Affordable Care Act and your personal health insurance coverage

[fjpod]

Ya know, I guess things are different in every state. Our group plan (in NY) for the office is what they call community rated and it has nothing to do with my employees ages. My premiums have been going up at least 8% every six months for the past 10 years. I'm being told by my broker that things will be about the same for us next year.

As a healthcare provider that accepts medical insurance...something has to be done about the myriad of companies, each imposing different rules, obligations, limitations, prior approvals, etc. on the patients and providers. I'm not saying I would want to work for cheap, but I would welcome a single payer system. There would still be different levels of benefits, but the administration of things would be greatly reduced. I now employ just as many staff to administer health and optical plans than I employ in direct licensed patient care.

Don't pity me because I take insurance, I get what I deserve, but I do ok, and I guess I get to employ a few more people because of it...but the public is getting shortchanged paying for all the administrative fees, from the insurance company staff, down to the doctors office.

[MikeAurelius]

A single payor system would be an ideal thing, and it would probably pay for itself just from eliminating the built-in redundancy the system has now by having so many different insurance companies with multiple computer systems, thousands of employees, all doing exactly the same thing all over the country. But dear lord, imagine the outcry if all these disparate for-profit companies were somehow forced to combine (or, heaven forbid, go out of business).

Right now, there are something like 48 million people without insurance in the US, out of approximately 315 million. We are paying for their health care through higher premiums and higher medical care provider bills. Just think how much we will save by having those 48 million people get preventative care at a family physician instead of the ER. Think how much faster it would be to get a bed in an ER if that happened.

That's what is at stake here.

Yes, the ACA is flawed, but it is a START. It is a beginning point for a process that will, in some form or another, change the way healthcare is provided in this country.

[Uncle Fester]

However, I also believe everyone should have basic access to healthcare.

And should be contributing for the care they will inevitably need.

[fjpod]

A single payor system would be an ideal thing, and it would probably pay for itself just from eliminating the built-in redundancy the system has now by having so many different insurance companies with multiple computer systems, thousands of employees, all doing exactly the same thing all over the country. But dear lord, imagine the outcry if all these disparate for-profit companies were somehow forced to combine (or, heaven forbid, go out of business).

Right now, there are something like 48 million people without insurance in the US, out of approximately 315 million. We are paying for their health care through higher premiums and higher medical care provider bills. Just think how much we will save by having those 48 million people get preventative care at a family physician instead of the ER. Think how much faster it would be to get a bed in an ER if that happened.

That's what is at stake here.

Yes, the ACA is flawed, but it is a START. It is a beginning point for a process that will, in some form or another, change the way healthcare is provided in this country.

+1

[fjpod]

And should be contributing for the care they will inevitably need.

+1. People need to be contributing while they are healthy and young in order to get covered care when they are sick and old. You just can't wiggle your way into medicare when you are 65 after not having health insurance your whole life. That's like buying car insurance after your car is stolen and expect the company to pay you for it.

[Joe Zewe]

And should be contributing for the care they will inevitably need.

I agree with you. The so-called "individual mandate" will require individuals to obtain coverage or face a tax penalty which I view as a positive of the ACA.

[Joe Zewe]

A single payor system would be an ideal thing, and it would probably pay for itself just from eliminating the built-in redundancy the system has now by having so many different insurance companies with multiple computer systems, thousands of employees, all doing exactly the same thing all over the country. But dear lord, imagine the outcry if all these disparate for-profit companies were somehow forced to combine (or, heaven forbid, go out of business).

Right now, there are something like 48 million people without insurance in the US, out of approximately 315 million. We are paying for their health care through higher premiums and higher medical care provider bills. Just think how much we will save by having those 48 million people get preventative care at a family physician instead of the ER. Think how much faster it would be to get a bed in an ER if that happened.

That's what is at stake here.

Yes, the ACA is flawed, but it is a START. It is a beginning point for a process that will, in some form or another, change the way healthcare is provided in this country.

I do not think the federal government could efficiently create and operate the systems necessary to administer a single payer plan.

Regarding the 48 million that have no coverage, I would venture that most of these people get little or no medical services. And I agree they clog up emergency rooms which is where they often go when they do need services. If these 48 million begin using "the system" we may see shortages in the availability of resources. We are about to find out we have a shortage of doctors, especially primary care physicians. Our capacity is based upon the uninsured receiving inadequate care. It may be short term pain, but long term the capacity will need to adjust in order to create access for all.

