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Subscribe to RSSThis fall, new insurance markets called exchanges will open in each state, marking the long-awaited and much-debated debut of President Barack Obama's health care overhaul.
The goal is quality coverage for millions of uninsured people in the United States. What the reality will look like is anybody's guess — from bureaucracy, confusion and indifference to seamless service and satisfied customers.
Exchanges will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The federal government will help many middle-class households pay their premiums, while low-income people will be referred to safety-net programs they might qualify for.
Most people will go online to pick a plan when open enrollment starts Oct. 1. Counselors will be available at call centers and in local communities, too. Some areas will get a storefront operation or kiosks at the mall. Translation to Spanish and other languages spoken by immigrants will be provided.
When you pick a plan, you'll no longer have to worry about getting turned down or charged more because of a medical problem. If you're a woman, you can't be charged a higher premium because of gender. Middle-aged people and those nearing retirement will get a price break: They can't be charged more than three times what younger customers pay, compared with six times or seven times today for most private plans.
If all this sounds too good to be true, remember that nothing in life is free and change isn't easy.
Starting Jan. 1, 2014, when coverage takes effect in the exchanges, virtually everyone in the country will be required by law to have health insurance or risk fines. The mandate is meant to get everybody paying into the insurance pool.
Obama's law is called the Affordable Care Act, but some people in the new markets might experience sticker shock over their premiums. Smokers will face a financial penalty. Younger, well-to-do people who haven't seen the need for health insurance may not be eligible for income-based assistance with their premiums.
Many people, even if they get government help, will find that health insurance still doesn't come cheaply. Monthly premiums will be less than the mortgage or rent, but maybe more than a car loan. The coverage, however, will be more robust than most individual plans currently sold.
Consider a hypothetical family of four with $60,000 in income and headed by a 40-year-old. They'll be eligible for a government tax credit of $7,193 toward their annual premium of $12,130. But they'd still have to pay $4,937, about 8 percent of their income or $410 a month.
A lower-income family would get a better deal from the government's sliding-scale subsidies.
Consider a similar four-person family making $35,000. They'd get a $10,742 tax credit toward the $12,130 annual premium. They'd have to pay $1,388, about 4 percent of their income, or about $115 a month.
The figures come from the nonpartisan Kaiser Family Foundation's online Health Reform Subsidy Calculator. But while the government assistance is called a tax credit and computed through the income tax system, the money doesn't come to you in a refund. It goes directly to insurers.
The Affordable Care Act is the biggest thing that's happened to health care since Medicare and Medicaid in the 1960s. But with open enrollment for exchange plans less than 10 months away, there's a dearth of consumer information. It's as if the consumer angle got drowned out by the political world's dispute over "Obamacare," the dismissive label coined by Republican foes.
Yet exchanges are coming to every state, even those led by staunch GOP opponents of the overhaul, such as Govs. Rick Perry of Texas and Nikki Haley of South Carolina. In their states and close to 20 others that are objecting, the exchanges will be operated by the federal government, over state opposition. Health and Human Services Secretary Kathleen Sebelius has pledged that every citizen will have access to an exchange come next Jan. 1, and few doubt her word.
But what's starting to dawn on Obama administration officials, activists, and important players in the health care industry is that the lack of consumer involvement, unless reversed, could turn the big health care launch into a dud. What if Obama cut the ribbon and nobody cared?
"The people who stand to benefit the most are the least aware of the changes that are coming," said Rachel Klein, executive director of Enroll America, a nonprofit that's trying to generate consumer enthusiasm.
"My biggest fear is that we get to Oct. 1 and people haven't heard there is help coming, and they won't benefit from it as soon as they can," she added. "I think it is a realistic fear."
Even the term "exchange" could be a stumbling block. It was invented by policy nerds. Although the law calls them "American Health Benefit Exchanges," Sebelius is starting to use the term "marketplaces" instead.
Polls underscore the concerns. A national survey last October found that only 37 percent of the uninsured said they would personally be better off because of the health care law. Twenty-three percent said they would be worse off in the Kaiser poll, while 31 percent said it would make no difference to them.
Insurers, hospitals, drug companies and other businesses that stand to benefit from the hundreds of billions of dollars the government will pump in to subsidize coverage aren't waiting for Washington to educate the public.
Blue Cross and Blue Shield plans, for example, are trying to carve out a new role for themselves as explainers of the exchanges. Somewhere around 12 million people now purchase coverage individually, but the size of the market could double or triple with the new approach, and taxpayers will underwrite it.
"Consumers are expecting their health insurance provider to be a helpful navigator to them," said Maureen Sullivan, a senior vice president for the Blues' national association. "We see 2013 as a huge year for education."
One goal is to help consumers master the "metals," the four levels of coverage that will be available through exchange plans — bronze, silver, gold, and platinum.
Blue Cross is also working with tax preparer H&R Block, which is offering its customers a health insurance checkup at no additional charge this tax season. Returns filed this year for 2012 will be used by the government to help determine premium subsidies for 2014.
"This tax season is one of historical significance," said Meg Sutton, senior adviser for tax and health care at H&R Block. "The tax return you are filing is going to be key to determining your health care benefits on the exchange."
Only one state, Massachusetts, now has an exchange resembling what the administration wants to see around the country. With six years in business, the Health Connector enrolls about 240,000 Massachusetts residents. It was created under the health overhaul plan passed by former Republican Gov. Mitt Romney and has gotten generally positive reviews.
Connector customer Robert Schultz is a Boston area startup business consultant who got his MBA in 2008, when the economy was tanking. Yet he was able to find coverage when he graduated and hang on to his insurance through job changes since. Schultz says that's freed him to pursue his ambition of becoming a successful entrepreneur — a job creator instead of an employee.
"It's being portrayed by opponents as being socialistic," Schultz said. "It is only socialistic in the sense of making sure that everybody in society is covered, because the cost of making sure everybody is covered in advance is much less than the cost of putting out fires."
The Connector's executive director, Glen Shor, said his state has proven the concept works and he's confident other states can succeed on their own terms.
"There is no backing away from all the challenges associated with expanding coverage," Shor said. "We are proud in Massachusetts that we overcame what had been years of policy paralysis."
Some questions and answers on how the exchanges will work
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Health care should not be an "insurance" at all. When our fellow humans are suffering, we should help them, period. The money we spend on weapons to kill each other with, alone, would pay for it easily.
