Author Topic: Impending repeal of Obamacare--what to do?  (Read 31825 times)

Moustaches

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Re: Impending repeal of Obamacare--what to do?
« Reply #250 on: December 09, 2016, 09:15:37 AM »
If a 20 year old with no dependents chooses to forego insurance, I say let'em.  But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.

Health insurance is not like other kinds of insurance because everyone eventually uses health care as we are all not immortal, and our hospitals policy is to provide emergency care to everyone regardless of insurance.  Even 20 year old invicibles need health care when they get in a car wreck, etc.  So when these young people without jobs go to the ER, if they have no insurance, they can't pay, and they are judgment proof because they have no assets, and so the hospital writes it off and then increases everyone else's bill.  This is why it costs $20 for a Tylenol in a hospital.  So we all end up paying for them regardless.
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Moustaches

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Re: Impending repeal of Obamacare--what to do?
« Reply #251 on: December 09, 2016, 09:17:40 AM »
Exactly.  They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage.  What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions?  The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.

No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!

With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.

I think we are in violent agreement here.  Yes, everyone needs continuous coverage.  However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.
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Kris

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Re: Impending repeal of Obamacare--what to do?
« Reply #252 on: December 09, 2016, 09:21:06 AM »
. Having health care tied to employment is retarded.

-W


Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.

There is some interesting history that led up to this being a "normal" employment benefit in the US.  Mostly due to wage freezes during WW2, resulting in businesses turning towards benefit packages to attract dedicated & experienced labor; which in that time, if you weren't in the army, likely implied that you were an older professional with a family.  So sponsorship of a family health insurance plan was a big part of the new benefit packages.  Following the war, the dominance of such benefit packages were ensured due to preferential corporate tax treatment that major manufacturers lobbied congress for, and got.  Prior to WW2, health insurance, if any, was not a normal employment benefit.  That was something that upper middle class or wealthy families would get in the same way people get automobile insurance today, by contacting an insurance agent and seeking it out.  The majority of middle class and lower didn't get health care via health insurance, they got it through mutual benefit societies or charities. I'm undecided about whether or not health insurance is a necessary part of health care for a single, young adult; but I am of the opinion that children should be granted special consideration.  If a 20 year old with no dependents chooses to forego insurance, I say let'em.  But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.

Yes, I knew this, but was too lazy to type it out as part of my response above.

The problem is the way things have played out since WW2, and the ways in which having insurance tied to employment has evolved in terms of attitudes and cultural norms, not to mention its intersection with the for-profit insurance industry.

That is a much larger subject. And that is what I was talking about when I said it is complete f'ed up that we think of it all as "normal."
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sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #253 on: December 09, 2016, 09:29:59 AM »
then in practice the health insurers will make your life miserable.

My experience is that people most need their health insurance when they are already miserable.  After a major accident, a debilitating illness, a sick child.  Then the insurance company comes along and does everything possible to pay as little as possible.  Hiring a minimum wage claims worker to send you fifty rejection letters for payment is heck of a lot cheaper than paying a $65,000 medical bill from a car accident.

In my case, my insurance company paid a lawyer to deny my coverage was valid, for months, because that was cheaper than just paying the bills.  I absolutely had legal insurance (through my university) but they had zero qualms about trying to retroactively deactivate my policy.  Any why would they?  They're a for-profit corporation with stockholders who want to see their income maximized and their expenses minimized, and the easiest way to accomplish that is to continue collecting premiums and then refuse to pay as many claims as possible.  The financial incentives for for-profit insurance companies are exactly backwards.  They make money by screwing with you in your must vulnerable state. 

I was in ICU when my insurance company started breaking their own rules, and then a nursing home after that, and I had to fight them on it while I was unable to use a telephone due to my injuries.  Evil, predatory companies.  It still makes me angry just thinking about it, all these years later.

waltworks

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Re: Impending repeal of Obamacare--what to do?
« Reply #254 on: December 09, 2016, 09:46:50 AM »
My assumption (probably stupid) is that revoking the tax benefits tied to paying employees via health insurance/etc would be popular with basically everyone. Companies *hate* dealing with insurance, there tons of tax code complexity involved, workers could move around and change jobs more easily, people could start a business without risking their whole families' health, etc.

I mean, if there was ever a win for everyone, that's gotta be it. I guess companies are saving a little money by paying people via benefit but it can't be *that* huge of a tax savings, certainly not enough to justify all the extra HR staff you need to administer it.

