A reminder of why HCR was not a disaster

[Recursion]

Since amnesia seems to have struck a large part of the board.

Already:
The Medicaid drug rebate has been increased
People with pre-existing conditions can now get health insurance through the high-risk pool with a premium that can only vary based on age and location and that premium is calculated as if the people were part of the normal medicaid pool.

In one month:
Insurers will be required to allow parents to keep their children on their policies until they are 26 (many insurers have already started doing this)
Children under 19 cannot be denied insurance based on pre-existing conditions
Insurance companies will not be allowed to charge copays for preventive care
Recisions will be forbidden
All insurance companies must reveal profit, bonus, and administrative costs
Blue Cross companies like Anthem, which just raised rates 14% will lose their Blue Cross status if less than 85% of their revenues for the year are spent on patient care

Starting in January:
Your W2 (so, your next W2, that you get in 2012 for your earnings in 2011) will show how much your employer pays for your insurance
All plans (not just Blue Cross) must rebate their customers if less than 85% of revenues are spent on patient care (to everyone screaming "what was done to control costs?!?!", this was done to control costs, setting a maximum profit margin for every insurance company. This doesn't address provider costs, but neither would a public option.)

Starting in January 2013:
The Medicare levy cap on earned income will be lifted completely -- all earned income will be subject to the Medicare levy.
For the first time ever, investment income will be levied for Medicare once it crosses above $200,000

Starting in January 2014:
Insurers will not be able to deny anyone insurance or charge them more than the overall pool because of pre-existing conditions (until then, these people will be in the "high risk pool" mentioned under "Already")
Insurers will not be allowed to establish per-patient spending limits (not that they'll want to, since they have to spend at least 85% of the money they get on patient care).
Small businesses will receive a subsidy for providing health insurance
The highest deductable anyone will be able to have is $2000 ($4000 for a family). That is all you will ever pay out of pocket in any year after 2014.
If you cannot find a policy that charges less than 9.5% of your income, you will be able to enroll in a state-controlled non-profit insurance plan (again, competition for for-profit insurers).

Can we please drop the BS drama that this bill was a disaster? It wasn't all that we wanted, but it's definitely not making things worse.

[Ozymanithrax]

1. This is a great overview of a great progressive bill.

But people who are against it on both sides of the aisle will just sing la la la while holding the hands over their eyes.

[depakid]

2. Irony, irony

The OP is what there is to sell though- so I guess people had better make the best of it.

[Recursion]

3. What's so bad about it? NT

[depakid]

8. If parts were sold as a patients' bill of rights- not a thing

But that's not what expectations were-

Instead, what people will (and are) seeing is a bogus bill of goods- and worse- an association with the predatory corporations that they hate- who drive them at their must vulnerable state into financial hardship.

Didn't have to be that way.

[Recursion]

10. When was it sold as a patient's bill of rights?

A bill colloquially called "The Patient's Bill of Rights" was voted on and failed in 2001.

Instead, what people will (and are) seeing is a bogus bill of goods- and worse- an association with the predatory corporations that they hate

A) Like it or not, the hatred of corporations is not as strong outside of DU as DUers think it is.

B) What they see are some very specific and important limitations on those corporations that I listed above, and that you can't seem to match with anything.

[depakid]

16. The bottom line is that Democrats are now the party of Health Insurers

And among other things- they now every abuse and medical bankruptcy coming down the pipeline.

Every single one.

Wish it wasn't that way- but that's how it is- and how it correctly will be perceived (as that wasn't what people thought was promised)

David Michael Green put it this way:

...here's a little riddle that any sixth-grader can easily figure out, although it seems to have eluded the brain trust at the White House: If insurance companies are winning big-time, then who is doing the losing? Something tells me that if Democrats are dumb enough to pass their own legislation, voters will provide them the answer to that puzzle in November of 2010, and then again two years later.

What could be stupider than saddling thirty-five million Americans with a new monthly bill that will probably represent the second or third biggest item in their budget, in exchange for crappy private sector health insurance that is unlikely to pay out when needed, and wastes a third of the dollars paid in premiums on bureaucracy and profits anyhow? Slapping fines on them if they don't pony up for the insurance, perhaps?

This bill alone could mobilize legions of people to go to the polls and vote for whichever party didn't do it, and I'm pretty sure the GOP won't be shy about reminding Americans who that is.

