[AngryMetalsmith]

I have to admit that I have not followed the Health Care Reform issue very closely and am asking for the PWN to bring me up to speed.

After speaking with a close family member tonight who was extremely upset that her company, that she retired from, is canceling her insurance on the grounds that Obamacare has made it too costly for them. She will have to purchase her own health insurance, and is scared that she will not be able to afford it.

So while I've heard the high praise from the Dems that the new bill is a good thing in that millions of uninsured will now have health care, it now looks like larger corporations are going to dump their retirees. She also said that if you don't buy insurance, then you will be fined $6000.

Can someone shed some light on this ?

 

[dante]

So she's retired but still getting insurance from her company?

The truth is that "Obamacare" doesn't impose specific costs on companies that are already offering health insurance. The concept that Obamacare is making it "costly" for her previous company is, well..... bullsh!t. Health insurance costs have been rising at 8-10%+ per year, and that hasn't really changed (so far). It's just that insurance companies have gone from claiming that an increase in medical costs caused higher insurance rates to blaming Obamacare, even though the increases are identical to previous increases.

I think that corporations are using the *excuse* of Obamacare to drop retirees, but there are no specific additional costs that they would have incurred by that company due specifically to the ACA. However with pre-Medicare retirees being eligible for purchasing it through the health care exchanges, apparently some companies are looking at shifting that burden to the retiree.

From CNN:

Under reform, pre-Medicare retirees will be able to buy coverage through health exchanges in 2014. So going forward, companies may give current employees money to purchase retiree coverage through the exchanges instead of employers offering it themselves, she said.

Basically now that there's an option for people to buy it themselves, corporations are behaving like, well, evil corporations. They can't do that to current employees (since they'd just leave and go elsewhere), but there's no "free market alternative" to a retiree getting benefits from elsewhere.

 

[AngryMetalsmith]

Thanks Dante.

Are there provisions in the bill that will reduce the cost of health insurance ? Or are we still at the mercy of insurance companies ?

 

[dante]

Also, if she's retired she would qualify for subsidies if she's making up to 400% of the federal poverty level (so 50-60k for a single person?).

Lastly, any penalty for not buying insurance is a percentage of income. It wouldn't be anywhere near $6000 unless your family member is pulling down *bank*.

 

[AngryMetalsmith]

I have to take every thing she says with a grain of salt since her main source of news is FOX. The most puzzling thing she said was that Obama is in bed with big corporations, yet she believes that Romney (certified corporate whore) will save the middle class by creating jobs. Makes my head spin.

 

[Jeremy R]

Thanks Dante.

Are there provisions in the bill that will reduce the cost of health insurance ? Or are we still at the mercy of insurance companies ?

The "provisions" are more like hopes. The theory on what will reduce the cost of health insurance is that by forcing everyone to have insurance, all the healthy people who are uninsured will now be paying into the pool and it will reduce costs. That sounds nice and cozy until you realize how unhealthy most all Americans are in general of all ages, and now that the health ins companies have to take all the really sick people who
they declined before, there is no way your cost are going to go down. It is insane how much health care cost one sick person can run up every month. I deal with it everyday.
Call me optimistic but I am still hoping that they make positive changes to the health care law to make it work in the future. As someone who works in this field, I have said all along that something has to be done with the current system, because it is not working.
The only way to get this bill passed was to rush it through really quick, and it had holes all in it.
For example, the very first thing the bill did was say that all children could not be turned down for coverage,
which means the gov't is forcing insurance companies to take in a bunch of sick high cost children. The health companies figured out how much money they would lose on that age segment, and they ALL quit offering ANY health insurance coverage for a child only policy. There was no provision in the bill to prevent this. So, since the day this bill was passed, when a parent brings a child from 0 to 17 years old into my office to insure their child, I have to tell them that there is not any coverage available for them whether they are healthy or not.
So basically you are now at the mercy of insurance companies AND the government. Good luck with that.

 

[Beef Supreme]

Thanks Dante.

Are there provisions in the bill that will reduce the cost of health insurance ? Or are we still at the mercy of insurance companies ?

There are a couple of big ones.

1) It insures more people which reduces costs in two ways. When people don't have health care they don't just die when they get sick. Hospitals are required to treat them. When they can't pay those costs get rolled into the billing rates for people who can. This makes treatment and insurance more expensive for people with insurance. Also, it brings healthy people (young people) who may forgo buying insurance into the systems which basically subsidies other people.
2) It requires health insurance companies spend at least 80% of premiums on actual health care. Customers get a refund if they don't. It basically limits how much money they can spend on marketing, lobbying and executive pay.
3)It requires insurance companies to provide a set level of preventative benefits such as physicals, breast exams, birth control, mammograms and other preventative care. This lowers long term costs as problems can be caught earlier.
4) It sets up exchanges that will promote competition between plans. The costs of purchasing health insurance as an individual are outrageous. It should help with that.
5) It reduces the donut hole in Bush's Medicare Prescription benefit. This will save seniors a ton of money.