Trump is beholden to nobody, so if anyone could propose it, he could.

-W

NoStacheOhio

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Re: Impending repeal of Obamacare--what to do?
« Reply #255 on: December 09, 2016, 09:53:38 AM »
then in practice the health insurers will make your life miserable.

My experience is that people most need their health insurance when they are already miserable.  After a major accident, a debilitating illness, a sick child.  Then the insurance company comes along and does everything possible to pay as little as possible.  Hiring a minimum wage claims worker to send you fifty rejection letters for payment is heck of a lot cheaper than paying a $65,000 medical bill from a car accident.

In my case, my insurance company paid a lawyer to deny my coverage was valid, for months, because that was cheaper than just paying the bills.  I absolutely had legal insurance (through my university) but they had zero qualms about trying to retroactively deactivate my policy.  Any why would they?  They're a for-profit corporation with stockholders who want to see their income maximized and their expenses minimized, and the easiest way to accomplish that is to continue collecting premiums and then refuse to pay as many claims as possible.  The financial incentives for for-profit insurance companies are exactly backwards.  They make money by screwing with you in your must vulnerable state. 

I was in ICU when my insurance company started breaking their own rules, and then a nursing home after that, and I had to fight them on it while I was unable to use a telephone due to my injuries.  Evil, predatory companies.  It still makes me angry just thinking about it, all these years later.

Just chiming in here to violently agree some more.

While not nearly as bad as your situation, I'll share my anecdote.

I turned 26 seven months before the age 26 provision in ACA kicked in. Many insurers/employers simply left people like me on the plan, rather than processing the removal/re-add. Not Aetna.

So I went to my independent insurance agent and said "please sell me insurance." It so happened that Aetna offered the best option for an individual plan, so I filled out all the paperwork and all that.

I have Factor V Leiden, which is a genetic mutation, but not a disease. Critically, I have no personal history of blood clots. They denied me coverage based on a "pre-existing condition." I called and explained which federal laws they were violating, and they said they didn't care, appeals have to be done in writing, no exceptions.

Fine. So I send them a strongly-worded letter with U.S.C. citations (mostly https://en.wikipedia.org/wiki/Genetic_Information_Nondiscrimination_Act). To which they reply, fine, but we're charging you a higher premium. I sent another letter citing the exact same laws I cited the first time, explaining how this was also illegal.

Four months later I had (retroactive) insurance that I never used, and went back on my parental plan as soon as ACA took effect.
« Last Edit: December 09, 2016, 09:55:52 AM by NoStacheOhio »
The first step is acknowledging you have a problem, right?

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Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #256 on: December 09, 2016, 10:46:24 AM »
My assumption (probably stupid) is that revoking the tax benefits tied to paying employees via health insurance/etc would be popular with basically everyone. Companies *hate* dealing with insurance, there tons of tax code complexity involved, workers could move around and change jobs more easily, people could start a business without risking their whole families' health, etc.

I mean, if there was ever a win for everyone, that's gotta be it. I guess companies are saving a little money by paying people via benefit but it can't be *that* huge of a tax savings, certainly not enough to justify all the extra HR staff you need to administer it.

Trump is beholden to nobody, so if anyone could propose it, he could.


-W
You are hilarious.  Trump is beholden to many.

waltworks

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Re: Impending repeal of Obamacare--what to do?
« Reply #257 on: December 09, 2016, 11:13:55 AM »
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.

So I will stand by my "not beholden to anyone" comment.

-W

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #258 on: December 09, 2016, 11:18:21 AM »
He didn't get any big money donations (at least in the context of a presidential election) either.

What counts as "big money"?

Today the news is reporting that Trump took 7 million dollars in donations from the person he has nominated to lead the small business administration in his cabinet.  That sure looks like "beholden" to me.  He's repaying his backers with political appointments.  What could possibly be more swampy than that?

waltworks

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Re: Impending repeal of Obamacare--what to do?
« Reply #259 on: December 09, 2016, 11:25:40 AM »
Meh, what does he care about a few mill, assuming that's true?

I agree that his appointments have basically been cronies. I'd say that shows that *loyalty* matters to him (unduly, IMO, since most of the appointments would on the face of it seem unqualified for their positions) but I don't think it has anything to do with  money.