[MikeAurelius]

I do not think the federal government could efficiently create and operate the systems necessary to administer a single payer plan.

Regarding the 48 million that have no coverage, I would venture that most of these people get little or no medical services. And I agree they clog up emergency rooms which is where they often go when they do need services. If these 48 million begin using "the system" we may see shortages in the availability of resources. We are about to find out we have a shortage of doctors, especially primary care physicians. Our capacity is based upon the uninsured receiving inadequate care. It may be short term pain, but long term the capacity will need to adjust in order to create access for all.

Yes, but. By combining the insurance companies into one form, the staff and systems are there already.

The 48 million are already being served by emergency care physicians, which make up less than 5% of the total number of physicians. There is plenty of room in the system.

[Steve Machol]

I do not think the federal government could efficiently create and operate the systems necessary to administer a single payer plan.

Actually they already do. It's called Medicare and it runs with only 3% overhead. In contrast, there is absolutely no current Insurance company that comes anywhere near that efficiency. In fact even with the ACA, companies are still only required to put 80% of their premiums back into actual medical care. Until now, they didn't even have to do that, and many were well over the 20% overhead anyway.

It's a myth (and apparently a popular one) that government cannot be as efficient as big business. In fact, we now pay more for many functions that have been turned over to private businesses - prisons, many military contracts that used to be handled by our service man and women (and who now find themselves without the chance to learn marketable skills while serving our country, guarding our embassies, etc. Look up what these services are actually costing us compared to what they cost before privatization. I think you'd be amazed. The whole concept of 'privatization' was not pushed because it would allow more efficient use of our resources. It was pushed by politicians that wanted to reward their supporters and friends with government contracts companies, Blackwater, Halliburton, CCA, etc. They are all charging more than what we paid when these functions remained with the government.

However people that are predisposed to thinking that all government is evil and inefficient will not be persuaded regardless of actual facts.

[braheem24]

I've had a 450% increase in my self paid BCBS plan over the past 6 years. I have gone to ZERO doctors in the past 6 years, I have filed for ZERO reimbursements in the past 6 years.

Probably Obama's fault I just can't prove it, maybe if I say it enough people will believe.

[BobV]

Off topic for a moment please...I started my new job today. My former employer could not have given me a better opportunity. My office is about 1 mile from my home. I would also like to thank you all for your kind thoughts. Bob V.

[Uncle Fester]

The fear being created by those who for financial or ideological reasons oppose the ACA is I believe remarkably similar to those opposed to Social Security and Medicare when they were enacted.

An untouchable 3rd rail for most politicians these days as the ACA will be in a couple of generations.

And yes- it's going to be a few years of hard work and compromise to fix the many roll-out gremlins.

[MasterCrafter]

Man you guys are making Government sound so great!! They are so efficient and thoughtfull, I'm thinking we should turn over all private bussinesses to the Government and let them run it. I mean this country is so screwed up by private companys.

If we the people would just get out of the way and let the Government show us how efficient they can be everything would be better.

Back to reality

The reason Medicare only runs 3% over is they are not being sued every second of everyday. Are any of you taking Lipitor? Sue them, you "may" get diabetes from it.

Nobody here metions the fact that Lawyers have killed our health care system.

[optical24/7]

M.crafter, just curious what you like or don't like about ACA? Is it;

No caps (used to be 1m$ caps)
No pre-existing exclusion
Children under 26 staying on parents policies
More competition in the ins. marketplace
Ins. companies having to stay at 20% (or below) for administration/advertising

What would you change about ACA?

[Now I See]

I'm hearing overload issues are keeping many from comparing plans today. Is this from today?

How much is your monthly payment doubling too?
Is that true with all the Bronze plans or just your current provider?

If you know you're using it for routine visits have you compared it too the silver plan and how much would that be?

Actually that is not a Bronze Plan under the ACA. The ACA Bronze Plan doesn't even go into affect until Jan. 1, 2014 and it will cover 60% of costs, not 50%. It sounds like what you have are changes to your employer based coverage. Here's more info on the Bronze Palns: http://www.healthpocket.com/individu...s#.UkrxVmR4ZiY

May I ask...was your old plan subsidized by your employer? Is your new plan not? If both of these plans are from the exchange, which I doubt, how could a lesser plan be more money?...subsidies aside? There has to be more to the story.

