Discussion:Obamacare - outrageously high premium increase

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Discussion Forum Index --> General Chat --> Obamacare - outrageously high premium increase


Natalie (talk|edits) said:

September 12, 2013
I just received a notice from my health insurance carrier. My family premium is expected to go up 59% next year after my current contract runs out and Obamacare kicks in. If I drop my dependents, the single plan will be 33% higher than the current rate.

Has anyone else received projected rates or received information from clients?

Fsteincpa (talk|edits) said:

12 September 2013
Mine renews in March or April. Should be fun.

Natalie, you have insurance through your firm correct?

Natalie (talk|edits) said:

September 12, 2013
Yes, that's correct. My contract ends 6/30/14, but they sent out a notice with the new rates.

Kevinh5 (talk|edits) said:

12 September 2013
My notice from Blue Cross said 'The good news is that health care reform will likely have minimal impact on you because you have a Grandfathered Plan. That means you're protected from the significant rate increases that others may face due to health care reform.'

Just opened it, I was going to throw it out as junk mail until I read your post.

CrowJD (talk|edits) said:

12 September 2013
Unlike most civilized Western countries who realized that a single payor system is more efficient and would cut down on numerous insurance contracts, and numerous hospital and doctor employees to construe those contracts, the dirty deal with Obamacare was that we left the private insurers in the mix.

The private insurer is NOT your friend.

On top of that, when certain people went around the country telling lies about the Public Option (and the so-called Death Panel), they got rid of the only leverage we had to hold in private insuers in check. That leverage was the public option.


In my state of Georgia, the elected insurance commisioner says openly that he will do everything in his power to thwart the law. Even one of our most notable Georgia conservative journalists pointed out that he was shooting the people of Georgia in the foot.

Bottom Line: whether you know it or not, our health system in the USA is in absolute crisis. I know this from many years of collecting medical debt. I saw many cases where insurance companies had screwed their customers royally and on purpose and left them high and dry to pay a bill. After we sued a patient and the patient tried to bring in his insurer to pay, I saw the insurance companies remove these cases to Federal court, as permitted under ERISA, where they would sit for years, and the poor patient on the hook for thousands in medical debt.

Our system is broken. Go ahead and repeal Obamacare or destroy it, but it will not be the end of the story I can assure you.

Private for profit insurance companies do not belong in the health business, just as they do not belong in the fire suppression business. Most first departments are either public or volunteer....for a good reason. You should not have to be a millionaire to have a fire put out at your house AND we don't need to have 20 firehouses on a corner all operated by different private companies.

If we want to reduce costs, go to a single payor system AND definitely give experienced nurse practitioners and Physician Assistants the right to open their own offices (especially in poor urban and rural areas).

H.D. Freifunk (talk|edits) said:

12 September 2013
@Kevin: My notice from Blue Cross said 'The good news is that health care reform will likely have minimal impact on you because you have a Grandfathered Plan. That means you're protected from the significant rate increases that others may face due to health care reform.'

Wow. That sentence from Blue Cross is a "tad" loaded in my opinion.  :) Of course they are private now. And many of OUR former not-for-profit community hospitals were allowed to go profit by corrupt politicians in the 90s. But where was the payback to the general public for years of a non-profit status? What did the community get for THEIR hospital? I won't go into this any further now. I've discussed it here before.

Obamacare may turn out not to be the answer, but don't kid yourselves, we will not return to the status quo. The status quo is chaos and it is not sustainable.

PVVCPA (talk|edits) said:

September 12, 2013
Our broker is doing early renewal for us and we are getting by with *only* a 20% increase. It would be 40%-50% increase if we waited for regular renewal cycle.

Natalie (talk|edits) said:

September 13, 2013
". . . it is not sustainable." Well I can tell you that a 59% increase is definitely not going to work.

With so many large companies and franchise shops indicating they will drop coverage for their employees, I cannot understand how this is all going to be covered. And unions don't like it either. Who benefits?

By the way, my insurance company is under Blue Cross as well. It is a nonprofit organization, but its CEO, Mr. Gold, brings in compensation over $1 million annually.

Gazoo (talk|edits) said:

13 September 2013
". . . it is not sustainable." Well I can tell you that a 59% increase is definitely not going to work.

Natalie, I completely agree with you.

We did not have true healthcare reform. The Obama Administration had already assured both the insurance industry and Big Pharma that they would still get a piece of the pie before this even got started. So in a sense, it was co-opted from the beginning.

The moderate Democrats in Congress made it pro-insurance company as well. There are definitely some good things about Obamacare, but the insurance companies are not a good thing.

We will not have real cost reduction until we get rid of the administrative overhead that medical facilities and doctor's offices have to carry in order to deal with the different insurance contracts.

Like I said, we don't need 20 fire stations run by private companies on one street corner. This was how it worked in England at one time by the way. You bought fire insurance from X company and they gave to a brass plaque to put on your home and if you had the plaque, a contracted company would put out the fire. Well, it didn't work, and we now have government run fire departments for the most part. It's more logical and it's cheaper overall...and even a poor man has his house fire put out.

The healthcare industry should not be making money for insurance companies. Let them make their money somewhere else. They are parasites on the system....giving little, and taking a lot. I have no doubt that we will eventually stumble into single payor. It always takes the U.S. a long time to do the right thing and the efficient thing, but we finally come around to doing it.

P.S. The USA is 33rd in the world in life expectancy, and 1st in the world in healthcare spending. Where is the money going? I know where it's going. Into the hands of parasites on the system who don't even deliver actual healthcare.

Incognito (talk|edits) said:

13 September 2013
Gazoo, In your post, if you substitute "healthcare" or "medical" with the word "education" then your post stands as a good argument against a single payor system.

http://www.huffingtonpost.com/2013/06/25/oecd-education-report_n_3496875.html

Any system is rigged if it is controlled by big business or big government. Neither of them are your friends. Their goal is the same as all of ours...to get paid a lot of money for life for doing nothing. The difference being is that they have the power to realize those goals. We don't.

PollyAdler (talk|edits) said:

13 September 2013
You have a point there. We could get get rid of medical insuranc altogether. It was the insurance (of all kinds) that allowed the prices to skyrocket over the years in the first place. And now, so much of the insurance goes to pay for contract compliance at the hospitals...and to pay for many brand new fancy administrative offices and giant...I am mean giant.... salaries for the mid-high and high executives at the hospital.

As an example, one of the hospital I represented was called **** General, north of Atlanta. They were a public hospital owned by the people of the county. Somehow, they became private....but strangely I don't recall any payback to to anyone for years spent as a non-profit, and probably the ability to float tax free bonds for construction. Who got paid for the buildings? I have no idea. Administrative salaries for mid-high, high executives jumped from $75,000-100K to $100-300K, and this was a while ago.

What happened with this public hospital was happening all over the country during the 90s. At same time, many long term non-profit insurers became for profit.

But I do think it's more likely we will stumble into a single payor affair one day. One possibilty is to put all primary care under a single payor-government subsidized plan....and let people buy insurance for speicalists and hospitalization.

By having primary care for all, we could greatly reduce expensive ER visits for non-acute care, free up the emergency rooms for emergency work, and save billions from early treatment of disease instead of letting it get to the the hospital stage.

However, as I've always said, I would give individuals the opportunity to opt out of any government primary care plan and not pay a dime into the system for the new subsidized primary care etc. The catch is, once they opted out of the primary care system, it would be permanent, meaning really permanent...they could not get back into it, ever.

This would allow the rich and the motivated to have their private concierge primary care if they wanted it.

Snowbird (talk|edits) said:

13 September 2013
Crow, you're a good lawyer ... if I ever need legal representation you would be the man. You ignore the facts that do not support your argument. For example, "The USA is 33rd in the world in life expectancy, and 1st in the world in healthcare spending." We are also number 2 in obesity (cannot believe Mexico has surpassed us)... a major contributor to poor health.

I like the line "The healthcare industry should not be making money for insurance companies." Maybe you should have also said the healthcare industry should not be making money for lawyers and insurance(malpractice)companies:)

Comparing fire departments (which I have never used and hope to never use) with medical care is real red herring.

We do agree that "The status quo(sp) is chaos and it is not sustainable." BTW, which single payer country would you like to emulate?

Gazoo (talk|edits) said:

13 September 2013
I stand by what I said. If Obamacare goes by the wayside, so be it. If it goes down in flames, so be it. Obama never really fought for it anyway, and I'm still not sure he even understands what he signed.

In fact, the Elephants would be fool to repeal it because they can bash longer if they just let it linger....unless it works. Who knows?

But I will say this, from my reading of history at some point you get a blowback. You get enough people running around without insurance or healtcare, and you will eventually get instability of some kind.

For one thing, you could have sick people (hepatitis) fixing your food at a resturant or prepping it in the grocery store or the food industry. A lot of people can't afford to take days off if they are sick and they come in anyway.

Finally, the present "ER System" of primary care IS NOT primary care. 'They can just go to the ER and the ER is like their doctor'...is a lie. It is not true. You con't come back to the ER to get your prescription refilled for hyertensives, etc. You get hypertension...it turns into strokes and kidney disease and heart attacks.