My point more generally was that, should he be so inclined, he could propose things (decoupling healthcare from employment, for example) that other people probably wouldn't/couldn't. I have very little faith that he'll do any such thing, but you never know.

-W

projekt

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Re: Impending repeal of Obamacare--what to do?
« Reply #260 on: December 09, 2016, 12:11:28 PM »
Who's he beholden to? What's a few million? There's a good chance that his businesses' situations aren't as rosy as the picture he paints. If he is having cash-flow issues with his businesses, he has a lot of reason to keep it private and scramble for the funds.

http://talkingpointsmemo.com/edblog/he-won-t-because-he-can-t

He had been using campaign funds to pay his own businesses a lot:

http://www.politico.com/story/2016/09/donald-trump-business-campaign-trail-228500

Hypothetically, if he were trying to keep cash flow up, he might take a campaign loan and funnel the money back to his companies in the form of revenue for services, so that he can eventually either raise enough campaign money to pay off the campaign loan or let the campaign loan default without hurting his companies.

Everyone knew that if Trump released his tax returns and it showed operating losses, he'd have been toast in the campaign. Perhaps he'd also be toast in business because people have often traded on his appearance of success.

TheOldestYoungMan

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Re: Impending repeal of Obamacare--what to do?
« Reply #261 on: December 09, 2016, 12:36:25 PM »
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.

So I will stand by my "not beholden to anyone" comment.

-W

There's a subtle but important difference between "asked for money but was rejected because they didn't like him" and "flipped the bird to the entire establishment."  Trump was not an anti-establishment candidate, he was the candidate neither establishment wanted to support.  He got the support of anti-establishment folks because enemy of my enemy, but mostly because the alternative was HRC.
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Daleth

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Re: Impending repeal of Obamacare--what to do?
« Reply #262 on: December 09, 2016, 12:53:34 PM »
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.

So I will stand by my "not beholden to anyone" comment.


Vladimir Putin heard that remark and is chuckling to himself as he lubes up behind a trouserless Trump.

Having declared bankruptcy 4 times, been sued for fraud, had casinos and other businesses fail, etc., Trump can't get bank loans anymore. He gets his money from Russian oligarchs. That's who he's beholden to. Good call, America.

Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #263 on: December 09, 2016, 01:00:49 PM »
If a 20 year old with no dependents chooses to forego insurance, I say let'em.  But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.

Health insurance is not like other kinds of insurance because everyone eventually uses health care as we are all not immortal,


Heath insurance and health care are not quite the same thing.

Quote

 and our hospitals policy is to provide emergency care to everyone regardless of insurance.  Even 20 year old invicibles need health care when they get in a car wreck, etc.  So when these young people without jobs go to the ER, if they have no insurance, they can't pay, and they are judgment proof because they have no assets, and so the hospital writes it off and then increases everyone else's bill.  This is why it costs $20 for a Tylenol in a hospital.  So we all end up paying for them regardless.

Well, yes & no.  I can see that argument, but there are much better ways to encourage a minimum standard of civic health care than what we ended up with.
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Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #264 on: December 09, 2016, 01:06:12 PM »
Exactly.  They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage.  What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions?  The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.

No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!

With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.

I think we are in violent agreement here.  Yes, everyone needs continuous coverage.  However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.

There is a better way.  Rather than depending upon a yearly risk pool, start a lifespan risk pool of one.  That's pretty much the idea behind the HSA.  I've ran the numbers many years in a row, and my own health kinda sucks, but the actual cost to me is within 2% one way or the other every year I've had it.
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NoStacheOhio

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Re: Impending repeal of Obamacare--what to do?
« Reply #265 on: December 09, 2016, 01:22:14 PM »
Exactly.  They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage.  What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions?  The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.

No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!

With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.

I think we are in violent agreement here.  Yes, everyone needs continuous coverage.  However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.

There is a better way.  Rather than depending upon a yearly risk pool, start a lifespan risk pool of one.  That's pretty much the idea behind the HSA.  I've ran the numbers many years in a row, and my own health kinda sucks, but the actual cost to me is within 2% one way or the other every year I've had it.

If we add some sort of safety net, this might work. Otherwise you get outliers like the person who gets cancer at 23 having been in an entry-level job for a whopping two years. Now they're looking at medical bills that are multiples of their annual salary. It's not the norm, but it's absolutely going to happen to somebody.
The first step is acknowledging you have a problem, right?

