TPM: "Premiums do not reflect the full cost of coverage."

[antigop]

Three Important Caveats On The Obamacare Premium News

http://talkingpointsmemo.com/dc/three-important-caveats-on-the-obamacare-premium-news

Premiums are usually the top line for the cost of insurance, but they aren't everything. People will also have to pay deductibles and other cost-sharing, like co-payments when they pick up a prescription. Those other costs add up.

For example, according to a Wednesday analysis from Avalere Health, an independent consulting firm, individuals with a silver-level plan from the Obamacare exchanges (which covers 70 percent of costs) will pay an average deductible of $2,250. That's double the deductible that most people with employer-based coverage pay now, according to Avalere. The deductible goes up for bronze-level plans (which cover 60 percent of costs).

The likely reason for those high deductibles is that insurance companies wanted to make headline-grabbing premium prices as low as possible. So they need to make up the expected costs elsewhere, said Dan Mendelson, Avalere's CEO and founder and a former Clinton health adviser.

"This is a highly competitive commercial market. They are pushing to get premiums as low as possible," Mendelson told TPM. "Consumers are going to have to understand this. You can't assume because you pay the premium, you're done paying."

Obamacare does include some protections. For many low-income people, the ACA limits how much they'll have to spend on health care. Individuals with an income at 200 percent of poverty or below won't pay more than $2,250 out of their pocket annually. If those people get in a major accident or are diagnosed with a serious illness, Obamacare is still going to help protect them from catastrophic medical costs.

[Hell Hath No Fury]

1. Health "insurance" is not health "care" -

The devil's ALWAYS in the details.

[antigop]

3. +100. nt

[Shivering Jemmy]

6. Single payer plans are not health care either

Health care is what medical professionals provide.

Insurance involves pooling assets to pay for that health care. Single payer health insurance is still just health insurance.

[enlightenment]

31. So,

is that the new deflection today?

You know good and well what the differences are between health insurance that serves as a gate-keeper between individuals seeking treatment and single-payer systems that allow individuals to receive treatment without filling out reams of paperwork and hoping that some faceless entity in a corporate office "approves" a percentage payment for the treatment after their deductibles and co-pays have been met.

My son lives in the UK. When he goes to the doctor, he makes an appointment and sees the doctor. He does not have to offer up a payment - that payment comes from the taxes that he and his employer pay to the government. THAT is single payer.
If he wants coverage for something that is not generally covered by the NHS, he is free to purchase additional "insurance" to cover those things - but he doesn't NEED it in order to feel confident that he is covered for most anything that could happen.

That's one variety of single payer; there are others that use a combination that include strictly regulated, not-for-profit insurance companies. You know that, too.

None are perfect systems, but they are all infinitely superior to encoding for-profit corporations into a system of health care access.

[Recursion]

48. No, the UK specifically is *not* single payer

Canada is an example of a single payer system. The provinces run their Medicare programs and people are assessed a monthly premium (and, yes, if you don't pay that, you can lose your insurance in Canada).

In the UK, the government runs the hospitals and the doctors are government employees. That's not single payer.

[enlightenment]

117. Really?

Canada's health care system is a group of socialized health insurance plans that provides coverage to all Canadian citizens. It is publicly funded and administered on a provincial or territorial basis, within guidelines set by the federal government.

Under the health care system, individual citizens are provided preventative care and medical treatments from primary care physicians as well as access to hospitals, dental surgery and additional medical services. With a few exceptions, all citizens qualify for health coverage regardless of medical history, personal income, or standard of living.
-- snip --
Certain provinces (British Columbia, Alberta, and Ontario) require health care premiums for services. Under the Canada Health Act, however, health services cannot be denied due to financial inability to pay premiums.

http://www.canadian-healthcare.org/ (pages 1 and 3)

I was very clear that there are a variety of single payer methodologies. You can dance until your feet fall off - it still doesn't make you right.

[Recursion]

118. There are not a variety of single payer methodologies. The UK is not single payer.

I didn't say you can be denied "health care" if you don't pay for your plan in Canada, I said you lose your insurance and have to re-enroll (as people keep pointing out, health insurance is not health care).

Canada is an example of single payer. The UK isn't.

[enlightenment]

119. Right.

The NHS is a socialized system of health care that is administered and paid by the government - one payer, paying the salaries of medical staff and for medical care. By definition, that is one system of "single payer". Medicare and the VA are also systems of socialized - or semi-socialized health care - and they are also "single payer".

Canada has a publicly funded, privately provided system - again, administered and paid by the government via in part by monies collected from those who are eligible to use the system. By definition, that is another system of "single payer". Denmark, Japan, and some other places have varieties of this system but they're not quite the same . . . they are varieties, not cookie cutters.

The thing that makes them the same is that they pay the bills for health care through a single point - beyond that they can vary, sometimes quite a bit.

Single payer refers to the finance - the method of paying - for the system. So you can have many varieties of single-payer systems. Canada's system isn't like the UK's - nor like Denmark's or Japan's - but they are all paid through a single entity.

The bottom line is that the difference is what happens at the door. If you hold a card - call it an "insurance card" or a "health card" or an "id card" - that tells a doctor or hospital or lab that you are covered under that country's system, you will receive care/treatment and you will not be handed a bill at the end of the day. You do not have to fill out forms for every event nor deal with all the other clap-trap that makes up the multi-payer, for-profit, private insurance based system that we have.

I honestly don't care what you think about this, really. I'm sick to death of these "you don't get it" arguments and "best we could do" arguments and "it was the Repukes fault" arguments and the "look how wonderful the ACA is" arguments.

I do get it - and I get you, too. Have a nice day.

[cui bono]

62. Single payer is not for profit. Insurance's goals are profit.

That makes all the difference in the world.