Incognito (talk|edits) said:

13 September 2013
However, as I've always said, I would give individuals the opportunity to opt out of any government primary care plan and not pay a dime into the system for the new subsidized primary care etc.

In your utopia, how does one opt out of not paying the income taxes that would be supporting this behemoth?

Gazoo (talk|edits) said:

13 September 2013
Behemoth? You don't think somewhere between 20million and 38 million people running around without insurance doesn't create it's own financial behemoth?

You think the ER's can sustain half-ass care for these people forever? (sorry for the cuss words)

These folks cost us now. The utopia is people thinking we're going to let them die on the street corners.

I am quite willing to let my predictions be tested by the developments of history. We'll see what comes along.

Incognito (talk|edits) said:

13 September 2013
How about we put a free urgent care clinic inside every Social Security office, and then allow hospitals to privatize and deny service to the uninsured.

CrowJD (talk|edits) said:

13 September 2013
As most of you know, we have gone around the mulberry bush on this issue many, many times. I don't think some of us will ever agree.

I'm through with fighting for Mr. Obama and his plan.... since he himself has currently chosen to hide behind Sec. Sibelius. Well, he can't hide, his name is attached to the law in the public mind. I actually lost faith in him when he put up a half-hearted fight for the public option. (Actually I lost faith in him in his first week in office when he appointed Larry Summers as an economic advisor).

Obama is not a man you vote for, it's just the alternatives seemed much worse ( McCain can have his good days, but sometimes he wakes up crazier than I am).

I think we all know pretty much where we stand by now. I fully expect America to take a very inefficient track to finally settling upon some solution. I think I know what that will be....but who really knows?

It's pretty certain now that the economy will remain slow, it's probably even slowing down as I write this. So how many more people will end up uninsured? We could put a robot in as Fed. Chairman because he'd have to keep the rates down. He'd have to keep the rates down because as it turns out the U.S. government owns most of the shaky student loans and a lot of junk mortgages...and they can't afford the defaults if the rates went higher.

So we are forced into low rates, and as has been proven....low rates do nothing to improve an economy...see Japan, see us. You can't push on a string...and there is no credit actually available so Americans can spend for what their incomes do not support. Slow going.

Natalie (talk|edits) said:

September 13, 2013
Ding, ding, ding. And we have a winner. CrowJD with, "how many more people will end up uninsured?" This is the big question.

"A lot of people can't afford to take days off if they are sick and they come in anyway." This has more to do with a company's sick leave policy than it does health insurance.

Incognito (talk|edits) said:

13 September 2013
Yesterday, Employer A was paying $1,000/mo for employee's health coverage and employee was paying $200/mo. Today, the premiums go up to $1,900/mo. Employer A notifies employees that they will now have to pay $900/mo to keep their health coverage. Employees protest and negotiate with Employer A to just give them the $1,000/mo as additional pay and they will go purchase their own insurance through the exchange. Some of the employees do, some don't. Alas, we now have more uninsured.

The employees that do purchase the insurance through the exchange will make this decision partly based upon their need for insurance, i.e. they will tend to less healthy than the ones that decide not to purchase the insurance. This causes a decrease in the quality of the pool of insured from what it was yesterday. Alas, we now have higher insurance premiums.

Cycle continues...

Markb29 (talk|edits) said:

13 September 2013
situation kind of sucked before ( if that is true - we have the best health care in the history of civlization), but let's assume health care was broken - no way more government makes it better - just different.

JMO as yours are JYO.....

CrowJD (talk|edits) said:

13 September 2013
@Natalie: "A lot of people can't afford to take days off if they are sick and they come in anyway." This has more to do with a company's sick leave policy than it does health insurance.

Yes, but these workers have just about zero power to force a change to the company sick leave policy. In actual fact, they usually try to go into work even if they are sick.

Let's face it, we are in an employer friendly environment right now and we'll probably be there for a while.

@Markb29: We have the best health care in the history of civlization

I would not put it that way. We have some amazing machines and gizmos and devices and we actually have too many of them. In other words, we probably have under-utilization of a lot of our very expensive diagnostic equipment. Every single hospital wants every single new toy...then the hospital puts pressure on the doctors to use those toys so they can pay for them.

But to decide who has the best healthcare in the history of civilization, I think you'd have to look at the life expetancy tables, and we come in around 30th. I think Italy does better than we do.

The single most important thing we could do to reduce costs is to have a primary care system that covered all Americans, and this would also improve health. A $4.00 bottle of blood pressure pills every month can save a heap in hospital bills, but you need a prescription to get it. Simple, basic medicine is what saves the most lives and money.

The other big cost is really sick and usually older people being kept barely alive but with no quality of life whatsoever. I think the positive development here is that many older Americans are doing advance directives now, and they have a better awareness that even in America, people die. Plastic surgery will not prevent eventual death.  :)

lll I think Natalie's earlier point was excellent. If your insurance goes up 59% and you can't pay that increase, then what's the use? A 60% increase is huge. The whole program becomes just talk. It becomes a joke. Now, the promise is that Obamacare will reduce costs going foward...but I'm not defending it for the President. Let him come out of hiding and make his case.

SumwunLost (talk|edits) said:

13 September 2013
Markb, I spent the first thirty six years of my life in the UK, taking full advantage of its health care system, paid almost entirely out of tax revenues. I have now lived here for almost twelve years and have enjoyed some fine health care. In my experience, health care in the USA is no better or worse overall than the UK (some things are better, some are worse). However the big difference is the cost to the economy. The four nations of the UK provide the same quality of healthcare for half the cost. In my view, Father Crozoodlerunk has nailed it. The model proposed by the President when he was merely a candidate was never going to work. The sooner we realize that (a) the current model is unsustainable and (b) healthcare is a right and not a privilege, the sooner we can improve the situation.

One final thought for the economists. A healthy workforce, ceteris paribus, means a more productive workforce. Is it worth the money to provide access to timely, appropriate healthcare for all? Surely the economy would benefit? A healthy nation making high quality goods that other countries want to buy at keen prices must surely be a win-win. If not, why not?

H.D.J. Friefunk (talk|edits) said:

13 September 2013
Excellent perspective, Sumwun.

The USA is 33rd in the world in life expectancy, and 1st in the world in healthcare spending.

You'd think at 1st in the world in spending we could do better than 30th in life expectancy. I'd like to be at least 10th for crying out loud.

Fancy machines and the newest medical toys do not save the most lives. Simple family, pediatric and internal medicine saves the most lives over time. Catch it early, educate the patient early, and you can make a big reduction in costs and lives later on.

.*I don't mean to insult any family docs, pediatricians or internists that may read this by calling them simpletons. It requires a lot of brains to make a proper diagnosis and devise a treatment plan.

Incognito (talk|edits) said:

13 September 2013
One final thought for the economists. A healthy workforce, ceteris paribus, means a more productive workforce. Is it worth the money to provide access to timely, appropriate healthcare for all? Surely the economy would benefit? A healthy nation making high quality goods that other countries want to buy at keen prices must surely be a win-win. If not, why not?

I would argue that a majority of business owners agree with this and have therefore provided benefits to their workers.

BTW, Are you proposing that we should only provide health coverage to the working class?

H.D.J. Friefunk (talk|edits) said:

14 September 2013
Ignognito, maybe the majority of businesses do, I don't know.

However, the job growth is in low level service and retail. They are usually part-time. They are devised on purpose not to offer benefits. The computer throws the schedule together every week for the employee....in other words, there is no regularity to the schedule. This alone can mess with your nerves and health. People can't plan. People can't parent if their schedule always changes.

Do these people need more education? Yes. Should they have paid more attention in high school? Yes. Should they have had more responsible parents? Yes. Should their parents be in jail or community service for negligent parenting? Yes, in my opinion.

If we want them to get a good post high school education, let's start by closing down the for profit, rip-off proprietary schools....since these schools are absolutely busting our budget with fraudulant student loans for bogus degrees.

I'll let Summwunlost respond. Sorry for interrupting.

P.S. I know a family that came over from Vietnam in 1972 dirt poor. They enrolled their kids in a public school full of minorities and burnt out teachers. All of the siblings now make in the 6 figures a year. Part of it was because they are naturally smart in math. The other part is that most Asian homes are not run like a democracy. When the kids are told to study, it is NOT presented as a option.

H.D.J. Friefunk (talk|edits) said:

14 September 2013
I saw this on a website tonight and I could not resist posting it here, maybe it will add a little levity to the situation. Quotes from Will Rogers:

"Things will get better---despite our efforts to improve them."

"Ten men in our country could buy the whole world and ten million can't buy enough to eat."

"You can't say that civilization don't advance, however, for in every war they kill you in a new way."

"If you ever injected truth into politics you'd have no politics."

"A fool and his money are soon elected."

"An economist's guess is liable to be as good as anybody else's."

"If there are no dogs in Heaven, then when I die I want to go where they went."

"If all politicians fished instead of spoke publicly, we would be at peace with the world."