1. If all the money we spend on defense went to health care it still wouldn't be enough. Inefficiency and greedy providers would soak it all up and demand even more.
2. Defense is a necessary evil. Life is competition for resources. It has been that way ever since it's beginning billions of years ago, and wishful thinking cannot change that fact. It has always seemed ironic to me that the creationism believing conservatives seem to understand that while the Darwinism believing liberals don't.
dan42day,
You have a myopic view of Liberals fostered by Faux News! I'm a liberal and believe in both a strong defense and in universal health care! A firm believer in 'Speak softly, but carry a big stick!'
Yeah, sure dan. Seems to me that the chicken hawk conservatives voting for wars usually are doing so for money and protection of coporations, not protection of citizens. Many of those same conservatives get deferments for themslves and their children while the poor represented by liberals usually get to go fight those wars.
Like that isn't how the defense industry is now? The money the Pentagon loses in the couch cushions every year could make a huge dent in American health care costs.
And as far as defense being a "necessary evil", we spend 14 times more than the top 5 world militaries combines and most are our own allies.
Just wait until this Dumbama -care hits you all in the second year of implementation! There is a high price to be payed nobody is telling you about now. Even on paper this mess does not look good. Now wait for the implementation with all those idiot minions hired to administer this BS.
Dan42day writes:
I thought the neanderthals went extinct. Don't we have something called 'civilized society' now?
Shipwrecked, the harbinger of gloom and doom... The sky is always falling for your sort I guess.
Try buying insurance without a government subsidy. Our insurance industry is out of control and something had to be done. The new rules on insurance companies were badly needed.
>I thought the neanderthals went extinct. Don't we have something called 'civilized society' now?
You need to learn history before you post garbage! Maybe at that point you'll catch up intellectually to a neanderthal.
Dan, maybe you might want to check your numbers. Seems the defesne budget is fully 50% of the federal budget. Health care is less than 25% of what's left.
JustOlJoe,
I wouldn't watch Fox News if you paid me. Funny you seem to have assumed that I do while chastising me for making assumptions about what people who call themselves liberals believe in! I stand by what I said as a generalization of the platforms of the right and left.
Really?,
Really? We haven't had a draft in this country in almost 40 years! What is a deferment? I would like to point out that since we have been at war for a decade now, those who join know, or should know, what they are getting into and bravely volunteer to serve their country. Are you talking about the liberals that sign up with the military to get pay and benefits hoping that they are never called on to earn them, and are too stupid to realize what is going on?
Also, are you talking about the 82 chicken hawk democrats that voted for the Iraq War Resolution? Or do you mean the 189 chicken hawk democrats who voted to expand the war in Afghanistan in 2010?
RTypo,
I agree that defense contractors are well represented at the trough, however, in 2010 the U.S. Health care bill was $2.3 trillion, almost 3.5 times as much as we spent on defense. So if every defense dollar was spent on health care, it would barely make a dent.
David,
Civilization, i.e. cooperation, is one strategy, but unless the co-op is defended, it only provides a rich prize for those who chose an aggressive strategy. Are you saying that all of those aggressive people have gone extinct? That would be delusional. I've noticed many progressive types tend to just ignore inconvenient facts that complicate their simplistic visions.
Swallow,
The last time defense was 50% of the federal budget was in the 1960s, before the Great Society Wellfare State came to be. In 2010, Defense was under 20% of the federal budget, and Medicare, Medicaid, and Childrens Health insurance, together came to just over 20%. Check your own damn numbers!
See, that's the trouble with this administration. They make idealistic statements, paint grandiose visions, and reactively approach the big topics without really thinking things out. 'We won't know what's in it until we look inside'- just pass the bill! When they run into others who try to differ with their ambitions, they start pointing fingers, blaming, scream & pout. The reality is anybody's guess- more like a nightmare.
don't forget that Obamacare was a COMPROMISE that was made due to the republicans NOT wanting Universal Health Care....anyone that doesn't like what we have now can thank the republicans...I hate the fact that Obama compromised BUT if he had not done so it would be business as usual for insurance companies....WE NEED UNIVERSAL HEALTH CARE AND WE NEED IT NOW!!!!
And let me remind u all that Hillary Clinton looked at this how long ago and it wasn't taken seriously at the time because it was deemed "Too Expensive"......what a joke some of u republicans are....and BTW I'm an Independent!!!
450.00 for a Family of 4 With 35K in income not too bad. But can they afford it? I do not think so.
Shipwrecked, after the second year of Obamacare, aka the Affordable Care Act, when insurance premiums are not outrageously high and more people have access to the system, and people are more satisfied in general with healthcare and all of the demons and boogeymen that you conservatives have been wetting your pants over in regards to healthcare reform never materialize, will you come on this forum and publically tell everyone that you were an idiot and had no idea what you were talking about? And if these things do happen, I'll gladly come here and do the same. However, they will not come to pass and everyone will see that the Affordable Care Act was a positive thing. I don't think it is perfect, and don't think it went far enough. I would much rather have seen a single-payer system, something like Medicare for all in this nation, like most of the rest of the industrialized world has. But this is better than the Republican plan, which was "Don't get sick. And if you do get sick, then die quickly."
America NEEDS An American UNIVERSAL SinglePayer HealthCare Plan like Our SANE Allys HAVE. When People find out the taxation amount taken out of their paychecks is equal to the amount taken from the HealthCare Country paychecks, AND THE EUROPEANS DON'T HAVE TO BUY "HEALTH INSURANCE", they simply get a government issued HealthCard good IN ALL their Clinics and Hospitals!!!!!!!!!!!!!!!!!!!!!!!!!! But Americans Still Do and will be REAMED and Financially Raped, WE are going to REVOLT...Hence round up as many American Citizen guns as possible!! Face It People: The Insurance Companies are so Evil and Powerful, That OUR President had to cut a deal with them WHILE they are swimming in Money, YOUR MONEY!!!TRillions of Dollars and So Much of YOUR "HealthCare Premium" Money is in secret Insurance Company Corporate Officer Numbered Accounts OffShore....To the Incredible Sum of $500Billion. Listen, when the ceo of United"HealthCare" took home for 2008 yearly salary $128,000,000 **C A S H** then SOMETHING is wrong with this Pretentious Arrangement. These "insurance VAMPIRES Know that When WE Americans FINALLY Create An american Universal healthCare System LIKE OUR SANE ALLYS HAVE, They Will NOT Be able to financially Gouge US Any Longer and The Jig Is UP. This new arrangement is a ScamSham forcing people to buy an insurance product After Killer Taxes are taken out of their paychecks, The insurance Robber Baron King Pins are Snuffling Up Their Sleeves.
