Thread: Obamacare A Big Lie From The Start...

Originally Posted by tkolter

There is a chart with the exact subsidies for each tier of care from 0% to 400% of the poverty line in fact its on the info page on the law on Wikipedia and other sources, I have a book explaining it and its also in there referenced in the law.

As for defunding yes the can do that by reconciliation which is allowed to be used once a year, which sacrificing it for the budget fight at the end of 2013. But if they do this the rest of the law stands and can be filibustered the Democrats have grounds they can say fine the mandate insurers take everyone and the rest stand, when YOUR bill comes up we will THEN consider a repeal. But you have one year to do that.

Now Romney can let states opt out of the exchanges and do so by executive order but states that opt in will get the funding.

I know they could eliminate filibuster in the Senate but neither party wants to lose that option really. My guess is if Obama is not returned to office and the Senate shifts to the Republicans they will do some reforms both parties can live with and not really do much more. If it gets dirty the Democrates can likely stall a full repeal since a partial repeal will not do what must be done romove the insurance company mandate, the one thing the rest of the bill is built around to make it work.

I will lastly note who says the law is bad its not in effect yet it could be a great law and do what was promised slow the costly growthof health care slowing it down. It might make more providers available and create better delivery models using the open markets creativity. If nothing else what is the plan let the poor rot bleeding the system, risking everyones lives if a pandemic hits and spurs on faster due to the uninsured not getting care when it mattered (remember HIV, polio, the early 20th century influenza outbreak) we are in a global environment it would just take one carrier to bring in something dangerous from abroad and some uninsured to get it and bammo it might come to your household. Just in my state there was a TB outbreak when they closed the state TB hospital and the poor didn't have options to get care soon enough and some of that is immune to treatments with drugs.

The law already allows States to opt-out of creating Exchanges that will then require the Fed. Gov. to set them up at no cost to the State. Has nothing to do with Romney. And several Fed Gov. funded studies and the CBO have projected that premiums will increase and that the revenue needed to subsidize premiums and establish Exchanges was far underestimated and will cost taxpayers much more that we were told just prior to the passage of the Law. Too many unknowns to give my support to Obamacare. The only portion of the law that made sense and was badly needed is the "patient protection" and Insurance regulations.

You can't have patiant protection and the insurance regulations and not have the mandate and added funding, that makes the insurer demands workable. Now the law may need work ,I agree, funding needs to be tightened up and I think the Medicaid expansion redone to say a similar coverage with more out of pocket costs and fees unless you get into regular Medicaid. And this only up to 100% of the poverty line. And the exchange subsidies should be a bit less generous at the low end.

For example we could have regular Medicaid, Medicaid Plus (for those not qualifying under the rules but on income) which would cost more to use say twice for day to day expenses in my state an office visit $10, drugs $8 and so forth and then exchanges that help a great deal but maybe less generous. And I would like a commitment states do what they can letting them free to add to the law with regulations and Federal help in new plans and ideas. If you want to add providers this must be done at the state level. One last idea Federal immunity from lawsuits for anyone providing care under plans using Federal money unless a judge panel allows a lawsuit with regs that the malpractice is adjusted down 1.25% per 1% of patiant risk removed (up to 20% of the caseload) so if Dr. Smith takes 20% government patiants his malpractice insurance drops 20% with government oversight of this. You want MD's and others that will matter if they pay $100k now and pay $75,000 it might help.

I'm not unreasonable but your not going to handle the cost increases long term unless you have a mandated universal system of some sort, show me one nation that managed that trick using capitalism as a model? Germany and other nations are not communists they just looked at the numbers and it doesn't work without such measures.

Originally Posted by hudson1955

I can't speak for anyone but myself. The problem is that there are currently no exchanges and the PPACA provides very little specific information on exchanges.
There is no guarantee that all States will have exchanges at all or that they will be up and running at the time the individual mandate takes effect.

Even the CBO was unable to guarantee that premiums through the exchanges would be less than current premiums, and many people may still not be able to afford the premiums and may not qualify for premium assistance.

