So, Let Me Get This Straight About HCR Mandates, Insurance exchanges Etc.

[stopbush]

Tell me where I'm missing the picture:

• If you have insurance through your employer, you have to stick with your employer's plan. You are not allowed to go into the exchange and to possibly get the same coverage for less.

• If you're employed but have no benefits through your employer, you can go into the exchange.

• If you go into the exchange and have a pre-existing condition, the insurers can charge you a premium 300% higher than a person without the condition

• If you're unemployed, you're mandated to buy insurance through the exchange. If you have a pre-existing condition, see point 3

• If you're unemployed and you cannot afford the mandated coverage (ie: you have to chose between paying rent, putting food on the table, keeping the lights on...OR, paying a monthly insurance bill that's maybe 300% higher than normal), you will be fined $750 for each year you don't carry insurance - AND THAT FINE WILL NOT BUY YOU ANY INSURANCE COVERAGE. You will still be uninsured, just $750 poorer. (BTW - does anybody know if that penalty applies to each individual in your family?)

Tell me how this is real reform/progress?

[TwilightGardener]

1. Where did the 300% figure come from? I thought that was age-related, not pre-existing related, but

I could be wrong.

[Zodiak]

3. Age is the new way to price discriminate

You are correct...it is only age.

But of course, the older you get, the more likely you are to have a "pre-existing condition", so the post you are responding to is not entirely wrong, either.

Basically they have replaced one form of discrimination with another.

[DrDan]

4. I think it is both - and the pre-existing conditions include

high blood pressure and cholesterol - which probably will include nearly everyone as they age.

So it could be quite a big payday for the insurers.

[TwilightGardener]

7. I wonder what they consider "age", then--anyone over 30? LOL.

[DrDan]

17. it will be scaled - but you can be guaranteed that there will not be an age that

does not generate significant profits.

[lapfog_1]

11. It's both.

And the percentages are "who knows"...

I'm guessing that my insurance from the exchange (over 50 with a pre-existing heart condition) will be 6 times that of a healthy 22 year old. BTW, I'm in reasonably good health and I've never smoked. I was born with a heart defect.

4 X for being over 50, 50% more for my heart defect (which has already been corrected through surgery... but it's still a Pre-existing condition).

[DrDan]

16. ouch

[stopbush]

5. That's the claim Howard Dean has been making on TV.

Maybe he is wrong. I don't know.

I posted the OP because I am confused by all the different stuff I'm hearing from different sources. I would really like those in the know to clarify these issues for me. I don't have time to read the whole ever-changing legislation.

[Cleita]

8. There seems to be no limit in the bill that I could discern as to how much

the insurers can charge in inflated premiums for those with medical conditions. Maybe Howard was just making a point by using an arbitrary figure.

[Fire1]

21. Yes, where did you find that magic percentage? n/t

[Hello_Kitty]

2. If you're unemployed you'd most likely qualify for Medicaid

Which is good for you but will place a crushing burden on a lot of states.

[Cleita]

6. It's not even good for the Medicaid recipient because they pay so low

most doctors won't accept it. No provisions have been made to update and fund Medicaid, which is why many of us wanted the Medicare buy in that would help low income and uninsured people.

[TwilightGardener]

9. Yabbut, I also heard that doctors were not happy with the Medicare buy-in, as they're

already pissed about low reimbursement rates for the intended population we have now.

[lapfog_1]

14. Medicaid and Medicare are completely different.

and almost all doctors refuse to take Medicaid patients.

Most accept Medicare but they don't like the hassle involved.

[Cleita]

15. They are a lot happier with Medicare than they are with Medicaid.

Also, they hate the Medicare Advantage programs and most won't take them. FYI those are the ones privately run by private insurance, where the senior citizens sign away their Medicare rights, and the insurance company gets the money instead. Apparently, they are doing what private insurance does best and that's denying claims. One company in my area offering MA were denying 40% of claims when they were investigated by the state insurance commissioner.

There's no doubt that the Medicare fee schedule needs to be updated. Also, the flow of money to the private insurance industry and big PhRMA through Medicare Advantage programs and Medicare Part D, is rapidly bleeding the program dry and needs to be stopped. However, I give little hope of this Congress doing this.

These problems are so easily fixed and real health care brought to everyone if Congress only had the will to make the big corporations to back off.

[madmom]

13. As it stands now, you can not get medicaid unless you have kids, unemployed or no.

[Hello_Kitty]

18. Yep.

I've had to explain repeatedly to people that Medicaid is basically a program for poor single mothers and not many other people. The expansion of Medicaid to all people below 133% FPL or whatever limit they decide will place a massive new expense on the states, who have to share the cost with the Federal gov't. My state, Arizona, which is broke and run by fundies and Grover Norquist bathtub morons in the legislature will not be able to sustain it.

[Bluenorthwest]

19. Where'd you get that misinformation?

Are you under the impression that Medicaid covers the unemployed?

[Hello_Kitty]

20. Believe me, I know it doesn't cover the unemployed. I'm unemployed right now.

But the bill expands Medicaid to cover everyone below 133% FPL, which most unemployed people are, given how low UI benefits are.

[madmom]

24. Does it say EVERYONE? I had not heard that, I did hear expanding to

to 133% of poverty level but not necessarily for EVERYONE.

[Hello_Kitty]

25. That's my understanding

Remember that FPL varies greatly by the number of dependents you have. For a single person 100% FPL is $10,800. 133% is $14,404. There are a lot of single people out there who make very little money but "too much" for Medicaid under the current system. Certainly most people on UI (if they're lucky enough to get it) will qualify for Medicaid.

[lapfog_1]

10. No... it's actually a *lot* worse than that.

The insurance companies cannot be charged with monopolistic practices (which is true right now, the only industry outside of some professional sports to be accorded such an exemption). So if they want to call each other up and say "Well, we are raising premiums next year 17%, how much are you raising yours?" there isn't a damn thing anyone can do about it.

There is NOTHING to contain costs. So those premiums that you got on the exchange, either with your money or the taxpayers money, well... they are going up and up and up and up and up and up and up and up...

The insurance companies will also all HQ in the state with the weakest insurance regulations and do business across state lines, thus avoiding any oversight or investigation by your insurance commissioner. Some will point out that this is only if both states agree, but who is kidding who, states don't agree on things like this, corrupt politicians in each state agree on things like this. And it's cheap to buy the vote of a state assembly person.

You won't be able to order online prescription drugs from anyone out of the country. Never mind if those drugs are 10 X less than the US purchased drug, even if the actual pills are made at the same plant. Everybody else in the world gets them for 1/10th of what we pay... but not us.

And, to pay for the subsidy that some will receive to buy their overpriced insurance on the exchange, a tax will be imposed on the Cadillac Insurance policies of a few management fat cats... err, and a whole bunch of union workers that make maybe $30/hour but who negotiated over the years to get decent health care for the union members.

Did I leave anything out?

The only thing anyone will get from trying to polish this turd is shit stains on your hands.

[liberal_at_heart]

12. oh man I really hope this bill does not pass

[Fire1]

22. EVERYBODY needs to read THIS. THEN make an

INFORMED decision.

http://stabenow.senate.gov/healthcare/Patient_protection_section.pdf

[Fire1]

23. Got a link? n/t

[eomer]

26. I think you are wrong on point #3.

Do you have a source for that?

At least in the House bill they would not be allowed to vary the rate charged based on pre-existing conditions. The only thing I've seen that is close to this is a provision that allows employers to give up to a 30% discount to employees who participate in designated wellness programs. I believe it's not based on medical conditions but is instead based on participating in preventive measures and such. And it is 30% not 300%.