Sure dan, the truth. Iraq. Bush, who did serve in the National Guard when sober, thanks to dad. That Bush. Who wanted to one up daddy and kick butt on a third world bully. The same country that was the enemy of Iran.
Let's see Rumsfield the guy who did have a deferment for military active duty. He was willing to go to war with the army we had.
Cheney, he had a deferment. He was only ex Halliburton who got no bid contracts for support of our military.
Should we discuss what they did about our next Secretary of State. Kerry. When he ran? Maybe we should talk about what they did with a real patriot General Powell.
Or maybe discuss how the lastest so called Republican used saber rattling in his run for presidency yet he spent his Vietnam in Paris, Poor Romney. Give it a break from the Faux news channel. In the debate Romney actually went along with the president finally. Would we now be in Iran under President Romnney? Thankfully we don't have to wonder? Afghanistan was the primary objective with defeat of Al Queda.
Thankfully this president and our military we will see 2 wars ended
Still unaffordable, most plans will be 80/20 so you have to pay your premium plus 20% of any service. ugh!
I would strongly suggest to those who do not have health insurance AND are opposed to the program that they not participate in the program. That will show President Obama and your so-called liberals how little you think of his program. So do yourselves a favor and don't enroll.
If you're a man you'll pay higher premiums regardless of whether or not you plan to bring children into the world.
Younger people will see their premiums rise two double, at a minimum, of what they pay today.
This is nothing new. This is just cost shifting. Wait a couple years, as one poster put it, you think premiums are high now? When community rating hits and the insurance company actuaries get a handle on the impact I wouldn't be surprised to see increases of 30%. For all the geniuses out there that think this is an insurance issue I've got news for you. It's not about insurance it's about US citizens wanting the best of everything without having to pay for it.
I don't care about politics, I don't care about government bashing, I care about what I get out of all this. It would seem, but the example above, that I would get some sort of break from the payments I have to pay now. I pay a lot for family coverage. So hopefully this will save me some money.
But I have to question how the "low income" category works. Lets say someone lives on government assistance or welfare today, does their share of the premium, or pool, come out of that check? Or are they getting a 100% free ride?
freedomfrys, the last thing I recommend is that anyone take advice on their health coverage from someone posting on Newsvine. Your advice is that someone with no health insurance turn this down just to make a point? Real swift thinking there.
freedomfrys: "I would strongly suggest to those who do not have health insurance AND are opposed to the program that theynot participate in the program."
Then DON"T expect free service when you show up to the Emergency Room for care. Get sick? Oh, well.
You mean like being addicted to nicotine?
Apparently not.
Keep in mind, the law absolutely, positively, calls for requiring a photo ID to be eligible. I think the ones who will get the biggest surprise are the ones who show up thinking this is just like going to the voting booth without one because of their skin color.
Someone needs to check their numbers all right, but it's not Dan. Let's assume you are correct, that means the current administration lied on official budgetary expenses and are hiding 40% of the 50% they're allocating to defense. No wonder they don't want to pass a budget.
A shockingly true statement from NBC. I'm truly surprised that they would even acknowledge this. The real question is 'who pays'? And that question has not been answered as yet. I believe that, ultimately, it will be stuck to the middle class to pay.
The 'Affordable Health Care Act' will be anything but affordable for many. This is simply yet another wealth transfer scheme by Obama and company.
It is also interesting that NBC indicated that information will be available in languages spoken by 'immigrants'. Of course one of the big 'benefits' is taxpayer subsidized insurance for illegals, despite what the Dems say.
One of the joys of on line banter is if you don't find something to criticize in the facts you can make something up and criticize that. Of course it is obvious that your mission is not to understand or discuss; it is, as always, to criticize President Obama and sneer ignorantly at Democrats.
Illegal residents aren't eligible for healthcare financial assistance.
Well said, don.
No, it won't be perfect, but considering what my family spends each month on health insurance and how we struggle to pay it since it uses almost half of our annual income, I am happy about it. Paying 400 a month would be wonderful for us!
Having something available in Spanish doesn't automatically means it's meant for illegals...lol. Are you dense or do you just know nothing about people who speak Spanish, Let? Do you think everyone who speaks Spanish is illegal? Sad.
Your last sentence, leroy, is profound and very true. It is a national shame that so many go without health care in this country. No, the ACA isn't perfect, but keep in mind that it would have been a better bill without having to be watered down so it would pass. Who do you think would have voted no...the Democrats (Blue Dogs are useless and don't count for the most part for most of the time) or the Republicans in Congress? Hmmm...
You got exactly what your republican colleagues wanted, you pay, and big companies benefit. Yay for big business.
No Republicans voted for this.The Democrats own this lock stock and barrell.You got EXACTLY what Obama signed into law.
I am surprised as well, letusreason. And this:
"Insurers, hospitals, drug companies and other businesses that stand to benefit from the hundreds of billions of dollars the government will pump in to subsidize coverage aren't waiting for Washington to educate the public."
These were the folks who were going to benefit all along. And they will.
The rest of us, who don't have employer provided insurance, will take a really good whack to the wallet - and the Supreme Court did say it was a tax.
mystixa: did you forget your meds today ! this obamacare was passed and rammed down ALL of our throats by the dems and obama, the Republicans warned us about this stupid plan and thats why not 1 voted for this mess.
that reading this article from msdnc even they dont seem so proud of it any more, because just like everything else its another TAX imposed on all of us ! putting the health insurance payments into the IRS department is a huge mistake and next year we will all pay !
Well, taking responsibility for oneself is often called "rammed down ALL of our throats."
I thought you guys were big on how Democrats and liberals are proud of forever raising taxes?
Colorado is forming a Health Insurance Cooperative, which is a non-profit member-owned health care provider. Membership will be sold alongside other insurers in our exchange. It's still in its formative stages so details are hard to come by as far as how much it will cost or what coverage will look like, but it's already received $69million to back initial claims.
Pale
Where did the $69 million come from?
