Author Topic: Obamacare survives  (Read 59748 times)

EricP

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Re: Obamacare survives
« Reply #200 on: June 30, 2015, 09:27:05 AM »
Regarding the poster with the $59 dental cleaning special - that is very likely a loss leader.  Get a new patient in, they are more likely to come back.  Attorneys offer free consultations for this very reason.  It is also why we accept some legal insurance plans.  We will absolutely lose money on some of the cases but make it back up when that person gets in a car accident and hires us as their personal injury lawyer. That's how groupon and all those other social networking coupon things work. 

I doubt they are straight up losing money on it, but I can believe that it's a "loss leader."

What I mean by that is if I'm a dentist I (generally) own my own practice.  I buy a building, equipment, etc.  Most of my costs are going to be fixed.  Regardless of how many patients I have it's going to cost me $X per month to keep this place open.

There are a few costs, however, that are variable.  The hygienists, front desk lady, power to run the equipment, etc.  Do I think that those cost $118 per chair per hour (I'm assuming two cleanings an hour)?  Doubtful, so it's better to have someone paying $59 in the chair then it being empty, but I'm betting he won't be able to afford his overhead (and pay himself) on only $59 per cleaning, which is why it costs the regular patients $250.

Edit:  Bottom Line is that most costs for stuff in the medical field are fixed.  They charge you $50 for a Band-Aid, not because the Band-Aid costs $50, but because the overhead for that Band-Aid costs $50. (The nurse that puts it on, the front desk staff, the back office staff purchasing the Band-Aid, etc.)
« Last Edit: June 30, 2015, 09:29:25 AM by EricP »

forummm

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Re: Obamacare survives
« Reply #201 on: June 30, 2015, 09:47:20 AM »
One plan I heard about that does work on free market principals is where the insurance company shares with the insured when they save the company money.  If two pharmacies are in network and one is $50 cheaper than the other, and you show them you did your homework and switched, they give you 50% of the savings.  That same program was also sharing with the insured when they caught and reported medical billing errors.

Nice idea. But limited in possible scope. As a patient you 1) generally don't know what your choices are for anything that's expensive and 2) generally don't have pricing info for those choices. It might be easy to pick a cheaper pharmacy. But the pharmacy costs are all pretty close to each other. It's the multi thousand dollar tests and surgeries that rack up the bucks. And you have no idea what those will cost in advance. Even an estimate from your insurance company or the provider is often substantially wrong. And you are probably more worried about which is the best doctor to do the surgery, or are incapacitated and can't make the choice (say if it's an emergency).

The movement towards patient directed care is very fraught with these complications and limitations.

Monkey Uncle

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Re: Obamacare survives
« Reply #202 on: July 01, 2015, 04:01:33 AM »
Edit:  Bottom Line is that most costs for stuff in the medical field are fixed.  They charge you $50 for a Band-Aid, not because the Band-Aid costs $50, but because the overhead for that Band-Aid costs $50. (The nurse that puts it on, the front desk staff, the back office staff purchasing the Band-Aid, etc.)

Isn't the overhead supposed to be covered by what they charge for the hospital room itself?  But I think you're on to something about the overhead in the US health care system, which is far higher than anywhere else in the developed world.  Part of that is due to the ridiculous complexity in our system, which tends to create positions that don't exist in single-payer systems.  But a big part of it is that administrators and executives in the medical business are very highly compensated.  I.e., they're gouging us because they can.  Why?  To pay themselves a lot of money.

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0


forummm

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Re: Obamacare survives
« Reply #203 on: July 01, 2015, 05:40:57 AM »
Edit:  Bottom Line is that most costs for stuff in the medical field are fixed.  They charge you $50 for a Band-Aid, not because the Band-Aid costs $50, but because the overhead for that Band-Aid costs $50. (The nurse that puts it on, the front desk staff, the back office staff purchasing the Band-Aid, etc.)

Isn't the overhead supposed to be covered by what they charge for the hospital room itself?  But I think you're on to something about the overhead in the US health care system, which is far higher than anywhere else in the developed world.  Part of that is due to the ridiculous complexity in our system, which tends to create positions that don't exist in single-payer systems.  But a big part of it is that administrators and executives in the medical business are very highly compensated.  I.e., they're gouging us because they can.  Why?  To pay themselves a lot of money.

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0

Yeah, the overhead for the band-aid doesn't cost $50. That's just what they are trying to get away with charging. Because they can. The charges on their chargemaster are literally just made up. Totally pretend numbers. If you look at the Medicare rates for stuff, it includes no allowances for $50 band-aids and other BS like that. It's a bundled payment for the procedure and the stay. And it will be much less than a private insurer pays. And much, much less than what an uninsured person would be billed. But the hospital *makes money* from the Medicare bill. Hospitals advertise for Medicare patients in Florida. Clearly it's profitable. They just make much more money from everyone else.

gillstone

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Re: Obamacare survives
« Reply #204 on: July 01, 2015, 08:27:06 AM »
Hospital chargemasters inflate the overall numbers and then when insurance, Medicare and Medicaid come in to actually pay they have t make the adjustments.  Go look at the audited financials for a hospital and you'll see a line item for "Gross Patient Service Revenue" followed by a significant adjustment that reflects the negotiated payments of insurance and mandated payments of Medicare and Medicaid.  Those who have to pay full price (the uninsured) eventually pay a fraction of what they are charged as well and that is reflected a bad debt write-off.  The accounting of hospitals is one of those flags that show exactly how messed up healthcare was and still is.

