OBAMA/TRUMPCARE MEGATHREAD

[bmags]

My personal favorite will always be Lieberman.

 

Trying to find a way to sabotage it close to the time there was a final, passable bill, in December of ~2009 (I think) he did a press conference where he outlined a plan to replace everything that was being talked about with a proposal to drop the Medicare age to 55.

 

As soon as all the Democrats said "Absolutely OMFG YES" he decided that was a terrible idea and never spoke of it again.

 

I actually forgot about his charade. Spector was more passable with PO than him.

 

I remember being pretty happy with Burris around that time because he was pushing PO as far as he could. Absolute P.O.S. taking that Blago appointment but I he was an excellent vote in 2010.

[cabiness42]

If you want to read it as cynically as possible, that any sort of publicly-available plan would be too good and private insurers couldn't compete with it.

 

"This is why we can't have nice things."

 

OK, but even though I am a public employee, all of the plans I have to choose from are private insurers. Maybe I'm just not understanding what's going on here.

[Chisoxfn]

I wonder if someone can explain how the tax penalty works.

 

We have insurance through my wife’s employer. Our oldest daughter just turned 18 in August and just started her first PT job about a month ago.

 

She was included on our insurance plan but we have been fighting with idiots at the insurance company because they kept insisting they needed more information to prove that we are US citizens. Apparently birth certificates, driver’s licenses and school ids weren’t good enough somehow.

 

Somewhere in the midst of all this, they kicked our daughter off. We found later it was somehow related to the fact that my wife was still going by her maiden name when she had her (we were 18 at the time). This made zero sense because we had our second daughter before we were married as well.

 

We’ll be able to get her back on before the year ends and she only works about 12 hours a week so I doubt her yearly income will even be enough to make the penalty enforceable but I’m not 100% sure on that.

 

 

Also FWIW, we found out that our insurance costs will actually go down next year. It’ll be around $60/month.

Don't quote me on this, but some of the considerations are going to depend on whether you claim her as a dependent or not. If you do, then I presume your income levels will be factored in and thus she might be on the hook for the penalty, which IIRC has a minimum dollar amount or something like 1% of your taxable income. This is off the top of my head and I'm making a lot of assumptions in here based upon other tax benefits, etc.

[Chisoxfn]

I agree with what you say, but with comments like these I'm just wondering how much of the 2009-10 health care fight you remember. Cutting doctor pay would have been impossible.

 

Nationalized insurance is a way easier sell than nationalized health care.

The hard part is, if only Obama care coverage cut approved rates, then you end up with more doctors who will just flat not accept that coverage. It is already happening and would continue to expand. It does seem that there is so much excessive fat in the entire billing process, etc. Part of it is because of all the complications in how to get something approved, you end up having to have so much overhead with people specialized on the billings, etc, to ensure they maximize the revenue, get paid, etc, that those costs ultimately just push up overall costs (got to make it up somehow).

 

I don't have that much of a problem if I go to the doctor for half an hour and it cost $50 bucks. I don't see anything wrong with a doctor spending 30 minutes on me and making that type of money. If you went to an attorney, they'd likely charge you far more then that. I have more issue with all the stuff that involves ridiculous mark ups on standard products as well as the absurdity of how people can work the system (whether it is having additional doctors in a room when it isn't really necessary...thus doubling the cost of a procedure to your insurance company...which then passes on more costs).

 

Other big elephant in the room is the costs related to medical malpractice and how all of the suits cause doctors to be so so careful that they prescribe so many unnecessary, tests, etc, that all add to the cost of the program as well.

[StrangeSox]

Defensive medicine isn't that much of a cost and malpractice reform has had little or no impact on overall healthcare costs where it's been implemented. It's also hard to separate out a "defensive" procedure from a "something else we can bill insurance for" procedure.