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Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #266 on: December 09, 2016, 03:31:45 PM »

If we add some sort of safety net, this might work. Otherwise you get outliers like the person who gets cancer at 23 having been in an entry-level job for a whopping two years. Now they're looking at medical bills that are multiples of their annual salary. It's not the norm, but it's absolutely going to happen to somebody.

It will happen to somebody eventually anyway.  There is no perfect solution.
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Unique User

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Re: Impending repeal of Obamacare--what to do?
« Reply #267 on: December 09, 2016, 03:39:58 PM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.

It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).

My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.

It is almost impossible to "shop" for procedures and especially not in the case of an emergency.

And I also +1 that Pence is *ss.

This.  This is exactly what I thought when I read Ryan's plan.  I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office.  Doctor's offices won't tell you, flat out won't tell you.  It's a crap shoot.  The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year.  His company only has HDHP plans also and fund HSAs to a certain amount.

And sounds like we all agree Pence is a sanctimonious *&%. 

Unique User

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Re: Impending repeal of Obamacare--what to do?
« Reply #268 on: December 09, 2016, 03:49:19 PM »
Meh, what does he care about a few mill, assuming that's true?

I agree that his appointments have basically been cronies. I'd say that shows that *loyalty* matters to him (unduly, IMO, since most of the appointments would on the face of it seem unqualified for their positions) but I don't think it has anything to do with  money.

-W

You're kidding, right?  Trump whored himself on the Apprentice for a couple hundred thousand per episode, cheated people out of thousands through Trump U and would stiff contractors for a $30k or less bill.  And as other people pointed out no US or European bank will lend him money and he's been lining his own pockets with campaign money.  I think he is much, much less rich that he says he is and a few mil, as you put it, means a lot to him.  But that is meaningless now since he will double deal and steal his way to real riches with the Presidency. 

Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #269 on: December 09, 2016, 06:09:13 PM »

This.  This is exactly what I thought when I read Ryan's plan.  I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office.  Doctor's offices won't tell you, flat out won't tell you. .

I've done it dozens of times.  I think it depends upon state regulations more than the ACA or whatever.  I can get "cash price" radiology care pretty cheap, but I have to drive across the state line into Indiana, and there is a law that prohibits the radiology office from verifying the actual cost of "cash price" care to my insurance company.  When I asked about this, the receptionist said, "you can try to turn in the receipt, but if the insurance company calls to check, we are prohibited by law from verifying that is what you paid us, or even that you were a patient."  So my trips to the radiologist do nothing for my annual deductible.  Also, my main doctor is a 'Doctor of Internal Medicine', not a general prac; and she will not deal with insurance forms of any kind.  That is actually in her contract.  I pay a monthly "membership fee" that covers any office visits, as well as my regular meds (that I get through my doctor's office, not a pharmacy), and I have her cell phone number.  Her only employee, that I know of, is a nurse.  No secretaries at all.  She does keep a real doctor's office, though; but I'm pretty sure it's a shared office deal of some kind.  The last time I went to that radiologist's office for two x-rays, it cost me $37 in cash.  But they do mean cash, even credit won't fly.
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gerardc

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Re: Impending repeal of Obamacare--what to do?
« Reply #270 on: December 09, 2016, 08:57:06 PM »
No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!

With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.

I think we are in violent agreement here.  Yes, everyone needs continuous coverage.  However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.

Not continuous coverage their entire lives! there'd be a one-time open enrollment window in 2017 or 2018 where everyone could reset their continuous coverage history and start anew.

You'd only need documentation from 2017/2018 on, and it would be digitally recorded, and automatic. Further, insurance companies wouldn't be allowed to retroactively deny coverage; it they accept the policy, then you're good to go forever.

former player

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Re: Impending repeal of Obamacare--what to do?
« Reply #271 on: December 10, 2016, 02:56:57 AM »

You'd only need documentation from 2017/2018 on, and it would be digitally recorded, and automatic. Further, insurance companies wouldn't be allowed to retroactively deny coverage; it they accept the policy, then you're good to go forever.
Good to go as long as you can come up with the cash for the premiums, on the nail, every time, for the rest of your life, without fail.