There are too many unknowns and I believe private insurers and groups(similar to employee group health or group health through organizations) could have worked as well and kept the Government out of it. Thus far nothing the Government has touched has faired well.

So, it seems to be an ungrounded fear of the unknown sort of thing.

Well, I live in Massachusetts. I am self employed and buy my non-subsidized health insurance on the state run exchange. For someone like me it is an absolute godsend. Before the exchange it was impossible to find out what private health insurance cost and what was covered for my money without going through a high pressure sales pitch from a salesperson in my living room. If I wanted to comparison shop I had to put up with this multiple times. The plans I ended up with cost a lot and covered little.

Basically all the state did was set a tiered criteria for coverage and a allow insurers and direct providers to offer plans that meet those criteria. The exchange is also open for small business employers. It is hugely popular. No politician in this state can be against it and hope to get re-elected.

The plans offered on the exchange all offer the same extremely comprehensive coverage, better than many corporate plans my friends are enrolled in. The only real difference is how much of the expense you are willing to take on yourself. Co-pays are $15-30 in all the plans. Routine exams and preventive care are free. Deductibles vary from zero to $2,000 depending on the plan you choose. The absolute maximum out of pocket expense is $5,000, and that is only for the cheapest plans. The most expensive have zero deductible and zero out of pocket. There is no upper limit on care. They will pay whatever it takes to fix you. There is no exclusion for pre-existing conditions.

I have saved many thousands of $$$, have far better health insurance than I ever had before and cannot be bankrupted by health care expenses. My premium has not gone up for next year and I just got a rebate check. If I was in my twenties I could get a plan that cost less than $100 a month. This is hugely attractive to the entrepreneurial set from MIT and Harvard and all the Tech companies already here, which is all of them. They can strike out on their own and not have any worries about health insurance coverage, which can be quite problematic in other states. Massachusetts has gained an edge in keeping cutting edge entrepreneurs here. It is far more difficult for a tiny start up to get health insurance for its people in Texas or California than it is here, and if your lead programmer has diabetes.....

At the beginning there were only four providers on the exchange but that has now expanded to seven. It apparently has a lot of appeal for health care providers. The demographic is ideal, higher income self employed or small business people since everyone with an adjusted gross income of less than $40,000 or so can get a subsidized plan and that is not us.

The PPACA has funds for the states to set up exchanges. If they fail to do so the Feds will use those funds to set one up for them. The mere fact that shoppers would be able to compare coverage and premiums on line would be a huge improvement for everyone, except maybe those who sell insurance. Hmmmm.....why again are the republicans so against the exchanges? Are they really going to toss the people under the bus to protect insurance salesmen?

You can have regulation of Health Insurance Companies and protections for insureds without the mandate and added funding. The mandate is only necessary due to requiring companies to insure non-group coverage for individuals who have already been diagnosed with illnesses that will require costly surgery or ongoing costly treatment and full payment of preventative tests. Insureds should atleast be responsible for their co-payment for preventative test. Those insureds with pre-existing conditions requiring surgery or continued care should be insured through high-risk groups or added to the Medicare program by creating another part to Medicare, say for example Medicare Part E that covers high-risk individuals and that requires they pay premiums for the coverage that will cover a certain percentage of the Governments cost to insure them. To do otherwise will cause others premiums to increase, not decrease and instead of paying for the uninsureds seeking ER treatment we will be paying far more to subsidize premiums and pay for pre-existing coverage and preventative testing.

Hmmmm.....why again are the republicans so against the exchanges? Are they really going to toss the people under the bus to protect insurance salesmen?

Originally Posted by hudson1955

Hmmmm.....why again are the republicans so against the exchanges? Are they really going to toss the people under the bus to protect insurance salesmen?

