News Count Me As Grateful For The Changes Coming In Us Health Care

[The Albatross]

Already heard that the January deadline will be extended perhaps to March... as they need 7 million participants in the program for it to work (Aetna CEO source). Some have said that they thought the gliches are US government bungling... others say intentional. I don't know. But what I do know is that the award for the design of the ACA website was a no bid award for a company with a reputation for governmental experience and who also had experience.

So this is really no big surprise, right?
Obamacare Web Program Developed By CGI (No-Bid Contract) Who Own SIlver Oak Solutions Who Developed PRISM Cyber Collection For NSA As Revealed By Edward Snowden

Hmmm, hmm hmm. I sure do love where this is going... not. Truth stranger than fiction? Yeah, but whether ACA stands or not I flat out don't like the way my government does business, governs, or plays politics with my livelihood and my tax dollars.

 

[anthony]

I don't know what any American honestly expects from a capitalist country model. Sorry, but the country model equals every man, woman and child for themselves, and not what is best for the collective or country. You can't have collective health care that works effectively based on the underlying economic model, because that model isn't structured to take from all and provide the poor basic rights to life. That is socialism, a dirty word within America, yet works effectively in many countries outside America.

 

[The Albatross]

Misleading consumers with the new browse feature? Great going. If a private sector company did that there would be hell to pay... but never mind, it's the government so it's all in bounds right?

[DLMURL="http://www.conservativeintel.com/2013/10/23/new-feature-healthcaregov-now-lies-to-you-about-what-youll-pay-in-premiums/#"]New feature: @HealthCareGov now lies to you about what you’ll pay in premiums[/DLMURL]

Yeah, America runs on free markets, or rather it did until ACA/Obamacare.

Fact Checking Websites Twist Cruz's Obamacare Comments
"Cruz is using inflated rhetoric. We rate his claim False.”

"The fact-checking websites of the left consistently do a wonderful job of pushing for prearranged conclusions. Nowhere has that been truer than this week’s fact-checking assault on Senator Ted Cruz (R-TX), who spelled out several problems with Obamacare as he continued his campaign against the damaging law.

This week, for example, Cruz stated that seniors were losing their health plans thanks to Obamacare. That is indisputable fact, given the fact that some 300,000 Floridians were cancelled from their health insurance plans. Yet liberal Factcheck.org wrote, “a drop in the number of plans does not mean a drop in the number of persons covered.” They should tell that to the seniors who have had their number of plans dropped from one to zero in the short term. Factcheck.org also nitpicked that Cruz said that people with disabilities were “losing their health insurance…right now.” They correctly pointed out that “most of the 9 million will be unaffected now and for at least three years.” But they neglected to mention that according to Kaiser, California’s Obamacare rollout will hit 456,000 enrollees, Illinois nearly 136,000, Minnesota 36,000, and thousands more across the country. Being shifted from private insurance to Medicaid is a move down, not up. And the number of plans available to the disabled is expected to drop significantly.

In typical Factcheck.org fashion, even the claims that Factcheck.org does not dispute are deemed to be untrue. When Cruz claimed that seniors “are facing higher prescription drug costs” – a fact undisputed even by Factcheck.org – FactCheck.org simply concluded that while costs rise on average, some seniors could face lower costs. Presumably if Cruz had pointed out that average life expectancy has risen over the past several decades, FactCheck.org would point out that some people died young. Similarly, Cruz claimed that “families of special needs children will face a new penalty for using savings to pay for medical therapies and health-related expenses.” FactCheck.org doesn’t dispute that fact either, but tries to claim instead that “advocates for these families say Cruz overstates the impact and ignores the benefits these families will receive from the Affordable Care Act.” In other words, Cruz is right, but FactCheck.org doesn’t like that he is.

FactCheck.org concluded, falsely, “Cruz Distorts ACA Impact on Seniors, Children.” The same could be said for FactCheck.org’s analysis, which distorts Cruz’s comments in order to spin Obamacare in the best possible light.