LOL...I have to laugh a little...I wish I could tell you there is more to this than I'm stating, but there is no other side to this, except to say we have BCBS. Other than that, it's like I said initially, we purchase our own insurance, no subsidies, we're both self employed. The prices I gave are from my current insurance company (BCBS.) BCBS has their own "bronze," "silver," "gold-whatever" plans. They sent a letter stating that if we keep our current "bronze" plan (a plan that we have had for years) through them, our premiums will increase to $1,100.00 per month (which is double what we are paying now,) we have no more "well" visits or "sick" visits with a copay...we'll pay out of pocket for any doctor visits until we meet our $2500 per person deductible. After we meet the deductible, we will pay 50% of the visit.

These are new prices for the same plan as we have had for years...we did not change anything...premiums up, coverage down. That being said, we have some serious decisions to make. I tried getting on the "exchange" yesterday...yeah, it was a little bogged down, to say the least. When things calm down, and I can get on the "exchange" we'll be looking into other options....

Will we find "the exchange" a benefit for us? We'll see.

[Steve Machol]

The reason Medicare only runs 3% over is they are not being sued every second of everyday. Are any of you taking Lipitor? Sue them, you "may" get diabetes from it.

Actually that is another myth started by Republicans who are upset because they believe that lawyers are more likely to be Democrats and lawyers are also the favorite targets of corporations which do not want to be held accountable for their actions.

Can you provide actual proof that the only reason Insurance companies have 20% or greater overhead is because of lawsuits and not because of profit motive and exorbitant Executive compensation. My guess is that you can't. The entire 'lawsuits are the biggest cause of health care costs skyrocketing in America' has yet to produce any proof of that affect? In fact, many studies have been done on this but none of them confirm that lawsuits play anything but a minor role in healthcare costs. Here are the results of one study that was published in the Journal of Healthcare Quality:

Dr. Marty Makary, an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine, and colleagues found in their review that U.S. malpractice payouts of more than $1 million added up to roughly $1.4 billion a year -- making up far less than 1 percent of national medical expenditures in the United States. The cost of U.S. healthcare was $2.6 trillion in 2010.

Nobody here metions the fact that Lawyers have killed our health care system.

Maybe no one mentions this (except of course Fox News, The WSJ and every other right-wing source at every opportunity) because there is no real proof that this is true. By the way, Texas passed tort reform ten years ago. Are it's healthcare costs significantly lower? Even the Heritage Foundation in it's glowing report of the 'Texas economic miracle' does not make those claims.

Does this mean that I am against tort reform. Heck no! I think we definitely need to reign in the costs of frivolous lawsuits. It just that the actual economic affect of these lawsuits has been greatly exaggerated for political reasons.

[Steve Machol]

BCBS has their own "bronze," "silver," "gold-whatever" plans. They sent a letter stating that if we keep our current "bronze" plan (a plan that we have had for years) through them, our premiums will increase to $1,100.00 per month (which is double what we are paying now,) we have no more "well" visits or "sick" visits with a copay...we'll pay out of pocket for any doctor visits until we meet our $2500 per person deductible. After we meet the deductible, we will pay 50% of the visit.

I recommend that you be careful with that. Only new healthcare plans provide all the benefits, including eliminating pre-existing conditions, removing caps, protecting you from losing your insurance if you get sick, etc. Most older plans are grandfathered in and may not have to provide all those protections. In fact, if you have to pay 50%, then this is not a plan that is covered under the ACA.

[fjpod]

...
Nobody here metions the fact that Lawyers have killed our health care system.

I did. Post #58.

What are you suggesting, the government step in and crush lawyers...or regulate them a bit?

[Uncle Fester]

Dr. Marty Makary, an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine, and colleagues found in their review that U.S. malpractice payouts of more than $1 million added up to roughly $1.4 billion a year -- making up far less than 1 percent of national medical expenditures in the United States. The cost of U.S. healthcare was $2.6 trillion in 2010.

And I'm willing to bet a lot (not all) of these judgements payments went back into the health care system to supplement the victims cost of care.

[MasterCrafter]

M.crafter, just curious what you like or don't like about ACA? Is it;

No caps (used to be 1m$ caps)
No pre-existing exclusion
Children under 26 staying on parents policies
More competition in the ins. marketplace
Ins. companies having to stay at 20% (or below) for administration/advertising

What would you change about ACA?

