Obamacare / Affordable Care Act : classic or dud?

As that article mentions, one of the reasons this is happening is due to Congress reducing or cutting promised payments to these co-ops, pushing them to failure more quickly.

So one thing I don't get about these plans is why they vary so wildly in benefits at the same cost, often from the same company:

$314.24/mo, $1800 Deductible, $5000 out of pocket max, $25/50 (general/specialist) copay after deductible, $10 prescription after deductible, $500 ER, $1000 inpatient copay after deductible
$316.74, $1200 deductible, $5200 out of pocket, $30/60/10 regardless of deductible, 30% coinsurance for ER and inpatient after deductible.

Both UnitedHealthcare Silver Compass Balanced plans so it should be the same network - I can't figure out why anyone would choose the $314 plan unless there's something I'm missing beyond what healthcare.gov offers in terms of info.

One of the problems with the "marketplace" system is that it's very difficult to value plans against each other due to complexity.

i'm fucking broke.
pell grants, extended into summer, a few summers ago, helped me. (no one ever talks about this.)
the expansion of medicaid covered my mental hospital stays.
i'd be on the streets now, were it not for the affordable care act.
i have serious mental illness. obama helped me, just like lbj might have helped me in the 60s.

sorry.
i'm sorry some of you are paying for it.
i had to drop out of an elite school for mental illness, and i'm looking into some kind of disability insurance now.
i'm so sorry you have to pay for this. i have ptsd.

is it me or is public awareness of the "penalty" still pretty poor?

I've had several friends bitch or lament about having to pay 'penalties for not being able to afford insurance' and on closer inspection pretty much all of them actually qualified for the exemption because the lowest premium in marketplace/work was more than 8.05% of their income. Or they didn't know they qualified for credits in the silver plan?

There's still criticism to be strewn about - it's improved, but I still think the website is a hot mess (I work with insurance administration and I found the application confusing in its requirements in many places), and some people like my mother do not quality for affordable insurance still.

but I feel like even many of my liberal colleagues are turning against the ACA for the wrong reasons - ie they're actually paying the penalty when they could have completed the Exemption forms or failing to notice they can get most of their insurance subsidized if they have low income (my brother for a while paid like $20/month for his, discounted from $200/month due to his earnings, though it increased pretty sharply the next year).

there are different types of exemptions: only some require that you register and get an official letter; some you can just claim on your tax return when you file it. As it is, the way the law is written, the IRS can't levy or put any sort of lien on your accounts if you fail to pay the "shared responsibility" penalty, unlike other income taxes and penalties due.

I have a feeling that people will be very unpleasantly surprised this year to discover how much the penalty has increased from last year.

So much time, money and media attention went into the web sites and fixing their problems that the public education part fell off the media radar during the rollout. Of course, it doesn't help that the Congress won't appropriate any new funds to iron out such wrinkles. The republicans thrive on public misunderstanding of how the system operates and who qualifies for what benefits.

I'd argue that they haven't done any worse at public education about the ACA penalties that about any other tax issues. There is a general problem with financial/legal literacy in this country. And this is the most significant revision to the tax code since the 80s ... and I remember when I started doing taxes about 15 yrs ago, and there were clients that still didn't understand that they could no longer write off personal credit card interest and payments on personal car loans, deductions which were eliminated in the 80s ... 15 years later, they still didn't know.

One of the major problems my clients had last year was that only people who bought insurance through the exchange got forms. If the exchange signed them up for MediCal (the medicaid equivalent), they got no form, so they didn't know if and for what months they were covered.

xxxpost, yeah, this was prompted by one such reaction. a friend of mine from New York was loudly urging her friends to 'make the right choice in Washington' because she had to pay the penalty last year. and yet, given what I know about her, most likely she either could have qualified for Medicaid (since NY expanded) or probably qualified for the individual subsidies for Silver plans and didn't realize it....or qualified for the individual exemption and just didn't complete the paperwork.

Like there are arguments to be made for sure - one of my friends knew she qualified for the individual exemption last year but said the website last year made it difficult to download the forms and she gave up. Others might argue that ok, the cheapest plan available is less than 8.05% of their individual income, but unique circumstances still meant they couldn't afford it (though there are still hardship exemptions involving the costs of caring for disabled family members, medical debt within last 24 months, etc).

But then you have people like my friend from NYC who get assessed the penalty cos, well, of their own dumb fault, and are blaming the administration for their inability to read. I wonder how many people will overpay this year because they either dont' want to bother with paperwork, don't know the exemptions, or w/e.

my parents were worried about it as well as my mom is currently uninsured but I know full well they will be exempt. humorously they do not qualify for much of a credit cos they actually make a fairly ok (if not great) household salary, but she should quality for the individual exemption anyway given the exorbitant premiums they wanted (over $750/month)...but then again she is in her 60s so not surprising.