The dysfunction of pre-ACA healthcare has severely altered the operations of insurers, hospitals, pharmaceuticals, doctors and patients.  The mix of adverse incentives to seeking treatment and perverse incentives to deny critical care are deeply engrained in our system and any reform package is going to be incredibly difficult to write and enact because there are guaranteed to be winners and losers in the change.   

The deep systemic problems of our healthcare is why the GOP has struggled to actually provide an alternative for the ACA they hate so much.  There are no simple fixes that can be explained in less than 10 words and compromises have to be made to make sure one reform doesn't destroy the entire system.  For example, getting rid of pre-existing condition exclusions on its own could drive up prices since people won't seek insurance until they need it (after the diagnosis) so to keep the prices relatively stable there has to be a mandate for everyone to buy insurance so the actuarial pool has more healthy people than unhealthy people.  You can't get rid of something people don't like (mandates) without getting rid of something they love (pre-existing condition protection)

BTDretire

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Re: Obamacare survives
« Reply #205 on: August 01, 2015, 10:15:21 AM »

My point was that it can't be an equivalent policy - if nothing else, your doctor doesn't accept it and therefore it's not the same policy.  The fact that the price is so different I think also indicates they're not equivalent.  I can't give you more details than that because I don't have the information, but I'm sure that you'd find differences when you looked at the actual plan documents.

 Equivalent in that once I pay my deductible, everything is 100% covered.  Except, mental healthcare, substance abuse and ambulance
have additional costs.
[/quote]

And your doctor doesn't accept it.  Thus, it's not the same policy.
[/quote]

 I didn't say it was the same policy I said it was equivalent.
Both policies do the same, they pay 100% after I pay my deductible. (A few minor exceptions)
Now, I have no idea what the reimbursment rates to the doctors are. I suspect they are less
and that is why my doctor (and many others) don't accept ACA policies.
 This is another reason that the higher cost for an ACA policy seems wrong. (lower reimbursment)


norcalmike

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Re: Obamacare survives
« Reply #206 on: August 01, 2015, 10:37:02 AM »
I am all for health insurance for everyone.
My concern is the cost will be drawn from those who have employee provided insurance.
My employer is already bracing itself for the "Cadillac tax" which will, most likely, be passed on to us, the employee through increased share of premiums.
My other concern is that insurance companies have already asked for premium increases to cover the expenses of the very sick people the ACA covers. A cost that will be passed on to me as well.
Great plan, I just wish the Govt. could pay for the ACA with the tax dollars I already give them.

forummm

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Re: Obamacare survives
« Reply #207 on: August 01, 2015, 11:21:04 AM »
I am all for health insurance for everyone.
My concern is the cost will be drawn from those who have employee provided insurance.
My employer is already bracing itself for the "Cadillac tax" which will, most likely, be passed on to us, the employee through increased share of premiums.
My other concern is that insurance companies have already asked for premium increases to cover the expenses of the very sick people the ACA covers. A cost that will be passed on to me as well.
Great plan, I just wish the Govt. could pay for the ACA with the tax dollars I already give them.

Congratulations, it essentially does just that. The ACA actually decreases the deficit by using Medicare dollars more efficiently (over-paying private Medicare Advantage plans by less--but still overpaying), penalties for those who have affordable coverage available but choose not to buy, a small tax on medical device manufacturers (an insanely profitable industry), and extending the Medicare tax to higher income household investment income.

And the Cadillac tax. Well, not so much. That is estimated to only bring in about $5 billion per year when it starts in 2018 because hardly anyone is affected by it, and those who are affected are affected very little. Anyone significantly worried about it may not understand what it actually is. It's a 40% tax on the employer's cost of the plan that's above a very high threshold ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). So if your individual coverage plan costs $10,300 (an incredibly expensive plan), the tax would be $40 for the year  ($10,300 - $10,200 * 40%). My plan costs something like $6k/year and has no deductible, a huge nationwide network, is going to cost us just a few hundred dollars to have a baby, etc. So a plan over $10k is a really lavish plan.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99

norcalmike

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Re: Obamacare survives
« Reply #208 on: August 01, 2015, 11:51:53 AM »
I am all for health insurance for everyone.
My concern is the cost will be drawn from those who have employee provided insurance.
My employer is already bracing itself for the "Cadillac tax" which will, most likely, be passed on to us, the employee through increased share of premiums.
My other concern is that insurance companies have already asked for premium increases to cover the expenses of the very sick people the ACA covers. A cost that will be passed on to me as well.
Great plan, I just wish the Govt. could pay for the ACA with the tax dollars I already give them.

Congratulations, it essentially does just that. The ACA actually decreases the deficit by using Medicare dollars more efficiently (over-paying private Medicare Advantage plans by less--but still overpaying), penalties for those who have affordable coverage available but choose not to buy, a small tax on medical device manufacturers (an insanely profitable industry), and extending the Medicare tax to higher income household investment income.