[Recursion]

63. Wait. That's two separate issues. Most US insurers are not-for-profit

And a single payer system could certainly be for-profit if that's how it was designed.

Single-payer simply means there's an insurance monopoly and monopsony.

[cui bono]

75. In the case of single payer health care we're talking about getting insurance companies out

of the picture and having the govt run it, like medicare. That's why people use the slogan "medicare for all". The point is to take the profit out of the picture as well as reduce the vast amount of administrative cost/waste. If you google it you will find plenty of descriptions of it. People have been talking about it for a long time, many other countries use a single payer system. Yes, if you want to just say what the meanings of the words themselves, out of context, mean, you could be right. But in the ongoing discussion of health care, that's not the case.

Are you sure the insurers are not-for-profit? First I've heard of that.

Report: Health Insurance Profits Rise Despite Health Care Reform

By Sophie Quinton
Updated: May 29, 2013 | 8:56 p.m.
January 5, 2012 | 2:48 p.m.

Health insurance companies made ever-widening profit margins in 2011, a result that defies the companies’ predictions that health care reform would put private insurers out of business, a Bloomberg Government analysis has found.

The law’s detractors, including Republican presidential candidates Rick Santorum and former candidate Michele Bachmann, R- Minn., have argued that the 2010 health care legislation put the United States on the road to socialized medicine. Bachmann and other Republican critics have described the law as a “government takeover of health care," but the Bloomberg report suggests the opposite: Since the law was passed, private insurers have become more and more involved in managing public health insurance programs.

In the first three quarters of 2011, the five largest publicly traded insurers reported their best three-quarter performance of the past decade, Bloomberg found. The companies' average operating margin widened to 8.65 percent in 2011, compared with 6.9 percent in the 18 months before the law was passed, surpassing Wall Street analysts’ expectations.

Profit margins for 2011 widened despite new and potentially costly requirements for private insurers under health care reform, such as making insurers accept children with preexisting conditions. Since the law was passed, coverage has remained stable, cost growth hasn't substantially accelerated, and profits show no signs of declining, Bloomberg found.

http://www.nationaljournal.com/healthcare/report-health-insurance-profits-rise-despite-health-care-reform-20120105

[Recursion]

83. A majority nationwide are not-for-profit, or were a couple of years ago

That's most Blue Cross/Blue Shield plans, most religious and university plans, etc.

The point is to take the profit out of the picture as well as reduce the vast amount of administrative cost/waste.

Again, "single payer" and "removing profit" are two totally different ideas. "Single Payer" refers to one specific thing, and not always what the people calling for it mean... Blue Cross was originally an attempt to get profit out of the insurance business, but it's not noticeably cheaper than the for-profit plans.

[cui bono]

86. Well as you can see there are plenty of for profit. Also, not-for-profit doesn't mean CEOs aren't

taking a huge bit off the top in salaries.

And again, when we're talking about single payer health care, it's pretty much a given that we're talking about it being govt run and removing the profit motive. I've never heard or read anything about single payer in this debate that allows for profit. If it did it would have to be one private company running the show and I don't think the laws allow for that sort of nationwide monopoly, though I admit I don't know the laws on that.

[Recursion]

87. Well, they could run it like most utilities are run

A single company is given the contract for insurance and has rates set by law. In a sense that's what we're doing with Medicare and Medicaid, since they contract out the actual insurance provisioning to a few large insurance companies, but the program continues to have a government "face" to the public.

[cui bono]

90. Okay, so then the rates will be set by law, keeping them low.

If not, the whole nation will complain.

However, I have never heard anyone mention this in anything. I still believe if we get single payer health care it will be govt run and that's what's being advocated.

[Shivering Jemmy]

70. no

Insurance can be for profit or not-for-profit.

At its heart, insurance is simply an algorithm whereby risk is distributed across a population to mitigate the effect of realized risk inside a subpopulation.

This occurs within insurance companies. It also occurs inside the government when taxes go to pay for a single payer style health care plan.

I believe that the latter would be preferable. Huge risk pool, massive bargaining power.

But it is still insurance.

[cui bono]

81. Single payer as discussed in the health care debate is not for profit as it would be govt run,

like medicare.

Insurance can be not-for-profit, but I don't believe the top health insurance companies in this country are:

http://www.nationaljournal.com/healthcare/report-health-insurance-profits-rise-despite-health-care-reform-20120105

[Recursion]

28. So Canada doesn't have health care?

All the government does there is provision insurance.

[Hell Hath No Fury]

51. The point is that having access to health insurance

too often -- as in the case of the ACA -- does not equal getting the actual health care you need. I am currently insured through an employer -- if something catastrophic were to happen to me I certainly wouldn't die, but there a dozen smaller things (including some minor surgeries) that I should have taken care of that I cannot due to high co-pays. I am very lucky in that I do not have a deductible -- many people under the ACA will NOT be that lucky.

[Recursion]

64. Yes, people who are finally getting *some* insurance are getting worse plans than you have

What they'll be getting out from under is the danger of racking up multiple hundreds of thousands of dollars in debt (plus free preventative care).

[PoliticAverse]

2. Also the doctor networks in the ACA plans are apparently smaller than those available in the same

insurer's normal employer-based plans in many cases, see:
http://www.latimes.com/business/la-fi-insure-doctor-networks-20130915,0,3866885,print.story
http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html

[Mass]

4. Yes. Same as Medicaid. Some doctors have little interest in taking care of the little guy.

[joeglow3]

72. My wife's office quit taking medicaid

Frankly it had to do with LOSING money by accepting it. They would pay $500 for a drug to administer and would get reimbursed $300 by the government. Can't stay in business too long with that model.

[antigop]

5. 76% of Americans live paycheck to paycheck

http://money.cnn.com/2013/06/24/pf/emergency-savings/index.html

Roughly three-quarters of Americans are living paycheck-to-paycheck, with little to no emergency savings, according to a survey released by Bankrate.com Monday.