Letusreason... according to the article, " taxpayers will underwrite it".
Pale... that sounds close to the dollar figure the Government 'borrowed from Medicare in order to reallocate it into Medicare AND ACA'.
Mike... yes it is indeed another Tax to We The People.
You do realize, don't you, that when someone who is uninsured, citizen or immigrant, shows up in the ER, you're already paying for it in higher premiums for your own insurance? You don't think the doctors and hospitals just write it off, do you? They're required to treat everyone, no matter what. That's one of the things the Affordable Care Act addresses by requiring everyone to have insurance. I don't understand why people, such as yourself, make such a fuss over this. Does your State not require you to purchase auto insurance if you drive?
NeverTooL88
That's a good point and it is too often ignored. In addition, medical costs are the #1 reason for bankruptcy and as we approach universal health care coverage those bankruptcies should all but disappear. Those bankruptcies leave all of the creditors of that person who could not pay their medical costs holding the bag ..... so our economy in general should be better for the changes in our health care system.
NeverToo... I agree with that point also, however, the other part of that is the continual dipping into other programs in order to fund another. The system is not working right now as it will penalize a whole lot more people as well. Add into that the impending " Immigration Reform " that will be kicked around. How much more do We The People need to handle? When does responsible fiscal accountability come into play by the Government? Deferrment seems to be the approach which is absolutely sickening.
But you folks are missing this point. There will still be 30 million uninsured who will continue to use the emergency rooms.
We have "immigration reform" coming in the next few weeks.
Care to guess who will get a complete subsidy?
If AHCA passed by Obama and the Dems (and a few Repubs) has flaws then fix the damn thing. The old system isn't working and premiums are becoming so horrendous that more and more people can't afford the "service".
Also, remember that they watered the AHCA bill down because of republican objections and to appease enough Republicans to achieve a super majority. We all know it takes a super majority to topple a Republican filibuster.
mpa
You interrupted a conversation thread among people who understand what is going on with unfounded speculation that enlightened no one. You have no inside track about the future immigration policy and your estimate of 30 million uninsured is pure (and pessimistic) speculation.
Ram, please explain how Oblamacare was watered down by Republicans, in that no Republican voted for it.
The US health care system is fragmented and the financing is as impossible to sort out as a tangled ball of yarn. Statements like "the middle class will pay" are essentially meaningless because of the layers upon layers of hidden costs and subsidies.
The self-insured subsidize employer-based insurance because the former is not tax-deductible. The underinsured subsidize corporate plans -- and the better the plan, the more the subsidy -- because large businesses have the bargaining power to negotiate both lower insurance and lower provider costs.
Insurers and providers pass those costs onto patient groups with less bargaining power.
Fee-for-service medicine offers no incentive for prevention, but it does encourage unnecessary return visits to hospitals, which drives up costs for everyone.
And then there's overtreatment and medical error introduced by unnecessary tests and the latest diagnostic device that adds little value but that is prescribed at high cost.
BTW, your question has been answered: Obamacare is primarily financed by a surcharge on Cadillac plans. Read the bill.
One wonders how many people will be unable to afford the co-pays, etc. necessary to actually go to the doctor when sick, because they have already been forced to pay $12K a year to a private corporation for "insurance," who would have had the money to go to an acute care clinic and pay out of pocket if they had remained uninsured.
That is one of the problems I have with this system. The government is requiring it's citizens to increase a private business's bottom line. It would be like the government telling me I have to spend 8% of my paycheck at TGI Friday's. If we are going to be a socialist society then jump in and do it right.
Have you ever had to pay out of pocket for a major medical event? Or even a minor one like a broken bone? It's typically several thousand dollars. But apparently the uninsured don't get cancer or run over by cars or accidentally shot in your world.
No, it isn't as good by any means as a single payer plan without for-profit companies getting all the loot and getting richer, but this was all that could be passed at this point.
ram - I was hoping for the single payer system as well. It doesn't make me a happy camper that the insurance companies will be making hay with my money and still calling a lot of the shots. At least some restraints have been put into place to protect the consumer, but I'm afraid it won't be sufficient.
Part of the law is that the insurers have to spend a certain amount per dollar for health care coverage and not just overhead. I don't see how many companies will survive considering how much of their time and money is spent on burying doctors and consumers in paperwork. I think we will end up with a public option. It will be rough for a while, but I am hoping health insurance will be more affordable for individuals in the long run. It's a start.
Do not expect too much from the ACA or you will be very disappointed. The ACA does not guarantee health care to anyone. It just requires and may help you purchase health insurance. You may or may not be able to use this insurance to access healthcare. Health insurance and healthcare are completely different things.
Despite this PR story from the insurance executives at the MA connector things are not that great here.
People are still going bankrupt because of health costs: http://www.boston.com/news/local/massachusetts/2012/09/09/medical-debt-massachusetts-persists-despite-health-law/mAIqhFsnbAtdtojrRsdqjI/story.html
People who have insurance are still unable to access healthcare because the state is encouraging a shift to "consumer based plans" to ration care: http://www.bizjournals.com/boston/blog/bottom_line/2013/01/so-everyone-has-health-insurance-now.html?page=all
People still cant afford insurance or the insurance they can afford doesn't provide access to healthcare: http://www.wbur.org/2013/01/22/free-clinics-uninsured
MA is a pretty benign environment as most of the local insurance companies are non profit. Despite this RomneyCare still doesn't work.
Sophie the controls on the insurance industry are pretty weak. Insurance will be unaffordable for older citizens if they are not eligible for Medicare as the insurance industry can charge them 3 times as much as younger citizens. There are no restrictions on the insurance industry death panels.
What the ACA will deliver is a massively expensive mess that will fail miserably if the goal is to provide healthcare for the American people.
What seems to be overlooked about this massive, bureaucratic boondoggle is the simple fact that Doctors are not going to accept the pitiful amount paid by this Medicade-laden joke.
Enjoy your stay in the ER, folks. And don't be surprised to wait 15-20 hours while you are there.
The interesting thing is that ACA creates competition in areas where there is none right now, small population, ruarl areas don't have the same insurance programs as in larger cities. But, it is funny how the people without coverage hate this thing because right now they get away with paying nothing. I think those people should have to fly a flag at their house, right below the US flag there already, to show everyone that we are paying their health care costs.