And the Cadillac tax. Well, not so much. That is estimated to only bring in about $5 billion per year when it starts in 2018 because hardly anyone is affected by it, and those who are affected are affected very little. Anyone significantly worried about it may not understand what it actually is. It's a 40% tax on the employer's cost of the plan that's above a very high threshold ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). So if your individual coverage plan costs $10,300 (an incredibly expensive plan), the tax would be $40 for the year  ($10,300 - $10,200 * 40%). My plan costs something like $6k/year and has no deductible, a huge nationwide network, is going to cost us just a few hundred dollars to have a baby, etc. So a plan over $10k is a really lavish plan.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99

i guess I will see what happens in 2018. I like my Kaiser for me and my wife at $13.00 per 2 week pay period. I sure would like to keep it that way

BTDretire

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Re: Obamacare survives
« Reply #209 on: August 02, 2015, 08:39:49 AM »


Quote
I guess I will see what happens in 2018. I like my Kaiser for me and my wife at $13.00 per 2 week pay period. I sure would like to keep it that way

 Do I have that right $312 a year?

 I'm at $8,448 a year for a family of 3.
No pregnancy, no preexcisting, $10,000 deductible.
Ages 60, 55, 22.
 Then again, an Obamacare policy is $13,508.
 Almost enough to make me want to retire, so I can
let the system subsidize me!   
Against all my conservative values though.                   

big_slacker

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Re: Obamacare survives
« Reply #210 on: August 02, 2015, 10:53:02 AM »
I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)

I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.

forummm

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Re: Obamacare survives
« Reply #211 on: August 02, 2015, 11:23:22 AM »
I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)

I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.

Well if it's $1k/mo, then you must be making at least $130k/year. $1k isn't so bad for a large income like that (at least 2.5 x the national average). It's not "cheap", but you could "afford" it.

iris lily

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Re: Obamacare survives
« Reply #212 on: August 02, 2015, 11:43:58 AM »
I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)

I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.

how much domyou think that you should pay?

Gin1984

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Re: Obamacare survives
« Reply #213 on: August 02, 2015, 01:59:42 PM »
I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)

I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.

Well if it's $1k/mo, then you must be making at least $130k/year. $1k isn't so bad for a large income like that (at least 2.5 x the national average). It's not "cheap", but you could "afford" it.
And it is better than not being able to get any at all.

big_slacker

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Re: Obamacare survives
« Reply #214 on: August 02, 2015, 09:22:51 PM »
This forum could use an easy multi quote. :) To answer the comments, and take this more as a frustrated rant rather than a debate:

Yes, income is above $130k currently. Does that make that number (which is for a high deductible plan BTW) any less batshit crazy? Does it make any kind of sense to try to launch a business with that hanging over your head and possibly sucking you dry every month? Especially considering I could work a day job without having to drum up customers, do my own financials and processes, pay more self employment tax and only pay $140/month for much better coverage? Is this how we as Americans want the deck stacked?

In terms of how much I think I should pay, can I answer that with a real life tale of healthcare from another country? I took a trip with my wife and kid back to the old country. A few days before our son gets some kind of weird cold thing that gets really bad on the flight over with his mouth stinking, fever, vomiting, etc. Bad stuff, we get off the plane and have to go to the pediatric ER. I'm cursing my luck knowing this is gonna cost me $1k+ like it would in the US. It was $40, and BTW just as professional, maybe moreso, than in the states. I've also gotten dental work done over there, and it's exactly the same quality and experience wise as here. Except I paid $120 for a root canal, filling and tooth extraction instead of what would surely have been over $1k here. Yes I have bad luck on trips, FML. This is the former eastern bloc FFS, and we can't get our shit together in the US of A???? To answer the original question, a lot f'in less.

It seems we're at the point where it's such a disaster than any small bandaid to the massively screwed system is met with a resigned, "Oh well, it could be a little bit worse." As a drill instructor friend of mine was very fond of saying: Unsat.

Gin1984

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Re: Obamacare survives
« Reply #215 on: August 02, 2015, 09:39:33 PM »
This forum could use an easy multi quote. :) To answer the comments, and take this more as a frustrated rant rather than a debate:

Yes, income is above $130k currently. Does that make that number (which is for a high deductible plan BTW) any less batshit crazy? Does it make any kind of sense to try to launch a business with that hanging over your head and possibly sucking you dry every month? Especially considering I could work a day job without having to drum up customers, do my own financials and processes, pay more self employment tax and only pay $140/month for much better coverage? Is this how we as Americans want the deck stacked?

In terms of how much I think I should pay, can I answer that with a real life tale of healthcare from another country? I took a trip with my wife and kid back to the old country. A few days before our son gets some kind of weird cold thing that gets really bad on the flight over with his mouth stinking, fever, vomiting, etc. Bad stuff, we get off the plane and have to go to the pediatric ER. I'm cursing my luck knowing this is gonna cost me $1k+ like it would in the US. It was $40, and BTW just as professional, maybe moreso, than in the states. I've also gotten dental work done over there, and it's exactly the same quality and experience wise as here. Except I paid $120 for a root canal, filling and tooth extraction instead of what would surely have been over $1k here. Yes I have bad luck on trips, FML. This is the former eastern bloc FFS, and we can't get our shit together in the US of A???? To answer the original question, a lot f'in less.

