The unofficial Obamacare thread...

[Ohdang]

Employer provided. My deductible went from $500 when I started to $1500 now. I pay $96 a month for it, just me, no family. Its still really good insurance comparatively speaking, but its getting worse every year.

 

[gourimoko]

Employer provided. My deductible went from $500 when I started to $1500 now. I pay $96 a month for it, just me, no family. Its still really good insurance comparatively speaking, but its getting worse every year.

I guess I'm still not understanding how you are correlating the ACA with the poor practices at the facility you work with? Not to sound dense, but could you connect the dots for me?

 

[Ohdang]

I'm at work right now so I'll have to be brief but the problems stem from how we are paid for services we perform.

Under the old system we would treat anyone who didn't have insurance or a way to pay and eat the cost. This would be a major expense for the hospital but we'd make it up with patients who did have insurance or from Medicare.

Under the new system we are seeing less people without insurance, and that is good, but we are being paid so much less for everything we do that it's actually costing us more money now to treat insured people than it did before to treat a mix of insured and uninsured people. The response has been to cut staff, supplies, etc to stay afloat. We aren't a for profit entity so it's not even profitability that's the concern, it's providing adequate care while being able to afford to stay open.

The lab specifically is hurting because people who "feel fine" are declining tests for prevention or early detection due to inflated deductibles and out of pocket costs. This is bad because prevention is cheap and easy and treating a disease after the fact is difficult and expensive.

Say we get a patient where the physician suspects meningitis because of the clinical picture he has. He doesn't know if it's bacterial, viral, or fungal so he orders labs. We run tests and report that it's bacterial and what antibiotics are effective against that particular species so the physician knows how to treat. We get reimbursed for our microbiology testing at about 70% of previous levels and it's determined that our testing in virology and mycology was an unneeded expense and won't be reimbursed. Hospital eats that cost and loses money. Can no longer make up that loss by profit margin on other tests due to reduced reimbursement, lays off a worker.

Shitty system before, but I kind of want it back.

 

[The Human Q-Tip]

Well, we've got a couple of recent developments. The first is the Supreme Court granting cert. in King v. Burwell, where the plaintiffs argued that subsidies are only available through State-run exchanges, meaning that they wouldn't be available in the 34 states that use the healthcare.gov federal exchange.

That's a very big deal, because the whole employer mandate is premised on the grant of subsidies. No subsidies, no employer mandate/tax. It also really reduces the individual mandate because the lack of subsidies will make insurance not "affordable" for many people, which means the mandate doesn't apply. Essentially, this kills most of Obamacare in states that choose not to run their own exchange.

I personally think there's a stronger argument here than there was for the individual mandate case that was heard in 2012.

The second Jonathan Gruber, the MIT economist who has been called the "Architect of Obamacare", being caught making repeated statements that the passage of Obamacare was premised on it not being transparent, and on the "stupidity" of the American people. Although based on the election results, it seems like us "stupid" Americans may have figured it out. Here's the refreshingly blatant bit of elitism causing the ruckus:

http://www.forbes.com/sites/theapot...ares-tax-hikes-and-subsidies-from-the-public/

 

[bob2the2nd]

Well, we've got a couple of recent developments. The first is the Supreme Court granting cert. in King v. Burwell, where the plaintiffs argued that subsidies are only available through State-run exchanges, meaning that they wouldn't be available in the 34 states that use the healthcare.gov federal exchange.

That's a very big deal, because the whole employer mandate is premised on the grant of subsidies. No subsidies, no employer mandate/tax. It also really reduces the individual mandate because the lack of subsidies will make insurance not "affordable" for many people, which means the mandate doesn't apply. Essentially, this kills most of Obamacare in states that choose not to run their own exchange.

I personally think there's a stronger argument here than there was for the individual mandate case that was heard in 2012.

The second Jonathan Gruber, the MIT economist who has been called the "Architect of Obamacare", being caught making repeated statements that the passage of Obamacare was premised on it not being transparent, and on the "stupidity" of the American people. Although based on the election results, it seems like us "stupid" Americans may have figured it out. Here's the refreshingly blatant bit of elitism causing the ruckus:

http://www.forbes.com/sites/theapot...ares-tax-hikes-and-subsidies-from-the-public/

the easiest argument is simply that Obamacare gave the states a choice to set up their own exchange or allow the feds to do so. Is the argument going to be the Act itself was INTENTIONALLY written in such a way to allow for the downfall of itself. 60 senators and 217 representatives wrote and passed a bill, that could be easily undone, by simply allowing the states to do what is in the bill? No chance in hell that stands in court-which it hasnt.

two if you are going to stick to your argument, which member of the 5 SCOTUS judges that voted in favor of the bill the first time do you expect is going to switch votes?