What do you do when it is a choice of paying health insurance or paying the rent, or buying food, or keeping your car on the road so you can work, or paying the copays so that your cancer treatment can continue?
Be frugal and industrious, and you will be free (Ben Franklin)

gerardc

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Re: Impending repeal of Obamacare--what to do?
« Reply #272 on: December 10, 2016, 12:24:33 PM »
Good to go as long as you can come up with the cash for the premiums, on the nail, every time, for the rest of your life, without fail.

What do you do when it is a choice of paying health insurance or paying the rent, or buying food, or keeping your car on the road so you can work, or paying the copays so that your cancer treatment can continue?

That's the case with Obamacare too, isn't it? The key is providing enough subsidies for those who cannot afford premiums, like in Obamacare, which is an orthogonal problem. I'm merely saying pre-existing ban + mandate with cash penalties of Obamacare can be replaced with pre-existing ban condtional on continuous coverage.

We can also be more flexible with the continuous coverage rule without messing with the actuarial value too much:
- Allow 2-3 months of interruption without coverage being considered broken
- Allow to "reset" your coverage history every 5 years, e.g. with an open enrollment window with no pre-existing checks.

Paul der Krake

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Re: Impending repeal of Obamacare--what to do?
« Reply #273 on: December 10, 2016, 01:34:49 PM »
There are some grace periods in the ACA:

https://www.healthcare.gov/apply-and-enroll/health-insurance-grace-period/

It's not much, but the whole idea behind the ACA was that subsidies would make premiums affordable and people wouldn't skimp on them.

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Re: Impending repeal of Obamacare--what to do?
« Reply #274 on: December 10, 2016, 02:24:07 PM »
Good to go as long as you can come up with the cash for the premiums, on the nail, every time, for the rest of your life, without fail.

What do you do when it is a choice of paying health insurance or paying the rent, or buying food, or keeping your car on the road so you can work, or paying the copays so that your cancer treatment can continue?

That's the case with Obamacare too, isn't it? The key is providing enough subsidies for those who cannot afford premiums, like in Obamacare, which is an orthogonal problem. I'm merely saying pre-existing ban + mandate with cash penalties of Obamacare can be replaced with pre-existing ban condtional on continuous coverage.

We can also be more flexible with the continuous coverage rule without messing with the actuarial value too much:
- Allow 2-3 months of interruption without coverage being considered broken
- Allow to "reset" your coverage history every 5 years, e.g. with an open enrollment window with no pre-existing checks.

There is a big difference, though.

Let's say you have some sort of preexisting condition. And let's say you have finally been able to get some sort of coverage under the ACA and you have been maintaining coverage for several years. Now let's say you run into an ongoing cash crunch that causes you to drop the coverage for a few months. You will then have to pay the ACA penalty, which sucks, but IT IS A ONE TIME PAYMENT. Come next enrollment period, your cash flow has improved again and you can buy back in on the same policy as before WITH NO PRICE PENALTY.

Under the GOP versions of the pre-existing conditions clause, if you had to drop coverage and then buy back in at some later point, the insurance company couldn't turn you away, but they COULD permanently jack up your premium. ETA, one of the most detailed GOP plans (the Price one, I think), would allow insurers to jack your premiums up to 150% every time you let your policy lapse.

So the difference of dropped coverage for people of uncertain cash flow is a single penalty payment 'ding' under the ACA, versus a permanent 'ding' under the GOP plan, that is, an ongoing payment increase for every occasion they let coverage lapse.

That is a big difference.
« Last Edit: December 10, 2016, 02:26:47 PM by wenchsenior »

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Re: Impending repeal of Obamacare--what to do?
« Reply #275 on: December 12, 2016, 01:03:26 PM »
No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!

With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.

I think we are in violent agreement here.  Yes, everyone needs continuous coverage.  However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.

Not continuous coverage their entire lives! there'd be a one-time open enrollment window in 2017 or 2018 where everyone could reset their continuous coverage history and start anew.

You'd only need documentation from 2017/2018 on, and it would be digitally recorded, and automatic. Further, insurance companies wouldn't be allowed to retroactively deny coverage; it they accept the policy, then you're good to go forever.

How is this any different then what I said before, as long as you replace the year 1982 with 2017, and then advance the current year to 2040?  I don't WANT to have to store files about my freaking health insurance for the rest of my life.  Digital storage is just as much of a burden.  And if you are saying the insurance companies or the Federal govt. will store all of my health insurance history, talk about the fox guarding the henhouse.
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Re: Impending repeal of Obamacare--what to do?
« Reply #276 on: December 12, 2016, 01:14:01 PM »
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.
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Re: Impending repeal of Obamacare--what to do?
« Reply #277 on: December 12, 2016, 01:43:17 PM »
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.