It seems we're at the point where it's such a disaster than any small bandaid to the massively screwed system is met with a resigned, "Oh well, it could be a little bit worse." As a drill instructor friend of mine was very fond of saying: Unsat.
Given that you are not paying $140 because your employer is paying the rest, yes that amount seems reasonable.

forummm

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Re: Obamacare survives
« Reply #216 on: August 03, 2015, 07:08:53 AM »
This forum could use an easy multi quote. :) To answer the comments, and take this more as a frustrated rant rather than a debate:

Yes, income is above $130k currently. Does that make that number (which is for a high deductible plan BTW) any less batshit crazy? Does it make any kind of sense to try to launch a business with that hanging over your head and possibly sucking you dry every month? Especially considering I could work a day job without having to drum up customers, do my own financials and processes, pay more self employment tax and only pay $140/month for much better coverage? Is this how we as Americans want the deck stacked?

In terms of how much I think I should pay, can I answer that with a real life tale of healthcare from another country? I took a trip with my wife and kid back to the old country. A few days before our son gets some kind of weird cold thing that gets really bad on the flight over with his mouth stinking, fever, vomiting, etc. Bad stuff, we get off the plane and have to go to the pediatric ER. I'm cursing my luck knowing this is gonna cost me $1k+ like it would in the US. It was $40, and BTW just as professional, maybe moreso, than in the states. I've also gotten dental work done over there, and it's exactly the same quality and experience wise as here. Except I paid $120 for a root canal, filling and tooth extraction instead of what would surely have been over $1k here. Yes I have bad luck on trips, FML. This is the former eastern bloc FFS, and we can't get our shit together in the US of A???? To answer the original question, a lot f'in less.

It seems we're at the point where it's such a disaster than any small bandaid to the massively screwed system is met with a resigned, "Oh well, it could be a little bit worse." As a drill instructor friend of mine was very fond of saying: Unsat.

The cost of care in the US is crazy high. Almost no one disagrees with that. The ACA is an improvement on the terrible system we had. So it's now much less terrible but still the system costs too much. And is worse IMO than what the other industrialized nations have. I think we should have just moved to "Medicare for all" and paid for it however (there are many ways to pay for it). Medicare would be much, much cheaper than the private system we have now. And it would be uniform around the nation so it would save people a lot of confusion and worry about being balance billed with astronomical (and made up) charges (like $20 bandaids at a hospital) and all the other unacceptable crap we have to put up with by having this hodge podge of payers. And Medicare itself could more easily continue to drive down the cost of care through coordinated innovation programs like they are in the process of doing now (via ACA). But that was never on the table because of the lobbying power of the industry that likes to continue to leech off of the rest of us and provide no value.

One of the good things the ACA does is to adjust the cost of your health insurance to correspond with your income. It actually makes it much easier to start your own business. For one, because you can actually get insurance on your own. And that insurance has to cover your kid's and your wife's health problems now--when before it would explicitly exclude coverage for them. So not only can you get care, but it's de facto affordable for you. If your small business is struggling and you only make $50k the first year, the tax credit will mean that you may only be paying a $100/mo for a low-deductible plan depending on your family size. But if you are successful at the $150k level, it might be $1k/mo for the plan because you can afford that.

If you're paying $140/mo for you insurance via work, your employer is paying something like $1k/mo for you. That money is coming from the salary they would otherwise be paying you if health care cost something more reasonable in this country.

Cassie

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Re: Obamacare survives
« Reply #217 on: August 03, 2015, 12:47:48 PM »
I agree that we should have put everyone on Medicare. The first year we retired & just collected our pensions we had to pay $10,000/year for health insurance from my former employer when we only made $40,000. Now they we both consult p.t. our income is up to around $70,000 so paying that much is a lot easier to swallow. Because my hubby is 5 years younger then me even when I go on Medicare we will continue to be [ripped off] by the state because even with me off it only goes down by 200/month & then I will need to buy a supplement. So no break in health insurance costs until I am 70. Most other countries have accomplished what we can't seem too. My DIL is from Poland & she gets all her good quality cheap care when she goes back home.

[MOD EDIT - please use another metaphor, thank you]
« Last Edit: August 06, 2015, 06:32:57 PM by FrugalToque »

BTDretire

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Re: Obamacare survives
« Reply #218 on: August 05, 2015, 10:28:51 AM »

The cost of care in the US is crazy high. Almost no one disagrees with that. The ACA is an improvement on the terrible system we had. So it's now much less terrible but still the system costs too much.

Yes, the ACA has rewarded the health insurance industry, the Health Care Select Sector SPDR ETF (XLV)
is up 113% since ACA regs started in 2012.

Eric

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Re: Obamacare survives
« Reply #219 on: August 05, 2015, 10:43:39 AM »

The cost of care in the US is crazy high. Almost no one disagrees with that. The ACA is an improvement on the terrible system we had. So it's now much less terrible but still the system costs too much.

Yes, the ACA has rewarded the health insurance industry, the Health Care Select Sector SPDR ETF (XLV)
is up 113% since ACA regs started in 2012.

And since correlation always equals causation, I guess there's nothing else to be said.

BTDretire

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Re: Obamacare survives
« Reply #220 on: August 05, 2015, 10:44:28 AM »

Quote
If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention. Before the Marketplace, many people could not by any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc. It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.

  Yes, I have a grandfather policy.

