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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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i dropped my healthcare insurance the first of this year.. the premiums went up and i am 45 years old and finally gave up .. i can not afford it anymore .it is cheaper to pay obama's tax fine and get free healthcare.. it does not pay to be responsible in this country anymore.. you win government.. game over.
I would pay the fine also. Anyway, obama is going to subsidize you up to 40k per year, up to 9% agi is the cap... (not a heck of a lot in LA or new york) after that you get to buy the 11k-15k policy per year on your own or the fines will bury if the IRS doesnt' come after you first.
If the Canadian health care system is so great why do the wealthy Canadians come over the border for care? I have neighbors who have second homes in the US and they talk about the wait to see doctors for such minor complaints as breast cancer (3 month wait). When she finally did get in to see someone the doctor "fired" her as a patient and she had to go out and find a new one. I seriously don't know who these people are who think "universal health care" is the way to go. We have doctors now refusing new patients (they don't get paid enough under government programs such as Medicaid and Medicare plus the payments are months in coming) and obamacare never addressed one of the major problems facing physicians - malpractice insurance. This is not a good plan and it's just going to get worse as the details unfold.
Doctors don't get paid enough? You been drinkn their koolaid way to long. I don't know of any fulltime doc making under 150 k unless he is running a mal practice practice. You can check any compensation survey out their mgma, amgma....Most of your surgeons are at 400k per year plus. Ortho, is 600k. The only issue with doctors is they are being trained by medicare --the inside con job taken out on poor americans. ....instead of like school teachers at the state level .That is WHY there is physician shortage and don't let any numbskull tell you anything different. And it is one about 20 reasons why us health care costs are astronomical.
Think that doctors make a lot? Not so fast. Even though their pay is in that $400-800K range, half or more of that is eaten up by malpractise insurance. One way to bring down medical costs is to enact Tort reform to limit lawsuits to a more reasonable level.
You know, the "crash-proof" airplane is feasible. Do you know why its not flying? Because its so expensive to build and operate that there aren't enough people who could afford the air fare to pay for it. We are the only healthcare system in the world that will treat everything for everyone who is insured. Unfortunately, we are getting to point where no one can afford it. All other systems (Canada included) cover everyone but not everything. That is the reality. Your note says "wealthy" Canadians. The key word is "wealthy". If you have money and want to spend it on healthcare, be my guest. The single-payer system in Canada is selective about which procedures they will pay doctors for. Yes, death panels. But, if you can afford the treatment on your own you can come to the U.S. who will sell you anything for a price, even if it only buys you three more months.
"If the Canadian health care system is so great why do the wealthy Canadians come over the border for care?" Because wealthy Canadians, like wealthy people all over the world, are arrogant, self-centered, narcissistic, selfish, greedy little pr!cks who think their sh!t doesn't stink and their wealth makes them superior to the great unwashed masses of average Canadians, and entitles them to get whatever they want, whenever they want it. Heaven forbid they be forced to wait on queue with their fellow countrymen for a few more weeks or months so those who are sicker can get care first. Noooo, a rich person is faaaaarrrr too important to wait! They must have their health care now, now, now, now, now NOW!!!!!
Such selfish, nasty little bastards.
And the sad thing about Americans is that, regardless of whether we are rich or poor, we have the same attitude as the rich. We each believe that we are unique, special and more important than the next person, and we should get whatever we want, whenever we want it, and the hell with the cost. So what if there are others who are weaker or sicker than us? Let them suffer and die if they cannot care for themselves, it is not my problem. Survival of the fittest, baby. Kill or be killed. That's the American way, and if you don't like it, get the f-ck out. Heaven forbid we be asked to pay a little more, or wait a little longer, so that someone less fortunate than us or in greater need than us get the care they need more than we do.
Simply put, we do not care about the good of of others, or the good of society as a whole. Our society would be much different if we actually did. We would not even be having this debate.
The cold, hard, sad truth about americans is that we do not give a dam about others. We care only about our own needs, and all the rest can hang. WE ARE THE MOST SELFISH ARROGANT AND GREEDY PEOPLE ON EARTH.
Misanthropy pure.
Deferments? That last draft was in 1973, FYI that was 40 years ago. Why are you even bringing this up?
The US spent $737 billion on military defense last year. The total us expenditures on health care were $2.5 trillion. While I agree there is waste in ALL government programs, using all military waste would hardly put a HUGE dent in American health care costs. Maybe a small one, like a door ding. I doubt I would report it to my insurance company.
Weird. For some crazy reason we in this nation feel compelled to try to help people that can't help themselves. We could just retreat back and become isolationists again.
Oh and China spends the second most. Are they our ally?
Affordable Care Act was basically written by the insurance companies. They made sure they will get money from everyone in the country and killed any type of single payer option.
Obamacare, like most things Obama, is a rich person's solution to rich people's problems. It doesn't do a thing in the world for the poor bastards who have to decide between food and heat every month. They're the ones who really need the help and the only "help" for them in Obamacare is that they don't have to pay his special tax.