FactCheck.org isn’t the only fact-checking outlet determined to back President Obama’s signature legislation. Glenn Kessler of The Washington Post claimed that “Sen. Ted Cruz (R-Tex.) continues to make assertions about the law that have puzzled and concerned readers. But it’s hard to know where to begin, as he repeatedly uses language that sketches the law in apocalyptic terms, even though the law has barely begun to be implemented.” Which readers are concerned? He never says. But he proceeds to minimize the damage from Obamacare by saying that if 10 million people are adversely affected, that “would be a relatively small percentage.” Which, of course, means that Obamacare is a huge waste of time, since by percentage, the 30 million people without insurance President Obama constantly harped on were a small percentage. Even Kessler is forced to admit that “some people…will have sticker shock.” He just thinks that’s not a huge problem – which is a perspective, not a fact-checking exercise. In the end, Kessler grants Cruz “two Pinocchios” for saying that millions will be hurt by Obamacare, even though it’s obvious that Cruz is exactly correct.

And Politifact got into the act, too, claiming that Cruz’s claim that “virtually every person across this country has seen premiums going up and up and up” thanks to Obamacare was false. But Politifact then quoted Robert Laszewski, a health insurance consultant and head of Health Policy and Strategy Associates, who said, “In the large employer market where most under-65 folks are, the Obamacare increase is a very few percentage points, like 2 points.” In other words, an increase, just as Cruz claimed. And again, Politifact recognized that in the individual market, “For some, those changes [from Obamacare] can translate into higher premiums.” Nonetheless, Politifact concluded, “Cruz is using inflated rhetoric. We rate his claim False.”

Actually, it is the fact-checkers who are using inflated rhetoric when they claim that they are checking facts rather than presenting their own opinions."

 

[DharmaGirl]

but the country model equals every man, woman and child for themselves, and not what is best for the collective or country.

Amen! This is not a "the best for all country". I am saddened by how cutthroat people can be. I happily paid my taxes knowing that people who were unable to work, or care for themselves. I know this isn't popular opinion.

 

[The Albatross]

[DLMURL="http://www.freedomworks.org/blog/lt1800/obamacare-services-repaid-by-your-heirs-after-you?source=twitter&awesm=freedo.mw_h11"]Obamacare Services Repaid By Your Heirs After You Die?[/DLMURL]

We all know that Nancy Pelosi said "we need to pass the bill to know what's in it," but one of the more insidious problems with Obamacare relates to the rules already in place for Medicaid, and the attempt to move as many applicants to Medicaid as possible.

An application for the Oregon Health Plan / Healthy Kids program - our version of Medicaid - contains the following passage:

"When a person that received OHP/HK [Oregon Health Plan / Healthy Kids] dies, OHA [Oregon Health Authority] or its designee may recover from the "estate" (as defined in ORS 416.350) of the person the amount of OHP/HK received by the person starting at age 55. This includes monthly payments made by OHA or its designee to coordinated care organizations. In cases where the person receiveing benefits is in an institution (such as a nursing home) for 6 months prior to death, the state will recover money for all OHP/HK provided regardless of age when received. OHA or its designee will not claim this money if the person receiving benefits is survived by a natural or adopted child that is under age 21, blind, or meets Social Security Administration criteria as permanently and totally disabled. If the person receiving benefits is survived by a spouse, OHA or its designee will wait until the spouse dies and submit a claim to the spouse's estate."

This is where things get crazy. This estate encumberance is not new to Obamacare, but the expansion of Medicaid under Obamacare is. As of today, not a single person in Oregon has signed up for private insurance through the private exchange. Instead, applicants are being told (when they are actually able to complete a paper application) Medicaid is their ONLY OPTION. And it's happening at an alarming rate.

A friend of mine in the know relates the following scenario: "Cover Oregon covers both Medicaid (Oregon Health Plan) and insurance (companies in the exchange). If you are at 138% of the poverty level, you qualify for Medicaid - and that's where cover Oregon will try to sign you up. If you are in Medicaid, they can recoup some costs from your estate. The example I heard was over a certain amount of assisted living before you die. If you are over the Medicaid line, you can get subsidies for the insurance plans through the exchange. But if you qualify for Medicaid but don't want it because of the estate issue, you're in a serious bind. You can still buy a plan through the exchange instead of Medicaid, but you won't qualify for the subsidy because you already qualify for Medicaid. They are coaching those people to inflate their income to get over the Medicaid line. And it only applies to Medicaid / Oregon Heath Plan - not private insurance bought through the exchange. This is where the working poor are getting the worst possible deal. If they qualify for Medicaid, they can't get subsidies for the exchange plans that people making more money qualify for. So they are forced onto Medicaid with the estate lien liability. Just another example of the Frankenstein's Monster that is Obamacare."