Quote
it was entirely optional for your plan to add all the preventive care you mention.


Yes, you are correct, I can only find a few things that were mandatory.
The preventive healthcare was not one of them.
 These are the mandated items as I find them.
Insurers cannot place lifetime limits on coverage for plans (i.e., plans cannot set a
maximum they will cover on a person over the life of the insurance plan).

Plans cannot deny coverage for a patient due to illness or unintentional mistakes on
insurance applications.

Dependents under 26 years of age who do not have insurance coverage can be
included on the employer plan of their parent(s).

Insurers cannot deny coverage to minors with pre-existing conditions.
« Last Edit: August 09, 2015, 10:03:58 AM by Qmavam »

MustardTiger

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Re: Obamacare survives
« Reply #221 on: August 05, 2015, 08:47:07 PM »
Was going to start a thread, but this is probably a better place to ask.

We are planning on sponsoring my mother in law for citizenship in the near future.  She is 58 yrs old, and has a reasonable nest egg in retirement accounts.  We will be taking care of her financially above what she can afford, but I am worried mostly about health insurance.

From my limited research, she would not be eligible for medicaid as a new immigrant.  She will most likely gift us a good chunk of her savings before, so when she is here she will have no income.  This is where I am confused.  If you are below the federal poverty level (which 0 most certainly will be), then medicaid is how you insure, correct? 

forummm

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Re: Obamacare survives
« Reply #222 on: August 06, 2015, 07:59:43 AM »

Quote
If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention. Before the Marketplace, many people could not by any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc. It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.

  Yes, I have a grandfather policy.
Quote
it was entirely optional for your plan to add all the preventive care you mention.
Yes, you are correct, I can only find a few things that were mandatory.
The preventive healthcare was not one of them.
 These are the mandated items as I find them.
Insurers cannot place lifetime limits on coverage for plans (i.e., plans cannot set a
maximum they will cover on a person over the life of the insurance plan).

Plans cannot deny coverage for a patient due to illness or unintentional mistakes on
insurance applications.

Dependents under 26 years of age who do not have insurance coverage can be
included on the employer plan of their parent(s).

Insurers cannot deny coverage to minors with pre-existing conditions.


Yes, those are the 4 things that changed for grandfathered individual market policies.

Cassie

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Re: Obamacare survives
« Reply #223 on: August 06, 2015, 10:30:16 AM »
My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA  insurance but does not get any $ off based on their incomes because she has a green card.

forummm

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Re: Obamacare survives
« Reply #224 on: August 06, 2015, 11:17:09 AM »
My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA  insurance but does not get any $ off based on their incomes because she has a green card.

Non-citizen legal residents with incomes in the 0%-400% of FPL ranges who don't qualify for Medicaid are eligible for premium tax credits. There's a special provision for legal residents because they don't always qualify for Medicaid that extends the tax credits to 0% FPL.

iris lily

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Re: Obamacare survives
« Reply #225 on: August 06, 2015, 11:44:10 AM »
I agree that we should have put everyone on Medicare. The first year we retired & just collected our pensions we had to pay $10,000/year for health insurance from my former employer when we only made $40,000. Now they we both consult p.t. our income is up to around $70,000 so paying that much is a lot easier to swallow. Because my hubby is 5 years younger then me even when I go on Medicare we will continue to be [------] by the state because even with me off it only goes down by 200/month & then I will need to buy a supplement. So no break in health insurance costs until I am 70. Most other countries have accomplished what we can't seem too. My DIL is from Poland & she gets all her good quality cheap care when she goes back home.

"------ by the state?"  [MOD NOTE: No kidding]

ok.

You can afford it, you have it, and I assume it works decently. That's a pretty sweet place to be, but ok.

« Last Edit: August 06, 2015, 06:33:48 PM by FrugalToque »

MustardTiger

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Re: Obamacare survives
« Reply #226 on: August 06, 2015, 12:27:30 PM »
My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA  insurance but does not get any $ off based on their incomes because she has a green card.

Non-citizen legal residents with incomes in the 0%-400% of FPL ranges who don't qualify for Medicaid are eligible for premium tax credits. There's a special provision for legal residents because they don't always qualify for Medicaid that extends the tax credits to 0% FPL.

So my MIL would be able to buy a plan on the exchange with a subsidy if she doesn't have any income?

forummm

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Re: Obamacare survives
« Reply #227 on: August 06, 2015, 01:47:48 PM »
My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA  insurance but does not get any $ off based on their incomes because she has a green card.

Non-citizen legal residents with incomes in the 0%-400% of FPL ranges who don't qualify for Medicaid are eligible for premium tax credits. There's a special provision for legal residents because they don't always qualify for Medicaid that extends the tax credits to 0% FPL.

So my MIL would be able to buy a plan on the exchange with a subsidy if she doesn't have any income?