I'm sure there are other but these are the ones I know of. As Dante's graph shows, insurance costs have been going up for a long time. This is an example of a company using the law as a scape goat to cut coverage. Your Fox news watching relative is blaming the wrong people which is the whole point of Fox news.

Of course, if we really want to save money we need to get rid of medical insurance companies entirely. It is a parasitic industry that does nothing to provide care.

 

[Jim Mac]

Another addition to the discussion:

The drive to reduce costs under the ACA is based on reducing "fee for service" with a movement towards managed care models. Fee for service (getting paid by the hour and/or by the service) tends to bulk up the cost of health care - hospitals are great at doing this - ordering every test under the sun when perhaps they are not necessary. In the human service world, I've seen mandated Pre-K services for kids with disabilities (think medicaid) do the same thing- a local for profit pre-k provider just got slapped for doing this, as a matter of fact.

Managed care, on the other side attempts to drive cost down by controlling interventions while at the same time upping the quality. There are good examples and bad examples of managed care, but this is the basic path that the ACA takes in order to provide "medicaid for all", essentially. Most Medicaid programs are managed care, and fvck me if i can remember the study, but OR recently did a lottery for expanding 10,000 medicaid openings. The study then cross compared those who won the "lottery" with those who didn't - those with health care had better health outcomes and generally felt better about themselves.

Another example of managed care that the ACA points to is the PACE program (Program for All inclusive Care for the Elderly) instead of the nursing nursing home model. The PACE program serves people in their home/day programs who are frail elderly (same population as nursing home people) and supposedly saves upwards (off the top of my head) of $60K per person per year, about 1/2 of what a nursing home costs per person per yr (100-120K per person per year).

Here is where people start yelling "death panels!!!", but in reality insurance companies already play that part; and in managed care they take the decision role further into private territory via what is called a MCO (managed care organization). The Gov't. essentially just wants to see proof of cost reduction and improved quality (metrics, metrics, metrics). In fact, MCO's, some being for profit, may be allowed to keep a good portion of the $$$ saved in this situation. This piece is critical in the debate at reducing HC costs - are we really just shifting how the money is pocketed by doing so?



EDIT: this info above is mainly for people who will end up utilizing Medicaid, which the ACA portends to expand. It does not affect people who get HI through their employer. It may end up affecting people who use Medicare, however, and will affect people who are dual eligible - who use both Medicaid and Medicare - think poor & elderly. These folks make up 30% of the people who use these services but end up utilizing 70% of its resources.

 

[dante]

Oh, AngryMetalsmith the penalty for your family member is ~2.5% of her income. So unless she's making $250k/year, she's not going to come anywhere close to that $6,000 penalty number.

So, basically, you're looking at penalties of approximately the following at the following income levels:
Less than $9,500 income = $0
$9,500 - $37,000 income = $695
$50,000 income = $1,000
$75,000 income = $1,600
$100,000 income = $2,250
$125,000 income = $2,900
$150,000 income = $3,500
$175,000 income = $4,100
$200,000 income = $4,700
Over $200,000 = The cost of a "bronze" health-insurance plan

I think that the problem here isn't Obamacare or even her former employer, but rather that your family member is an idiot... (apologies if you actually *like* your family member)


edit: Those are also the numbers for when Obamacare *fully* kicks in in 2016. So if she's eligible for Medicare by that time she doesn't even really have to worry about anything.

 

[syadasti]

Romney supports the ACA, its basically his own plan, let her see Romney in his own words say it:

 

[dante]

Caught this last night, and it was probably the most powerful video/speech that I've seen yet this cycle:

 

[dante]

Longer intro video. During her DNC speech she had the annoying habit of speaking while the crowd was still applauding/cheering.

 

[Pesqueeb]

I can't find it online, but the latest issue of Money has a 3 or 4 page series of charts and explanations so easy even a republican ought to be able to figure out how the ACA works and how much/if it's going to cost them out of pocket to be insured.

 

[$tinkle]

Caught this last night, and it was probably the most powerful video/speech that I've seen yet this cycle:

may zoe grow up healthy enough to have a tax-payer funded abortion

/rush

 

[Pesqueeb]

may zoe grow up healthy enough to have a tax-payer funded abortion

/rush

I would willingly give my tax dollars to have Rush aborted.

 

[stevew]

Caught this last night, and it was probably the most powerful video/speech that I've seen yet this cycle:

what about this....

just a little bit verklempt.....?