___________________________________________-- Igcognito's question repeated:

One final thought for the economists. A healthy workforce, ceteris paribus, means a more productive workforce. Is it worth the money to provide access to timely, appropriate healthcare for all? Surely the economy would benefit? A healthy nation making high quality goods that other countries want to buy at keen prices must surely be a win-win. If not, why not?

I would argue that a majority of business owners agree with this and have therefore provided benefits to their workers.

BTW, Are you proposing that we should only provide health coverage to the working class?

_______________


(See you folks later. I've had too much coffee tonight.)

Spell Czech (talk|edits) said:

14 September 2013
There is no such thing as too much coffee.

Gazoo (talk|edits) said:

14 September 2013
SC, that's not what I want to do, it's just the only thing I can get hold of in America. My Indian blood would prefer to chew on a coca leaf, but I've lost my import connections (they were all legal). In fact, I think one of the treaties that the White Man broke gave us a right to chew on them. You can work in the yard all day chewing on the coca leaf and not break a sweat. It's very invigorating; but no jitters: you can sleep like a baby at night after mowing your yard, and all the neighbors' yards too. That was the secret to the great achievemnts of the Inca and the Maya (they mixed the leaf in with hot chocolate). I have to settle for my coffee and my snuff now, but I do so in a permanent state of silent protest.

The Indians in lesser India perfer the betel leaf and the Vietmanese chew on the betel nut. I have tried neither. I actually wrote a paper one time regarding the mysterious subject known as the Soma. Drink of the great Sanskrit civilizations. I finally settled on betel leaf mixed in with a bit of poppy from Afganistan. My teacher agreed with me, but gave me a B because my theory did not result in a recipe (in metrics, not standard cups and measures).

I don't consider this off topic since in involves subjects in the medical field (pharmacology and folk medicine).

SumwunLost (talk|edits) said:

14 September 2013
Incognito, oh good Heavens no! I argue that decent healthcare should be available to all, irrespective of ability to pay. If we cut out the fat that the insurance companies generate, the economy would have more money to spend and we could provide proper healthcare at minimal or no cost at point of need. Here is an example of the money that is wasted. In the past two weeks my local hospital system has sent me a bill for $200, another for $700 and a third for $250, all for the same service in April. I haven't been able to speak to a real person yet but, as best I can work out, they sent the $200 bill in anticipation of insurance covering most of the cost. Then the insurance got denied, so they sent a bill for $700. Then the insurance company decided to pay most of the claim, but not all. So I am left with $50 more than I was expecting and I know it will cost me more than that to find out why they are not paying that last $50 ($200 is what I was expecting to pay out of pocket). So we have whole departments devoted to dealing with this nonsense and they can't even deal with it competently. I haven't even had a proper bill that explains why the bill was so high, nor have I had an explanation from the insurance company.

I have also spent months going back and forth between my dental insurance company and my (soon to be ex-) dentist, trying to work out why the bill for a simple tooth extraction was more than I was quoted (the procedure took 10 minutes and there were no complications) and why the insurance company is not paying the percentage it says it will pay. Again, what is the cost of doing all that billing? What is the cost of going back and forth with the insurance company? The problem is that even the best healthcare providers have to be businessmen first and carers second.

When it comes to healthcare this country is so screwed up.

Actionbsns (talk|edits) said:

14 September 2013
Natalie, I think you indicated at one point that you were able to participate in a state offered program that helped pay or reduced your insurance premiums. With the ACA, will that program still exist or will it be absorbed by the Federal program offering credits? If that's the case is that part of what makes up the 59% premium increase? Or is it a combination of that and moving into a higher cost age bracket? We experienced a substantial premium increase a few years ago with Kaiser when we moved into the final level of premium cost prior to Medicare kicking in and long before the ACA, So far I haven't seen anything on rates, and when I took a seminar a couple of weeks ago on the ACA, rates weren't available they were still talking about the plan levels of Bronze, Silver, Gold and Platinum. It looks like the credits available from the Federal government in a lot of cases will help out substantially with the premiums. I think that in a few years, once this program is in place, the argument from the population will be more along the lines of "Don't mess with my ACA benefits", similar to "Don't mess with my Medicare benefits". The insurance companies are ticked off that they are not so much in charge right now and they are trying to bully people. In actuality they will have more premium dollars because more people will be insured and you can't tell me that the other side of their combined mouths isn't just drooling over that prospect. It's a major upheaval to the way our country has handled things, but we can't continue to have people uninsured and feeling like they can't seek medical attention when it's needed. We also can't continue to have people declined by insurance carriers for pre-existing conditions, or told that medical episodes aren't covered because the insured "lied on the application by not disclosing that surgery they had when they were 10 years old".

H.D. Freifunk (talk|edits) said:

14 September 2013
We should at least have a single payor system for primary care, and it should be majority subsidized by the government. This alone would bring down our national costs by billions if not trillions over time.

And again, I don't know where Incognito gets his information that a majority of businesses provide benefits to their workers already (I guess he means health insurance). I'm not sure if this is true. As I mentioned above, most new jobs are part-time, many not offering even 20hrs/wk, and designed on purpose not to pay benefits.

As far as Obamacare...it gets down to Natalie's point: what's with this 59% increase? Kevin finds out he will just have a minimal increase. None of this was thought out by Obama or the legislators who passed this Bill...the reason being they all had "cadillac" government plans. The last I heard, none of them were covered by this law...so what do they care?

I don't have much faith in this insurance "marketplace", it sounds like bull to me. I guess we may find out if it's just bull.

Anyway, the costs will not go down until we ultimately get the many insurance businesses out of healthcare, they are parasites on the system and they force the doctors and the hospitals to incur great overhead exepense....more administrators etc. Plus the insurance companies get their profit margin.

And keep in mind, medicine was already undergoing great change in America before Obamacare just due to the growing number of older Americans. So there was already a move to an assembly line..more rationalized, less personal approach. This is extremely unfortunate, and maybe it will be alleviated one day when we let more nurse practitioners and Physician's Assistants into medicine.

Natalie (talk|edits) said:

September 15, 2013
Paula, the program you are referring to is still in place, so that will help a bit. For others who are not familiar with it, we have a state program called "premium supplementation" that allows for a refund from the state if business income is below a certain level and premium costs for the single plan are above a certain amount.

Supporters of Obamacare make a big deal out of business credits, but they do not apply to business owners (>= 2%) who also happen to be employees of their businesses. I also wonder if businesses that are eligible are getting the credits.

In my case, health insurance coverage for my family will not be an easy decision. I will need to look at the tax impact of keeping my husband and sons on my firm's plan (S-corp) as well as credits offered through the exchanges if I dump them and keep just the single plan (which would be required by Hawaii law). Alternatively, I could also dissolve the S-corp and simply go through the exchange for all of us. The family premium from a Kaiser website indicates it would be much cheaper to go this route (without considering tax impacts), but I would imagine coverage is also much less.

I was shocked at the increase projected for our plan because I have two children. I thought that would have a positive impact on our rates. In addition, we're a pretty healthy family (we generally eat well, work out way more than what's recommended), but it appears that has no bearing on our rates.

By the way, Paula, keep in mind that in Hawaii, the health insurance companies are well represented on the exchange. I don't think HMSA is too upset, especially since there are only two insurance companies offering insurance through the exchange, and HMSA is one of them.

Actionbsns (talk|edits) said:

15 September 2013
Natalie, don't sell short the Kaiser plans if you are thinking of changing. Kaiser is excellent coverage and the facilities in Honolulu are very good. There are several different plans to choose from which are all encompassing and have co-pays from $15 to $35, labs are fully covered or they'll carry a co-pay (depends on what you chose). If that turns out to be substantially cheaper, you could cancel your corporate insurance, purchase the plan with your husband as the primary, probably qualify for the credits, and still satisfy the requirement of Hawaii for health insurance. You would just opt out based on the fact that you have medical coverage through your private plan. There is a form for doing this. S corp med on the W-2 may be a little tricky. I asked about the health insurance deduction on the 1040 for self employed people at the seminar I took, the response was that, if the credit is applied, then the taxpayer would take that on the appropriate line, if the insurance premium exceeds the credit, the difference will go on the front of the 1040. The Chamber of Commerce is sponsoring a seminar this Thursday on the ACA and the three major insurers are to be represented along with a major insurance brokerage firm. I've signed up for that, they may have one in Honolulu as well.

Gazoo (talk|edits) said:

15 September 2013
lol. Our insurance commissioner (Ga.) has vowed to nuke the implementation in any way he can. Some things never change.

Natalie (talk|edits) said:

September 16, 2013
Paula, I just sent you some information about Kaiser. Thank you for pointing out another option. I am not looking forward to making an analysis of what will work out best.

SashkaCPA (talk|edits) said:

17 September 2013
What if you drop out from your current plan, pay penalties for the months that you will not have any coverage and only buy insurance when you’ll need to see a doctor? Drop out again the month after?

There is no waiting period to join, gvmt cannot deny health insurance and penalize you for not having it at the same time or can they? No preexisting condition. So what are the risks of not having it and buying it only when you need to?