If she's a non-citizen legal resident who is ineligible for Medicaid, and ineligible for any other source of affordable health insurance, then most likely, yes.

https://www.healthcare.gov/immigrants/lawfully-present-immigrants/

Quote
Lawfully present immigrants and Marketplace savings

If you’re a lawfully present immigrant, you can buy private health insurance on the Marketplace. You may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income.
•If your annual income is 400% of the federal poverty level or below: You may be eligible for premium tax credits and other savings on Marketplace insurance.
•If your annual household income is below 100% federal poverty level: If you’re not otherwise eligible for Medicaid you’ll be eligible for premium tax credits and other savings on Marketplace insurance, if you meet all other eligibility requirements.

https://www.healthcare.gov/blog/10-things-immigrant-families-need-to-know-about-the-marketplace/
https://www.healthcare.gov/immigrants/immigration-status/
https://www.healthcare.gov/immigrants/lawfully-present-immigrants/

Cassie

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Re: Obamacare survives
« Reply #228 on: August 06, 2015, 06:19:39 PM »
Perhaps my son & DIL were given wrong information but together they make $40,000 which qualifies them for a subsidy. However, they were told that only my son was eligible and not her.

IL: yes we can afford it now because we are choosing to keep working to supplement our pensions. However, once we quit working we would still pay a fourth of our gross income for health insurance. Yes that is being [MOD EDIT: Nope, it isn't.  It really, really isn't.]

« Last Edit: August 06, 2015, 06:40:28 PM by FrugalToque »

Paul der Krake

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Re: Obamacare survives
« Reply #229 on: August 06, 2015, 07:20:39 PM »
Not surprised at all that your family has gotten wrong information with regards to immigration status and ACA eligibility. I tried signing up the first time around through in excahnge (from October 2013 until January) and after hours on the phone it became clear that training the support staff to the intricacies of the immigration-related paperwork was a very distant afterthought.

forummm

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Re: Obamacare survives
« Reply #230 on: August 06, 2015, 07:45:46 PM »
Perhaps my son & DIL were given wrong information but together they make $40,000 which qualifies them for a subsidy. However, they were told that only my son was eligible and not her.

IL: yes we can afford it now because we are choosing to keep working to supplement our pensions. However, once we quit working we would still pay a fourth of our gross income for health insurance. Yes that is being [MOD EDIT: Nope, it isn't.  It really, really isn't.]

The call center staff are not experts. They just read scripts--like most other call centers. And they probably don't have a great script for this topic. They aren't even dedicated to healthcare.gov. The next call they get is probably about tires or something.

The links I posted above are accurate and if you fill out the online application you should have a correct result. If you don't, please PM me the details. I know someone who works there and can get it straightened out.

MustardTiger

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Re: Obamacare survives
« Reply #231 on: August 07, 2015, 11:53:21 AM »
Thanks forummm, very good info.  I have just one more question that I can't seem to find.

When considering ACA subsidies, would my MIL apply by herself or would she be considered part of our household?  I know that I have to sign an affidavit of support, but I am not sure about this question.  This would obviously mean the difference between a significant subsidy and none as I believe as a household of 3 we would fall out of the income range.


MustardTiger

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Re: Obamacare survives
« Reply #232 on: August 07, 2015, 12:06:13 PM »
Also it seems like a reasonable option would be to pay her for childcare when we do have kids.  Seems like you could plan the amount to get the maximum subsidy and eventually qualify for medicare.

iris lily

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Re: Obamacare survives
« Reply #233 on: August 07, 2015, 12:36:17 PM »
Perhaps my son & DIL were given wrong information but together they make $40,000 which qualifies them for a subsidy. However, they were told that only my son was eligible and not her.

IL: yes we can afford it now because we are choosing to keep working to supplement our pensions. However, once we quit working we would still pay a fourth of our gross income for health insurance. Yes that is being [MOD EDIT: Nope, it isn't.  It really, really isn't.]

oh gee, I really did not intend to have your post moderated. That's a little heavy handed, I think.  Sorry about that. (but moderators, do what you think best, I'm not challenging it.)

Back on topic, our outside income is $28,000 plus some change that DH will make this year in occasional jobs. We  pay out $12,000 in health insurance. I'm ok with that, it was a conscious decision to retire early, I wasn't forced out. We do have income from investments but it varies from year to year, I never know how much it will be.

forummm

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Re: Obamacare survives
« Reply #234 on: August 07, 2015, 12:37:45 PM »
Thanks forummm, very good info.  I have just one more question that I can't seem to find.

When considering ACA subsidies, would my MIL apply by herself or would she be considered part of our household?  I know that I have to sign an affidavit of support, but I am not sure about this question.  This would obviously mean the difference between a significant subsidy and none as I believe as a household of 3 we would fall out of the income range.

It's based on how you file your taxes. I can't advise you on what's the right way for you to file your taxes (talk to a tax professional). But if you claim your MIL as a dependent, she's included in your household. If you don't, then she's not.

https://www.healthcare.gov/income-and-household-information/household-size/

Also it seems like a reasonable option would be to pay her for childcare when we do have kids.  Seems like you could plan the amount to get the maximum subsidy and eventually qualify for medicare.

If money changes hands then SE tax is due. Include that in your thinking.

MustardTiger

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Re: Obamacare survives
« Reply #235 on: August 07, 2015, 01:26:38 PM »
Thanks!  I can't even imagine how an immigrant would figure all this out.

forummm

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Re: Obamacare survives
« Reply #236 on: August 07, 2015, 01:32:45 PM »
Thanks!  I can't even imagine how an immigrant would figure all this out.

