Politics Obamacare

You use the word minor. I have repeatedly stated the law is a convoluted mess, full of unknown and unintended consequences - as these consequences come to the surface we repeatedly hear about the need for minor fixes. The issue illustrated here is not a minor issue to the families involved and certainly was not necessary - who would come up with a system that would move a minor child from a family plan with coverage from a private sector company to Medicaid? The federal government is forcing states to incur unnecessary costs. In principle this is a major flaw - but I do understand and even expected your description of it being minor.

Are we going to address the inferior Medicaid outcomes? When? How?

Simple fixes? If simple what are we waiting for regarding these simple fixes? If a fix requires an act of Congress, by definition, can we call it simple?

Some Tea Party types support approaches to fixing health care insurance in ways that would not have been as disruptive as the ACA. And there are many non-Tea Party types who would throwout the ACA and go for something like single payer - are they extremists too? Or, is it that you have a blind dislike of anything Tea Party types may suggest?

 

You have stated repeatedly that you dont know what is in the ACA...that is, when you have not misrepresented it.

I have tried to explain the law as I understand (I'm not an expert, but I am confident that I know more than most), citing numerous provisions of the law, that you choose to ignore, repeating the same old rhetoric and offering no solution other than some undefined voucher system.

As an aside, I thought it was humorous when Republicans voted on the recent, 1500+ page, $trillion budget bill w/o having read the bill...after their sanctimonious criticism of Democrats voting for the ACA wi/o reading it.

I agree that this provision impacts a relatively small number of children and families, but millions of others will benefit. The overall benefits far outweigh the "fixable" deterrents.

I am all for Medicare and Medicaid reform. In fact, the ACA includes significant reforms of both, that again, you choose to ignore.

Gutting these programs in favor of a voucher system is not reform.

Yes...the fixes are relatively simple, with a cooperative and willing Congress. History is replete with examples from comprehensive health care programs.

And yes, in the current political environment in the US, a single payer system is extreme and has no chance of passage, which is why I and many just view the ACA as a small step, but one that will help millions of Americans.

 

Now I am in it. Now I have experience with the website. Now I know people who have had their hours reduced. Now I know people who lost their old insurance. Now I know what the premiums are. Now I know people who have seen dramatic increases in premiums. Etc. Etc. At one point I did not know, but I gain knowledge everyday. Don't you?

I doubt I am ignoring my own insurance. Did you go through the process for your coverage this year? Is it possible I know more about it than you? Do you have one of the "Cadillac" employer plans and are just going to be happy to have the tax paid on your behalf?

 

Ace...you're talking about one component of the ACA, that which impacted those previously with insurance on the individual market (less than 20 million total) or approximately 15% of the population.

And for every person, who lost their insurance (prior to the ACA, many lost it annually in any case as a result of no restrictions on insurers), many others (more than 40%) had their premiums reduced through tax subsidies and those who didn't now have consumer protections that were not previously available.

But I am talking about the ACA in its entirety. No longer excluding those with pre-existing conditions or dropping patients when they develop a serious illness for which you and the Republicans have offered no alternative solution, greater consumer protections for all, the provisions for free (no co-pay) preventive care that you suggested might be wasteful, the Medicare/Medicaid reforms that you chose to igore, the investments in medical technology and other cost saving programs that you also ignored when presented, etc.

 

...today. Repeated - I believe there are better ways to fix our healthcare system.

I would even support single payer over the ACA. If we intended to totally disrupt the entire system we should have gone all the way.

 

LOL if you think the GOP would allow single payer. Double-LOL

 

The fact is that the ACA is the law of the land and already working to both improve access/affordability and ultimately to lower costs.

It is unfortunate that the right would rather continue to misrepresent it with selected anecdotes rather than work in a productive manner to improve it.

 

Don't need the entire party. We have Medicare for the elderly. We have SHIP for children. We have Medicaid for the low income/disabled. When Dems passed the ACA, with no Rep. support - I believe it was Blue Dog Dems. who would not support single payer.

Either way if I was an advocate of single payer, I would not share your defeatist attitude.
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What is your experience with it?

Over the holiday's I spoke to a senior citizen with a civil service job at a Junior College who was specifically told his hours were being reduced because of the ACA. He specifically told them that he was on Medicare and did not need any other insurance. It did not matter. He was financially harmed. He is a Democrat, he supported Obamacare the previous year, now he is against it. You can pretend that "misrepresentations" are the problem - reality is that as people live through this mess fewer and fewer are happy with it. I have yet to come across an up a 26 year-old adult who benefited from being able to stay on their parents policy.

Perhaps I missed it, but are you in it? Do you have direct experience? Or are you happy with your "Cadillac" plan, have you gotten some special exemption, what?

 

Another anecdote? You spoke with a senior citizen.

Here is anecdote for you. Last year, my mother saved over $500 on prescriptions as a result of the ACA closing the Medicare donut hole.

Not an anecdote, but real data from real people More than 3 million seniors saved an average of $866 last year.

Is that a sufficient response to your conversation with one senior?

As to the bigger picture, I put together a program funded by the Atlantic Philanthropies and the Robert T Woods Foundation to provide small grants to 20 cities to enable those cities to help uninsured or underinsured residents get access to quality affordable insurance through the ACA. As part of the project, I have participated (via video conferencing) in city hall meetings with over 1,000 individuals and heard about their experiences before the ACA and their experiences in enrolling in the ACA.