Fewer than one in four Americans have enough money in their savings account to cover at least six months of expenses, enough to help cushion the blow of a job loss, medical emergency or some other unexpected event, according to the survey of 1,000 adults. Meanwhile, 50% of those surveyed have less than a three-month cushion and 27% had no savings at all.

[Puzzledtraveller]

22. This is very important.

In some cases households will not be eligible for subsidy and not expanded medicaid services where it applies. These households may really want insurance, need insurance but have nothing left at all to pay for it or are already living in debt.

[antigop]

24. it's overlooked (or ignored) in the discussion. People are stretched now. nt

[Hydra]

57. It's ignored, because that section of the population is "unimportant"

It took me a long time to zero in about why some people were raving about the ACA when it was going to starve some people out.

I figured out that they are in the upper tiers money-wise and can't get insurance or have to pay astronomically due to pre-existing or other problems.

Good for them, but there are people who simply can't afford it and will be forced to get it anyway. I guess any sacrifice is fine as long as they're taken care of.

[antigop]

73. I do think there is some truth to your post. However, 76% is a quite large population.

If they live paycheck to paycheck, they cannot afford premiums, copays, deductibles, and max OOP.

I guess the 24% that don't live paycheck to paycheck won't have a problem.

[Hydra]

100. I was part of that gap with no insurance and no money for it

I got lucky and got a job where I'm getting it mostly paid for, but I recognize where I was going to be, so I try to speak up for it. The people that attacked me for bringing this up would first try to say how I would be benefiting(pretending it would all be paid for by subsidies, which it wouldn't) and then would shift and say that it was benefiting them, so I should be happy for them and ignore the rest. Finally, one admitted that they were having trouble getting insurance for themselves at a reasonable rate and were above subsidy level.

For the people doing well, they don't get what it's like to have $5 left at the end of the pay period(if you're lucky). $100 per month extra for something you can't afford to use will have to come from somewhere. Clothing? Tooth paste? Food? Even worse for people with kids.

I'm lucky not to be one of the people hurt by this...but the fact that they must apparently be sacrificed so the insurance companies can have more customers and the better off can have theirs for less speaks very ill of our priorities in getting this GOP plan passed.

[OhioChick]

30. Precisely n/t

[OhioChick]

7. What I don't understand is

If a person's income is 200 percent of poverty or below, how are they going to come up with the $2,250 out of pocket cost?

[antigop]

8. BINGO! nt

[PowerToThePeople]

11. they won't n/t

[bhikkhu]

12. $2250 versus - unlimited liability

Its not easy for anybody I know, but in my case the difference is incurring a debt I could plan for and work to pay off, versus bankruptcy or losing our house.

[lumberjack_jeff]

111. Exactly right. n/t

[antigop]

15. Cost sharing reductions -- only if you buy a silver plan (per Kaiser)

see below -- post #14.

[pnwmom]

17. For many of them there will be an expanded Medicaid program,

unless they live in a state with an obstructionist Governor.

For others, the ACA provides for income-based subsidies for out-of-pocket costs including deductibles.

[OhioChick]

19. And if there isn't an "expanded Medicaid program" in their State? n/t

[pnwmom]

21. That is a problem that must be fixed -- but it's not the fault of the ACA.

The blame rests on the red state governors and the Supreme Court who enabled them. The people in those states should be putting up an outcry that their federal tax dollars are going to help expand Medicaid in other states but not their own.

[WinkyDink]

25. No? Could the ACA not have been written to take care of this craven loop-hole?

[riqster]

26. It's the fault of an Activist Court, not the ACA

[pnwmom]

27. There wasn't a loophole. It was more of a carve-out created by the Supreme Court.

All states were given Federal funds to pay for the program for three years, and required to pay only 10% after that. Some of the states objected and the Supreme Court went along with them.

If the writers of the act had had a crystal ball, maybe they wouldn't have written in the 10% cost-share. But if they hadn't, the bill might not have been passed in the first place. As it was it barely squeezed through.

[leftstreet]

47. Then the Obama Admin should have abandoned the ACA

...as written

[jeff47]

55. Leaving 25M people without access to health care.

Excellent plan!

Even without expanded Medicaid in all states, the ACA makes the situation much, much better.

[Recursion]

67. Why, so red states can hold the other 25 million people hostage too?

No thanks.

[leftstreet]

77. Where are you guys getting the '25 million' talking point?

That's new

[Recursion]

88. I love how people assume ACA supporters are incapable of reading each other's posts

I saw it the same place you just did.

[pnwmom]

69. Oh yeah, right. Abandon the whole ACA till that part could get fixed. What a brilliant idea.

Because NOTHING is always better than something.

Anyone living in the real world knows that the Dems would have been happy to rewrite that part, but the Rethugs will only accept total repeal -- not improvements or fixes.

[leftstreet]

76. No, abandon the mandate

Until the problems could be 'fixed'

The ACA changes to insurance company regulations are FINE

[pnwmom]

82. The experience of NY State has already proved that that won't work.

NY already has guaranteed insurance without a mandate, and insurance rates have gone up and up as more and more healthy people leave the system.

There's no way Congress would have passed the ACA without the mandate. Again, it barely passed as it was.

http://www.kaiserhealthnews.org/Stories/2013/July/19/new-york-and-individual-mandate.aspx

Analysis: N.Y. Insurance Market Called 'Poster Child' For Individual Mandate

The nosedive in health insurance prices that New York officials announced earlier this week was driven by many factors, but the most important was the individual mandate, a central component of Obamacare.

That’s because insurers are betting they can use that often reviled requirement that takes effect Jan. 1 to nag, nudge, push and prod 2.6 million uninsured New Yorkers, especially the young and healthy, to buy coverage.