Because you are assuming a perfect process and perfect people and I am not.  Because insurers have a reputation for looking for any loophole possible to get out of paying large claims.
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Metric Mouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #278 on: December 12, 2016, 01:56:29 PM »
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.

Because you are assuming a perfect process and perfect people and I am not.  Because insurers have a reputation for looking for any loophole possible to get out of paying large claims.

Hey, you don't have to convince me. The quicker we can get away from needing to deal with health insurance companies for anything, the better.
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Re: Impending repeal of Obamacare--what to do?
« Reply #279 on: December 12, 2016, 02:44:21 PM »
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.
Because employer insurance does not require proof of prior insurance.  They only go for that, once you have claim.

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Re: Impending repeal of Obamacare--what to do?
« Reply #280 on: December 19, 2016, 09:37:21 AM »
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.

Because you are assuming a perfect process and perfect people and I am not.  Because insurers have a reputation for looking for any loophole possible to get out of paying large claims.

Hey, you don't have to convince me. The quicker we can get away from needing to deal with health insurance companies for anything, the better.

I think we can all agree on that.  Here are some ideas (all of which will not happen under Republican government):

1. Enable everyone to get Medicare.  This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies.  The government would have massive bargaining power to keep prices down as well.  All the complexity would be removed and the administrative costs would go down for all involved.  However, many health care insurance provider employees, and administrative people would lose their jobs.

2. Keep Obamacare, but with stronger regulations.  Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance.  This would get all the young healthy people into the insurance market, reducing premiums for all.  However, those who don't want insurance would now be forced to have it.

3. Abolish the usage of corporations for health insurance.  Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.

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Re: Impending repeal of Obamacare--what to do?
« Reply #281 on: December 19, 2016, 09:43:54 AM »
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.

Because you are assuming a perfect process and perfect people and I am not.  Because insurers have a reputation for looking for any loophole possible to get out of paying large claims.

Hey, you don't have to convince me. The quicker we can get away from needing to deal with health insurance companies for anything, the better.

I think we can all agree on that.  Here are some ideas (all of which will not happen under Republican government):

1. Enable everyone to get Medicare.  This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies.  The government would have massive bargaining power to keep prices down as well.  All the complexity would be removed and the administrative costs would go down for all involved.  However, many health care insurance provider employees, and administrative people would lose their jobs.

2. Keep Obamacare, but with stronger regulations.  Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance.  This would get all the young healthy people into the insurance market, reducing premiums for all.  However, those who don't want insurance would now be forced to have it.

3. Abolish the usage of corporations for health insurance.  Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.

I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).

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Re: Impending repeal of Obamacare--what to do?
« Reply #282 on: December 19, 2016, 03:18:13 PM »
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.

So I will stand by my "not beholden to anyone" comment.

Vladimir Putin heard that remark and is chuckling to himself as he lubes up behind a trouserless Trump.

Having declared bankruptcy 4 times, been sued for fraud, had casinos and other businesses fail, etc., Trump can't get bank loans anymore. He gets his money from Russian oligarchs. That's who he's beholden to. Good call, America.

I don't believe Donald Trump has ever filed for bankruptcy.

So, corporations aren't people after all!

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Re: Impending repeal of Obamacare--what to do?
« Reply #283 on: December 19, 2016, 05:48:11 PM »
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.

So I will stand by my "not beholden to anyone" comment.


Vladimir Putin heard that remark and is chuckling to himself as he lubes up behind a trouserless Trump.

Having declared bankruptcy 4 times, been sued for fraud, had casinos and other businesses fail, etc., Trump can't get bank loans anymore. He gets his money from Russian oligarchs. That's who he's beholden to. Good call, America.

I don't believe Donald Trump has ever filed for bankruptcy.

Technically, no he hasn't.  He has filed Chapter 9 (corporate bankruptcy) on behalf of several of his independent companies, but has never done so personally.
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Re: Impending repeal of Obamacare--what to do?
« Reply #284 on: December 21, 2016, 05:09:32 AM »
1. Enable everyone to get Medicare.  This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies.  The government would have massive bargaining power to keep prices down as well.  All the complexity would be removed and the administrative costs would go down for all involved.  However, many health care insurance provider employees, and administrative people would lose their jobs.