It's too complicated for even people with graduate degrees. I can't stand having to pick between plans at work--and they are all easy to get and have pretty clear premiums associated with them. The whole system has so much confusion and non-transparency built into it. Single payer would be worth it just to make everything easy to figure out. The potential to save $1 trillion per year is just a bonus :)

Paul der Krake

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Re: Obamacare survives
« Reply #237 on: August 07, 2015, 01:38:12 PM »
Thanks!  I can't even imagine how an immigrant would figure all this out.
It's selection bias at its finest: people who made it through the heaps of BS that immigration authorities have thrown at them to get here tend to have a much higher tolerance for bureaucratic nightmares and fact-finding missions.

Laws are not written with immigrants in mind, at all.

MustardTiger

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Re: Obamacare survives
« Reply #238 on: August 07, 2015, 04:13:28 PM »
Ya, after going through the process of getting my wife here, (first fiance visa, then residency) I can understand why so many ppl come here illegally.  I bet I have spent 5k and spent many countless hours doing paperwork to get everything we needed. 

forummm

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Re: Obamacare survives
« Reply #239 on: August 07, 2015, 05:29:59 PM »
Ya, after going through the process of getting my wife here, (first fiance visa, then residency) I can understand why so many ppl come here illegally.  I bet I have spent 5k and spent many countless hours doing paperwork to get everything we needed. 

Most people come illegally because even if they did all this work, they still couldn't get in because of quotas or other barriers to legal immigration. Even if you are willing to spend money and do paperwork, you just can't get in if you're from a country where everyone wants to leave and come to the US.

Cassie

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Re: Obamacare survives
« Reply #240 on: August 07, 2015, 05:50:07 PM »
IL: I think that you are spending a ridiculous amount of $ for your healthcare too.  I wasn't trying to offend people either. I guess I was insensitive and at least the mods have a sense of humor about it.  It cost my son a lot of $ to get his fiancee here too.  They were approved the first time but had proof that for 3 years they had been visiting each other in Europe so it was a real relationship.  I think because of all the cheating in the past that is the reason that it is so difficult now to get fiancee visas & expensive.

MustardTiger

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Re: Obamacare survives
« Reply #241 on: August 07, 2015, 07:14:58 PM »
Ya, that was the strangest part.  Having to create a timeline proof of our relationship.  The thing that really bugged me was paying ~600 to send in a form, and have it take months to get approved.  You would think for that kind of money they could do business in a timely fashion.  LOL Gov't I guess.

big_slacker

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Re: Obamacare survives
« Reply #242 on: August 08, 2015, 09:22:46 PM »
Ya, that was the strangest part.  Having to create a timeline proof of our relationship.  The thing that really bugged me was paying ~600 to send in a form, and have it take months to get approved.  You would think for that kind of money they could do business in a timely fashion.  LOL Gov't I guess.

Getting OT, but my wife and sister in law are from PL (Dzien dobry BTW!) and my wife did it the easy way. Green card lottery winner, next to nothing in terms of paperwork. Just waiting for enough time to pass and getting her citizenship. Sister not so much. She was on a J1 and fell in love. Got married and had to deal with the typical slog through the process. My memory of the timeline isn't perfect but it was under a decade to get citizenship the legal way. But not that much under a decade, lol!

alsoknownasDean

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Re: Obamacare survives
« Reply #243 on: August 09, 2015, 05:07:07 AM »
I'm staggered at the amount that people pay for insurance over there in the States. $1000+ a month, yet still with a $5000+ excess? That's just ridiculous.

I'll do a quick comparison to show that public healthcare isn't quite as bad as some of you lot think it is. Here in Australia universal healthcare was introduced in 1975. At the time, the average life expectancy from birth in Australia and the United States was about the same.

By 2011, the average Australian has a life expectancy of over three years longer than the average American. Sure, correlation doesn't mean causation, yada yada, but maybe just a little bit of that is due to our public healthcare system, which by the way costs us just over half as much as a percentage of GDP.

We have a private system as well as the public healthcare system (and private hospitals as well as public ones), and lots and lots of us have private insurance too (there's incentives via the tax system once your income is above a certain level). My health insurance is $110 a month which partially covers dental and optical and the like and covers my hospital visits (with a $500 excess), so I don't have to go on a waiting list for non-emergency surgery. Doctors visits are partially subsidised (and fully subsidised for some people), about half of a $70 doctors visit for me is subsidised. Many prescription medicines are partially subsidised too.

It's not perfect, but geez it's better than the clusterfuck the American system seems to be. I'm sure Obama would have liked to introduce something similar, but he wouldn't have been able to get it through.

Sources are as below, I didn't use Wikipedia. :)

http://www.cdc.gov/nchs/data/hus/2011/022.pdf
http://www.aga.gov.au/publications/life_tables_2005-07/downloads/australian_life_tables_2005-07.pdf

http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3105.0.65.001
http://www.cdc.gov/nchs/data/databriefs/db115.pdf

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
« Last Edit: August 09, 2015, 05:09:05 AM by alsoknownasDean »

forummm

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Re: Obamacare survives
« Reply #244 on: August 09, 2015, 06:38:20 AM »
I'm staggered at the amount that people pay for insurance over there in the States. $1000+ a month, yet still with a $5000+ excess? That's just ridiculous.

I'll do a quick comparison to show that public healthcare isn't quite as bad as some of you lot think it is.