 

[The Human Q-Tip]

the easiest argument is simply that Obamacare gave the states a choice to set up their own exchange or allow the feds to do so. Is the argument going to be the Act itself was INTENTIONALLY written in such a way to allow for the downfall of itself.

The intent behind the Act doesn't trump the express language. It's not the responsibility of the courts to fix a legislative mistake. If that's what it was.

But I think the language limiting subsidies to state exchanges was deliberate -- they just didn't anticipate the reaction of the states.

It is perfectly reasonable to believe that folks who drafted that law preferred that the states, not the federal government, establish the exchanges. However, the federal government could not (for constitutional reasons) just require the state governments to establish those exchanges It had to do it via incentives, like it did with the Medicaid expansion, or like it does with highway funds. "We'll give you money if you do what we want."

So with the ACA, the incentive for states to establish their own exchanges is that their citizens will get subsidies if they do, but the citizens won't get those subsidies if a state doesn't create an exchange. And, they figured the law would be so popular that very few states, if any, would refuse. Those that refused anyway, thereby depriving citizens of a subsidy paid by the federal government -- would be swallowed in a tidal wave of negative public opinion.

The mistake was miscalculating opposition to the law. States preferred to turn down free money for those citizens rather than create the exchanges. Oops.

The kicker is that old Gruber himself -- "the architect of the ACA" -- is on tape on saying that limiting subsidies to state exchanges was a deliberate choice intended to heavily incentivize states to set up their own exchanges. He's validated the argument made by the Respondents that it was a deliberate choice. So the "why would they sabotage their own law" argument fails because they did not expect their actions to result in states refusing to create exchanges. The choice was deliberate -- it was the consequences that were unintended.

Now if you are going to stick to your argument, which member of the 5 SCOTUS judges that voted in favor of the bill the first time do you expect is going to switch votes?

I obviously can't guarantee that the Respondents will win -- I'm simply pointing out that it is a better legal argument than with the last case. If I had to pick someone who would switch, the obvious choice is Roberts, who was all set to throw it out last time but changed his mind very late in the process .

Whether he will or not, I don't know. It's easier to toss it for this because it is a statutory rather than constitutional issue, so there is not the normal 800 lb gorilla of having to construe in favor of constitutionality if at all possible. He also already proved that he was non-partisan the last go-round, so that would be less of a concern as well.

It's a very good argument, though. Plain language is a bitch to get around.

 

[Jack Brickman]

My health insurance went up four dollars a pay period pre-tax. Thanks Obama!

 

[Cavsfan1985]

I just got doing my benefits, my premium just went up 25% at work, $180/check to $225/check, and the deductible went from 2500 to 4000 until I go to 80/20 cover, I do not get 100% cover until; my out of pocket is 10K, and the HSA contribution from the company went from 1500 to 1000. Overall, I will spend 3K-4K more this year on healthcare. The company shared the stats, that those over 50 spent 75% of the overal healthcare spend for the company, and those who smoke heath care costs were 65% more the those who where not. They added a $25/check smoking surcharge which I am glad, but my costs still went up.

I paid $4,680 in premiums this past year, and my family and I just spent a little over $700 total in all healthcare costs which I paid out of pocket outside of the free annual physical.

I understand that it is insurance and you have the coverage if you need it. But when I started with the company it was $90/pay period for a family, with 80/20 coverage up to $2000 which it went to 100%, with copay's of $20.

Just fun to see the effect government has on those of us who do the right thing, go to college, work hard get a good job. They find other ways to take money out of my pocket.

Just to show the math,

Before - max total out of pocket was, $2340 premiums + $2000 max = $4340
Now - Max total out of pocket, $6500 premiums + $10,000 dedutible - $1000 HSA = $15,500

The biggest hit to me is the premiums, going up over $4,100 the past few years.

 

[The Human Q-Tip]

Well, that was part of what Gruber was talking about in terms of a lack of transparency being a virtue. The ACA was oversold -- more people would be covered, the coverage would be better, care would be better, and it would be cheaper. The proverbial free lunch.

The truth is that it essentially amounts to all the folks who had good coverage subsidizing those who didn't. The Gruber videos out there are really fascinating because they're so bluntly honest. He said it never would have passed if you'd have told all the people who were satisfied with their coverage that their coverage would be more expensive than it would have been otherwise.

You're paying more because that's the inevitable result of more mandated benefits -- such as no lifetime limits, no pre-existing coverage, and other mandated "improvement" to the insurance your employer provides.