Also, it seems that there should be some funding for the unfunded Bush Part D Medicare program generated in this program or elsewhere.
Exactly. They are passing the cost of their risk onto the rest of us. The mandate puts an end to that. I'm weeping many bitter tears.
You asked for it, you got it! Obamaaaaaaaaa. You are a ignorant person if you do not believe that there will be plenty of Obama's cronies who will get rich off this fiasco.
I have read several of these comments and I realise people still do not get it. Until the middle man ( insurance companies) are forced out of the health business there will never be equality in health insurance. The rich and the politicions have theirs and everyone else can fight over the left overs, which even that will make the rich richer.
It is unfortunate that they no longer allow high deductible plans. These are great plans if you can save your money and don't have ongoing health issues. It is much better to pay the doctor out of your pocket a couple times a year and pay less premiums and only use insurance in the rare case where you get huge expense.
Then again too many stupid people that would not save the lower premiums to pay the deductibles just like all the people that where crying about their adjustable rate mortgage.
I am still waiting for the administration to address the other side of the coin - health providers. Every intelligent person knows that the health care providers network will be overwhelmed with new patients. There has been reports that many doctors are retiring this year. Some of those who are not retiring will not take new patients. And with the metals plan as mentioned, providers will initially only select those with the platinum plan, then work their way down.
No it wont.. as it is nearly all these people with serious ocnditions are being treated in the ER which is the most labor intensive practice we could have. Those people will start to be seen through normal channels reducing cost and labor as well. As the article states most who stand to benefit most don't even know about the program, and it will take time for that to filter down to that level. This gives a slow rising curve to any change that does happen. As those people do filter into the system they are insured, so they are paying for the services, and business.... I mean health care providers can respon accordingly.
More health care providers could be the integrative medical professionals they selfishly don't let into the system.
Carlyn - Most private practices don't want to deal with Medicaid patients as their reimbursement is much lower than private insurers. AKA the government can't keep up, and they mandate the bare minimum treatments be done.
Sorry mystixa but a study published in the NEJM last year compared ER utilization in MA after RomeyCare withe other states. It found no difference. It can be very difficult to see a primary care doctor so people go to the ER. The push to "consumer based" insurance plans as a way to ration care force people in the ERs looking for free care.
So, I have this great plan, no longer can anyone without insurance go into a doctor or the ER unless they pay cash upfront. There that ought to solve the problem. Just go die on your own dime and get off mine you jerks. Well actually it seems to be a Republican problem with the ACA, hmm, why don't they come up with their own plan as outlined in the ACA? Right, they haven't offered a solution to anything have they.
Koya, you are full of it. Most providers are happy to accept the Medicare approved amounts as full payment. Mainly because as an individual you can negotiate a payment much lower if you pay outside of insurance. For instance. A simple visit to a dermatologist will be charged out at $1500 for a 5 minute visit. If you ask for a direct payment charge it comes to about $300. Which still seems outragous for that 5 minute visit. I watch my Medicare payments and they go out very quickly. Which of course like SS most people don't have a clue as to how it all works until they enter the program. Frankly Medicare has its ducks in order much better than most private health insurers do. It ain't the doctors, the problem lays with the insurance companies where they separate the customer from the provider then 80% of their cost is "overhead". Insurance has always been a scam. They are guaranteed a profit over their cost then, hmm, if you raise your "costs" then your profit (as a percentage) is higher, simple math.
I don't understand the whole thing but I'll say this,If it costs me more money then it already does then the government can kiss my ass!
Wreck
If you already have health care coverage you will probably pay less in the long run. If you choose not to have health care coverage the government will tax you and the rest of us will benefit. Your choice.
Don the way I understand it what you said isn't entirely true because if you already have health coverage through work or some other means you will have to start paying income taxes on the base value of that insurance. So say you already have a health insurance equal to what they are selling totalling roughly $12,000 dollars. Under this plan you will have to start paying income taxes on it. Not to mention they will have to raises taxes to pay for all the government subsidies involved. My family is lower middle class with employer health insurance and this looks like it may hit us pretty hard. I am not an Obama Hater I respect him as our President and I believe he is doing what he thinks is best for our country, but I really don't see this going well. Hopefully I am wrong.
Not completely correct. A complete loss of the medical exeption will be unrelated to the affordable care act. What we have as law now under that act has a cap on the tax credit at $10,200 for individuals and ~$27k for families. So if your given insurance amount was on an individual then the taxed amount would be for $1800, the amount over the cap. So somewhere in the $40 range. (that range depends on your bracket of course)
allislost
In at least some cases the tax bite will be offset by refunds from health insurance companies who are now obligated to spend 80% of premiums on actual health care. There will also be some premium decreases because young adults who typically don't have high medical expenses will now be in "the pool." Overall, I am more optimistic than you, but then I did not choose "allislost" as a screen name.
If it turns out to be a big mess, most people won't even file taxes anymore.
This was not what I was hoping for on a national level, but we'll see how it plays out. My concern is how much I'll have to pay when my paycheck is currently low at my new job (budget cuts ended my last position and health insurance was not a luxury I could afford). Hopefully, I'll be in a better position soon that offers coverage. I absolutely feel the pinch and need eye surgery - not in the budget. Hope I'm able to swing it before I lose the sight in my right eye. I don't mind working hard - I put myself through college without assistance. But it's simply not enough at the moment when I also have a daughter to support.
"The Federal Government will subsidize" Dumbasses.The TAXPAYER will.I was reading an article on THE HILL. Obama's immigration plan will probably add millions to the "subsidized plans." Another lie Americans were told.
You're wrong and Ignorant !!
What Obama has done is a great start ! Eventually I hope you get universal health care like all industrialized countries have.
Where am I wrong fool.You are showing your stupidity .
As opposed to where they are now? ..getting care based on state subsidized plans, or medicare, or just going to the ER and not paying. As people get more of the care they need then care will become cheaper by reducing the severity of the afflictions since every poor person won't have to wait until their life is at risk before going into the ER and getting emergency treatment. People are already paying this.. and changing the structure of those payments, whether it be through insurance subsidies or even a single payer plan that wont be changed at all.
We know that Americanfools is a European who lobs anti-American bombs from behind his/her keyboard. We don't which bankrupt EU country is home, but we should strive to be like them at all costs!