Well I do like a few things

No pre-exosting conditions
No Cap

Some I dont like:

Children are now 25 in this country - Really? why not make Children 40, 45? I mean there are alot more people living in moms basement

There would be more competition in this country if people could buy insurance cross state lines...that would be more Competitive

What I dont like is the Government telling us what we have to do... I know alot of people on these forums love that

Plus Obama and the Democrats have changed the ACA 17 times since they signed it into law and they wont let the Republicans change 1 thing? Obama has a myway or the highway attitude. He was suppose to be the one who would reach across party lines...remember that?

There are so many unknowns.... I would scrap it altogether and actually have a bi-partisian HealthCare overhaul

[fjpod]

What I dont like is the Government telling us what we have to do...

There are some things we need to do for the common good. If we can get some of the not so sick people out of Emergency Rooms, if we could pass some sort of Tort reform, if we could streamline the business process of insurance, we could all benefit. What's the big deal? You pay taxes now, don't you? You collect or will collect Social Security? You will use medicare? In order to get something, you have to do something.

[fjpod]

There are so many unknowns.... I would scrap it altogether and actually have a bi-partisian HealthCare overhaul

There is no such thing as bi-partisanship anymore. Maybe if we were attacked by Martians, the two parties would get together like we saw when we were attacked on 9/11...but right after that the bickering started...

The ACA was voted on by Congress. Both parties had something to do with it...for better or worse. That's about as close to bi-partisanship as we are ever going to get. The Supreme Court ruled that the ACA was valid and not illegal. What else do you want? I'm sure the Plan will be modified over the coming years in response to problems. So if a democrat is president, they are bad changes, and if a republican is president that automatically makes them good?

[opty4062]

+1. People need to be contributing while they are healthy and young in order to get covered care when they are sick and old. You just can't wiggle your way into medicare when you are 65 after not having health insurance your whole life. That's like buying car insurance after your car is stolen and expect the company to pay you for it.

What about the working poor? Apparently there are millions of them out there, hence the ACT in the first place. What exactly are they wiggling when they pay into the system for years? And for that matter, why use the word wiggling? (Here I am going on a wild goose chase) Must the assumption always be that the other guy is trying to get something over on "us"? That everyone else is just looking for a hand-out on "our dime"? As often as this may be the case, it shouldn't get in the way of assisting people who need it. /ideological soapbox

[optical24/7]

Well I do like a few things

No pre-exosting conditions
No Cap

Some I dont like:

Children are now 25 in this country - Really? why not make Children 40, 45? I mean there are alot more people living in moms basement
Keep in mind, these 18-26 year olds are among the healthiest age brackets in this country needing less care, thus them paying into the system lowers the costs for those more in need. It's also not unusual for a 24 year old to be in collage and possibly not working/working enough to afford health coverage on their own yet.

There would be more competition in this country if people could buy insurance cross state lines...that would be more Competitive
With the exchanges there will be more competition. There are companies able to sell here in Texas that couldn't before. Now your rate will vary by where you live, just as it always has simply because health care cost to vary from region to region.

What I dont like is the Government telling us what we have to do... I know a lot of people on these forums love that

Hey! I am a conservative. But I also know that there has to be rules, regulations and laws for the betterment of society, like traffic laws, drivers license, mandatory car ins, ect. As example if you didn't have to have a driver's license, would you still get one?

Plus Obama and the Democrats have changed the ACA 17 times since they signed it into law and they wont let the Republicans change 1 thing? Obama has a myway or the highway attitude. He was suppose to be the one who would reach across party lines...remember that?

And it will go thru many changes as we see how it plays out. I object much more strongly to the republicans in the house holding our country hostage over this bill that got voted on and passes into law!

There are so many unknowns.... I would scrap it altogether and actually have a bi-partisian HealthCare overhaul

Bi-partisian politics in Washington? Ha!... HaHa!.... Bwaaa Ha Ha!!!

[MasterCrafter]

Bi-partisian politics in Washington? Ha!... HaHa!.... Bwaaa Ha Ha!!!

Hey, thats what Obama said

You have to be the first "conservative" I've seen thats loves ObamaCare, Big Government, and hates what the Conservatives in the house are doing.

I suppose your one of those Conservatives that loves reading the NYT, watching CNN and logging on to the Huffington post.

If your so Conservative why do you defend the Dems changing the law 17 times but not letting Conservatives make one change? AS a Conservative your not mad that the Dems and Obama rammed this thing down our throats without having 1 conservative have anything to say about it?

Come on man!!