One of my coworkers is facing 140% increase in premium and she is looking for other options. As I was typing just learned that exchange will be opened October through end of March.

Gazoo (talk|edits) said:

17 September 2013
You no sick, no problem. No insurance, no problem.

So what are the risks of not having it and buying it only when you need to?

You sick, buy insurance. No sick, is dropping.

I like the way the Ukrainians and the Russians is thinking. Sashka awarded pin of Republic on user page.

CrowJD (talk|edits) said:

17 September 2013
I agree, Gazoo. That was the first good idea that has been generated on the forum to dodge this bullet. Amerikans no match for those who have been dealing with Petersburg bureaucracy for centuries.

Captcook (talk|edits) said:

17 September 2013
@Sashka- There is an enrollment period each year, similar to Medicare, in which you have the opportunity to enroll unless you experience a "qualifying event". Qualifying events include losing your job, getting a divorce, birth of a child, etc. Here is a List. The Oct-Mar period you mention is this enrollment period. It is 6 months only this first year and will likely be much smaller in future years. If an individual chooses not to sign up and in April has a major medical event, they will not have the option of enrolling and having insurance pick up the tab.

It is a good question and one I have been asked many times. I wish this dynamic would get more press.

CrowJD (talk|edits) said:

17 September 2013
D'oh!

Gazoo (talk|edits) said:

17 September 2013
Bah! Amerikan stupidity. Sashka still keep pin.

SashkaCPA (talk|edits) said:

17 September 2013
Captcook, are you saying that government will deny me having health insurance on April 1, 2014 and leaving me without health insurance for next 9 months? And year later will charge me penalty for not having insurance even though I tried?

My understanding is that you still will be able to buy insurance, after close of enrollment period, through brokers and you cannot be denied. How much will it cost if you buy it midyear? Will you be able to cancel it? Will you be penalized for early cancellation? I do not know.

PollyAdler (talk|edits) said:

17 September 2013
That's why we call it the home of the free. You are free to do anything but what you really want to do.

http://www.youtube.com/watch?v=rUpI9MeLZkQ

I do agree that if you have Kaiser Permanente in your state, do check with them for a quote. Their HMO plan has good in-system primary care doctors for the most part and you can change at any time for any reason. Their in-system specialists are also good, however, the specialists can sometimes be very overworked unti Kaiser decides to hire another one in that field to handle the increasing workload. Kaiser offers more options than just the HMO option, and even under the HMO, you may have an option to go outside of Kaiser and hire a community physician, but your co-pay will be higher.

Regarding Sashka's idea: the idea of no pre-existing conditions already puts stress on actuarial theory, however, if you allowed people to purchase insurance just when they needed it, I think it would blow actuarial theory out of the water.

I hope Cook will come back and address Sashka's last questions, or maybe someone else will know the answer.

Natalie (talk|edits) said:

September 17, 2013
Sashka, if I were the only one I had to worry about, I probably wouldn't get insurance, period. I have two young boys, however, and I would not even attempt to play those kinds of games.

Can you share more information about your coworker who faces the 140% increase? Is that under an individual plan? Is she over 60?

SashkaCPA (talk|edits) said:

17 September 2013
She currently has catastrophic policy than cost her just under $4K (it include free check ups). She has two kids, both out of high school but still under her policy. Now with a bronze plan she will be paying close to $10K. She is under 60.

SashkaCPA (talk|edits) said:

17 September 2013
She receive letter last weekend that her policy will no longer exist as of January because it doesn't qualify as minimum required under ACA.

Actionbsns (talk|edits) said:

18 September 2013
Sashka what will the credit be for this person? My understanding is that the credit can be utilized similar to the EIC which can be taken on a paycheck. So, if that is the case, then the credit will offset a good deal of the premium and do so on the same basis as this person is making premium payments.

SashkaCPA (talk|edits) said:

18 September 2013
We've been using this calculator

http://kff.org/interactive/subsidy-calculator/

to estimate premium for next year and as soon as your income goes 400% above poverty level subsidy = ZERO. I'll have do to my own calculations just to make sure.

Captcook (talk|edits) said:

18 September 2013
In discussions I've had with insurance brokers, people with individual policies will see the biggest changes just as Sashka is describing. The whole "you can keep your policy, if you like it" was and is a load of crap. Health insurance in this country is no longer a vehicle to decrease the risk any individual assesses they have in this field. It is a government mandated product. If it were t-shirts, the conversation would go like this:

Gov't: We have shirts lots of shirts! You have to have a shirt; come buy shirts. Citizen: I'd like a blue shirt. Gov't: We don't have that. Citizen: How about a red shirt? Gov't: We don't have that. Citizen: A green shirt? Gov't: We don't have that either. We have black or white. Your choice. See? We're not controlling the industry. We give you a choice.

Concerning enrollment, I was only referring to the health care exchanges. I honestly don't know what the dynamic is surrounding coverage on the "open market" mid-year. I would only assume an insurance company could charge you a premium many multiples of what the cost would be if you had secured it earlier if you only pursue coverage when you have need to be covered. I don't know this for a fact, but it is a good question. This would be a good time to engage an insurance professional who can answer these questions. I've heard and discussed many of these dynamics with insurance professionals, but just as they have discussed many tax related items with me they don't try to be an expert on taxes anymore than I try to be an expert on insurance. I know just enough to be dangerous.

CrowJD (talk|edits) said:

18 September 2013
We have mandated car insurance too. It tends to go down in price as you age, and depending on your zip code and things like that. However, try to add medical payments to your car insurance policy now (usually never a good idea, but for the sake of argument) and you will faint when you get the quote.

When Hillary tried health care reform, she tried to get to the root of the problem which was that the medical system itself is just riddled with stupidities, outdated licensing requirements, too much under-utilized equipment and so on. They have a very carefree attitude toward the dollar.


J. Paul Getty refused to let the first director of his Malibu museum buy an electric pencil sharpener: he told them to crank their own.

Because most of the public actually believes that doctors and hospital administrators have this secret knowledge and doctors somehow "know more", they are afraid to challange the way they do things and thier absolutely spoiled and wasteful approach to "non-budgeting".

A growing numer of doctors don't even have to leave their offices to walk to the hosptial anymore: need a building for your office? Here it is! (And keep in mind, they do this EVEN THOUGH we have hospitalists now to cover the admits. and hospital care).

Overall, the problem with Obamacare is that it was everything but reform. USA: 30th in life expectancy, 1st in spending. Gag.

When a friend of mine collected hospital bills for many large hospitals, he saw the run-of-the-mill hospital portion for gallbladder surgery go from 4K to 11K overnight. No other business in America could get away with this. There was no justiifcation for it. They prey on the stupidity of the American public to buy insurance and hide themselves from the cost.

Captcook (talk|edits) said:

18 September 2013
We have mandated car insurance too.

...but you have the choice of whether to drive a car. Not the same.

CrowJD (talk|edits) said:

18 September 2013
That's true. As I said above, I am through defending Obamacare now that I have seen that all these government insured politicians did not look at the cost.

But, the status quo in the American healtcare system is not sustainable, in many ways, and for many reasons. We are going to have reform...it's just a question whether we stumble into it, or whether the system collapses and we are forced into emergency action.

Buffet says the law needs fixed. It does need fixed and I thought we could go back and work on it. It will not be worked on in the present political environment.

Most people don't know the actual state of our healthcare system, which is understandable. There are those who do know (mostly insiders), but who are in complete denial: they got toys to pay for.

Podolin (talk|edits) said:

18 September 2013
"We have mandated car insurance too.

...but you have the choice of whether to drive a car. Not the same."

I have seen this argument (about mandated car insurance) so often, and it is not a logical comparison.

So far as I have ever seen, the only kind of car insurance that is mandated is liability (protect or compensate the other person or car you damage). The exception, in which you must insure your own car for theft and collision, is when you finance it, so as to protect the lender or lessor.

If you pay cash for your car, you do not need to insure the car.

CrowJD (talk|edits) said:

18 September 2013
If you pay cash for your car, you do not need to insure the car.

That's not true in my state. You still must carry a minimum of tort coverage even if the car is paid for. I think we could be saying the same thing, but in different ways.

So, in my state, if the car is paid for, you can drop the "collision coverage" but you must keep at least minimum coverage for personal liability.

Snowbird (talk|edits) said:

18 September 2013
The collapse of the health system is going to happen quickly. Large companies trying to get control of health care costs will direct employees to exchanges Walgreen Joins in Exodus of Workers to Private Exchanges Health care one of the most uncontrollable costs for companies ... by putting the employees into the exchange, they can budget what they are going to pay.

My only hope is that when it happens, we have a President that is a fixer ... like a Romney, Bloomberg, Giuliani, can even be a liberal effective governor or mayor ... please not another community organizer do gooder like Obama or Hillary... to clean up the mess is going to take a lot of political and managerial skills.

CrowJD (talk|edits) said:

18 September 2013
Yeah, I saw the story about Walgreen's on Brietbart. (No comment).

Of course the conservative media is trying to hype every percieved problem with the roll-out...just as the liberal media would do with a conservative program they didn't like.