Intelligent and educated people in the US know that the healthcare systems in other industrialized nations are far superior in many respects. But that doesn't stop jingoistic cries of "We have the best healthcare system in the world!!!!" from politicians and other dolts. We think we're the best at everything.

gaja

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Re: Obamacare survives
« Reply #245 on: August 09, 2015, 08:57:05 AM »
Lastly, your estimate of the inefficiencies in US health care is way off.  The total health care spending in the US is something like $3.0 trillion.  If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0

I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita

Yeah, you're ignoring the point I made earlier, that I bolded this time.  Here's a reference showing that we should be spending more than other OECD countries, because we're richer than other OECD countries: http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/

Please notice that in your link, Norway and Luxembourg have higher GDP and substantially lower health care cost. The main difference between the Norwegian and Swedish health care (Sweden at 12th place, Norway at second place in the above mentioned wikipedia list), is the salary costs. A doctor might make more in the US, but we pay our cleaning staff, administrators, nursing aids etc substantially more. So I would guess you would end up closer to Sweden. I have talked to people who have tried the US health system, typically on holidays or while working a year or two in the US, and they say that the main difference is luxury: They get better food, nurses that have time to talk to them, freshly renovated rooms, etc. Also, a lot of time, doctors here will tell you to take a painkiller and see if it gets better by it self. MRIs, X-rays, and extended blood tests are reserved for when it doesn't get better. Antibiotics are strictly regulated, and only given if they are sure it is bacterial (and that it won't get better anywhy if you just wait a bit). There have been serious discussions the last years about how much money should be spent on treatments that only increase life span by a few months, or if there should be an age limit. It sounds horrid when you first hear it, but a lot of medical experts claim that a lot of the most expensive and intensive treatments for the sickest people only increase the length of time they are suffering.

I pay 8.2 % of my salary to the "Social security fund". This covers health care, unemployment, sick leave (1 year at 100 % pay, 3 years at 60 %), public pension, unemployment benefits (2 years at 60 %), etc. For most people, the cost of this is less than $500/month.

beltim

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Re: Obamacare survives
« Reply #246 on: August 09, 2015, 09:14:29 AM »
Lastly, your estimate of the inefficiencies in US health care is way off.  The total health care spending in the US is something like $3.0 trillion.  If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0

I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita

Yeah, you're ignoring the point I made earlier, that I bolded this time.  Here's a reference showing that we should be spending more than other OECD countries, because we're richer than other OECD countries: http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/

Please notice that in your link, Norway and Luxembourg have higher GDP and substantially lower health care cost. The main difference between the Norwegian and Swedish health care (Sweden at 12th place, Norway at second place in the above mentioned wikipedia list), is the salary costs. A doctor might make more in the US, but we pay our cleaning staff, administrators, nursing aids etc substantially more. So I would guess you would end up closer to Sweden.

Yes, those data suggest that there's a point at which spending more on health care solely because you live in a wealthier country doesn't make sense.  But that point is closer to Norway and Luxembourg, and not, say, Portugal or Poland.  So you could argue that the US should be spending ~1/3 less on health care to bring it in line with the other richest countries in the world.


Quote
Also, a lot of time, doctors here will tell you to take a painkiller and see if it gets better by it self. MRIs, X-rays, and extended blood tests are reserved for when it doesn't get better. Antibiotics are strictly regulated, and only given if they are sure it is bacterial (and that it won't get better anywhy if you just wait a bit). There have been serious discussions the last years about how much money should be spent on treatments that only increase life span by a few months, or if there should be an age limit. It sounds horrid when you first hear it, but a lot of medical experts claim that a lot of the most expensive and intensive treatments for the sickest people only increase the length of time they are suffering.

I pay 8.2 % of my salary to the "Social security fund". This covers health care, unemployment, sick leave (1 year at 100 % pay, 3 years at 60 %), public pension, unemployment benefits (2 years at 60 %), etc. For most people, the cost of this is less than $500/month.

This is a great illustration of a philosophical difference in health care systems.  Public health care systems are set up to reduce type 1 errors - that is, false positives.  The US health care system, especially the most expensive private insurance plans, are set up to minimize type 2 errors - that is, false negatives.  Reducing type 1 errors is much cheaper.

Cassie

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Re: Obamacare survives
« Reply #247 on: August 09, 2015, 11:19:02 AM »
Most European countries seem to realize that universal-single payor health care is the way to go. My DIL is from Poland & she gets all her health care very cheaply when she goes to visit & Poland is not a rich country.

beltim

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Re: Obamacare survives
« Reply #248 on: August 09, 2015, 02:24:58 PM »
Most European countries seem to realize that universal-single payor health care is the way to go. My DIL is from Poland & she gets all her health care very cheaply when she goes to visit & Poland is not a rich country.

The main reason she gets her health care cheaply is because Poland is not a rich country.  She probably also gets food, housing, and transportation pretty cheaply there too.

Which isn't to say that the US wouldn't reduce costs with a single-payer system (they would).  But most of the difference between the cost of health care in Poland and the US is the relative cost of living.

Cassie

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Re: Obamacare survives
« Reply #249 on: August 09, 2015, 02:54:43 PM »
Poland is not cheap for the people that live there. Even though everything costs less then for us in the states they also make a lot less. My DIL does not live there but gets her medical care on visits home.