What happens in New York won’t happen in the rest of the country. No one should expect premiums to drop by 50 percent anywhere else. New York is an anomaly. It’s big. It’s expensive. It’s a place where people use a lot of health care services, and there are a lot of insurers in the game. It’s also highly regulated. People who buy their own insurance can easily pay $20,000 a year for coverage; Cut that in half, and the prices are still exorbitant


But the main thing that’s different about New York is that the state passed many of the health insurance reforms that are part of Obamacare (along with some that are not) many years ago, only without an individual mandate.

“New York is like the poster child for why you need an individual mandate,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reform. “They implemented all the reforms without the individual mandate, and premiums just went through the roof.”

SNIP

[Skittles]

80. they can't

that's why it is health "insurance" and not health care

[lumberjack_jeff]

110. If they don't get sick, they don't have to.

Would you prefer that we stick with the current system in which the person should come up with $250,000 for a coronary bypass or cancer treatment?

$2250 is the most the insured will ever, hypothetically, have to pay.

[Nye Bevan]

9. All preventive care is free under Obamacare, whether or not you have met your deductible.

And there is no copay.

So your regular check-up is totally free. The following also count as preventive care and are also free:

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use to prevent cardiovascular disease for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Diabetes (Type 2) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for everyone ages 15 to 65, and other ages at increased risk

Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella

Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Syphilis screening for all adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users

For women:

Anemia screening on a routine basis for pregnant women
Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher risk
Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
Domestic and interpersonal violence screening and counseling for all women
Folic Acid supplements for women who may become pregnant
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
HIV screening and counseling for sexually active women
Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
Sexually Transmitted Infections counseling for sexually active women
Syphilis screening for all pregnant women or other women at increased risk
Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Urinary tract or other infection screening for pregnant women
Well-woman visits to get recommended services for women under 65

For children:

Autism screening for children at 18 and 24 months
Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
Cervical Dysplasia screening for sexually active females
Depression screening for adolescents
Developmental screening for children under age 3
Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Fluoride Chemoprevention supplements for children without fluoride in their water source
Gonorrhea preventive medication for the eyes of all newborns
Hearing screening for all newborns
Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Hematocrit or Hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
HIV screening for adolescents at higher risk
**Hypothyroidism screening for newborns

Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
Diphtheria, Tetanus, Pertussis
Haemophilus influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella

Iron supplements for children ages 6 to 12 months at risk for anemia

Lead screening for children at risk of exposure
Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years.
Obesity screening and counseling
Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
Phenylketonuria (PKU) screening for this genetic disorder in newborns
Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Vision screening for all children.

https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1

[frazzled]

10. In other words ...

What you are buying is predominantly what we used to call major medical (the only kind of insurance we had back when I started buying it in the late 1960s), and partially to cover regular medical costs, above a certain amount.

So let's put it this way. If you have no insurance currently (or have been unable to attain it) you will pay the full price of things like X-rays or tests; with the insurance you'll pay up to $2,250. Remember, however, if it's preventative care, like a physical or a mammogram or colonoscopy (this last costs $2K out of pocket at least), it's free under Obamacare. So you can get a lot of doctor time and tests in for absolutely no co-pay under the new system. If you are young and weren't using the doctor, you won't pay a copay at all if you continue not seeing the doctor, or if you use only preventive services. But if you get hit by a car while riding your bicycle, you won't have to go into bankruptcy under this insurance plan. And you're paying into the pool for future use and to underwrite the general care of everyone. It only works that way (and it's the way that a Single-Payer system would work, given that increased taxes would need to underwrite the system.)

I don't like deductibles either. We were able to get out of them with our employer-based insurance by switching from the PPO to the HMO version of the Cigna insurance offered. (We got unhappy when the deductibles started to get in the $2,000 annually realm.) The network for the HMO insurance was wide and included all our same doctors and specialists. The only bummer is that you have to get clearance from your primary care physician for almost everything. But there is 0 deductible, and greater coverage on other things--and the premiums were cheaper. We've been thrilled with it. I hope there will be some HMO-type plans on the exchanges.

[Yo_Mama]

42. Yes, that's really the truth

For many these policies will effectively be major medical, and most doctor visits/more minor treatment will be out of pocket.

The gap that I see is for lower-income persons in actually getting treatment.

The nice long list of things that are preventive care and free is great, but what happens if something is found that NEEDS to be treated? What if your sugars are off, and now you need treatment for diabetes, for example?

I'm afraid that many of the lower income people are going to fall through the gaps with this system.

[frazzled]

43. Lower income people are going to get extremely low premiums

And I guess the point of the Act is that preventative medicine is going to reduce the number of people whose diabetes is out of control in the first place.

Also to consider: this is the beginning. This whole system is going to get tweaked and improved as it continues. That's been the case with all major legislation, such as Social Security.

Finally, I guess that the similar system in place in MA has been working pretty well. Let's not despair before we've tried it (Green Eggs and Ham lesson).

[Yo_Mama]

44. Preventive medicine is just diagnosis

Nothing to do with treatment, for the most part.

Ah, well, I'll just quite posting the obvious. The truth is that Americans don't care about poorer people any more. They just don't.

[frazzled]

46. Not true

Teaching people how to control their blood sugar levels, test them, adjust their diets, etc. is completely more than diagnosis.

[antigop]

13. you could end up paying that deductible each year nt

[antigop]

14. Cost sharing reductions -- only if you buy a silver plan (per Kaiser)

http://www.kaiserhealthnews.org/features/insuring-your-health/2013/070913-michelle-andrews-on-cost-sharing-subsidies.aspx

But the Affordable Care Act also established another type of financial assistance for people who buy plans on the marketplaces, also known as exchanges. Cost-sharing subsidies can substantially reduce the deductibles, copayments, coinsurance and total out-of-pocket spending limits for people with incomes up to 250 percent of the federal poverty level ($58,875 for a family of four in 2013). Those reductions could be an important consideration for lower-income consumers when choosing their coverage.

