Obamacare / Affordable Care Act : classic or dud?

I've heard (of) Dwight Twilley -- it sounds like a seventies ringer (it's what he is, no?) going New Wave in 1981.

haha whoops

we have off-shore contractors who cancel polices willy-nilly, I can't even determine wtf they were trying to do to begin with. spend 1/2 my work days reinstating them, it's ridic. 6 fucking logins/passwords I have to use for various systems but hey let's give barely-trained not-really-employees the ability to term policies, excellente.

93% of our accounts have at least 1 data discrepancy between our files and the government's, whole system is a mess

Just to recap: Lang broke the law by refusing to get health insurance coverage because he prided himself on being able to pay his bills out of pocket. But he got sick and actually had too little savings to cover even relatively small health care bills. By now open enrollment has closed. But he figured he'd be able to buy in if he got in a jam or wait till he got sick to buy coverage. Luckily the ACA's Medicaid expansion covers him regardless. But the state of South Carolina refused to accept Medicaid expansion even though the federal government would pay for it. Lang is left in precisely the situation that would exist if the ACA had never been passed. So he blames Obama.

that's just one guy, who is most likely going to go blind (needlessly) unless he gets charitable support. his story has gotten enough exposure that it wouldn't surprise me if a conservative kickstarter helped him out.

there must be so many stories like this in the states that refused to accept medicaid expansion. there are 19 states that refused the expansion. over a million people in texas alone that won't gain access to medicaid and are unlikely to get insurance on their own.

die quickly. go GOP

Well I got another document request letter in the mail. It needs information to verify my household income, which is that I have no real steady household income at the moment, so I'm kind of unsure what to send....

you probably want to send a copy of your most recent tax return.

is there any reason (except for politics) that the language at the heart of the supreme court case - the bit that says the federal government can subsidize coverage only in states that set up their own health insurance markets - could be changed via an act of congress?

various articles have discussed the potential fallout of a supreme court decision that would take away the subsidies. if there was no congressional response, millions would lose their coverage and in the process drive up premiums for people that already have insurance (the death spiral). or, states could try to build their own exchanges as fast as they can. or, congress could grant an extension of the subsidies until 2017 (that's the wyden bill with mcconnell's support).

but no one ever mentions just changing the language in that one section of the law itself. is that not an option? with a functioning u.s. congress, couldn't they just introduce a bill to formally amend the law so that it's more clear that any state can receive subsidies, regardless of whether or not they set up their own markets (as the authors of the law clearly intended)?

No, there is no reason other than politics and animus towards the poor and sick. Congress could've fixed the language.

But worry is setting in: http://talkingpointsmemo.com/news/supreme-court-obamacare-republicans-backlash

yep, that specific article is what prompted this thread revive. the politics behind this confuse the hell out of me. clearly there's a large chunk of conservatives who would like to obamacare go down in flames, no matter what. but then there's also growing recognition that some republicans are getting nervous and are trying to figure out how to salvage the whole thing. that article talks a little about the wyden bill to extend the subsidies until 2017, which has mcconnell's support. but...why not just add a handful of words to the original law and fix the problem at its source?

Senator John Thune ‏@SenJohnThune 30 minutes ago
Six million people risk losing their health care subsidies, yet @POTUS continues to deny that Obamacare is bad for the American people.

i think i mentioned this upthread - GOP slimebags attempting to capitalize on confusion

special place in hell etc.

6-3 seems excessive. what about the veneer of bipartisanship?

http://live.scotusblog.com/Event/Live_blog_of_opinions__June_25_2015

*years after the fact, when no one notices or remembers*

oh, i guess it's not a job-killer, oops

http://www.washingtonpost.com/news/wonkblog/wp/2015/08/12/no-obamacare-isnt-killing-full-time-jobs-new-evidence-shows/

One provision of the law, which is widely known as Obamacare, requires businesses with more than 50 employees to offer health insurance to those working at least 30 hours a week. That mandate took effect this year.

Republicans, and some Democrats, worried that employers would look for ways to get around the mandate, either by giving their employees fewer than 30 hours, or by hiring fewer people.

..."The data, to date, basically say that that hasn't happened, at least on aggregate basis -- that there really hasn't been nearly the change that some people were expecting," said Chris Ryan, a vice president at the payroll-management firm ADP.

Analysts at ADP studied the payrolls of the firms' clients, about 75,000 U.S. firms and organizations. They expected that as businesses prepared for the mandate to take effect, they would adjust their employees' schedules, limiting them to no more than 30 hours a week. Yet ADP found no overall change in employees' weekly schedules between 2013 and last year.

According to ADP's analysis, shifts in scheduling were trivial in every sector of the economy, even in industries that rely heavily on part-time work, such as leisure and hospitality.

man, it's going to be hard to keep track of all the admissions and apologies from the GOP and fox news, whoa now

Love the language they often use. Job KILLER. It is going to MURDER jobs. Jobs are going to meet their mortal end. Quite unlike actual humans if they don't see a doctor.

if Nixon's Plumbers were around they'd be working overtime to get Sanders the nom.

well i guess this is the rong thread

After all these decades I can't imagine the world as it would be today if Ed Muskie had been elected.

Well, year 2 on this: dud again. My health co-op - Health Republic of NY - shut down last week. That's 0/2.

Well, this sucks: http://registerguard.com/rg/news/local/33615907-75/oregon-insurance-co-op-health-republican-to-close.html.csp

Looks like co-ops are shutting down nationally.

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.