[Iwritecode]

Don't quote me on this, but some of the considerations are going to depend on whether you claim her as a dependent or not. If you do, then I presume your income levels will be factored in and thus she might be on the hook for the penalty, which IIRC has a minimum dollar amount or something like 1% of your taxable income. This is off the top of my head and I'm making a lot of assumptions in here based upon other tax benefits, etc.

 

If I claim her as a dependent would she be on the hook for it or would it be on me?

 

Also she will only not be covered for like 1 or 2 months total out of the year.

 

Edited November 14, 2014 by Iwritecode

[StrangeSox]

If I claim her as a dependent would she be on the hook for it or would it be on me?

 

Also she will only not be covered for like 1 or 2 months total out of the year.

Then she is good either way. You have to be uncovered for more than three months.

[bmags]

The hard part is, if only Obama care coverage cut approved rates, then you end up with more doctors who will just flat not accept that coverage. It is already happening and would continue to expand. It does seem that there is so much excessive fat in the entire billing process, etc. Part of it is because of all the complications in how to get something approved, you end up having to have so much overhead with people specialized on the billings, etc, to ensure they maximize the revenue, get paid, etc, that those costs ultimately just push up overall costs (got to make it up somehow).

 

Unless you are referring to medicaid for obamacare coverage, it wouldn't dictate rates. But even in the medicare/medicaid refusals, i highly doubt that number has increased enough to matter. The "cash only" doctors make a lot of noise but the client base for them is too small to be a game changer. The point of ppaca was to allow individual consumers to get group leverage for insurance.

 

PPACA actual did a lot for billing processes to help with costs and they seem to be doing a decent job with what little data we have on it. Costs have, again, slowed the past 5 years and did not accelerate rapidly in 2014. Most PPACA plans are coming in below last years.

 

This bill has been remarkably successful so far.

[Chisoxfn]

Defensive medicine isn't that much of a cost and malpractice reform has had little or no impact on overall healthcare costs where it's been implemented. It's also hard to separate out a "defensive" procedure from a "something else we can bill insurance for" procedure.

On the 2nd point, very true. What information do you have on malpractice having little to no impact on overall healthcare costs?

[Chisoxfn]

Unless you are referring to medicaid for obamacare coverage, it wouldn't dictate rates. But even in the medicare/medicaid refusals, i highly doubt that number has increased enough to matter. The "cash only" doctors make a lot of noise but the client base for them is too small to be a game changer. The point of ppaca was to allow individual consumers to get group leverage for insurance.

 

PPACA actual did a lot for billing processes to help with costs and they seem to be doing a decent job with what little data we have on it. Costs have, again, slowed the past 5 years and did not accelerate rapidly in 2014. Most PPACA plans are coming in below last years.

 

This bill has been remarkably successful so far.

I am specifically referring to those plans under obamacare coverage being more particular with pricing and if that were the case you would have doctors that would not accept that type of insurance and would focus on those insurances and accept those insurances from more your company sponsored private plans. Clearly I understand the obamacare are still private insurers, however, if politicians wanted to they could specify that if you are an exchange covered plan we will only pay x for this and y for this coverage, etc. May not be the case now, but it could be done.

[Chisoxfn]

Unless you are referring to medicaid for obamacare coverage, it wouldn't dictate rates. But even in the medicare/medicaid refusals, i highly doubt that number has increased enough to matter. The "cash only" doctors make a lot of noise but the client base for them is too small to be a game changer. The point of ppaca was to allow individual consumers to get group leverage for insurance.

 

PPACA actual did a lot for billing processes to help with costs and they seem to be doing a decent job with what little data we have on it. Costs have, again, slowed the past 5 years and did not accelerate rapidly in 2014. Most PPACA plans are coming in below last years.

 

This bill has been remarkably successful so far.

Flawed statistic since a lot of PPACA plans were extremely cautious with pricing and relatively expensive to try and protect tail risk from a riskier population, especially in year 1 of Obamacare. There were companies like Kaiser who intentionally bid extremely high as well to again minimize risk on their end. I also can look at my wife and I's coverage, both of which have deteriorated with the advent of Obamacare. My wifes to the point that the Company basically downgraded their coverage to what is minimally required for a company with its employer base, etc. In fact, I can't think of anyone I know who isn't expecting, between increased premiums and deductibles, pretty significant increases to their overall cost of health.