"Particularly for people who have to utilize a high amount of services, the reduction in total out-of-pocket costs" can be important, says Dana Dzwonkowski, an expert on ACA implementation at the American Cancer Society’s Cancer Action Network.

Cost-sharing reductions will be applied automatically for consumers who qualify based on their income, but only if they buy a silver-level plan, considered the benchmark under the law.

[OhioChick]

16. "only if they buy a silver-level plan?"

What about the other tiered plans?

[ProSense]

18. In the piece linked to,

Obamacare does include some protections. For many low-income people, the ACA limits how much they'll have to spend on health care. Individuals with an income at 200 percent of poverty or below won't pay more than $2,250 out of their pocket annually. If those people get in a major accident or are diagnosed with a serious illness, Obamacare is still going to help protect them from catastrophic medical costs.

...Avalere Health is primarily addressing deductibles for unsubsidized plans.

Despite Lower Than Expected Premiums, Exchange Consumers Will Face High Cost-Sharing Before the Out-of-Pocket Cap
http://www.avalerehealth.net/news/spotlight/Exchange_Benefit_Design_Release.pdf

Yet Avalere Health put out an analysis that claims 80 percent of those participating in the exchange will be subsidized.

Avalere Analysis of Exchange Rates for 2014

As stakeholders prepare for the launch of open enrollment in less than a month, one of the key questions that remain is what pricing will look like in exchanges. Avalere Health analyzed public rate filings released by 12 states1—8 state-run and 4 federally-run or partnership exchanges. Based on the analysis, minimum premiums for a 40-year old, non-smoker averaged across states is $261 per month for a Silver exchange plan. Premiums for the lowest cost Silver products available in each state range from $197 per month in Maryland to $383 in Vermont—a difference of $186 across states. “Regardless of whether the state or federal government is operating the exchange, we are seeing competitive Silver premiums in the low $200 to $300 range in most markets,” says Caroline Pearson, Avalere Vice President. Furthermore, an estimated 80 percent of exchange enrollees will qualify for premium subsidies that will further reduce the cost of coverage.

http://www.avalerehealth.net/news/spotlight/20130904_Avalere_Rate_Analysis.pdf

Kind of hard to figure out what the point of the TPM piece is. The next study TPM cites is a by conservative organization, and then it debunks the findings.

There are some caveats. For a 27-year-old man making less than 400 percent of the poverty level, the law's tax credits will go some of the way -- though not always all the way -- toward offsetting those costs. In addition, the institute's analysis doesn't account for the fact that the health insurance offered through Obamacare is much more comprehensive than the existing plans that it used for comparison. Insurers must cover a wide range of medical services, so the consumer is getting more coverage for the increased cost. Plus, there are the aforementioned limits on how much lower-income people can ultimately be asked to pay out of pocket each year.

Tim Jost, a Washington and Lee University professor and Obamacare advocate, observed in Health Affairs Wednesday that insurance under the ACA will offer "bankruptcy protection" to young people who are paying more for coverage in a way that insurance before the ACA didn't.

[Puzzledtraveller]

20. Me shocked? No.

[WinkyDink]

23. I'm TIRED of being told what I "must understand;" that is, what I must ACCEPT. We knew this would be

the case with MANDATORY FOR-PROFIT INSURANCE, did we not?

And who decided that "a 27-year-old man" was to be the benchmark? How about a 65-year-old woman?

[antigop]

29. Wouldn't a 65- year old woman be on Medicare? However, older people can be charged more

than younger people.

[enlightenment]

36. How about the median age?

That's 37.2, according to the CIA Factbook. That would be a reasonable in-between, but it wouldn't pack the same punch as a 27-year old man (single, no dependents, non-smoker, living in a state with a plethora of exchange options).

Let's face it - this is all part of a transparent and concerted propaganda push for a program that has been enacted as law - we can't escape it, so the push is designed to convince us to "like" it, I guess.

Like most propaganda, it is loaded with manipulations of fact that make things look rosier than they really are - or will be. Not lies, but not exactly truth either.

On DU there are those that support this propaganda and trumpet its "truth" at every opportunity - and there are those who don't (who are, of course, labeled as enemies of the good and the righteous by the supporters; that's par for the course).

[antigop]

38. yes, enlightenment, I do think the news coverage could be better. Older people can be charged up

to three times more than younger people.

The coverage doesn't list premiums for older people (pre-Medicare).

[jeff47]

60. Take the numbers in the coverage and multiply by 3. (nt)

[antigop]

68. The point is...premiums are not listed in the news coverage for older people.

The premiums are listed for younger people.

And the news coverage only focuses on PREMIUMS for younger people....

The whole story is not being told.

As the OP states, "Premiums do not reflect the trust cost of coverage."

[jeff47]

93. The premiums for younger people are driven by the premiums for older people

The 3x limit causes the young to pay more than they would have without that limit - that's how health insurance works, the relatively healthy subsidize the relatively unhealthy.

So the insurance company sets the premium for the older folks, then divides by 3 to set the premium for young folks. Multiplying by 3 will be an excellent measure of the premiums for older people.

As for the rest of the costs, that gets extremely complicated, so it's not something that can be concisely reported. For example, preventative care is free. And the actual deductible is capped by income as is the total out-of-pocket. There's far too many variables for a concise story.

[antigop]

94. you are missing the point. The premiums that are being released in the press

are the premiums for younger people.

The premiums for older people are not being stated.

The press coverage is misleading. It's not telling the whole story.

Also, the press coverage does not even state that policies will have deductibles, co-pays and max oop.

As the OP states, "Premiums do not reflect the full cost of coverage."