Obama and the moderate Democrats had to make a deal with the devil to get this done.... it was fixed from the beginning to protect the big money in the insurance and pharmaceutical industries.

So, this is the plutocracy we have to abide by today, there is no use kidding ourselves about it. We know who finances the elections and that's on both sides. It's totally corrupted by corporate money.


BUT.... whether Obamacare goes down in flames or not (which is still an open question despite conservative wet dreams to the contrary)....we will have reform. It may not be Obamacare, but it will not be business as usual.

But this is not surprising in America. It is a part of our personality as a nation that we can only act in a true crisis. We did not get true reform in Obamacare, what we got was a bill that passed and the fact it made it's way through various court challanges. It was always half a loaf, which I thought was better than nothing. The public will decide, on on the public timetable. It may take ten years before we get real reform, but we'll get it.

Podolin (talk|edits) said:

18 September 2013
You still must carry a minimum of tort coverage even if the car is paid for. I think we could be saying the same thing, but in different ways. We are. In the same, not different, ways, such as you must keep at least minimum coverage for personal liability.

Natalie (talk|edits) said:

September 18, 2013
Obamacare is bad, bad stuff. Take a look at this. Pay particular attention to the "implications" sections.

CrowJD (talk|edits) said:

18 September 2013
Trust me, it will continue to get worse until enrollment ends. It will get badder and badder. The reports will be unbelievable .... and some of them will be half true. Some of them might be all true. Some of the stuff said in the coming months might be outright lies told by professed Christians.

But it's possible that the Republicans are going to stop this in it's tracks right now with the debt negotiations.

Incognito (talk|edits) said:

18 September 2013
Crow, I heard the bad news on CBS. The C does not stand for Christians, nor does it stand for Conservative. In fact, there are fewer Christians on this station than they have Conservatives. I think they have 1 Conservative or maybe he no longer works there. I believe he got canned for putting joke names in a broadcast about some plane crash. But that might just be an urban myth.

Gazoo (talk|edits) said:

18 September 2013
Oh, I've seen the bad news (regarding the polls particularly), though I have not looked through the polls myself. I mean, CBS could report some bad news which is absolutely true. But even though I have not run into any outright lies about Obamacare on cbsnews.com, I have encountered them elsewhere. I've encountered the most boldfaced lies on sites dominated by conservatives, many of whom profess (loudly and constantly) that they are Christians.

(Sometimes these folks testify so loudly and constantly, I wonder whether they are Christians. A woman sure of her faith might not need to testify constantly about it. Only God knows.)

Look, I'm willing for the public to decide what they want to do about Obamacare. Time will tell. And the Republicans in the House have the opportunity to strangle this baby in the crib (again), if they can get the upperhand in the debt negotiations. This is one time that Mitch McConnell (*secret liberal) can't have his way with the Tea Party.

.* I don't call him a liberal, but a lot of the Tea Party people call him a liberal (sort of a sneaky, secretive liberal, like Nixon was, or like Goldwater).

CrowJD (talk|edits) said:

19 September 2013
Mr. Obama said recently, on NBC with Chuck Todd, that within one or two years after the implementation of Obamacare the cost would go down. I hope he means by that the cost of premiums, otherwise, it looks mighty bad for Hillary or Joe.

Actionbsns (talk|edits) said:

20 September 2013
I just returned from a seminar sponsored by the Chamber of Commerce. Lousy lunch and not a lot of real information, cost $50. Representatives from the three major insurance companies were there, one of these presenter's had some very good information to offer, one of them thought he was very funny, the other was neither good nor bad just not informative. I think there are probably a lot of seminars right now that have very little value which is too bad.

After the seminar one of the people in attendance stopped by to chat with the lady I sat next to and all of us engaged in a conversation. The attendee seemed to be one of those kinds of people who learns one fact then knows all there is to know about a subject, but she did bring up a point and I'm not sure if it's true or not, but it could explain why Natalie's premium is so high and others have increased. The attendee said she had spent considerable time on the phone with HMSA (Hawaiian for Blue Cross/Blue Shield) and her understanding of the premium calculation is that for a family, a premium calculation will be made for each member based on age within the age group for which they are a member (the 21-64 age group would have a different premium amount for each age in that group). So, where a family premium used to be something like a premium for the insured plus, then a spouse, then the "family" (all of the kids no matter how many), there will now be four calculations or more if there are more kids. Does anyone have a clue how these premiums are being calculated? There was still no information provided on the plans, stop losses, co-pays, premiums, all things you need to know to decide on coverage. I did ask specifically about Natalie's 59% increase and the 40%-60% increases someone else mentioned, unfortunately, questions were written on a card, handed in and only two or three were actually addressed, and mine was not.

H.D. Freifunk (talk|edits) said:

20 September 2013
Here is the Kiaser Family Foundation calculator. You can get idea of what information they request to run the calculation. I don't know if this will answer your question or not, I'm just posting it for those interested. "This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA)."

http://kff.org/interactive/subsidy-calculator/

Make sure to read the Notes, they are important. The premiums are based on a silver plan and there is other important information in the notes.

The H.J. Kaiser Family Foundation is not the same thing as Kaiser Permanente.

This may not be what you are looking for, but it is cheaper than $50.00!

Bilbo (talk|edits) said:

20 September 2013
Ours is 11% increase from BCBS and we have high users and older employees. A lot of the variance is because of the banding taking place.

At under 50 full time employees, we have to consider if we will not be better off moving the medical premium to salaries and letting the employees shop the exchange. Those with families and spouses are getting raped and have been for a long time. The company covers most of the employee cost.

If we let the employee go to the exchange they may well benefit from the subsidy - especially families with one non working spouse.

Joanmcq (talk|edits) said:

21 September 2013
My premium for a silver level plan is more than $150 less than I was paying on COBRA. the weird thing is the cheapest plan is through Blue Shield, not one of the not-for-profit options. I'm in CA, and CA embraced the exchanges. The co-pays are somewhat higher, but it'll cost less than the premium difference.

And I'll be able to actually get insurance, which I couldn't on the open market before due to pre-existing conditions.

Natalie (talk|edits) said:

September 24, 2013
". . . how these premiums are being calculated?" Age is a big part of the premium increase, but with two kids, I expected it to level out. I have been unable to find the age brackets used in determining the premiums. In addition, insurance companies are also allowed to charge more in areas that have higher costs of living. I have been unable to determine if that means all of Hawaii will have higher rates or just certain areas in Hawaii.

". . . moving the medical premium to salaries . . . " This is an option some employers are considering, but it gets to be a little complicated, given that salaries are tied to other things such as retirement benefits.

Joan, what is your annual deductible? I understand the bronze plan in Hawaii has a > $6,000 annual deductible with co-pays up to 40%.

Actionbsns (talk|edits) said:

25 September 2013
Natalie, one of the speakers at the seminar I attended indicated that the premium structure has to be consistent throughout the state, which, in Hawaii will mean some islands will experience lower premiums and others higher as it evens out. As far as premiums being age rated and rated by location, that's not new. In the past, I've calculated premiums for personal health insurance and small group insurance, and it always started with age, sex, and health history, then, after awhile, it included smoker vs non smoker. In California, when I was researching premiums last year for my brother, I had to enter his zip code along with his age and sex, healthe didn't matter because he's on Medicare, to get a premium quote. I entered a northern California zip code just to see the difference, and there was a substantial difference. So these are not new issues, just ones that people are becoming more aware of. Just as an FYI - Hawaii health insurance rates have been WAAAAAY lower for the same coverage than rates in California ever since I've lived here

Natalie (talk|edits) said:

September 26, 2013
. . . premiums being age rated . . . This is new for the small business group that I was a part of (and I thought for other plans in Hawaii as well). Premiums were based on the experience of the group, not individual ages of the participants. I would still like to know what those age brackets are.

Gazoo (talk|edits) said:

26 September 2013
"Second, with respect to adults ages 21 to 63, we propose one-year age bands so that consumers would experience steady, relatively small premium increases each year due to age. If broader age bands are adopted (for example, five-year bands), consumers would experience larger premium increases when they reach the end of one age band and move into the next. Although five-year bands are currently common in the small group market, we are also proposing to apply the same age-band structure to the small group market to align with our proposal that the per-member rating buildup approach be used in both the individual and the small group markets. We request comment on this approach."

https://www.federalregister.gov/articles/2012/11/26/2012-28428/patient-protection-and-affordable-care-act-health-insurance-market-rules-rate-review#h-25

Proposed Regs. I would guess they are using these Regs. I began my search based upon the Notes section at the Kaiser Family Foundation above. It took me less than ten minutes to do this. Whether this approach is actually being used, I don't know.

Natalie (talk|edits) said:

September 26, 2013
Thanks Gazoo. It looks like the adults are weighted 3 to 1 compared to kids, which would explain at least in part why my premiums went up so much, even though I have two kids.