 

 

[Chisoxfn]

Flawed statistic since a lot of PPACA plans were extremely cautious with pricing and relatively expensive to try and protect tail risk from a riskier population, especially in year 1 of Obamacare. There were companies like Kaiser who intentionally bid extremely high as well to again minimize risk on their end. I also can look at my wife and I's coverage, both of which have deteriorated with the advent of Obamacare. My wifes to the point that the Company basically downgraded their coverage to what is minimally required for a company with its employer base, etc. In fact, I can't think of anyone I know who isn't expecting, between increased premiums and deductibles, pretty significant increases to their overall cost of health.

Re: change in coverage and specifically overall costs. I will give one specific example, wife covered under work (previous and now) and with change, her job moves to essentially obama care standard required, premiums are still up, but on top of that, the cost of having our next child in April will be up 900%. We will have went from spending $250 for our first child (out of pocket) to an expectation of $2500 (and if she ends up with a c-section, it would be even more out of pocket). This is with the amount company pays towards the coverage remaining a constant.

 

That is real dollars. A real difference. Is that entirely obamacare's fault, no, but I can tell you flat out they weren't the first and only company to drastically reduce overall health coverage to less platinum plans as a result of obamacare.

[Cknolls]

Premiums for health insurance up 9.3%... Premiums for dental up 25%....premiums for vision up 50%... Co-pays up another $3... RX's up $2.... And coinsurance went from 100% coverage to 95%...

[ptatc]

On the other hand, any time the topic of reduced doctors' compensation comes up, plenty of people scream that they'll all just leave the country or stop practicing medicine.

The problem isn't that simple. People currently complain about the quality and time it takes to see a physician. If you make it less attractive for people to become physicians, it will make the quality and shortage even worse.

 

the best way IMHO is to go to an HSA system. Hospitals charge up to 60% less when paid in cash. Use insurance only for the catastrophic injuries. Everything else, cash. Much of the cost the hospitals and physicians trump up is due to insurance companies taking 180 days to pay.

 

By the way even though hospitals and physicians may charge 117,000 or whatever, they know they aren't going to get it. They charge that and the insurance company says it will only pay 30,000. They hospital gets 30,000 and ingores the rest. It's mostly just monopoly money.

[greg775]

Serious question. I know a lot of people without health insurance. They can't afford it or are unemployed.

Let's say you have no health insurance and have the start of a heart attack and call 911. Take me through what happens to you in terms of getting treated then charged for services.

 

Thank u

 

 

p.s. read another good op/ed story today that said Obama flat out made his plan incomprehensible to get it passed and lied about certain things in Obamacare knowing full well they were lies to the public.

[Brian]

I don't know what insurance you guys have, but my deductibles and premiums haven't budged.

[Jake]

Serious question. I know a lot of people without health insurance. They can't afford it or are unemployed.

Let's say you have no health insurance and have the start of a heart attack and call 911. Take me through what happens to you in terms of getting treated then charged for services.

 

Thank u

 

p.s. read another good op/ed story today that said Obama flat out made his plan incomprehensible to get it passed and lied about certain things in Obamacare knowing full well they were lies to the public.

 

A non-politician who was hired as a consultant for the creation of Romneycare and Obamacare commented that the law might have benefited from people not knowing exactly how it all worked - he was commenting on the fact that it used taxes to pay for poor people's health insurance. Of course, anyone with a head on their shoulders knows that all kinds of harmful rumors were spreading about the PPACA and therefore it's rather doubtful that they benefited at all from Dems not shouting from the rooftops that it involved taxes - especially since there was all kinds of huffing and puffing about "the biggest tax in US history" and all kinds of false garbage along those lines

[StrangeSox]

Gruber was am economic consultant, not a political one. He was not the "architect" of the law, either.