 

[Maximus]

 

[Maximus]

This Democrat Is Giving Up on ObamaCare
The disastrous rollout of the Affordable Care Act was the catalyst for my party’s midterm thumping.
By
BURKE BEU
Nov. 13, 2014 6:00 p.m. ET
16 COMMENTS
I grew up in a Democratic family. I have been a registered Democrat since age 18, a Democratic candidate for statewide office in Colorado and a party precinct captain in that caucus state. I’ve volunteered for numerous Democratic candidates and contributed to party causes and campaigns. The 2014 election results were extremely disappointing for me, but hardly a surprise.

I voted for Barack Obama in 2008, then lost my job in the Great Recession. I was lucky; my brother lost his job and his house. I survived on part-time jobs while paying out-of-pocket for my health insurance.

I voted for President Obama again in 2012, then received a cancellation notice for my health insurance. This was due to ObamaCare, the so-called Affordable Care Act. However, I couldn’t afford anything else.

Midterm elections in the second term of a presidency are difficult on the president’s party, and the Obama administration’s crisis-of-the-month headlines weren’t helpful. Ultimately, though, ObamaCare was the catalyst for my party’s midterm thumping.

ENLARGE
White House press secretary Josh Earnest speaks about Medicaid and the Affordable Care Act in July. ASSOCIATED PRESS

ObamaCare is a failure. For anyone who thinks this is a misprint because no Democratic activist would make such a comment, let me add that it is too big, too complicated and too expensive. Without a public option within its network of exchanges, ObamaCare is a giant blank check to the insurance companies that pushed it through Congress. It punishes responsible consumers like me and treats younger individuals as fools who are expected to pay the bills while not paying attention.

Now we learn in videos that came to light this week that Jonathan Gruber, MIT economist and a key architect of the Affordable Care Act, proudly relied on his perceived “stupidity of the American voter” as the basis for designing ObamaCare. Such comments, along with the program’s notoriously dysfunctional website and false assurances that people can keep their previous health plans, are insults to every citizen regardless of party.

Contrary to Medicare, which was quickly accepted at a time of economic vitality as a meaningful complement to Social Security, ObamaCare was the sequel to an overpriced economic stimulus package that didn’t stimulate very much. Those least affected by the recession benefited the most from the stimulus. I think that’s called “trickle-down economics” when Republicans do it, and the economy continues to struggle for good jobs and a real recovery. ObamaCare is part of the problem, not a solution.

For most Democrats in Congress, Medicare was originally a model for health-care reform. Single-payer, universal coverage was the favored approach. Then Republicans let loose the “socialized medicine” boogeyman and Democrats panicked.

Fearful that doing nothing was worse than doing the wrong thing, Democrats gave up on Medicare for the masses and opted for a drastic alternative. ObamaCare is an outrageous combination of private-market inflation, government bureaucracy, excessive mandates and a ridiculously delayed implementation schedule. When the thing finally kicked in, it hit hard—and there is plenty more pain on the way.

Worst of all, ObamaCare looks and feels exactly like what it is: a health-care plan devised by lawyers and corporate executives rather than true health-care providers. Democrats are top-heavy with attorneys, and this hurts the party on many issues.

If Hillary Clinton is looking for an immediate opportunity to distance herself from the Obama administration, she should promise to appoint a licensed health-care professional, such as a physician or registered nurse, as her secretary of Health and Human Services if she is elected president. I know she hasn’t announced her candidacy, but the time has come to stop playing coy.

We Democrats need to get over ourselves, start anew on a national health-care policy, and return to our progressive principles. We claim to be the party of the underdogs, but on ObamaCare we simply catered to a different set of fat cats.

We resent Republicans who act morally superior and pretend to have a monopoly on patriotism, but an elitist attitude doesn’t look any better on us when we refuse to admit that ObamaCare is broken beyond repair. Measurable outcomes and actual effectiveness are the honest indicators of a successful program, not good intentions or high hopes.

We say that we are the party of the people, but “the people” too often become a singular, monolithic concept for us. We speak for the people, don’t you know, because we can decide what is best for them so they really don’t need to speak for themselves.

The people decided otherwise on Election Day. I hope my party is listening. When the next Congress convenes in 2015, Democrats need to work with the new Republican majority, repeal ObamaCare, override a presidential veto if necessary, and start from scratch on health-care reform.

 

[Ohdang]

it pains me greatly to know the Republicans will use the repeal of the ACA as a giant victory celebration and a booster seat for their high horse, but it still needs to go.