H.D.J. Friefunk (talk|edits) said:

27 September 2013
Natalie, you guys were experience rated. You kept yourselves so healthy, you made it easy on the insurance company, and they rewarded you for it. Now, you'll be lumped in with the masses. If you have to knuckle under and buy a policy under this new system, then I suggest you buy a huge box of chocolates for yourself on the way home from work (do this once a week), and fill the trunk of your car full of the worst snacks the kids and your husband could eat, and start living like the rest of America. Give up your bike for good. Buy slacks with elastic waists. You'll all be sick in no time and you'll fit right in with the rest of the country. Then you'll feel like you are getting your money's worth on the new premiums.

Podolin (talk|edits) said:

27 September 2013
Then you'll feel like you are getting your money's worth on the new premiums.

The old joke goes like this.

Life ins. salesman tries to sell a big policy to Joe. Joe says he is young and healthy and does not need it.

Salesman says Sam down the street bought a big policy just a month ago. He too was young and healthy, but he was in a fatal car accident and it's good he had the insurance.

Joe says Sam was just lucky.

H.D.J. Friefunk (talk|edits) said:

27 September 2013
lol. Sam got his money's worth all right. I would write it like this: Sam was in a fatal car accident and he was glad he bought the insurance. :)

Natalie (talk|edits) said:

September 27, 2013
That's one way to look at it, but at over $21,000/year, that's a tough pill to swallow.

H.D.J. Friefunk (talk|edits) said:

27 September 2013
I agree that is completely insane and it will make it extremely difficult for many professionals to continue in private practice...and then where do they go when everyone else is looking for work too? The doctors are the only ones who can afford such premiums; and if premiums are like this in a lot of states, then there will be trouble. Is there any possible way you could find another plan? I hope you can.

I don't want to get back into a political discussion, but the system is utterly broken. It was broken before Obamacare was passed. It has to do with the way we train doctors and what it costs them to be trained, outdated licencing laws, higher payment for procedures rather than preventive care, under-utilization of expensive equipment (and the need to order tests to pay for the machines)... I could go on and on. Excessive administrative costs. We will just have to stumble into some solution. That's the American way.

CathysTaxes (talk|edits) said:

27 September 2013
Because of the requirements of Obamacare. I know a doctor who has had his own practice (with a partner) for 30 years who just sold his practice to a hospital so now he's an employee. His partner used to give this many immigrant patients, who don't have health insurance, big discounts. Now he can't and his patients are complaining. The doctor said he's tired of spending so much time doing administrative work (where he's not bringing in revenue) and not taking care of patients. He's also tired of the receivable problem. Does anyone know if Obamacare tried to reduce costs by putting caps on awards for malpractice? This doctor is in Illinois. His premium is $55,000 a year (times two if you count is partner). In neighboring Wisconsin and Indiana, the premium is $5000 a year. If he charges $90 for a visit, then he and his partner would have to see 1,112 office visits to make up that difference in revenue (more if you include their costs in seeing these patients)! That's 22 extra visits a week, and longer hours. Plus when he retires, he has to carry insurance until the statue of limitations is up on his patients (pediatricians have a much longer statue of limitations). This system is horrible!

H.D.J. Friefunk (talk|edits) said:

27 September 2013
Because of the requirements of Obamacare. I know a doctor who has had his own practice (with a partner) for 30 years who just sold his practice to a hospital so now he's an employee

I lay this whole thing right on the steps of the conservative Heritage Foundation which first came up with the plan that we now call Obamacare.

This is nothing more than Heritagecare! If it fails, it's falls right into the lap of the Heritage Foundation (a so called conservative foundation).

But listen, we need to give it a chance to swim. As Partick Henry said-----Let it sink, or let it swim. * Sometimes I wonder if the so-called conservatives are worried about it's succeeding. Is that what scares them? I don't know. But they sure are laying on the horror stories thick.

Some Elephants have now voted more than 41 times to repeal a bill that came out of their own think tank! The nerve. What kind of peanuts are these Elephants eating? Well, they may not all be Elephants, some of them are Tea Party lunatics, which Sarah Palin now calls "really a third Party".

I have confidence that the American people will stumble around and do the right thing in the end. Now I am going to go put on my "Heritagecare" tee shirt and wear it around to all the stores today, starting with Walmart.

.*He said this in the same year that he made his other famous remark.

SashkaCPA (talk|edits) said:

1 October 2013
Since health care premiums calculated based on your MAGI how many self employed will intentional understate their income in order to qualify for lower premiums?

You pay your proper tax obligation on April 15 to avoid IRS penalties and file extension. On October 15 file tax return with much lower income, purchase health insurance based on filed income, amend tax return.

Gazoo (talk|edits) said:

1 October 2013
Yikies. Good information. I personally would not put this idea in my file so that I could maintain deniability, however, I will have my wife print this page and place it in a file for me.

I say to anyone, only Russian and Ukrainian know how to handle bureaucracy. American are babes in the woods. Little mushrooms the Americans are. Green peas.

PollyAdler (talk|edits) said:

1 October 2013
Yes, and as usual, nomenclatura (номенклату́ра) get special treatment. Subsidy for congressional staff members and members of congress. I want to know more facts about this subsidy.

CathysTaxes (talk|edits) said:

1 October 2013
Of course people who get most of their income from tips will definitely understate their income.

PollyAdler (talk|edits) said:

1 October 2013
Fortunately, there is a silver lining to these dark clouds. The restaurant workers won't have to show up sick to work no more and give their customers hepatitis and other coodies. They will have health care and and I thank the Lord for it.

"It is the responsibility of the Federal Government to establish a comprehensive health care system that will insure a basic level of health care for all Americans...The Federal Government should also insure adequate funding for this basic level of care through a national health insurance program" Statement of the American Bishops, 1981.

We still do not have a national health insurance program for the masses, but we will have single payor one day. We will have this one day.

The Affordable Care Act was a law hatched out of the conservative Heritage Foundation. It is a market based system which still depends on private insurance...and it will still choke the system with administrative costs and pay to administrators to review various contracts and comply with them. It is a first step, but just a tiny step on the way to the system that we will have one day.

Incognito (talk|edits) said:

2 October 2013
I used to be against the idea of socialized medicine, but I am now converting. Look! We already have it. See Medicare. Let's open up Medicare to include everyone. However, the care should be reduced to the minimum. If you need a lab test for a lump in your throat, you get put on a 3 month waiting list. This will help control costs because doctors order every test under the sun for fear they are going to get sued.

If you want anything better than minimum care, then you can purchase supplemental insurance or pay out-of-pocket for that service.

Increase the Medicare Tax to put more money in the system and allow anybody to do an HSA. Let the taxpayer class think they are getting a benefit here.

PollyAdler (talk|edits) said:

3 October 2013
I have no idea what you mean by socialized. I guess the money the TP and business pays in FICA counts for nothing.

"costs because doctors order every test under the sun for fear they are going to get sued."

That is a lie perpetrated by Med-mal insurance carriers. Doctors order tests, especially the most expensive & unnecessary tests, to pay for expensive machines.

We have medical malpractice tort reform in many states. It limited recovery for pain and suffering. Why? Because malpractice lawyers are paid out of this portion of the settlement. The insurance companies wanted to kill the malpractice bar, and trust me, it takes a lot of training and dedication to do this type of law.

It is a loss to all Americans who are negligently and sometimes recklessly injured by doctors every day when we lose our malpractice bar. It's been a long, long time since an amateur could practice this type of law. Why? Because doctors, hospitals and staff are known to lie and to close ranks and to protect each other when they get sued because they screwed up.

The medical malpractice lawyers often advance a lot of their own money to pay expenses in these cases to investigate them, and they could and do lose that money if they lose the case, or bring a lousy case. They don't bring lousy, worthless cases. The cases have to be prescreened in most states by at least an RN, and such report must be attached to the lawsuit to prevent the filing frivilous lawsuits.

Strange though that when they passed tort reform in many states, they did not put a cap on insurance premium increases. Strange indeed. And when the insurance companies got just what they wanted (tort reform) the rates started to creep back up again after three years or so.

CrowJD (talk|edits) said:

3 October 2013
I want to make a personal appearance myself to congratulate the President and the conservative Heritage Foundation on the passage and the beginning of implementation of the Affordable Care Act.

I don't know what some of the Elephants will do with themselves now that it's gone into effect. What will they do with their time? Some are promising to continue the fight <insert sound effects, laughter>

Let the law sink or swim. If it needs improvement, we will improve it. I am optimistic. My understanding is the people of Mass. are pretty much pleased with Romneycare.

I am a little more hopeful about the future of healthcare in America now that we have taken this first tiny step, and I am also optimistic that statistics will win out and that most of the lily white, highly gerrymandered districts that allow a few anarachists to win seats in the House cannot remain lily white forever. Statistically and demographically, it's impossible. <Again, insert wild laughter, hooting and hollering>

H.D. Freifunk (talk|edits) said:

3 October 2013
HOLD THE PRESSES:

As an idependent (everybody with a brain knows that there are no idependents, but we pretend we exist), as an idependent I must object that the Tea Party anarchists failed in the recent attempt to kill the Affordable Care Act.

They did not fail. They never said they would repeal this act. They said they would shut down the government. They said this in their campaigns when they ran for office. They were running for office to shut down the government.