I think "not wanting to bother with paperwork" is a big thing ... also the fact that there were legal challenges in court, which probably lead to people thinking it could be a waste of time if the challenges succeeded. I still am annoyed that only people who buy insurance through the exchanges are eligible for refunds, as opposed to people (like me, because I was lazy), who bought the same plans direct from the insurer.

this is another on the long pile of "things that frustrate me about the waning days of the fourth party system". because the aca has some pretty serious problems and kind of needs to be amended to address those problems. for instance, it's pretty clear to me at least that the aca needs to realign its incentives some. encouraging people to get healthcare they can't afford by taxing them money they don't have has, uh, some drawbacks as a strategy.

unfortunately, but the republicans' whole "we don't negotiate with anybody" schtick and their refusal to talk about the aca in terms aside from outright repeal, their pathological insistence on breaking absolutely everything they can get their hands on and blaming somebody else for it, makes the flaws of the system impossible to address. also any time i bring up the fact that the aca has some issues that should be addressed, people accuse me of being a republican shill. that doesn't help much either.

pshaw, two large per month is pocket change if you're not lazy

http://boingboing.net/2016/06/28/mississippi-state-rep-tells-di.html

My health care co-op just went into receivership and now my coverage ends on the 31st of this month.

The infuriating thing is that it wasn't really mismanaged. It was shot down because the republicans in Congress have refused to fully fund the transitional payments that were designed to bridge the period when the sickest population would sign up quickly, while the healthiest population would drag their feet until the tax penalties compelled them to sign up. If the ACA were being implemented as it was written, then my co-op would be doing just fine.

Fuck you, congressional republicans! May you all be profiled, then shot by cops during traffic stops. Multiple times.

Yup, same thing happened to me in NY more or less. But eventually another company sprung up with cheap barebones plans so it ended up OK in the end.

http://www.businessinsider.com/aetna-re-evalutaing-obamacare-business-2016-8

Aetna (third largest) considering leaving the exchanges.

Talk about self-fulfilling. Exploitative health care industry makes untold billions of unfair profits, ACA steps in the prevent or limit that, health care industry makes untold millions less in unfair profits. This is why we need(ed) single payer, because for profit health care industry doesn't give a crap about health care.

Not exactly, although I agree with the ultimate conclusion that single payer would be preferable.

I mean the issue here isn't exactly that the ACA is "limiting" Aetna's profits, it's that they're losing money on the products that they offer on the exchanges. But they don't have to offer those products, so the ACA isn't forcing them to lose money. The problem is that if enough companies withdraw from the exchanges (United Healthcare already did or already is going to, I believe), then the exchanges won't work very well.

Aetna just pulled out in 70% of the counties and 11/15 states where it currently offers exchange plans.

if anyone has a Best Aetna Pullout article to offer...

time to propose single payer!

Here you go. I propose single payer.

Classic.

I got a letter saying my current plan won't exist in 2017 and that I'd be auto-enrolled in the nearest equivalent, with a 23% premium hike. I started researching available 2017 plans, intending to drop back to the most basic coverage, and started digging a little deeper into the subsidies and family income reporting. It turns out that I'd mistakenly included my wife's SSDI in the household income last year, and that I had been eligible for a ~$325 subsidy but hadn't taken it. According to the ACA rep (who I got to after being on hold for less than a minute), that subsidy will be applied to my 2016 tax liability and not just vanish in a puff of "oh well."

And since that subsidy still exists for 2017, I've signed up for a silver plan for just over half of what the bronze plan was going to cost me. Deductible drops from $6800 to $1750. PCP visits for a buck, generic drugs for a buck.

Just in time for it to all go away, maybe. Fuck you, Trump.

Trump will have a lot of enthusiastic aiders and abettors in the Republican Congress, who were elected by enthusiastically misinformed voters, whose misinformation and disinformation was funded by greedy, corrupt 1%ers, who will be even more wealthy (they hope) once they kill the ACA -- and probably many thousands of poor and working class people.

well, the wealthy will be wealthier because they will eliminate the extra tax on investment income for wealthy people that goes to funding the ACA. One of the primary changes of Trump's tax plan is reducing taxes on rich people and the types of income they have.

it's a good thing! someday i might be rich and i'll need that tax break .thanks trump

In the last year I finally got a great deal on my health care plan. Made too much for Medicaid, but low income enough to get a $20 a month plan ($500 subsidized). Welp, hopefully I get at least one more year out of it.

Cool dad.