 

 

[cabiness42]

I don't know what insurance you guys have, but my deductibles and premiums haven't budged.

 

It all depends on whether or not your plan was already compliant with the new rules. Mine haven't gone up, but my in-laws had theirs go up 15%.

[ptatc]

It all depends on whether or not your plan was already compliant with the new rules. Mine haven't gone up, but my in-laws had theirs go up 15%.

The state of illinois is a self insured group and mine went up over 50%.

[Jake]

I'm very happy that my parents are now paying less for their premiums and getting loads more stuff covered. They have no illnesses, but are growing older and are overweight, and they were constantly getting nickeled and dimed on everything to the extent that they were just avoiding the doctor. My poor mother had to pay around $2k for a colonoscopy. I can't remember what reason it wasn't covered, I think it was actually just built into the plan that way. They own a small business, so they're doing fairly well for themselves (relative to the average American, who is not doing well), but were still paying around 30% of their income for health insurance before the PPACA

[Y2HH]

I don't know what insurance you guys have, but my deductibles and premiums haven't budged.

 

My specific plan didn't change, but many of the others did, which include higher premiums, higher deductibles, higher co-pays, and higher maximum out of pocket expenses.

 

I do pay a tick over 400$ a month for my health coverage, but I consider my specific health coverage to be diamond level.

[Chisoxfn]

It all depends on whether or not your plan was already compliant with the new rules. Mine haven't gone up, but my in-laws had theirs go up 15%.

Well a lot of it depends on the true cost of your plan. If it is an employer sponsored plan, is your cost up because employer is subsidizing less or is it up because total premiums are up. In some cases, premiums might be up, but your company might step up and keep your costs flat. That doesn't mean the costs are the same.

[cabiness42]

Well a lot of it depends on the true cost of your plan. If it is an employer sponsored plan, is your cost up because employer is subsidizing less or is it up because total premiums are up. In some cases, premiums might be up, but your company might step up and keep your costs flat. That doesn't mean the costs are the same.

 

The total cost of my plan has only gone up 1-2% per year. My in-laws are not on an employer sponsored plan and theirs went up 15% because they had to add a bunch of coverages required by the ACA that they didn't already have. My plan already had all those things.

[StrangeSox]

On the 2nd point, very true. What information do you have on malpractice having little to no impact on overall healthcare costs?

 

http://www.pbs.org/newshour/rundown/could-...th-care-system/

NEWSHOUR: You say that similar reforms have already been enacted in California and Texas. Have they altered the health care landscapes there in any way?

 

SAGE: The California reform has been in place for almost 40 years, the Texas reform for only 10 years. Both reforms have reduced litigation and stabilized liability insurance premiums paid by physicians. Neither state’s reforms have had substantial impacts on health care spending, physician supply or patient safety.

 

Study: Don’t expect big health-care savings from medical malpractice reform

 

But in three states over the past decade that enacted laws to put stricter limits on medical malpractice lawsuits, there hasn't been much of an impact in the volume or cost of emergency room care, a new Rand Corporation study shows.

 

The finding suggests that doctors "are less motivated by legal risk than they themselves believe," casting doubt on the level of savings that could be achieved through medical malpractice reform, according to the study published in the New England Journal of Medicine on Wednesday. The findings try to help clarify a topic still up to for debate — just how much wasteful "defensive medicine" could be eliminated from health care.

 

...

 

 

The new Rand research comes a few weeks after another study determined more than a quarter of hospital procedures were considered defensive actions, but just 13 percent of hospital costs could at least be partially attributed to defensive medicine. Further, that study published in the Journal of the American Medical Association said completely defensive hospital orders accounted for just 2.9 percent of the costs, mostly because of additional days of hospitalization.

 

It basically ends up with more money in doctors' pockets due to reduced liability insurance premiums and reduced liability and not much else.