Massachusetts has a very high percentage of its citizens covered by health insurance. The premiums for those who do have to pay are very high. This has led to many young couples deciding not to marry because the unmarried young mother and children will be covered by free State insurance.
I work with two young men. The first has two children, a dog , a house...everything but a marriage license. The other is married with one child and pays a very high percentage of his paycheck for mandatory health care coverage which is part of the reason he doesn't own a home. He said "I would have been better off if we didn't get married." and I can't say he is wrong.
You can go to kindergarten registration meetings here and meet a woman pregnant with her third child and her "fiancee". We are making fragile families with our attempt to provide everyone with health care coverage in Massachusetts in the system we are now going to do nationally.
Alice that is an interesting social observation. That is the problem with implementing stuff like this health care over haul. It's difficult to see how one choice may affect something seemingly unrelated. I do believe that something needs to be done with the skyrocketing price of health care, but I hate to see them implement a bad idea just because we lack a good idea. I think an intelligent way to figure this out would be to have states implement a health care change of their own design. That way you would get variations in the plan states would be able to see what their neighbors are doing that works and what doesn't and adjust accordingly. I dislike federal government throwing their weight around. One plan seldom works in all situations.
There hasn't been any reason to get married other then social and religious conviction for a very long time. If these people dont see the point because of a financial payback then thats a pretty weak social contract to be basing your imaginary utopian marriage world on.
I think the term fragile family is used by sociologists. It's not an imaginary benefit to have strong families. Marriage is not irrelevant to society- not according to studies conducted to explain strong social structures.
allislost
Good comment; Ah, yes, The law of unintended consequences. How many times has the Government rolled out a brand new program designed to help the masses and it ends up costing society as whole?
How about this for an idea? Do away with Employer Sponsored Health Insurance. Have the employers give a voucher for the amount they now spend on insurance or just add that amount to the employees salary. Open up the cross state restrictions and let the market set the price, you know, just like they do homeowners or car insurance. Let's create a little competition in the market. Also, this would do away with that pesky, "It is violating my Religious Freedom" argument.
This is one of those unintended consequences I was talking about. Do you know why we even have employer sponsored health insurance? Oh, I know the answer, I am just wondering if anyone else does?
@ Alice
Excellant post, you make some very good observations, and don't let the fools who say marriage is antiquated or obsolete bother you. They are the ignorant Progressives who believe the State is the final say.
I have been posting this in the "Anti-gun" vines to explain the rise in gun violence since the '60's, but I think it segues nicely here too. If what you say is true about Ma., then I can only surmise that in a few years time, this may very well be the norm for the rest of the nation. I can only wonder if this is an intended goal of the Progressives. One more way of creating a "Fatherless" family?
@ Mystixa
Then why all the hub bub about "Gay" marriage? And perhaps you should do a little research, studies consistently show that kids from married parents perform better and get into less legal trouble than those from single parent families.
Translation to Spanish and other languages spoken by immigrants will be provided by law enforcement and INS. We are hoping to clean the house!
Law enforcement and INS? what's your point? I know several U.S. citizens and residents who don't speak English either because they just moved here or are elderly and never learned it. They might live in areas of the country where everyone speaks their language. English is not the official language after all. Sure, everyone should learn it, but it doesn't automatically mean they are illegal if they haven't. Maybe we need to clean house of ignorant people like you.
If you want a healthy, productive society you MUST have some kind of universal health care.
sick and unproductive people are a drain on the economy.
I have universal health care and we have the best in the world. In 2002 France ranked 1st and the usa 32th. Believe me, it will cost every one less ! If you have universal health care, people will go get care before they become too sick to be saved.. It will save everyone a lots of money. PREVENTION IS KEY TO SAVE MONEY TO ALL. So support it !! I know, I have it !
It looks like France can't afford it either.
Americanfools2008 will you not make any allowances for different in cultures? What works in France may not work for "Foolish Americans" I hate comparison from one area to another about anything. A different mind set will change the outcome drastically. I can already see the "Eat another cheeseburger I don't have to pay the medical bills" mentality ruining this one.
The problem isn't with the base system, its in the implementation of that system. We were doing fine with a free market medical system until the medical field got universally turned into a big business proposition. With corporatism you have to turn a higher profit each year, turning sick people into nothing but a commodity. Your local family doctor can no longer treat you like a person and rake in the massive profits that are required by such a system.
Since the industry got greedy our care costs have sky rocketed. Not even a single payer system could support that for long. Eventually even this model under the affordable care act will fail due to rising costs. Going through an insurance system like this merely spreads out the cost amongst all the people as much as possible with private companies and delays the effects of rising costs.
mystixa
And just exactly when did the "industry get greedy"? Can you say maybe in the '60's, when they came out with Medi-Care?
Oh, yeah. My mom still has the hospital bill from when my older brother was born, Aug, 1960. It was $89 for a five day, pampered stay. Adjusted for inflation that is about $670 dollars. And what does it cost today? $10K? $12K? Of course that does not take into account the change in litigation that takes place today or the advances in diagnostic equipment.
@ American Fools
And how many people live in France, 65 million? Population density of 119? And what percentage are non white? (not being racist, just pointing out that we have a more diverse culture, which requires different medical needs)
Compare that to America 312 million? Population density of 34? As some one from the midwest, where it can be 50 miles to the nearest doctor, we have different needs here.
And how long do you wait to see a doctor? I can usually get into one on the day I need to see one, and I am self pay, uninsured.
NO, you people who think Universal is the way to go are suffering from what I call "Serf's Syndrome"; {I'll give up my freedom, in exchange for security and protection}. Like in medieval times, the Lord of the Castle would "protect" his serfs from marauders in exchange for their working his land. Only, in truth, he cared not for them, only the fruits of their labor, which was his wealth.
And you want to know the difference between Americans and Europeans? We got over being 'serfs' 236 years ago.
The sad thing is, we are reverting.
@Americanfools- Frustrating, isn't it? Americans complain about the cost of HC, the cost of "private insurance" and our abysmal results under the current system. You correctly suggest Universal (which would eliminate the insurers, cut the $2.3B annual tab in half, eliminate the 20% annual inflation in HC "private insurance" premiums and eliminate Pharma extortion) - all of which are FACTS. Then they complain about "socialized"anything, population density and"serfdom" (?to private insurers?)as reasons to continue the current unaffordable and irrational HC system.