You don't understand the law, it is a money maker for insurance companies due to the mandate, they won't lose money but will make money, while the current insureds will see their premiums rise due to subsidizing premiums for the current uninsureds.d

And, Exchange does not mean cheaper or affordable premiums. And, those with costly pre-existing conditions that require expensive future surgery and continued medical treatment should be insured through a high risk plan. Mandating that insurance companies cover them is going to increase everyones premiums far more than we currently pay for those uninsureds that receive free care by providers and hospitals and visit ER's

The law is the best we are going to get save it can be modified or worked with, face it there is not going to be a one payer system or any reforms unless insurers, medical providers and drug companies have their interests they will want to make money and get things they want out of it. This is the USA not Europe and not a communist state one leg of our society is private companies.

As for medical care the reason for the individual mandate is to get everyone into insurance or Medicaid they can based on ability to pay. Are some of you ignorant to the fact a poor person needs insurance they can afford to use for health care seeing doctors, getting medicines, going to hospitals and be not financially broken? Lets say I worked my normal hours and number of days and earn $9,000 a year how exactly can I afford a premium, co-pays and related costs without serious help paying for this? I'm not a criminal, I'm not a bad person just a disabled man with issues that doesn't want to go on SSI and be more of a burden taking your tax dollars. But if I end up going blind or losing a foot or something at some point I will need all I can get if I get medical care I could maybe avoid this altogether being less of a burden just needing some help with medical care.

And there is no free care in my state the hospitals can't bill me that is true but everyone else can if they choose to so far I was able to avoid collections, some opt not to try and others take payments and work with me. But I still have cerebral palsy, a bad heart and low level diabetes all uncared for with no drugs or regular medical care.

Something must be done and the Republican have no plan to replace ACA with so why would I trust them to repeal and replace with anything in time to help me if they replace at all?

we were suppose to get ObamaCare.. that included a public option, what we got instead was CongressCare with the conservatives individual mandate


.

I did come up with a way to help states on the Medicaid expansion since its a loophole in the law, and propsed this to my Republican state senator. Here it is just drop everyone currently on Medicaid and the new people and auto re-enroll them under income this will immediately drop the state costs to ZERO and reduce the costs longterm with an impressive 45 cent savings per dollar (we pay 55 cents and the Feds 45 cents currently). It will of course burden the Fed side but that is not the states problem and they just need to find the money.

Originally Posted by hudson1955

You don't understand the law, it is a money maker for insurance companies due to the mandate, they won't lose money but will make money, while the current insureds will see their premiums rise due to subsidizing premiums for the current uninsureds.d

And, Exchange does not mean cheaper or affordable premiums. And, those with costly pre-existing conditions that require expensive future surgery and continued medical treatment should be insured through a high risk plan. Mandating that insurance companies cover them is going to increase everyones premiums far more than we currently pay for those uninsureds that receive free care by providers and hospitals and visit ER's

Part of the law requires health insurers to spend 80% of their premiums on care. If the spend less they are required to give rebates to policy holders. States are allowed to set higher rates for this. Massachusetts has set a rate of 88% and just I got a rebate. Insurers are also required to take on people with pre-existing conditions and are not allowed to set annual or lifetime limits for care. This is no windfall for insurers and some of the most profitable in the past are considering getting out of the business entirely since their high profits came from spending less than 80% on care, denying coverage for people with pre-existing conditions, putting annual and lifetime limits on care, arbitrarily dropping coverage and other things they are now prohibited from doing.

I live in Massachusetts, am self employed and buy my insurance through the state run exchange and it covers more for less money than any plan I could get before. Over 96% of the people in Massachusetts now have health insurance and the cost of caring for the uninsured has declined precipitously. Premiums have not gone up by double digits every year like in the past either, in fact this years premiums have not gone up at all and are slated to go down next year because emergency room use, a huge expense for hospitals, has declined so much because so many of the people who used to go to them can now see a local doctor instead.

One thing a lot of people do not understand is that everyone already pays for the uninsured and these free riders increase the cost of health care for everyone. Hospitals are required to treat everyone who shows up in their emergency room. It is far cheaper to get these free riders, many with chronic conditions, into a managed care situation via insurance than leave them to go to emergency rooms when their condition deteriorates into a crises. It saves money for everyone.