It is not fair to say Obama care does nothing for the poor.
Obama care expands medicaid to include more lower income people. It also gives major federal subsidies to help these people pay for private health insurance.
I do believe it will be just like car insurance. You can mandate people to buy it, but there is always going to be some percentage of the population who will not pay their share of the premiums. They will loose their private insurance covered and continue to show up at the emergency room when they get sick.
Things are different here.
NO private practice.
Hospitals are non-profit as they are owned by the PRC.
The Doctors and Dentists make next to nothing as compared to US salaries.
There are a few private-type healthcare facilities that cater to foreigners, but are very expensive.
The Federal Government can kiss my a$$! My healthcare is none of their business, and if the IRS comes knocking at my door to ask why I didn't answer their questionaire about my health insurance, they can kiss my a$$ too! The so-called "HIPPA" law states that I don't have to share my medical information with anyone. So screw you, Obama!
Next you go to the ER (the American version of socialized medicine), I hope you'll have to kiss their asses.
Defund the Military Industrial Complex by 70%. Put in the single payer system that covers everyone at a great savings, (check out how smarter nations in Europe do it), by eliminating the profit motive that Corporate whore America insists on for Big insurance, Big pharma, and the AMA.
Health care is a right. Our constitution covers the general welfare and happiness of our citizens. You cannot have either if you can go bankrupt due to medical needs.
P.S. Addiction to nicotine IS a pre-existing condition. If anyone should pay for this, it must be the tobacco industry. Not their victims.
Health insurance is no more a right than life insurance. Someone has to pay and you obviously want it to be someone else.
FYI...Medicare and Medicaid is 23% of the federal budget. Social Security is another 20%. The Department of defense is 19%. You can't rob Peter to Pay Paul.
Please explain to me how we treat 30 million new people with the same number of doctors? I can not see how quality of care will not suffer.
The 30 million are going to the doctor now, they are just not paying their bill. Usually it is the emergency room or minor care.
I will not, under any circumstances, participate in this farce. Let them try to fine me. I'm young and have money to pay doctors in cash when I need it. I will not be coerced into paying a dime into a system which I neither voted for nor benefits me in any way.
FYI - I hope that you're healthy and/or wealthy.
A simple trip to the ER can cost you a few thousand with very little 'extras'.
Get a CT, EKG, EEG or MRI's plus the diagnosticians and specialists have charges that add up quickly.
A problem requiring surgery with a hospital stay could easily suck you for $10K +.
Major problems or procedures could run $100K +.
Those costs are what the hospitals charge insurance. You can negotiate a direct cash payment with healthcare providers. Ask the Amish, they do this all the time.
Karma's a b!tch and she bites. With an attitude like yours I cannot wait to see what she has in store for you.
ACA will cause the spiraling higher inflation to start, about then Iran will detonate a Nuke and all the Arabs will kowtow and start another Oil Embargo on the Infidels. That will be the start of WWIII and Insurance isn't going to matter, we'll be lucky to survive. The Mexican Illegals will arm themselves and shazam we have been overthrown, how will a country respond to an army of 11-13 million already in their midst and an active insurgency. The Dictator already has a deal cut with Mexico City where the new orders will come from. Vote Democratic, Vote Republican, it won't matter their both the same.
coo-koo.......coo-koo.......coo-koo.......coo-koo.......
....on an somewhat unrelated note.....this is the perfect example of someone who should NOT own a gun. He/she shouldn't be allowed within 500 feet of one!
By the Border..........
The illegal wetbacks will overthrow our government? Not a chance. They can't even get their cars started. Then again, if Obama succeeds in disarming our citizens, then maybe they have a shot at it. Hahaha..... just kiddin'.
How could any of the "free market principle" people NOT like this idea. Consumers are given many more choices than they have now.....you'd think the GOP would be all over this as an idea. As a matter of fact, they were all over this idea about 20 years ago.
Oops, that's right.....Obama championed this legislation; well, pick up the pitchforks!
'Affordable' health care for everyone. A noble goal. Notice it didn't say "for everyone who wants it" - it's a requirement and you get fined if you don't find room in your budget to pay for it.
Meanwhile EVERY American taxpayer gets to subsidize it again - and where does it come from? Let's look at the hypothetical family of 4 with $60K income and total cost of $12K and out-of-pocket cost of $4K. That means the government is going to be paying $8K for that family - or roughly $666 (interesting number) per month. Where do those tax dollars come from? Someone please explain the economics of this to me: here we seem to have a program that all by itself costs more to operate than the tax base brings in. Just spitballing - but lets say that family of 4 gets their taxable income down to something like $40K - that means their tax bill is around $6K - where does the other $2K/year come from? And where does the money to pay our representatives, those in the Executive branch, national defense, and all the other federal programs come from?
I suspect that for the working population, part of it is going to come in the form of added taxation of the value of the employer's contribution. I didn't say new tax, just same tax applied more broadly. There's already a requirement this year to report the value of the employer's contribution toward cost of insurance they offer on W-2s - how long before that becomes considered real income and taxable at the individual level?