2. Keep Obamacare, but with stronger regulations.  Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance.  This would get all the young healthy people into the insurance market, reducing premiums for all.  However, those who don't want insurance would now be forced to have it.

3. Abolish the usage of corporations for health insurance.  Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.

I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).

Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths...  Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.

It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs.  I think that any push for improving the current system is going to be fought hard by democrats, sadly.
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Re: Impending repeal of Obamacare--what to do?
« Reply #285 on: December 21, 2016, 05:52:08 AM »

Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths...  Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.

It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs.  I think that any push for improving the current system is going to be fought hard by democrats, sadly.

Optics matter in this fight. If they frame it as fixing and improving ACA, I think the democrats will at least come to the table. If they repeal first without a plan (which is what it looks like they're trying to do), then yeah, they're going to have a tough time getting any democrats on board, even if they propose a revised version of ACA in the end.
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Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #286 on: December 21, 2016, 06:11:15 AM »
1. Enable everyone to get Medicare.  This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies.  The government would have massive bargaining power to keep prices down as well.  All the complexity would be removed and the administrative costs would go down for all involved.  However, many health care insurance provider employees, and administrative people would lose their jobs.

2. Keep Obamacare, but with stronger regulations.  Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance.  This would get all the young healthy people into the insurance market, reducing premiums for all.  However, those who don't want insurance would now be forced to have it.

3. Abolish the usage of corporations for health insurance.  Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.

I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).

Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths...  Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.

It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs. I think that any push for improving the current system is going to be fought hard by democrats, sadly.
The democrats have been fine with improving the current system for years.  What they are not fine with is is worsening the current system which is what the GOP wants.  Removing people from care, having people lose access are all main points of the Ryan plan especially when you look at his wish for medicare.  That is not improvement.

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Re: Impending repeal of Obamacare--what to do?
« Reply #287 on: December 21, 2016, 06:43:24 AM »
If the Democrats are smart they will not work to "fix" or replace it.  Let the Republicans own it, you break it you buy it.
« Last Edit: December 21, 2016, 09:31:12 AM by jim555 »

wenchsenior

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Re: Impending repeal of Obamacare--what to do?
« Reply #288 on: December 21, 2016, 07:53:21 AM »
1. Enable everyone to get Medicare.  This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies.  The government would have massive bargaining power to keep prices down as well.  All the complexity would be removed and the administrative costs would go down for all involved.  However, many health care insurance provider employees, and administrative people would lose their jobs.

2. Keep Obamacare, but with stronger regulations.  Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance.  This would get all the young healthy people into the insurance market, reducing premiums for all.  However, those who don't want insurance would now be forced to have it.

3. Abolish the usage of corporations for health insurance.  Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.

I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).

Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths...  Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.

It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs.  I think that any push for improving the current system is going to be fought hard by democrats, sadly.

Jail time might not deter Americans from doing shit, that's true. I was just making the point that apparently it DOES deter people from going without health insurance in the handful of countries that use it as part of their incentive package, because in those countries most people are covered by private insurers and yet their system works fine apparently, and there is near universal coverage. Would Americans behave differently? Probably. We're definitely 'special'.

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Re: Impending repeal of Obamacare--what to do?
« Reply #289 on: December 21, 2016, 10:01:07 AM »
The democrats have been fine with improving the current system for years.  What they are not fine with is is worsening the current system which is what the GOP wants.  Removing people from care, having people lose access are all main points of the Ryan plan especially when you look at his wish for medicare.  That is not improvement.

Which is how I think the democrats will frame it. As mentioned above, it won't really be about improving the debacle that is the ACA (it probably can't be 'fixed' by its nature, but it could be improved) it will be about how the ACA is so perfect, and any change that changes coverage or allows people to opt out or doesn't increase penalties will be seen as 'worsening the current system.'  So that was my point - the democrats will fight any improvements in the general system because of small deficiencies in the changes, without offering working suggestions of their own, and then blame the republicans, which is what the R's have been doing for years. Unsurprising, but not really helpful.
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Re: Impending repeal of Obamacare--what to do?
« Reply #290 on: December 21, 2016, 11:47:02 AM »
If Republicans want to improve it they can expand Medicaid in those states where they have blocked it.  They could do this today with no Democrats.
They could cease their lawsuit to block cost sharing reductions for the Silver plans.
They could increase the subsidies and lower the OOP on the plans.