His point is well taken: the two parts of Obamacare - the nonfunctional exchanges and the expansion of Medicaid - are creating a two tier health care universe. When the exchange plans get more and more expensive, they will do the obvious and compassionate thing and continue to increase the income threshold to qualify for Medicaid. Service on Medicaid was already problematic, and in many cases providing substandard care. Imagine how bad it will be after untold numbers of new users are added to the system. The end game will be very much like the NHS in Great Britain (which I've blogged about previously) - If you have a good job, you get private insurance. If not, you are on single payer (Medicaid), forever relegated to the welfare system. And there you'll be an indentured servant, even after you die.

 

[Sweetpea76]

The change in policy from the ACA forced my insurance company to cover a biopsy that saved my life. I would have had to wait an additional 4 months for it otherwise.

 

[DharmaGirl]

You can still buy a plan through the exchange instead of Medicaid, but you won't qualify for the subsidy because you already qualify for Medicaid

I'm in the same boat. I don't want Medicaid because my therapist doesn't take it, I have a 2,300 spend down to meet Medicaid standards, and I have to pay full price for the exchange since I "qualify" for Medicaid. I will continue paying COBRA since my therapist accepts it and I've had my doc for 7 years. She knows me so I don't get stressed out. I get Medicare in June.

 

[Pietro]

There were a number of things, regarding insurance and coverage, that needed to be addressed in order to ensure that the country has a viable medical infrastructure, both technically and economically. This includes coverage for procedures that are considered "standard" but which, previously, insurers could simply ignore if they chose, as @Sweetpea76 mentioned. In general, there was enormous good that could have come-out of working through this in a thorough and thoughtful manner.

That's not what we've gotten. The current situation involving ACA, Medicaid, and Medicare is so complicated and full of holes that, in the long run, it will not only prove to be largely ineffective, it will cost an absolute fortune because of all the built-in inefficiencies.

I gave it a chance. I watched the rollout and played with the site myself (the site is another issue ;) ). I looked into what benefits there are, the changes, etc. Yes, in the short term, more people, at a certain income level, will be able to get access to health insurance. And some of the issues that needed to be handled have been. But, overall, the plans being offered now are of a lower quality of coverage, or significantly more expensive. This is not entirely the fault of the government -- the insurance industry is doing its absolute best to take advantage of the situation by eliminating more costly plans -- those with lower deduction thresholds -- and replace them with plans that not only meet the new ACA standards, but also end-up more profitable for them. This is not entirely a reaction to ACA -- the insurers had, apparently, already been planning on moving in this direction.

What we should have gotten was a general set of playing rules for minimum insurance standards, such as including mental health coverage and continuity of coverage; a revamping of the three government medical programs into one single program; and a simplification of the bureaucracy that simply provides subsidies to those who earn them, but, otherwise, allows everyone to simply get insurance wherever they want, as they do now. Along with this, they should have created a catastrophic illness fund that all insurers pay into, in order to deal with the major illnesses that can cause financial problems for the insurers -- this would have lowered costs for insurance significantly across the board. And they should have finally removed the general link between employment and health insurance, because this link makes it more difficult for contractors and self-employed people to afford insurance.

In short, there is much that should have been done, and wasn't. There is much that was done, and shouldn't have been. Instead of simply setting-up the playing field, they decided they were going to field both teams as well, which makes for a very biased and sloppy game.

 

[The Albatross]

My spouses insurance provider had us sign a "smoker/non smoker affidavit". I was honest. Shortly before that we were notified that we only will be able to use three pharmacies: Sams, Walmart or Walgreens. I picked my pharmacy specifically because of my pharmacist and his team are willing to look up and be diligent about my allergies. Don't have the same confidence in any of the three as I was briefly a pharmacy technician at one of the three... and it was the only job I ever walked off of.