[jeff47]

95. So you're arguing multiplying by 3 is beyond the ability of readers?

Also, the press coverage does not even state that policies will have deductibles, co-pays and max oop.

So stories about premiums are only talking about premiums. Shocking.

Next you'll be complaining that stories about Congress are not talking about bear attacks.

As the OP states, "Premiums do not reflect the true cost of coverage."

So go to healthcare.gov, and it will tell you EXACTLY how much it will cost for you. It's not possible to provide an exact cost without asking a lot of information.

[antigop]

96. no, the press coverage doesn't state that older people can be charged up to three times

what a younger person is charged.

People don't necessarily know that. I'll bet a lot of people don't know that. That's the point. People are only being "fed" the rates for younger people.

The press coverage gives rates for younger people. It's misleading and not telling the whole story.

[jeff47]

98. Because the ACA poofed into existence yesterday. (nt)

[antigop]

99. That's all you got? Then I'm done. Have a great afternoon. nt

[jeff47]

103. I'm surprised. I expected you to call the general public idiots

who can't follow a story more than 5 minutes old.

[jeff47]

59. Because that would be even less helpful

Health insurance premiums massively rise late in a person's life - the price versus age is not linear. So the 37.2-year-old is going to be paying sightly more than a 27 year old, but significantly less than a 42 year old.

The 27-year-old is more-or-less the lowest possible premium. The ACA puts a cap where insurance premiums can only increase by 3x due to age. So the price for a 64-and-11-months person is 3x the 27-year-old's cost.

[enlightenment]

114. Well of course.

The success of a propaganda campaign depends on maximizing the best-case scenarios and minimizing everything else.

[jeff47]

115. Because multiplying by 3 is beyond most people's ability?

[enlightenment]

116. Because

propaganda isn't about making things transparent. It's about convincing people that something is in their best interests through careful manipulation of the facts.

You can haul out that line as much as you like - and based on this thread, it appears you find it useful - but whether or not people can't multiply by three isn't what this is about.

[WinkyDink]

106. OOPS! I should have just used my age of 63!

[jeff47]

56. The ACA makes man vs. woman irrelevant.

And the ACA also means age can only add up to 3x the cost.

So multiply the 27-year-old's plan by 3, and you get what a 64-year-old woman's maximum premium will be.

[AgingAmerican]

32. Last August the Obama administration decided to delay the cap

on out of pocket costs until 2015. This means the insurers can rob us for an extra year.

[OhioChick]

35. Whaat? n/t

[subterranean]

66. That delay is not for the plans on the exchanges.

It mainly affects group plans with separate administrators for medical services and prescription drug benefits. The cap will go into effect as scheduled for the exchange plans. (see link below)

http://abcnews.go.com/Politics/obamacare-cap-health-costs-delayed/story?id=19950052

[AgingAmerican]

105. It is for out of pocket expenses

Co-pays and deductibles. Supposedly to grant "relief" to the insurance companies.

http://www.dailykos.com/story/2013/08/13/1230889/-Obama-Administration-Delays-Out-Of-Pocket-Caps-To-Grant-Insurance-Companies-Transition-Relief

"The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.
The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy."

This is absolute bullshit. They claim their computer systems are not yet set up for the changes but they have had four years to do it. Just another bleeding of the public for the benefit of greedy faceless corporations.

[subterranean]

108. Yes, but only for certain types of group plans.

If you're on a group plan with separate administrators for medical and drug benefits, then you'll have to wait an extra year for the cap on out-of-pocket costs. But for most insurance plans, including those sold on the exchanges, the cap will go into effect in 2014 as scheduled.

[Dragonfli]

33. People above 200% of poverty but not of the well healed cul de sac liberal variety

Are still just as fucked and sure to face bankruptcies for serious illnesses in the family (that is the best case scenario that assumes you have some credit or savings to come up with the constant expensive door vigs and deductibles, if you can't, you just don't get care and die).

Some honesty about the truth of the ten thousand pound vampire in the room being fed our blood would be appreciated at this point.
For some reason however, the limo liberals that have the means to pay the vig not only don't give a rats ass about the horrible truth but feel compelled to defend their continued blood sucking presence rather than sticking to extolling the progress that actually has been made towards the good.

Why must they defend an evil system?
They should instead simply point out the truth that many people before the ACA that could not get, or afford, insurance will now have the opportunity to be insured and perhaps receive preventative treatment that may save their lives, that is true and positive.

What is also true is that insurance companies will still price out people from using services for serious illness if they can't beg, borrow or steal the money to pay the constant exorbitant costs specifically designed to discourage use of the policy to access actual care. Also, even if they can borrow the money, the result will be bankruptcy, a loss of all savings and credit as well as anything valuable that will have had to have been sold along the way by people trying desperately to survive their serious illness.

Sicko is now a mandatory and subsidized fact of life that was further codified rather than solved and the lack of honesty about that sickens me because there is no need for that, they should simply point out the many that will at least have a chance to fight the insurance companies for survival rather than not having any option at all which really will be an improvement.

This denial and attempt to hide the evil nature of the health Insurance industry is disgusting to me.

[antigop]

34. as I have stated repeatedly....it doesn't do you much good if you have insurance but can't afford to

get sick.

Post #5: 76% of Americans live paycheck to paycheck.

eta: Plus, the ACA does not address dental and vision coverage. These are absolutely needed.

[Dragonfli]

40. Anybody that has had to use insurance to fight serious illness knows that truth

I lived it and lost everything including my wife and I was one of the lucky ducks that had some savings and credit to pay the vig.

Had I not had credit or savings? Living from paycheck to paycheck would have meant no care, a sooner death and a far more painful death.