Try this:
No private insurers
50% reduction in costs
No fee-for-service extortion - no Pharma extortion
Improved results
Everyone covered
Can Americans even abide success?
NON-PROFIT SINGLE PAYER AND NOW!...or simply the PUBLIC OPTION RE-INSERTED INTO OBAMACARE!
Everybody likes to jump on the bandwagon of vilifying those without insurance. But they are not the problem. Follow the money - and the money is not with the uninsured. The problem is that anymore, you walk into a hospital and it's a 23 star hotel. Hospitals over-charge for everything, insurance pays for it so in turn raises prices for the insured while squeezing out those who can't afford it.
Some of the equipment is expensive but most people won't even need it. And shouldn't the advance of technology make some of this stuff cheaper anyway? Of course nothing is cheap when your citizens are unemployed. But apparently the media is tired of that story.
The problem with AHA is that we're getting a colonoscopy when what is needed is gastroscopy. If we can toss the Constitution aside to force people to buy insurance, surely we can toss it aside (unnecessary) to force hospitals, insurance companies and pharmaceutical companies to stop price gouging. But nobody will address that issue since everyone is too busy trying to see through the smoke of complexities of this Pandora's Box for health care.
It will be interesting to see if health care costs can come down enough to cover all the subsidizing of premiums. I don't see that happening. Looks like another social program that will be ran in the red.
Won't be long until there are more people riding in the wagon than pulling it. We're probably there already and just don't know it.
This wont reduce overall healthcare costs. Some factors will make look like they are coming down. There will be less overall use of the ER for general but delayed care, and that will be trumpeted as a major success. The overall plan isn't structured to save costs at all though, its about spreading those rising costs to everyone. All the same companies are involved along with the same structures that have led to ever increased costs. The only thing that will reduce costs is changing the expectation that every medical innovation will bring about windfall profits, and that every medical degree will bring wealth with it. The whole system starting with excessively expensive universities would have to change in order to bring down health care costs, and theres no sign that is even being looked at.
Rob -
You are spot on!
"Affordable Care Act." Once agian, The People have been duped. The government can pee on us and tell us it is raining - and The People will respond with comments about how romantic ii is to walk in the rain.
Sad.
So this is supposed to go into "effect" Jan 1, 2014 so why am I being hit with a HUGE penalty on this years taxes???? I was laid off last March 5th and I haven't been able to find permanent employment since (been told several times I'm overqualified). I've been doing a temp job here and a temp job there but as of yet haven't been able to land a full time job. Needless to say I don't have insurance. My husband's company offers it but it's so expensive that it would come down to do I feed my family or do I pay for health insurance. We've been avoiding going to the Dr's or the Hospital because of no insurance. I thought I had until the end of the year to find something. I'm already taking a huge hit on my taxes because we had to sell our home at a huge loss (almost $93,000) but to now get hit by this other tax? Why do I even bother? I'm just beyond disgusted and frustrated. And please don't start a political war on this. I can't stand either political party!
I believe if you cannot pay the " tax " the government will pay for it. The money will come from a pool. Of course they won't force you to pay if you dont have money, how could they ?
Fool -
Are you so ignorant as to think government and "pool" are really pots of gold at the end of the rainbow?
True statement: "If you cannot pay for it, your neighbors will be forced to." Despite your love of French Socialism, not everyone here wishes it. Enjoying paying for those PIIG's?
I have universal health care. I CHOOSE my doctors, for emmergencies there is no waiting time and the care is great ! All the government does is pay part of the bills.
You people really should not worry, if all industrialized countries do have universal health care it is because it is good and because people want it ! For the ones that criticize it, you really have no idea what you're talking about because you DON'T KNOW AND DO NOT UNDERSTAND HOW IT WORKS.
The most important is that everyone be covered.
And exactly where does the government get the money fool? Looking at your other posts tells me no mental health is covered under whatever it is you say you have.
It is the government's business to find the money ! They find it to pay billions in military, no ?? Do you ever question where they find the money to pay for all these weapons
cut off the military budget and there we go !! you will have the money for health care.
But, fool, then we wouldn't be able to afford the gas we are going to put in your fighter planes to support the French efforts in Mali.
You are really a tool.
I guess we could save a lot of money on military expenditures. But then who is going to protect France next time. Look at your govts financial situation. It is not working.
Good luck.
The American mantra: "Don't confuse me with facts or the truth- my mind's already made up. I'm committed to outspending the entire world on BOTH defense and healthcare. Unrepayable debt is good. Deficits are good. We are Americans. We are #1 at everything. Universal HC? Never! That's socialism! $800B defense? America's right and might can't be jeopardized. Private HC insurers are good. Fee-for-service providers are better. Pharma extortion is best. The military-industrial complex is America at its best."
Fool,
Don't forget, even if you cut off military expenditures, you are stil left with a LOT of personnel who need to be paid. They might get a little pi$$ed off if you stop their paycheck (what little of it there is).
Poor people keep screaming for universal health care. We will get universal VAT tax like the EU. Guess what YOU get to pay too no more screaming tax the rich.
It's too bad Romney couldn't have run on his greatest legislative achievement. It's obvious he planned to do so - he took a Republican plan that had languished for several years and had the guts to implement. And it's working!
Unfortunately, he couldn't have foreseen that when it was his turn to get the party's nomination, that his party would decide to go crazy and disown their own legislation - healthcare, climate change, just to name two. Romney definitely got a raw deal in that respect...
Before you start claiming the Mass insurance plan is "working," you should check to see if the $1 BIILION federal bailout of the plan has been repaid. (Hint: it hasn't)
You cannot go on with the old system, it is ruinning millions of americans, and next it could be you.
You people need universal health care and eventually I hope you get it !
Why don't you question where is the money coming from to pay for your insane military machine ?? YOU are paying for all these weapons, military personal etc... and what is it giving you personnaly ?? NOTHING !
Americanfools, please refrain from constantly showing your ignorance. I don't remember anyone invading America. Maybe, just maybe, that defense money buys something France doesn't have.
The line that got me was the examples. Even with the government credit, the guy in the example was still forced to pay $410 a month or 8% of his income whereas the lower income guy would still have to pay $115 a month or 4% of his income.
That is a lot more than a car payment for many people so I guess this law will make it more difficult to balance owning a nice car and get health insurance.
How much is your life worth to you ??