After the initial frustration with the enrollment web site, the response has been overwhelmingly positive with high levels of satisfaction with the choice of plans, the costs and the coverage. There will be additional city hall meetings in these cities several months down the road after these residents have had experiences with patient care and I will be particpating.

SO yes, I think have a decent representative understanding of how the process has worked to-date based on participating in these meetings as opposed to your handful of friends and neighbors.

I work for a public interest group with less than 75 employees. We are in a health insurance pool with other small public interest groups. We have a limited choice of plans, none of which is a "cadillac" plan.

I would have more choice (15-20 different plans) if I were to shop on the Insurance Exchange.....but I would lose my employer contribution (75% of premiums)
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added:

I am now in the ACA, as is every consumer in a group (employer) plan. I now have free (no co-pay) preventive care. I cant have my policy rescinded if I have a serious illness this year and I cant be dropped next year if that illness were to become what an insurance company might consider a pre-existing condition. I have new limits on out-of-pocket expenses. I can keep my 20 year old daughter on my plan until she gets a job. I have a new easy-to-access appeals process that did not exist before if I have complaints...

 

Yes.

Yes. In the course of a conversation with people I will bring up many different topics I am interested in, does this make me unique. Are you suggesting that you do not talk to people about topics like the ACA. If you spend a day with family and friends on an occasion like a holiday, what do you talk about. Yes, your anecdotes would be more interesting to me than your often flawed studies.

Did she have a Medigap, or Medicare supplement plan - was there an impact on her premiums? Will there be an impact on her premiums? What other impacts might she face? I will give a citation just for food for thought - I already know you think the source is biased and will later say I never provide any data - a predictable pattern:

Obama Medicare Agenda: Why Seniors Will Fare Worse

 

Many MA plans exclude a growing number of prescription drugs. This was occurring before the ACA and continues.

Thanks for the article from the Heritage Foundation....one of the top ACA mythmakers.

What it fails to note is that overpayments to MA providers has been steadily rising, currently averaging more than 15% higher than suggested costs based on Medicare costs when the rate was supposed to in the 10% range. The ACA puts MA programs out to bid, making it more competitive with the intent of getting back closer to the 10% suggested range w/o lowering services. There is no evidence that it will result in the higher costs suggested by Heritage.

I probably didnt explain it as well as needed. This is a bit more objective on the changes to Medicare Advantage:
Will Obamacare hurt Medicare Advantage? | PolitiFact

You want Medicare reforms. This is one of them and no objective analysis puts the cost to seniors as high as the anti-ACA Heritage Foundation., but it is true that it is too soon to know the full impact. Senior groups are certainly not screaming about these changes.

 

You are so predictable.

 

You got the right, Ace!

I have far more confidence in the credibility of studies by objective, non-partisan organizations like the CBO, with no political agenda (and supported for the most party by independent analysts), than the Heritage Foundation that starts with a widely acknowledged agenda and cherry picks and manipulates data to make it fit.

But I give you credit for having to balls to describe non-partisan studies as "flawed" and offer the Heritage Foundation in its place. That takes chutzpah!

 

A new PricewaterhouseCoopers report finds that the average premium on the Insurance Exchanges is lower than the average premium of an employer-sponsored health plan

The PWC report confirms what the CBO predicted last year.

Much to the chagrin of the Heritage Foundation, Ace, and their prediction of runaway costs and skimpy coverage. Or maybe HF had it right the first time, back in 2003 when they proposed insurance exchanges as they way to increase competition and offer affordable insurance...but that was before it Obama's name on it which changed everything for HF.

 

Flaw - The average premium on the Insurance Exchange includes a low cost bronze plan which relative few people will actually select - you have an average taken based on options rather than actual selections. The average premium of employer sponsored health plans would be an average of plans actually selected and in place. The comparison is meaningless and allows for a misleading conclusion.

Flaw - The demographics of people currently using the Insurance Exchanges is different from the demographics in employer sponsored health plans. Comparison is meaningless and allows for misleading conclusion.

Flaw - Employer sponsored health plans have historical loss patterns upon which premiums are adjusted - accurately reflecting actual costs. The plans in the Insurance Exchanges have no such history, in fact there is concern in the industry and among many in Congress that major bailouts may be required for insurance companies providing coverages in the Insurance Exchanges - with real loss data we may find actual premiums needed to be significantly higher than what is offered. Comparison is meaningless and allows for misleading conclusion.

O.k. - I just pointed out three major flaws in the time it took me to type this post. If I could type faster it would have taken less time. In honesty at the very lest those who cited this should have included a footnote outlining these obvious flaws - why didn't they? Why didn't you? Is it based on an intent to be misleading.

 

Not quite correct, Ace. Did you read the full PWC report? The full CBO report?

Of course, there are no flaws in Heritage Foundation study....predicting future costs based only on the absoulte worst case scenario or least likely outcome.

 

I do applaud noticing that comparisons of dissimilar groups can be problematic.

 

The demographics of those shopping on the Insurance Exchanges are not that different from those in group (employer) plans:


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Of people choosing plans so far, 60 percent selected silver plans and 20 percent signed up for bronze plans. Thirteen percent chose gold plans, and 7 percent platinum coverage.

Not all the different from group plans, where 20-25% are similar to what would be characterized as Bronze plans on the Exchanges.