Not to mention that by luck I had insurance for the first time in my life due to a good boss that made it affordable enough that I only had to take on an additional 12 hours a week to be able to squeeze it into the "paycheck to paycheck" reality, prior to that a premium was simply not possible. Without a better than average boss? Even the nightmare I lived would not have been possible, only a worse nightmare.

[antigop]

41. so sorry, Dragonfli. So very sorry...it doesn't have to be this way. nt

[Puzzledtraveller]

74. That deserves a standing ovation!

[leftstreet]

79. +1

[raouldukelives]

107. I would suspect many of them are invested in health care & pharmaceuticals.

The last thing they want to see is people getting access to health care without a middle man like themselves to turn a buck on someones tragedy.

[seveneyes]

37. Any increase in costs the ACA incurs on existing policy holders

Should be covered by government rebates to the holders.

[Pretzel_Warrior]

45. The low premium-high deductible scheme has pervaded employer based

health insurance to shift cost onto employees that are high users of insurance. Not saying it is right or wrong-just pointing out many people are dealing with this now.

Another side benefit to think about is this will create a low enough premium for young healthy folks to participate in higher numbers.

If people realize how much this will save them when catastrophic health issues beset them, maybe these deductibles can. E seen in that larger context.

[antigop]

49. yes, you are correct...there has been a shift toward HSAs and high-deductible plans.

The point is....

76% of Americans live paycheck to paycheck and many cannot afford the deductibles, co-pays, and max out of pocket, especially if they have catastrophic health issues.

And if you have a chronic condition, you may pay the deductible and max OOP each year.

[Liberal_Stalwart71]

50. I need to clear this up about the single payer system, too, because I tire of the

misperception...

In a single payer system, we need to understand that people are still paying for health care services. In countries that have socialized medicine, if you will, citizens DO pay into that system. Single payer simply means that a *single payer*--the government--pays for service delivery. That doesn't mean that people get shit for free. Even the poor pay into the system. Everyone pays into the system!! Citizens pay taxes and actually they pay considerably high taxes to support their health care system. Most of them don't mind paying high taxes, either.

So I guess I don't understand what the issue is here. Obamacare will provide subsidies for people who cannot afford health care coverage. The revenues from the savings that are generated from reducing regulatory waste and from everyone paying into the system will help pay for the subsidies that will help low-income individuals and families. In theory, it sounds like a good idea.

So Obamacare isn't perfect. We need to work to improve the system.

But, single pay isn't perfect, either. It's an ideal situation of course. However, I get the feeling that most people are under the impression that under a single payer model, people are getting free health care and so that works better for low-income people. It's not true. People do pay into that system; it's just that they don't have the insurance companies and the like.

[antigop]

52. oh, good grief. Who is saying people get free health care under single-payer?

The OP is about deductibles and affordability under the PPACA.

[Liberal_Stalwart71]

54. It just seems that people think Obamacare is horrible because people

should be paying nothing. How would you design the system? How much should people be paying? How much is affordable is so relative; it's hard for you to determine that for someone else.

[cui bono]

65. I've not seen anyone say health care should be completely free.

Of course single payer would be funded through taxes of some sort. The point is you take out the profit motive and things become much cheaper. So less deductibles, less scrutiny over whether you should get a life saving procedure, etc...

I can definitely determine that when you take out high CEO salaries and profits that there is less money needed for the health care system.

[Liberal_Stalwart71]

84. O.K., fair enough. However, a start: 80-85% has to be directed to health care

coverage now, not like it was before where it was all about denying coverage and not providing care. At least now there is more accountability where there was none before. Not denying based on preexisting conditions, no recission of care, and not tying coverage to employment. Those are improvements. I prefer a single payer system---taking profit out of it. However, I like that we're now looking at the reducing fraud and waste in Medicare and closing the donut whole. Admittedly, it ain't perfect, not neither is single payer.

I spent several years studying the NHS in England. Even the Brits were frustrated with it. That wasn't a perfect system, either. Nothing ever is.

[Hell Hath No Fury]

58. The issue is -

that with a true single payer like in your example, yes, you still pay into the system but you are guaranteed care -- no co-pays, no deductibles. With the ACA you pay for "insurance" premiums -- and you are still paying the additional costs of co-pays and deductibles. If you cannot afford those co-pays or deductibles you may not get the care/treatment you need.

[Liberal_Stalwart71]

61. But I think Obamacare tries to correct at least some of the co-pay nonsense for some

of the plans, no? Depending on the plan and the type of services, you may be able to avoid co-pays altogether. For instance, for some plans, women don't have to pay co-pays for pap smears or mammograms. That didn't use to be the case before Obamacare. Now, again, it ain't perfect. And those deductibles are horrible, again, depending on the plan and the options you choose.

However, I do like the fact that there is some competition: a family and "go shopping" for better options--lower deductibles, lower co-pays or no co-pays, etc.

It's not perfect, but again, we can work towards a better system, no?

[Hell Hath No Fury]

89. Preventative care -

does not have a co-pay. So, a woman gets her mammogram for free. That is fantastic. Now, what if that free mammogram reveals cancer? The woman needs surgery. She may face post-op chemo or radiation. She could be responsible for up 40% of the cost of her total treatment depending on her plan. For the folks who are neither poor enough for the expansion of Medi-cal or rich enough for the delux plan (or private insurance) that is a HUGE fucking deal that will not be solved by the ACA.

[Liberal_Stalwart71]

97. Yes! Yes! Yes! We agree on that. This culture needs to change. We agree!

But we can't blame that on Obamacare, either. It's the culture! It's our lifestyle. When I studied in England, we learned that it was very much imbedded into the fabric of British culture that people see their GP once every 6 months. A mainstay of the NHS preventive care mantra: Brits are required to visit their GP or Health Nurse once every 6 months.

