would placate bond investors if the government breaches its borrowing limit, the Journal said.

However, heads of the nation's largest financial institutions told the officials in meetings that prioritizing some payments would create insurmountable uncertainty for investors, drive up borrowing costs and disrupt markets, the Journal said, citing people familiar with the meetings.


Read more: http://finance.yahoo.com/news/top-u-bankers-warn-against-085655481.html

---

This is the US banking industry calling Rand Paul an idiot:

http://www.washingtonpost.com/blogs/post-politics/wp/2013/10/06/rand-paul-its-irresponsible-of-obama-to-talk-about-default/

"I think it's irresponsible of the president and his men to even talk about default. There's no reason for us to default. We bring in $250 billion in taxes every month. Our interest payment is $20 billion. Tell me why we would ever default," Paul said on NBC's "Meet The Press." "We have legislation called the Full Faith and Credit Act, and it tells the president you must pay the interest on the debt. So this is a game."

October 5, 2013

To "The Reviewer"

My fingers moved, alas too slow but I wanted to plead mercy in your review



Oh dear reviewer when you return to the dimly lit balcony of your cavernous abode snuggled in the remote forests of the region where schools have prayer and text books with detailed illustrations proving creationism to promiscuous square dancing 'abstaining' teenagers prey speak not poorly of us.

We found your link astonishing, your banter refreshing, your literary references uplifting, and your fecal contributions non odious.

Should we be blessed with your continued contributions I can assure you that they will bring forth a multitude of interlocutors, for more reasons than you will be able to contribute.

In your reviews please do not blame other DUers for any mistreatment you received here. Please lay all the blame at my door and find the other 200,000 contributors blameless.

In your reviews be thorough, unflinching and objective. Of course you must include all of the instances where DUers found themselves amused without reason and snarky without remorse. Tell them that you were given no quarter and you received no mercy. No one offered to break mythological bread and there appeared to be no areas of metaphysics that we could reflect together with.

Tell them the hard truth. We do not like Olive Garden, even those of us who have never partaken of "endless pasta".

But, and this we really must insist on. you must tell them that the people who inhabit DU seem to be experts in Speleology, and no my Roger Ebert of political forums that has absolutely nothing to do with correct spelling.

And when you have finished this review be so kind to send us a link so that we can be enlightened and fill our day with mirth.

October 3, 2013

Finally got my Health Insurance. The Affordable Care Act isn't that good.

It is fucking unbelievable.

No wonder they are scared.

1) Application Process
I am 'beached' with nothing to do because of the shutdown so I have a lot of time and once it is settled will have nonstop work until December so I was highly motivated to get it done fast.

I made several calls, used the chat operation and finally found that 3 AM was the time when I could get on.

Once in the system the actual sign up process is amazingly well done. It is easy, approachable and if you have problems you can use the chat or the phone to talk to somebody. The phone wait time dropped from 45 minutes to immediate pick up right now.

The phone counselors don't have a lot of options at their end but I was able to get information to fix some hiccups. It was obvious that the entire site is straining and the people answering questions also are having problems using the site.

I finished all but the last page which sets up payment options and then the site froze again. When I talked with the operator I was shocked when he said that I was the first person he had talked to that was able to get that far in the process. Of course some people managed to get all the way through and wouldn't need to call.

What is interesting is that they have been able to ramp up the call center so that there is no wait at all but that the traffic on the site is staggering.

2) Subsidy

I think that most of us have had the experience of making too much to qualify for government support except in some exceptional times. I am sure that I am not alone in thinking that the subsidies wouldn't be that great.

I was shocked to find that the ACA is paying 40% of my premium.

Last year was something of an unusual year for me. I am self employed and moved states so my gross income was lower and I had a lot of business expenses so my adjusted gross income was in the low 40s to low 50s (not sure which income they used because I recently filed an amended return). I never expected that level of subsidy, hell I didn't expect a dime.

3) Plans

I intended to search and pick out the lowest non profit plan I could find. Because of the subsidy though I decided to go to get a gold plan.

It had low co pays, zero deductible and maximum $ 10,000.

It is 'for profit' but the HMO is ranked #1 in my state and I have 1000 primary doctors in the system.

Total Cost $ 765 per month, my monthly premium is $ 444 for my wife and I.

For a 59 year old diabetic that is a stunning, revolutionary change.

4) Glitches

There were several glitches along the way. Among them:

1) People who you call in to really don't have any 'super power' at this time to over ride the system.
2) Lots of little things aren't working for example I had a lot of problems logging in so I tried 'forgot my password' option and a message came up saying they sent an email to my account but none came.
3) Another glitch at one point I had a verification problem for my wife and had to upload immigration documentation but it wouldn't upload.

But the biggest problem we had was verifying my wife, a permanent resident. As part of the process they are using IRS and Immigration databases to verify and there is a typo in my wife's name on her green card.

They have a "live" human option to assist with verification. If you have a verification problem then you will need your ID# and phone in and tell them that you need to set up a "Verification conference call with Experian" to verify the disputed person.

Now here is the interesting part: We had the problem last night at 3:00 am "Experian" wasn't open so we had to get back in line this morning and try again but when we logged on the verification was settled. That means that either they began waving all of the people with similar problems (one of the phone counselors said they were getting a number of people with verification problems) or that they automatically flagged my application for review and did it individually. Either case that shows a pretty high level of course correction in the middle of a unbelievable traffic.



Some here have health insurance and don't realize what it is like to go a decade without access to good care when you have a serious problem (and this was after I had very high level PPO plans for 20 years but lost it when I got sick).

I know that there will still be some for who this plan isn't going to deliver as much help as they need.

But, at least in my case, it was a much much better plan than I think even the more optimistic of us thought. If the shutdown is concluded and I can get back to work I will be able to finish the year at a level that may make them take back the subsidy and that would make me very happy but I was stunned to see how big the subsidy was based on last year's numbers.

This is going to be a major improvement in a lot of peoples lives and that is why the Republicans are trying so hard to sabotage it.



There is going to be one economic boom related to the ACA early next year. There are going to be millions of people like me who have "pent up demand" for medical services who are going to rush in for medical care in January. In the beginning the insurance companies are going to have to write big checks for a lot of people who have been putting off medical care. I predict that the final irony of the initial stage of the ACA will be that it will be a minor stimulus event on its own during the first quarter of 2014.

This isn't the end but the first step until we get universal single payer. In my opinion its a much bigger first step than we thought it was.

The one thing they could and should still do is to restrict people applying on a particular day by limiting those to certain letters of the alphabet. For example first day Last Names starting in A-D and so on. That would solve a lot of problems and reduce wait time.