My life and my health is worth way more than a damn car !
My husband and I are paying about $10k a year for the both of us, and have been for a long time. We have health insurance in lieu of a new car.
JRS -
Everyone is going to have to start making decisions more taxing than that. Food or music lessons for the kids? Gas for the car to go to work, or a family vacation? New water heater, or new brakes on the family vehicle?
Face it, we all just got whacked with a large tax increase in the name of "affordable."
fools -
I would guess that 99.99999% of Americans don't really care what your personal preferences are.
we should pay taxes for health care and there should be a none profit business like medicare that takes care of everything without trying to rip everybody off while trying to drive their Owen Mercedes. a car is a necessity to get to work that nobody can do without or you will not have any money to pay the taxes for health care.
It works in australia, canada and europe ! so if it does, it's because people want it and are happy with it.
You know what ?? It will bring you some security in your lives and security is what many americans need.
All Socialist Governments.Ours is not(yet)
Our government is becoming more and more like those all the time. "fools" is hoping we are economically devestated to the point where we need to join the EU and bail them out with our "happy" tax dollars.
She is kind enough to inform us of what we need.
Hilarious.
If you think Healthcare is expensive now,just wait until Obamacare kicks in.
BTW. If you itemize your deductions and take the Medical Exspence Deduction,SURPRISE!! YOUR TAXES JUST WENT UP about 2.5%!! What happened to "Your taxes wont increase one thin dime"?
The SURPRISES have just started, I'm afraid.
slodon... I read through the ACA facts. I simply shook my head. Alot of eyes will be opened up soon and tons of screaming will begin to occur.
Yeah Greatly, will all probably pull out our assault rifles and head into civil war.
That actually might be a good thing...long term.
Who will be qualified to apply for coverage with one of the exchanges? To obtain insurance through one of the exchanges, even if you don't need premium assistance, will you have to prove you have been turned down by all the other private insurers before you can even apply with your State's exchange?
From the article..."When you pick a plan, you'll no longer have to worry about getting turned down or charged more because of a medical problem." Will you still have to fill out forms with 10 years of medical history? If yes, Why?
From the article..."If you're a woman, you can't be charged a higher premium because of gender. Middle-aged people and those nearing retirement will get a price break: They can't be charged more than three times what younger customers pay, compared with six times or seven times today for most private plans." Great! I hope that turns out to be true.
Let's say you currently have an individual policy that is becoming prohibitively expensive as you get older. In my case $1,100 per month for single coverage. With the advent of the exchanges, will the private insurance you have be forced to automatically bring your premium down to the maximum noted above "three times what younger customers pay"? I hope so. What will be be benchmark age for "younger customer"? Who sets that benchmark? If my insurance company doesn't reduce my premium, can I apply for coverage with the exchange for the purpose of reducing my premium? I hope so. Or, will I be forced to keep current coverage at the higher price and prohibited from applying with the exchange?
I just don't think anyone knows how this is all going to work out. It seems to me that Obamacare jumped into bed with the drug companies and insurance companies and those guys will have it figured out so that they continue to make huge profits controlling the access to care and how much is charged for the insurance. Will I really get a price break because more individuals will be forced to have coverage?
How will "income" be defined I wonder? Will you be required to take your tax return to a clerk at the exchange? Say I've been unemployed for a year and my tax return has no income noted other than unemployment benefits. If the clerk at the exchange thinks I look rich will they be requiring some net worth testing, requiring me to divulge bank account names and account numbers?
In the long run, What is this all going to lead to? As several commentators have pointed out, Obamacare seems more about insurance and has nothing to do with health care or reducing the percentage of GDP being spent on healthcare. It seems to me to be about increasing the money flowing in the health care industry and putting even more power and control in to the hands of the federal government.
nobody wanted it when Obama done it and they still don't what it. it js a big complicated mess. to many fat cat insurance company's waiting to take in that mandatory money or you get a fine crap. to many money grubbing pigs as usual . they don't care about anybody just there money. the Canadian system works just fine and they lie abut it all the time. they couldn't just ask them how they do it and do it they wouldn't screw anybody out of their money that way. there should be no profit in health care. why?. they make everything A BIG COMPLICATED MESS
"Affordable" - as in - somebody gets something for little or nothing and somebody else pays for their own plus the costs of the person getting it for nothing. Example - I can "afford" a new Rolls Royce if you pay for it for me.
Pay the DAM EXTORTION/PENALTY/TAX,whatever the hell you want to call it! It's a lot Cheaper!
You Suckers think this is going to be Cheap?Well think again.You thought you were paying for the non insured before?
Wait till you see what you're going to be paying for your policies,plus the people whio can't afford this Obama RACKET!
HAVE FUN!
I guess my question is......why should there be heath insurance at all?.....when you go to a hospital ER room, the prices of goods and services are so jacked up it is beyond ridiculous! wouldn't it be more feasible to pass regulations to cap off these hikes? There is no reason why anyone should be charged 100 bucks to rent a hospital gown or 20 dollars for a band-aid!
it the capitalist pigs in this country . they don't care about anybody. other country's care about people more than this one and it shows look it up. everybody wants to drive a hot car and live in a million dollar house. why do you think all those people from other counties want to come here its the word where they come from and its to get money. its a big joke to them. the good people stay and the money grubbers come here.
I can't wait for alternatives to be able to dump my Anthem Blue Cross plan. This company is a fine example of "profit over product". My plan premium will be raised 24.5% in an obvious effort to squeeze a little more profit before their profit will be capped when the Affordable Care Act takes effect.
You folks may just want to wait to learn more about the coming health care benefits and cost savings for all (except the insurance companies) before spending a fine Sunday with partisan sounding inaccurate criticisms and complaints.
the people couldn't afford healthcare before and they even more so won't be able to afford it now. the economy is going to go to hell more than ever. and Obama is to worked up trying to put some worthless gun ban law on everybody rather than getting everybody worked up on fixing the economy and creating jobs. wait! lets stall some more and talk about immigration for who knows how long. that's good
Yeah, Obama just went off on a tangent, trying to push his commie gun laws instead of jobs, economy, blah, blah,blah. Couldn't be that Obama is responding to a public outcry to do something about gun violence, or anything. Obama has been working his ass off tho try to help the economy all along, dragging the dead-weight, deadbeat, obstructionist republicans along with him.