Racheal Maddow played tape after tape last night showing rabid Tea Party anarchists promising to shut down the government if they were elected. They will deposit their paychecks as they tear down the house, like any demolition crew would do. Nothing out of the ordinary there.

So, actually, the Tea Party anarchists won this round, so HA HA on the institutional Republican Party (losers); and I say this as an American Independent (I am actually a German, but since there really are no American independents, I am playing the part of an independent in their place).

SumwunLost (talk|edits) said:

3 October 2013
Incognito, minimum care is not acceptable in a socialized system. I have experience of both the English and Scottish healthcare systems (similar but separate). The difference between here and there is that one country rations healthcare based on need and the other rations based on ability to pay. I have said it before and I will say it again. the UK systems and the US system provide broadly the same level of healthcare, but the UK systems cost the economy half the price.

Father Crozoodlerunk has mentioned many times about letting Nurse Practitioners and Physician's Assistants run their own practices. I am not convinced but I take the general point. One problem with US healthcare is that so many doctors want to be specialists so they can earn the big bucks. What we really need is an increase in general practitioners so that we all have easy access to primary care. That is where the problems can be identified and prioritized. When I lived in England, I had a medical issue that developed over a period of months. My primary care doctor referred me to a specialist who agreed to see me nine months hence. In the meantime, he advised my doctor to increase my medication. When I saw the specialist (seven or eight months later, as it happens) he already had data from my primary care doctor on which to base a treatment plan. I put it to you that that was an efficient use of scarce resources.

Compare my situation with my dad. He saw the doctor when he felt unwell. Doctor referred him that day to a specialist at the local hospital, eight miles away. He was put on the next ambulance (this service is free at point of need) to the hospital, had his tests and got the results a few days later. He had cancer surgery within a couple of weeks of his first appointment, had chemo at home via oral medication and recently got the all-clear. Swift intervention, proper care and appropriate follow-up (all free at point of need) gave him his life back. Even his primary care doctor was on the 'phone with him the day he was discharged from hospital, checking up on him and making sure he was listening to my mum. He made home visits until my dad convinced him he would quite like the walk to the surgery.

Now, how is all this paid for? Well, when you add the taxes the American on median earnings pays to the cost of health insurance, it is far more than than what the average Briton pays in taxes. That, alone, tells me we are being inefficient.

H.D. Freifunk (talk|edits) said:

3 October 2013
"What we really need is an increase in general practitioners so that we all have easy access to primary care."

Yes. It would save us billions of dollars. Patients must receive consistent care. Emergency room care is not consistent because emergency rooms are not designed to treat chronic conditions. However, the treatment of conditions like diabetes early on can save big bucks for the medical system in the long run.

If we don't fix our system, the emergency rooms, even in the rich areas, will be the first thing to go.

On the subject of PAs and Nurse Practitioners, some of these people are truly excellent. They would fill an imporant need, especially in rural and under-served urban areas. We need to let them open their own offices in the rural areas at least. In the internet age, they can easily be in contact with doctors at the large medical centers if need be. Again, saving the system big bucks by providing basic preventive care and consistent treatment.

Number one (No. 1) in medical spending, and thirtieth (30th) in life expectancy will not cut the mustard, and us Real Americans are going to fix the problem, and this is the first tiny step in that direction.

Incognito (talk|edits) said:

4 October 2013
... minimum care is not acceptable in a socialized system.

Alas, acceptability and reality are not always the same. What is acceptable in your utopia may not necessarily be realistic in this world/universe where time and resources have limits. Socialism can only provide the minimum for the majority. If there is no such thing as eternity, then selfishness is the most noble of all the virtues.

SumwunLost (talk|edits) said:

4 October 2013
Incgnito, let's clear up a few misconceptions. Firstly, socialized medicine (to use that ugly American term) is not a utopia - it actually happens in almost every other first world country and quite a few in the third world. Secondly, we are not talking about socialism here. A healthy workforce leads to a healthy economy. Consider the Industrial Revolution in the UK. Mill, factory and coalmine owners used their immense wealth to build city parks for their workers. The formed and funded works brass bands to help the workers clear their lungs after a hard week's work in dusty, enclosed spaces. Pretty minor stuff by today's standards but a contribution to overall health nonetheless. It also perpetuated a contribution to the enlightened entrepreneur's bottom line. That sounds like capitalism - investing money to generate more money and then sharing the wealth with those who created it.

Now consider the situation of Scotland. It has had a National Health Service since 1948. It is independent of the other NHS sytems in the UK. It provides the following free at point of need: doctor visits, hospital stays, emergency room visits, prescriptions, personal care for the elderly, ambulance service for those who need it to get to appointments and probably a few other things I have forgotten. Dental care is subsidized, although I gather it can be hard to find an NHS dentist in many areas these days. Routine eye care is deregulated except for those on welfare, but if there is a medical issue it gets dealt with in the same way as any other medical problem. My dad has regular check-ups for his glaucoma and has had surgery for cataracts in the past couple of years, all at no cost (at point of need). Overall, in my experience, the level of care is comparable to the USA.

Now you might wonder about the cost of all this and what it might do to the economy. Well, if Scotland votes to become independent next year, it will immediately become the sixth-wealthiest country in the world. And who will it replace in that position? The USA (if the USA is lucky enough to still be in that position in a year's time). As I have noted before the tax cost of all this is about half of what we pay here, once you add in health insurance costs.

Of course, the problem is that you cannot lift up the Scottish system and drop it right into the USA. Nationalization would incur prohibitive one-off costs. However, the new system is a half-baked dog's breakfast of an idea. It needs considerable work before it represents something acceptable in a civilized country. If we can get rid of the notion that looking after one's fellow man is somehow wrong we can make advances that will benefit the whole country. We need to look sharp, though, because we are in danger of losing out to other economies who put the legitimate needs of the whole ahead of selfish desires.

H.D.J. Friefunk (talk|edits) said:

4 October 2013
My utopia? Excuse me, its a large group of people who spend their life submerged Twenty Leagues Under the Sea in the land of conservative talk radio, modern day conservative devil preacher talk, and the Fuax news network that live on the Isle of De Nile.

That is where these nuts live on the far right: the Isle of de Nile. It is their utopia.

The extremists on the right are looking for a utopia that they think is modeled after the 1850s, but even in the 1850s they had problems that one individual could not fix by himself. (The conservatives call these super individuals "Sovereign Sheriffs" today; Sovereign Buffoons would be a better word..

I am no utopian. But I do part with many liberals, progressives, and Democrats in saying that I would be satisfied with basic doc-in-the-box care for many lower middle class and poor Americans (or any other person who chose this option). Doc in the Boxes can provide good, preventive and consistent care.

It sure beats the hell out of the emergency rooms which are being destroyed by an influx of patients today who do not belong there. I mean if you want to go to Dante's Inferno, go to a inner city or even a suburban ER: they see it all; and it's hard on the doctors, the nurses and particularly on the nurses aides.

Maybe the Bronze Plan under the Affordable Care Act is like doc in the box, but I fear it still offers too much (to pad the insurance company profits).

The ER medical personnel are completely burnt out by the time they can see the patients who really need emergency care. The ER workers are the heros of our times. Go down there and volunteer and take in the smells for the day. Fight off the parasites that inflict our street people and our poor and our children.

I don't believe in Cadillac care for all. As I've said before, the rich and the gamblers should be permitted to opt out of all government insurance once they become 25 years old.........but the decision to opt out is irreversible, by Constitutional Amendment. Let the rich and the gamblers go to their concierge doctors and hospitals and let them pray for good investment returns and the sober expenditure of their capital.

When I say opt out of government programs: no Medicare and no Medicare tax, no Affordable care act compliance or penalties. Zip. Zero.

But once you opt out, it's permanent. If you die on the street because you ran out of your loot, you will be buried under the nearest patch of diggable land to where you dropped, by law. No marker. Picked up and dropped in a hole. Throw in some quick lime, and pile some dirt on top of you and that's it.

Some of the hippies of the '60s have become the libertarians of today, and they are the utopians.

But like MLK used to say....I'm not worrrrried. I'm not worried because I know that one day America will stumble into the most efficient system which is single payor. We waste way too much money in administrative overhead today, and in insurance company profits and under-utilization of equipment (too much expensive equipment that must be paid for by doctors ordering unnecessary tests).

Wiles (talk|edits) said:

23 October 2013
When I run for Senate next year and win, I will be proposing the following single payor system. Everybody is now covered under Medicare. The 1.45% Medicare tax will now be assessed on every item of income: Social Security, pensions, interest (including tax-free), capital gains, ... Since revenue will be less than spending, worse than it is now, then services will need to be reduced. You don't have to worry about those details, as there will be people much wiser than you determining what is best for you. You will be in in good hands.

Anybody can purchase additional supplemental insurance and everybody will be allowed to fund an HSA.

I was also going to include a mandate that all elected officials be subject to the same rules, but I think that might kill my bill. So, for now, the ruling class is exempt.

Gazoo (talk|edits) said:

23 October 2013
Trust me, private insurers determine what's best for you and they've been doing it for years, and just try fighting them if you are sick.