 

[MalTalm]

This Democrat Is Giving Up on ObamaCare
The disastrous rollout of the Affordable Care Act was the catalyst for my party’s midterm thumping.
By
BURKE BEU
Nov. 13, 2014 6:00 p.m. ET
16 COMMENTS
I grew up in a Democratic family. I have been a registered Democrat since age 18, a Democratic candidate for statewide office in Colorado and a party precinct captain in that caucus state. I’ve volunteered for numerous Democratic candidates and contributed to party causes and campaigns. The 2014 election results were extremely disappointing for me, but hardly a surprise.

I voted for Barack Obama in 2008, then lost my job in the Great Recession. I was lucky; my brother lost his job and his house. I survived on part-time jobs while paying out-of-pocket for my health insurance.

I voted for President Obama again in 2012, then received a cancellation notice for my health insurance. This was due to ObamaCare, the so-called Affordable Care Act. However, I couldn’t afford anything else.

Midterm elections in the second term of a presidency are difficult on the president’s party, and the Obama administration’s crisis-of-the-month headlines weren’t helpful. Ultimately, though, ObamaCare was the catalyst for my party’s midterm thumping.

ENLARGE
White House press secretary Josh Earnest speaks about Medicaid and the Affordable Care Act in July. ASSOCIATED PRESS

ObamaCare is a failure. For anyone who thinks this is a misprint because no Democratic activist would make such a comment, let me add that it is too big, too complicated and too expensive. Without a public option within its network of exchanges, ObamaCare is a giant blank check to the insurance companies that pushed it through Congress. It punishes responsible consumers like me and treats younger individuals as fools who are expected to pay the bills while not paying attention.

Now we learn in videos that came to light this week that Jonathan Gruber, MIT economist and a key architect of the Affordable Care Act, proudly relied on his perceived “stupidity of the American voter” as the basis for designing ObamaCare. Such comments, along with the program’s notoriously dysfunctional website and false assurances that people can keep their previous health plans, are insults to every citizen regardless of party.

Contrary to Medicare, which was quickly accepted at a time of economic vitality as a meaningful complement to Social Security, ObamaCare was the sequel to an overpriced economic stimulus package that didn’t stimulate very much. Those least affected by the recession benefited the most from the stimulus. I think that’s called “trickle-down economics” when Republicans do it, and the economy continues to struggle for good jobs and a real recovery. ObamaCare is part of the problem, not a solution.

For most Democrats in Congress, Medicare was originally a model for health-care reform. Single-payer, universal coverage was the favored approach. Then Republicans let loose the “socialized medicine” boogeyman and Democrats panicked.

Fearful that doing nothing was worse than doing the wrong thing, Democrats gave up on Medicare for the masses and opted for a drastic alternative. ObamaCare is an outrageous combination of private-market inflation, government bureaucracy, excessive mandates and a ridiculously delayed implementation schedule. When the thing finally kicked in, it hit hard—and there is plenty more pain on the way.

Worst of all, ObamaCare looks and feels exactly like what it is: a health-care plan devised by lawyers and corporate executives rather than true health-care providers. Democrats are top-heavy with attorneys, and this hurts the party on many issues.

If Hillary Clinton is looking for an immediate opportunity to distance herself from the Obama administration, she should promise to appoint a licensed health-care professional, such as a physician or registered nurse, as her secretary of Health and Human Services if she is elected president. I know she hasn’t announced her candidacy, but the time has come to stop playing coy.

We Democrats need to get over ourselves, start anew on a national health-care policy, and return to our progressive principles. We claim to be the party of the underdogs, but on ObamaCare we simply catered to a different set of fat cats.

We resent Republicans who act morally superior and pretend to have a monopoly on patriotism, but an elitist attitude doesn’t look any better on us when we refuse to admit that ObamaCare is broken beyond repair. Measurable outcomes and actual effectiveness are the honest indicators of a successful program, not good intentions or high hopes.

We say that we are the party of the people, but “the people” too often become a singular, monolithic concept for us. We speak for the people, don’t you know, because we can decide what is best for them so they really don’t need to speak for themselves.

The people decided otherwise on Election Day. I hope my party is listening. When the next Congress convenes in 2015, Democrats need to work with the new Republican majority, repeal ObamaCare, override a presidential veto if necessary, and start from scratch on health-care reform.

Somehow I missed the headline and started reading this as a Maximus post. I was about to call bullshit on you being a Democrat and voting for Obama in 2008

 

[The Oi]

From what I know about @Maximus, he did technically grow up in a Democratic household.

 

[Soda]

From what I know about @Maximus, he did technically grow up in a Democratic household.

Are you calling @Maximus black?

Before someone suggests I'm saying it's bad to be black, I'm not. Marcia Fudge commented that the reason the Democrats lost the mid-term elections is because black folks didn't turn out. Might be true, but quite a generalization (saying all black folks are Dems) for someone who's platform thrives on individual/human rights.