We are not in the exchange, yet our choices are limited and our costs are increasing... and they only cover my apnea supplies (mask, tubing, filter, etc) after a $1200/yr deductible. Our insurer is all up in the middle of Obamacare.

We are seriously looking for private alternatives and looking to ditch his employer benefit now.

Edited to add: This same insurer will not allow the name brand med and forces me to use a substandard allergy generic med that includes filler ingredients I'm allergic to like talc and corn starch... even though two doctors said "NO Generic" on my prescription. They also would not allow the pediatric name brand drug even though it contains no dairy... I am allergic to dairy which would have been 2 5mg Singulair instead of 1 10mg Singulair. On the generic I am not managed and have to judiciously use two meds about 8-15 times a month which sets me up for other issues. It wasn't easy, but it is a whole lot harder now.

We get re-evaluated in October 2014 and we are pretty much expecting spousal coverage to be dropped by his employer... if not both of us. Not a happy camper and pretty pissed off, frankly.

 

[Pietro]

This same insurer will not allow the name brand med and forces me to use a substandard allergy generic med that includes filler ingredients I'm allergic to like talc and corn starch... even though two doctors said "NO Generic" on my prescription. They also would not allow the pediatric name brand drug even though it contains no dairy...

THIS is the kind of crap that should have been legislated, that insurers cannot countermand a doctor's order. Hell, if you choose the brand, you're going to pay more for it, so where's the real problem? Could it be that someone gets a kickback for pushing generics instead of brand drugs? :whistling:

Shortly before that we were notified that we only will be able to use three pharmacies: Sams, Walmart or Walgreens.

This whole "in-network" thing has gotten very much out of hand. I have never accepted an HMO, because I don't want anyone telling me what medical services and products I have to use. However, it's getting more and more difficult to avoid this. And, frankly, I'm not entirely sure that the "in-network" concept really makes plans cheaper -- I think it's more about squeezing more profit from them. I'm 100% in favor of making a profit, and a good one at that. But when an entire industry begins doing things the exact same way, such that there's no longer competitive choice, you have the makings of a monopoly. And that essentially what the medical insurance industry is becoming. And ACA, the way it's currently structured, might actually be encouraging this inadvertently (or maybe not inadvertently).

We get re-evaluated in October 2014 and we are pretty much expecting spousal coverage to be dropped by his employer...

This is another crazy thing. It's going to get the point where employer-offered coverage is going to bloody worthless. Which then means that I'm left as a pool of 3 people, which means I now have to pay exorbitant rates for basic coverage, on the order of at least $800 per month or more -- close to a house payment (where I live, anyway).

I'm beyond pissed-off about this. In fact, I'm having to exert more than a little control to keep my language civil, although there's no getting around the proper term for this situation: cluster-f**k. I'm going to have to become a lot more mercenary in my outlook towards work, now, in order to afford health care.

 

[BloomInWinter]

This is a bit of good news and has rang true for the people in our community.

"Seven in 10 people who have signed up for government-subsidized health insurance coverage through federal marketplaces set up under the Affordable Care Act (ACA) have a premium of $100 a month or less, according to a new report from the Department of Health and Human Services (HHS).

Federal subsidies available for qualifying applicants have seemingly driven down the price of health care, with an average monthly premium of $82 for those choosing plans while assisted by tax credit, according to the new figures.

The report shows that 69 percent of people who selected a plan through the federal marketplace with tax credits had a monthly premium of $100 or less, and 46 percent had a premium of $50 or less.

That is compared with an average cost of $346 for insurance in the marketplace without subsidies."

http://america.aljazeera.com/articles/2014/6/18/obamacare-premiumslow100.html

I'm glad for my friends in my support group who are now finally able to afford therapy. It's been hard watching them go it alone knowing they deserve help and their financial situation was because of their abuse.

 

[DharmaGirl]

With the expanded Medicaid, I was able to get Medicaid, which was really important since I my COBRA (health care for employees who leave a job and can pay for it) payment was going up to 1,041 a month, plus deductibles, copays, and coinsurance. I would have lost my house. Now I can keep my house, and therefore my two mastiffs.