"At some point or another we have to be responsible or have a part of the responsibility of what is going on," Huizenga said. "Way too often, people pull out their insurance card and they say 'I don't know the difference or cost between an X-ray or an MRI or CT Scan.' I might make a little different decision if I did know (what) some of those costs were and those costs came back to me."

The father of five offered a personal example of how this shift might play out. He says his youngest son fell and injured his arm. Not sure if it was sprained or broken, he and his wife decided to wait until the next morning to take the 10-year-old to the doctor's office, instead of going to the emergency room that night. The arm was broken.

"We took every precaution but decided to go in the next morning (because of) the cost difference," Huizenga said. "If he had been more seriously injured, we would have taken him in. ... When it (comes to) those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don't have a cost difference, you'll make different decisions."

http://www.mlive.com/news/grand-rapids/index.ssf/2016/12/sons_broken_arm_bill_huizenga.html

Fast forward ten years, dad's lying in a heap at the bottom of the basement stairs, 'yeah, pop, it looks pretty bad, could be that your spinal column is crushed, but maybe we should sleep on it, don't wanna jump the gun.'

https://www.nytimes.com/2017/01/17/us/politics/congressional-budget-office-affordable-care-act.html

The nonpartisan Congressional Budget Office said on Tuesday that repealing major provisions of the Affordable Care Act, while leaving other parts in place, would cost 18 million people their insurance in the first year and could increase the number of uninsured Americans by 32 million in 10 years, while causing insurance premiums to double over that time.

had a discussion w/ someone yesterday who said we don't need a mandate to offer pre-existing coverage bc once we deregulate insurance industry as well as medical industry prices for insurance will come down enough that low risk consumers will buy insurance in bulk willingly and then from the glut of new customers insurance companies will be motivated to provide insurance for pre-existing high risk consumers as a charitable venture.

i really tried to steelman his pov during the conversation but i think there really is no good argument for this perspective that doesn't just come out and admit that healthcare should be unattainable to some ppl - or put others into lifetime debt.

philip klein apparently agrees:
http://www.washingtonexaminer.com/gop-will-fail-on-obamacare-if-they-cant-admit-a-simple-truth/article/2611075

Republicans are in serious danger of repeating Obama's mistake, because they are having a tough time stating a simple truth, which goes something like this: "We don't believe that it is the job of the federal government to guarantee that everybody has health insurance."

and then from the glut of new customers insurance companies will be motivated to provide insurance for pre-existing high risk consumers as a charitable venture.

...the likelihood of HEALTH INSURANCE COMPANIES, of all the greedy bastards throughout history, to suddenly get a collective social conscience and voluntarily do unprofitable things seems...seems unlikely at best.

Belly bassist Gail Greenwood talks about her endometrial cancer and the ACA: http://bellyofficial.com/2017/01/17/personal-note-gail/

They'll repeal ACA and kick the responsibility down to the state level in the form of block grants, and it'll be a mess and everyone will get to keep running in perpetuity on ineffiecicient government.

to a certain extent a lot of responsibility is already at state level -- the Medicaid expansion -- the states that didn't comply ended up fucking over a bunch of people, but what were the fucked over people going to do? Move to another state?

http://www.motherjones.com/kevin-drum/2017/06/if-obamacare-dies-national-health-care-will-take-its-place/

“We’re not seeing any evidence of a death spiral or a market collapse,” said Cynthia Cox, Kaiser’s associate director of health reform and private insurance. "Rather, what it looks like is insurers are on track to have their best year since the [Affordable Care Act] began.”

http://www.politico.com/story/2017/07/13/obamacare-markets-health-care-240487

never mind all that though. the gap between the rich and the poor is way too narrow in the US. cut those taxes!

tax cuts here we come!

http://www.politico.com/story/2017/09/15/bill-cassidy-obamacare-repeal-bill-242770

^ this isn't being played up in the press, in large part because the chances of its failure are too real and why chance another high-profile failure? if the trumpets start to blow fanfares for this coming to the floor, then they probably have 50 votes nailed down, with Pence to break the tie.

With Paul already against, Murkowski and Collins can block it. I don't see how it can pass. It's a slightly clever thing, to slide some money around between the states to cushion the blow of the cuts from senators that matter, but not clever enough, what with Kentucky and Nevada probably taking a beating.

If they just wrote a plan that said 'defund health care in California and New York, give half the money to red states, half the money to the rich', that would probably pass...

Obamacare is finished. It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.

He's right, it's dead and gone. Only thing left is the rotting husk known as Trumpcare. Enjoying owning it.

It's not dead and gone and it's still torturing me and my family.

which means it's doing exactly what it was designed to do--bring on single payer.