 

[pnj]

can't see the rest of her body but.... I'd hit it ^

 

[kidwoo]

can't see the rest of her body but.... I'd hit it ^

I can't tell if she's actually looking at me or not.

 

[Silver]

After speaking with a close family member tonight who was extremely upset that her company, that she retired from, is canceling her insurance on the grounds that Obamacare has made it too costly for them. She will have to purchase her own health insurance, and is scared that she will not be able to afford it.

Tell her to get a job. I hear Walmart is hiring. I don't feel like supporting her lazy ass to sit at home and eat chocolate all day.

She doesn't like that bed? Too ****ing bad, she made it, she can sleep in it.

And yes, she's factually wrong on just about everything. Of course, as a Fox viewer, that's normal.

 

[JohnE]

...ladies and gentlemen, that was Silver, our resident sensitivity, caring and sharing expert.

 

[stevew]

...ladies and gentlemen, that was Silver, our resident sensitivity, caring and sharing expert.

with a little word play....poof....you'd swear he's a republican.

 

[binary visions]

can't see the rest of her body but.... I'd hit it ^

I can't tell if she's actually looking at me or not.

It's even hotter when she can look you in the face and keep an eye on her business at the same time.

 

[Pesqueeb]

It's even hotter when she can look you in the face and keep an eye on her business at the same time.

 

[Jim Mac]

It's even hotter when she can look you in the face and keep an eye on her business at the same time.

Dood, watch out for the ban hammer!

 

[dante]

Right. Because a doctor using an outdated procedure (saline abortion, at 7 months no less) on her mother during pregnancy is somehow equivalent to the prospect of a young mother facing the prospect of losing her 2 year old daughter due to the repeal of "Obamacare"?

Seriously?

Or did you just do a quick search for "tear jerker GOP convention" and that was the first video that popped up?

 

[Silver]

...ladies and gentlemen, that was Silver, our resident sensitivity, caring and sharing expert.

She wants a world where poor people get fvcked all the time without lube, and now she maybe realizes that she's not rich.

Boo hoo.

 

[AngryMetalsmith]

She wants a world where poor people get fvcked all the time without lube, and now she maybe realizes that she's not rich.

Boo hoo.

You don't know squat about my family ya grumpy pecker wood. She's 72, never been rich, worked her ass off for a company that she thought would take care of her like they were supposed to. She's scared, and unfortunately FOX news keeps perpetuating the fear.

If you would like to add constructive input to this thread then feel free, other wise go back to your anti-Catholic kiddy diddlers meetings and shut the fvck up.

 

[Silver]

You don't know squat about my family ya grumpy pecker wood. She's 72, never been rich, worked her ass off for a company that she thought would take care of her like they were supposed to. She's scared, and unfortunately FOX news keeps perpetuating the fear.

If you would like to add constructive input to this thread then feel free, other wise go back to your anti-Catholic kiddy diddlers meetings and shut the fvck up.

Tell her to stop watching Fox then. Simple solution. They are the communications arm of the people who actively work to screw over retirees. She's got cable, so try BBC world news or something.

I have dumb relatives too. Hell, one of my Uncles is so racist the Klan would probably turn him down for membership because it's so over the top. Just because he's family doesn't make him not racist.

 

[AngryMetalsmith]

She used to not like FOX, now she thinks they tell the truth. She used to be pro-choice, now she's anti-abortion. I hate seeing a family member get sucked into the fear machine, but there is nothing I can do about it.

FOX brainwashing techniques

 

[Silver]

She used to not like FOX, now she thinks they tell the truth. She used to be pro-choice, now she's anti-abortion. I hate seeing a family member get sucked into the fear machine, but there is nothing I can do about it.

FOX brainwashing techniques

Program her tv so it skips Fox on the channel list

Worth a shot. Otherwise you're going down the rabbit hole for a not so fun ride.

 

[Jeremy R]

She's 72,

Then she is practically in the clear. I thought we were talking about somebody who retired BEFORE 65.
All she needs to do is to get a medicare supplement plan F. They will not be much more than $100 a month
for her at her age, and it is 100% coverage. The only thing else she may need is the Medicare Part D drug card if that fits into her needs and budget. Also, do not let some scummy F*** trick her into a Medicare advantage plan.

 

[AngryMetalsmith]

Thanks Jeremy, I'll pass that along to her.

 

[dante]

Wait, since *all* Americans over 65 are on Medicare, there is zero chance of her having to pay a penalty of any sort due to "Obamacare".

What's more is that if she's planning on voting Republican in November, I hope that she has enough savings built up to pay for a nursing home.