When Republicans say "improve it" they are really saying "make sure it can't work and monkey wrench it".

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Re: Impending repeal of Obamacare--what to do?
« Reply #291 on: December 28, 2016, 11:57:46 AM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.

It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).

My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.

It is almost impossible to "shop" for procedures and especially not in the case of an emergency.

And I also +1 that Pence is *ss.

This.  This is exactly what I thought when I read Ryan's plan.  I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office.  Doctor's offices won't tell you, flat out won't tell you.  It's a crap shoot.  The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year.  His company only has HDHP plans also and fund HSAs to a certain amount.

And sounds like we all agree Pence is a sanctimonious *&%.

The practice my doctor is associated with has a cost estimator on their website.  Put in the type of visit or procedure and you get an estimate of the total cost.  And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.

It sounds like your doctors need to join the 21st century...

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #292 on: December 28, 2016, 12:41:49 PM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.

It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).

My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.

It is almost impossible to "shop" for procedures and especially not in the case of an emergency.

And I also +1 that Pence is *ss.

This.  This is exactly what I thought when I read Ryan's plan.  I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office.  Doctor's offices won't tell you, flat out won't tell you.  It's a crap shoot.  The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year.  His company only has HDHP plans also and fund HSAs to a certain amount.

And sounds like we all agree Pence is a sanctimonious *&%.

The practice my doctor is associated with has a cost estimator on their website.  Put in the type of visit or procedure and you get an estimate of the total cost.  And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.

It sounds like your doctors need to join the 21st century...
Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.

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Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #293 on: December 28, 2016, 01:51:57 PM »

Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.


True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount.  It has worked for me every time, even when an estimate was not available.
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Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #294 on: December 28, 2016, 01:53:07 PM »

Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.


True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount.  It has worked for me every time, even when an estimate was not available.
Oh no, I'm not saying they are high.  I have had an estimate and then, with exactly what I had put in, my cost was double.

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Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #295 on: December 28, 2016, 01:53:33 PM »
If Republicans want to improve it they can expand Medicaid in those states where they have blocked it.  They could do this today with no Democrats.
They could cease their lawsuit to block cost sharing reductions for the Silver plans.
They could increase the subsidies and lower the OOP on the plans.

When Republicans say "improve it" they are really saying "make sure it can't work and monkey wrench it".

I don't think we share the same ideas about what an improvement would look like.
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
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Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #296 on: December 28, 2016, 01:54:41 PM »

Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.


True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount.  It has worked for me every time, even when an estimate was not available.
Oh no, I'm not saying they are high.  I have had an estimate and then, with exactly what I had put in, my cost was double.


Oh, I understood what you had implied, I was contradicting you.  My experience is different.
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
~ Frederic Bastiat

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #297 on: December 28, 2016, 01:57:41 PM »

Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.


True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount.  It has worked for me every time, even when an estimate was not available.
Oh no, I'm not saying they are high.  I have had an estimate and then, with exactly what I had put in, my cost was double.


Oh, I understood what you had implied, I was contradicting you.  My experience is different.
Yes, people's experiences can be different.  That is not actually contradicting me (at least not with any actual base).  That still does not negate my point which is that IMO  those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.

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Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #298 on: December 28, 2016, 02:19:50 PM »
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.


Neither sufficient, nor necessary.  Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount.  Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form.  When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available.  How long ago was this experience that you refer to?
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
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Freedom2016

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Re: Impending repeal of Obamacare--what to do?
« Reply #299 on: December 28, 2016, 02:33:16 PM »
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.


Neither sufficient, nor necessary.  Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount.  Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form.  When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available.  How long ago was this experience that you refer to?

Seems to me you could obtain the "cash discount" price from the provider, and then turn around and reimburse yourself from the HSA.

But more broadly, I don't get how far one can take this "cash patient" idea once you get into serious disease. I had breast cancer 6 years ago and just 3 weeks ago I had the last of 5 expensive surgeries. How would this HSA/cash patient idea work in a situation like mine?

The bill from this surgery was ~$18K billed to/paid by insurance (on a ~$23K rack rate).
« Last Edit: December 28, 2016, 02:45:12 PM by Freedom2016 »