But hey, we still preserved the private insurers under the ACA. I mean the scheme came out of the conservative Hertiage Foundation...which I think Jim Demented now heads up...or maybe he's in a SWAT-team- like offshoot of Heritage.

When we lost the public option, we lost all checks on the corrupt private insurance marketplace. I do agree that the President and Congress should be covered under the ACA with zero subsidies.

Bilbo (talk|edits) said:

30 October 2013
We are renewing early. Our premiums are down and the coverage is better. The employees pay a small part of the premium for themselves and all the premium for their dependents. Most employees will see a reduction. The breakeven point seems to be about 58 years old. We should extend medicare down to age 55 to tweak the market based system we call Obamacare. At the very least we should allow a buy in at full cost. And medicare needs to be allowed to negotiate drug prices to further decrease cost.

We just went through open enrollment in October. It is worth going through it again to get the better policies and lower cost.

Captcook (talk|edits) said:

1 November 2013
My wife's company just found out yesterday they are able to stay on their association plan, which has changed their plan date to 12/1. This gives them 11 months in 2014 while still living under the old rules. For the first time ever, their premium decreased. Based on the new plans, it would have went up 27%.

Incognito (talk|edits) said:

4 November 2013
I think ACA may be a boon for the insurance companies. The limited data that is being shared with the public is showing that the majority (close to all) of the individuals signing up for insurance are going on the Medicaid (taxpayer-funded) plan. These are the previously uninsured who would use the emergency room as a walk-in clinic. The costs of those uninsured visits were previously passed through to the insured via higher premiums. So now we have a situation where the costs for the previously uninsured are now paid through Medicaid (taxpayer). Since cost sharing will dramatically decrease it seems the premiums for the insured should be going down, not up. If my logic is correct (doubtful), then it seems that the insurance companies are now going to be pocketing what used to be cost-shared.

Kevinh5 (talk|edits) said:

4 November 2013
You seem to imply that all of the uninsured are poor. Or that all of the sick are poor and thus eligible for Medicaid. I don't think that's the case at all.

Incognito (talk|edits) said:

4 November 2013
No. I don't think that's what I am implying. I am making an assumption that the people who are now going to the exchange and signing up for Medicaid were previously uninsured.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/31/in-first-month-the-vast-majority-of-obamacare-sign-ups-are-in-medicaid/

Perhaps, this is where my logic fails. It could be that those new Medicaid sign-ups were previously paying for private insurance or had coverage through their employer.

Umk395 (talk|edits) said:

4 November 2013
It's so weird that the President, House and Senate aren't willing to eat their own dog food. How funny is it that those who tell us how great Obamacare is won't eat their own food? Classic stuff. Guess it's "illegal". LOL (See Kathy Sebelius's testimony from last week).

Captcook (talk|edits) said:

5 November 2013
I think it's reasonable to assume the mix of the early registrants would be those previously uninsured and eligible for medicaid. Most people currently on individual plans that will no longer be offered are still shopping their options and haven't made a decision. Also, most small businesses haven't gone through their renewal and decided whether to keep coverage or drop. I think a significant number will drop and their employees will need to find other coverage following notification of that happening.

Gazoo (talk|edits) said:

5 November 2013
I saw on cbsnews.com yesterday that some white house operative (one Mr. Cutler) wrote "Hurricane Larry" Summers (office inside the white house) THREE YEARS ago and warned Summers that the whole effort to get ready for the rollout was a massive FU.

I guess Summers either ignored the letter, or he discussed it with the President and they both decided it was a good day for a little golf and the hell with it.

This man Summers never ceases to amaze me. He's had his thumb in the middle of every rancid pie since he was in the Clinton Administration. He entered the academic world, and his financial genius destroyed the Harvard endowment. Just inexplicable that he would still be in positions of power, and this reflects back on the President who only recently decided that Summer's reputation was so bad, he could not appoint him to the Fed.

Ultimately, the problem with the rollout rests with the President who fouled his own nest royally. The President and Summers seem to think alike, they seem to be buddies: and after them the deluge.

Well, the bottom line with the American people is the cost of premiums and the hope is that this so called marketplace will reduce them, at least over time. Well, it's not a true marketplace. From what I am reading in the sane press, some people are quite satisfied and some are not. If we have to go through this silliness to finally get to single payor, maybe it will be worth it.

Incognito (talk|edits) said:

5 November 2013
It was purposely designed to fail, as some are beginning to realize. And now we are willing to capitulate and give more control to a government that rules by fear.

This is not a donkey vs elephant thing. They are all the same. The trend of more government control and less personal freedom continues under both. And the trend of electorate to gladly give up their personal freedom continues as well. Freedom is becoming less understood and less desirable by the people of America.

Markb29 (talk|edits) said:

5 November 2013
Freedom is becoming less understood and less desirable by the people of America.

agreed.....

Snowbird (talk|edits) said:

5 November 2013
Crow, glad to see you are still drinking the 19th century kool aid that collectivism will yield substantial efficiency to the economy, i.e. single payer. The government cannot even develop a website, but you willing to handover 16% of the economy ... what, 4 times larger than the military. It was very popular line of thought in the 19th century that greater concentration and the elimination of middle men would provide greater benefits ... large government farms, only 1 car company owned by the government, government hospitals ... we know how well that worked out.

Umk395 (talk|edits) said:

6 November 2013
Spot on, Snow B. Spot on.

Joanmcq (talk|edits) said:

6 November 2013
Maybe health care shouldn't be 16% of the economy? We all know our system is incredibly inefficient.

Markb29 (talk|edits) said:

6 November 2013
We all know our system is incredibly inefficient.

You are correct and there are many reasons for this (including the current heavy hand government has in the medical system) but my guess is that putting the government in charge is not going to make it more efficient.

Fr. Mackelhenry (talk|edits) said:

6 November 2013
We need a light government hand in health care. That's why Americans hate Medicare so much! Oh wait, they love Medicare! My bad. And we can afford it, and I got a secret for everyone: Medicare is not going anywhere.

I feel sorry for the people out there who have been brainwashed into thinking that any insurance company is their friend. That would be like making friends with an (unregulated) Chinese pet food company.

We need to cut out the administrative fat from healthcare and the wasted overhead used to interpret many different insurance contracts and go with a single payor. It's the only way we can really lower premiums. I have no doubt we will have it one day, but America always likes to take the long route.

The free market (which is only a free market for the poor and middle class) is a joke. The big corporations and the elite will only deal in fixed markets, and they have the politicians in their pockets to get them fixed in their favor. Wake up, friends.

Captcook (talk|edits) said:

6 November 2013
I feel sorry for the people out there who have been brainwashed into thinking that any [government] is their friend. That would be like making friends with [anyone out to exploit you].

I find it fascinating that any educated individual (am I assuming too much here?) can say we need to "cut out the administrative fat" and advocate single payor in the same sentence. Since when has there ever been a gov't program that wasn't heavy on the administration? I'm not saying medical billing to insurance companies isn't burdensome. It most definitely is. However, Medicare billing is no less burdensome and a switch to single payer is wrought with negative consequences. If gov't wants to share the burden of health care costs, make insurance premiums and certain care an above-the-line deduction with the possibility of a credit and maintain Medicaid for the truly poor. The best solution puts incentives for bargaining and price shopping in the hands of patients and not a third party (insurance company or gov't).

Incognito (talk|edits) said:

6 November 2013
Oh wait, they love Medicare!

And I loved it when Taco Bell gave away free Doritos Locos Tacos after Angel Pagan stole a base in the World Series last year. Perhaps we need a 'light government hand' in fast food also.

SashkaCPA (talk|edits) said:

8 November 2013
49-State Analysis: Obamacare To Increase Individual-Market Premiums By Average Of 41%

Eight states will enjoy average premium reductions under Obamacare: New York (-40%), Colorado (-22%), Ohio (-21%), Massachusetts (-20%), New Jersey (-19%), New Hampshire (-18%), Rhode Island (-10%), and Indiana (-3%).

The eight states that will face the biggest increases in underlying premiums are largely southern and western states: Nevada (+179%), New Mexico (+142%), Arkansas (+138%), North Carolina (+136%), Vermont (+117%), Georgia (+92%), South Dakota (+77%), and Nebraska (+74%).

[1]

Gazoo (talk|edits) said:

9 November 2013
What this illustrates is that the Georgia Insurance Commissioner's Office (the supposed regulator of insurers in GA and long in the pocket of the insurance industry) has been allowing the health insurance companies to sell trash in our state; now they can't sell so much trash and the premiums may go up....may go up. There are a lot of words floating around out there on talk radio and in the conservative business press which are not reliable.

It will take a while for this to shake out....ultimately it will be up to all the American people to decide if this program is working.

Captcook (talk|edits) said:

10 November 2013
A lot of trash is sold in every market. It only continues when people don't do the research, and then continue to buy it. With something as valuable to one's life as health care insurance, why would anyone not be prudent in their purchasing decision? It boggles my mind, the mindlessness with which people conduct their purchasing decisions. This is certainly not limited to health insurance.

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