In this country, how would the average American react if our federal government mandated that we see a general health care provider once every 6 months or even once every year? Not only would the Teabaggers be screaming about death panels--they already do!--but I would imagine even the more liberal of us would be yelling about the NSA. It's just not a part of our philosophical makeup. I wouldn't mind it. I'm sure you and other liberal-minded folk who long for that kind of preventive care-based health care system wouldn't mind it, but what about other Americans who would complain about having to rearrange their schedules, take off work, plan for child care? What about all the lame ass excuses they'd make for why they couldn't go to the doctor to get a preventive care check-up? Or even why they couldn't make the necessary lifestyle changes to prevent diseases in the first place? Americans are lazy people by and large. I don't have that much faith in the average American will.

But I do agree with you. If more people would orient themselves towards preventive care--if this is something that the American health care system could reorient itself towards, I think things would definitely change for the better, and certainly would save so much more money. I think that's what we ultimately strive for. Obamacare won't get us there in the long run. I do think it's a start, but we got a long way to go.

I want the public option. The health care exchanges are a step in that direction. I work for the federal government. Federal government employees--yes, that includes Congress and their families--pretty much have the public option if they want it. It works fairly well. It's affordable. It works. Every American should have access to it if that's what they want. And that's the next logical step.

But ultimately we want to move towards preventive medicine with the end result being much better health outcomes than what we have now. You're right. ACA will not be the long-term solution and that's not what I'm suggesting, but it's better than what we have currently and I think we can use that and make much-needed, vast improvements here on out, provided that we work to elect more progressives to Congress. I'm afraid of what will happen in 2014. We Democrats don't get it together and work to keep the Senate and bring in more liberal Democrats, this country will be doomed. It's not about Obama anymore.

[Romulox]

91. This is a ridiculous misdirection; a textbook strawman argument. nt

[dkf]

53. Another concern is if you can't get an appointment you may be forced to go out of network...

And then your bill could be $$$$.

[Skittles]

78. people forget these are the "introductory" prices

"subject to change"

[antigop]

85. that is a very good point. nt

[Romulox]

92. Mandatory, for-profit health insurance: what could go wrong? nt

[JoePhilly]

101. Maybe we should defund it. Call Ted Cruz now.

[TheKentuckian]

102. I think that support for the law actually suffers from overselling despite terrible promotion.

It should have been the "Curb the worst evils of the wicked and insane individual market so we are trying to get it to more closely align with the still considerably evil but way less shockingly horrible group market" Act.

[kentuck]

104. Put that on the list...

Things to change in the new healthcare law...

[Dragonfli]

112. We never passed or even tried to pas a health care law, we passed a law to mandate insurance

Insurance has nothing at all to do with health care, they do no check ups, perform no procedures, surgeries or therapies. They do not even operate x-ray equipment or have technicians that draw blood.

The only purpose health insurance serves is as a completely unnecessary middleman that if anything strives really hard to discourage or outright block you from receiving health care while charging you for their assault. That is a simple fact. They serve an equivalent relationship to health care that a protection racket mobster serves to the safety of shop owners, they are protection racketeers really, if one were to honestly review what they do for health care.

But hey, it was more important to feed a vampirific and completely unnecessary industry with a new captive group of victims to receive their non-services (or more aptly healthcare denial services) because you know, our money won't fly into their accounts without a bit more strong arming because they were losing customers that no longer had/have the money in the budget to pay them to deny care whenever possible.

Like any good mobster that was having trouble getting protection money from clients that ran out of money, they called up some strong arms on their payroll in Government to twist some arms and break some kneecaps and force the poor bastards to pay the protection. All the arm twisting and broken kneecaps that made sure they'd get their protection money won't help their "customers" who simply don't have the money for deductibles and co-pays get actual health care.

So lets just put getting rid of mobsters that do nothing but suck profit and deny health care on the list of things that impede health care when we pass the next, I mean first health care law in this country and join the rest of the world that does not understand the cruelty of our mobster middle-men, our double cost of health care, and our inability to receive very much health care even with our extra costs and myriad of middle-man mobsters.

Let's pass a health care law and not a protection racket protection act before we talk about making the protection racket slightly less abusive yet still unnecessary and evil in the future.

I know, I know, I don't understand the need to prop up our uniquely American industry of vampires and mobsters because I hate capitalism, yadda, yadda, derp.

[antigop]

113. word for the day: disintermediation

http://www.huffingtonpost.com/wendell-potter/disintermediation-a-big-w_b_2522075.html

But while we agree that lawmakers do indeed need to focus on affordability, we disagree on what they should do. Insurance executives want Congress to get rid of some of the most important consumer protections in the Affordable Care Act, a.k.a. ObamaCare. I believe it's time to focus on the value--or lack thereof--that private health insurance companies actually add to our health care system.

Several years ago, a coworker asked our CEO during a staff meeting what kept him up at night. He responded with a single word: disintermediation.

Merriam-Webster defines disintermediation as "the elimination of an intermediary in a transaction between two parties." So what my boss was saying was that sooner or later, Americans might reach the conclusion that private insurers are no more essential than travel agents (remember them?), and that by dispatching health insurers to the history books, we could reduce spending on health care by billions if not trillions of dollars.

Much of what I was paid to do in my former job was to create and perpetuate the impression that insurers are "part of the solution" and "add value" to the system. I put those words between quotation marks because they were used repeatedly by my CEO and other industry leaders and became our mantras, especially in conversations with policymakers and the media.
...
Yes, insurers, it is time for affordability. And time for us as a country to take a good look at why we need to keep you around.

[lumberjack_jeff]

109. Gold, Silver and Bronze refer to actuarial benefit rate.

Gold = 80% (meaning that the insured population can expect that 80% of expenses will be covered)
Silver = 70%
Bronze = 60%

If most employer plans have a gold actuarial value, then yes. It stands to reason that silver individual plans will have higher co-pays and deductibles. Bronze plans, higher yet.