They also want to block grant Medicaid and cut it by a third over the coming decade. Of course, that will hurt poor kids, but that's not all. Almost two-thirds of Medicaid is spent on nursing home care for seniors and on people with disabilities, including kids from middle class families, with special needs like Downs syndrome or Autism. I don't know how those families are going to deal with it. We can't let it happen.

Very few people realize that MedicAID is what kicks in to pay for your nursing home care after your savings runs out. It's not Medicare at that point, but Medicaid.

 

[Jim Mac]

More on my wonky points of the cost of long term care! CBo predicts that around 2032 most boomers will be in this situation:

http://www.nytimes.com/2012/09/07/health/policy/long-term-care-looms-as-rising-medicaid-cost.html?_r=1&hp

an excerpt:

With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way.

Though former President Bill Clinton overstated in his convention speech on Wednesday how much Medicaid spends on the elderly in nursing homes — they account for well under a third, not nearly two-thirds, of spending — Medicaid spends more than five times as much on each senior in long-term care as it does on each poor child, and even more per person on the disabled in long-term care.

Seniors like Rena Lull, 92, who spent the last of her life savings on $250-a-day nursing home care near Cooperstown, N.Y., last year, will face uncharted territory if Republicans carry out their plan to replace Medicaid with block grants that cut spending by a third over a decade. The move would let states change minimum eligibility, standards of care, and federal rules that now protect adult children from being billed for their parents’ Medicaid care.

Now, like a vast majority of the nation’s 1.8 million nursing home residents, Mrs. Lull, a retired schoolteacher with dementia, counts on Medicaid to cover most of her bill. But her daughter Rena, 66, also a retired schoolteacher with a lifetime of savings, no longer knows what she can count on in her own old age.

The presidential election may decide Medicaid’s future. But many states faced with rising Medicaid costs and budget deficits are already trying to cut the cost of long-term care by profoundly changing Medicaid coverage, through the use of federal waivers.

One of the compromises of the ACA was to leave out any support for long term care for the frail elderly/disabled...oops.

 

[$tinkle]

One of the compromises of the ACA was to leave out any support for long term care for the frail elderly/disabled...oops.

don't worry; all those full throated "arguments" against all aspects of ACA will grow strangely dim when their now destitute parents move back in within the next decade.

ask me how i know this.
go ahead.


ask me, in your best morrissey voice

 

[Jim Mac]

don't worry; all those full throated "arguments" against all aspects of ACA will grow strangely dim when their now destitute parents move back in within the next decade.

ask me how i know this.
go ahead.


ask me, in your best morrissey voice

Ah, dude...I will use my Paul Bearer voice:

I too know this as I spent 100K on my pops in this very same situation.

 

[dante]

don't worry; all those full throated "arguments" against all aspects of ACA will grow strangely dim when their now destitute parents move back in within the next decade.

ask me how i know this.
go ahead.


ask me, in your best morrissey voice

This is why I feel that the Romney/Ryan plan is probably the *least* financially responsible action. In another 10 years when the changes to Medicare are about to go in (and after a decade of drastic cuts to Medicaid), there's going to be politicians getting elected based on "restoring Medicare/Medicaid". So any of the future savings will disappear, and we'll have had a decade of not raising the revenues needed to save these programs.

We did it with Medicare Part D, where the "donut hole" was in place because we couldn't afford to close it in the original '05 bill. Well, now it's closed. The Bush Tax Cuts were "temporary" because they had to be in order to be called revenue neutral, and now we've extended them once and will either extend most of them, or all of them based on who's elected in November. We've extended the Alternative Minimum Tax fix how many years in a row now?

 

[Jim Mac]

This is why I feel that the Romney/Ryan plan is probably the *least* financially responsible action. In another 10 years when the changes to Medicare are about to go in (and after a decade of drastic cuts to Medicaid), there's going to be politicians getting elected based on "restoring Medicare/Medicaid". So any of the future savings will disappear, and we'll have had a decade of not raising the revenues needed to save these programs.

We did it with Medicare Part D, where the "donut hole" was in place because we couldn't afford to close it in the original '05 bill. Well, now it's closed. The Bush Tax Cuts were "temporary" because they had to be in order to be called revenue neutral, and now we've extended them once and will either extend most of them, or all of them based on who's elected in November. We've extended the Alternative Minimum Tax fix how many years in a row now?

Exactly. I believe that the ACA will eventually have to address this issue. I was disappointed that the CLASS Act was jettisoned from the law. It would have at least attempted to address issues with long term care costs.

 

[$tinkle]

http://www.myfoxorlando.com/story/20432143/kenya-hospital-imprisons-new-mothers-with-no-money

 

[Pesqueeb]

http://www.myfoxorlando.com/story/20432143/kenya-hospital-imprisons-new-mothers-with-no-money

Wasn't that Newt's position on health care?