I don't know....but I am thinking Medicare and Medicaid could be on the short list, so this is really just moving money from one "program" to another. What I haven't heard is if we will still be paying the medicare tax.
The other thing I can't figure out is if this is a 'battle' between hospitals and insurance companies. Most insurance companies force hospitals to accept a "negotiated" rate.
I too have the same question. I considered that if they are creating premiums based on income, then do the "wealthy" pay much more than middle class which would create a cusion on costs?
I also question how that will work for people on welfare. Will they need to pay monthly as well? If so does it come from that welfare check?
One good thing about Obama's reelection is that he will be in office to take the heat if it fails. This is one thing that won't be Bush's fault.
Why are we not being offered the same healthcare plan that is afforded to Mr. Obama and members of Congress or why are they not getting the same plans as us "lowly" common folk? Because Obamacare is crap that is why. The elite in Washington get something different than their constituents and we the taxpayers pay for both plans. How is it that nobody is complaining to their Congressmen/women about this sham?
Now, now. The aristocracy always has been and always will be.
You need to stay 'downstairs' and learn your 'place'.
As the communist leadership used to say, "we are all equal...we're just a little more equal than you are".
I call BS!! The "people" who stand to benefit the most is the insurance companies....who are now guaranteed at least 8% of every dollar in the country.
I as a retired military member, am now going to have to pay for medical care that was promised for free during my active service duty, and will be denied the same level of care that I had in the past! I was informed that I now have a new co-pay for each visit to the doctor, as a result of my service connected disability! I thank you Oboma Care for the opportunity to have served a career only to be ripped off!
I as a retired military member, am now going to have to pay for medical care that was promised for free during my active service duty, and will be denied the same level of care that I had in the past! I was informed that I now have a new co-pay for each visit to the doctor, as a result of my service connected disability! I thank you Oboma Care for the opportunity to have served a career only to be ripped off!
I hear you brother. As a fellow disabled vet, I was promised all my service connected disabilities would be taken care of 100%. Last year, they gave me the big middle finger by saying they would only be responsible for 40%. This is the thanks we honorable vets get for serving this country.
Gary3009-2 and chuckzul.......
You can thank the brainless idiots who supported Obama in both elections. This is what we get for letting the uneducated masses vote in our elections.
Actually no you can thank the GOP for all the cuts and they aren't done yet. If they allow the sequester to happen to defense it will hit the VETS again!
Hey, gal. Of course we're not done with cuts. What don't you understand about our government spending over 1 trillion dollars more per year than we are earning??? If you don't understand that, then I hope YOU aren't in charge of your family's budget!
The link to the calculator is 404. Go here:
healthreform.kff.org/subsidycalculator.aspx
I think that a lot of people will experience sticker shock when they actually see the new silver benefits. Community based rates, elimination of preexisting conditions, preventative benefits covered at 100%, and out of pocket maximums will be driving deductibles up. All of these changes are good for the overall health care system, but they have to be paid by someone. That someone is will now be individuals and small groups (shop) with private health insurance.
Because of politics the federal government is way behind on detailing how the Federally Facilitated Exchange will work. I don't think that the systems will be ready by October 1st open enrollment period. I am betting they will announce a delay sometime this summer.
I simply can't afford it. Flat out. And when I don't pay the IRS will make it worse for me. I have considered going' off grid' for a long time. Perhaps now is the time. Or I could use the entitled mentality and go get the health care my state provides me cause I am a veteran. (not sure why I should get free stuff because I signed up for a job though) Hey, maybe that is the answer! Mandatory military service and then health care for life.
Somebody has to pay for all these "benefits." You simply cannot bring some 40 million new patients into the health care system at no cost. Since most of these new beneficiaries will be subsidized, the tax payer gets hit with the bill. Obviously, we have a moral obligation to help those truly in need, but I'm outraged at the prospect of having to pay for someone else who simply refuses to get a job and work for their own welfare - and, unfortunately, there are a lot of those people around. Indeed, the cost of insurance for those of us who actually pay for our benefits (either individually or through our employer's health care program) will continue to climb steeply. I think we'll be very unpleasantly surprised at the actual costs next January (and beyond).
2 points:
1: there are only 100 cents in every dollar
2: It's against the law for insurance companies to lose money. They must have the funds to pay claims. Running out of funds to pay claims? Raise rates.
When the claims start coming in, rates will escalate greatly by 2016. The idea is to require the young and healthy to enter the market and subsidize the unhealthy and old. Rates will look good in 2014, but will escalate after a few years. By necessity, the companies must increase rates to cover claims. When the young and healthy determine that there are few penalties for not buying, they will opt out, leaving older and unhealthier members filing claims without the subsidation of the healthy. Oh, if you are young and not in, just sign up from the ambulance taking you to the hospital. Kinda like confessing or converting on your death bed after a life of sin.