As I said- better wave around the benefits- and say, at least we did something because the costs will be coming home to roost in every mailbox across the country.

[Recursion]

18. "and wastes a third of the dollars paid in premiums on bureaucracy and profits"

Read the law. 15% at most for administrative costs and profits.

[depakid]

21. Watch the reality as it unfolds

and as Americans will see and feel it.

Right here on this forum.

Double digit premium increases- and higher deductibles, copays and CEO salaries and bonuses

[Recursion]

23. Deductables will be capped at $2000 (yes, they should have done that right away)

And it sucks that that has to wait until 2014. But, higher deductables than that will not be possible.

And, if your argument is now "wait and see", well, that's mine, too.

[golfguru]

50. Out of pocket & deductibles capped, insurance premiums have NO CAP

Hell they can cap out of pocket at $10 and then jack up your
health insurance premiums to $1500 per month.....which is ALL
OUT OF POCKET.

[Recursion]

52. "capped" at 9.5% of income

Also affected by the fact that they can't give a particular person an arbitrary premium anymore; it all has to be group rates.

[eridani]

74. So they'll just fuck us over with copays instead.

Big whoop.

[Honeycombe8]

89. None of that applies to most Americans, whose ins. is provided for by employers.

No deductible caps or anything applies to group policy coverage through employers. Most Americans are covered through group policy coverage. So these caps really apply to just a segment of the population that has private insurance coverage.

Although, I would doubt that many group policies have deductibles higher than even $1K, much less $2K. The reason for THAT is...the employer might then be faced with having to set up HSA accounts for its employees. Employers do that for high-level employees (CEOs and VPs), but they don't normally do that for the "regular working people."

So if the deductible is $999, then the employer doesn't have to worry about it. HSAs can be used ONLY when the deductible is over $1K or something like that.

I certainly HOPE people can still buy a high deductible policy on the open market. Some people would prefer to self insure up to several thousand dollars, and then for ins. coverage to kick in.

[Honeycombe8]

90. I hope people can still buy ins. w/$5,000 deductible, if they want.

Some people would prefer to self insure for up to several thousand dollars, and THEN for insurance to kick in.

It keeps the policy premium down, and it's just less hassle. You also get some better price deals, if you pay in cash, I'm told.

So if that right was taken away....chalk up another one for the ins. cos.

Cha-ching.

[Recursion]

98. Nope

That "right" (:eyes:) is gone, or will be in 3 years.

[Jackpine Radical]

78. CEO bonus=medical cost.

Advertising=medical cost.
Lobbying=medical cost.

Yes, these are exaggerations. Slight exaggerations. Just wait & see what gets reclassified into the category of "medical cost" in order to provide the illusion of the magical 85%.

[Recursion]

99. They're floating that idea

If it doesn't get shot down, I'll be throwing molotov cocktails with you.

[Recursion]

19. Is your problem just the fact that people will pay higher taxes if they don't buy health insurance?

*shrug*

OK, if that really bothers you, I guess...

[depakid]

20. LOL- use a Republican frame

Some folks never learn.

No- mine (and every other American with half a lick of sense) expected and was up for problem solving.

Rarely in anyone's lifetimes was there a better opportunity.

[Recursion]

22. And this solved a lot of them

It solves problems like having your policy rescinded, being denied coverage for pre-existing conditions, not being able to afford health insurance. It lets you get preventitive care for free. It statutorally limits the profits of insurance companies.

[depakid]

61. It doesn't "limit the profits!"

LOL.

Like I said, fighting for a strong patients' bill of rights and putting Republicans behind that 8 ball (as Dean noted at one point) would have been smart tactics. That could easily sold. And that's essentially what you have left, so the Dems had better be waving that bloody shirt around this fall.

Otherwise- what you have are unpopular mandates and taxes on good coverage- double digit rate increases and higher deductibles and copays. A system that doesn't put a dent into medical bankruptcies. Worse, the electorate now associates the party with health insurers and PhARMA -which is where Republicans ought to be.

[Recursion]

96. "It could have easily sold"? IT DIDN'T

The McCain-Kennedy Patients' Bill of Rights did not pass the Senate in 2001. So, no, it's not an easy sell.

[depakid]

110. Who controlled the White House & Senate filibuster in 2001?

No "60 votes" nor Presidential signing there.

Obama and the Dems had more ammunition in terms of appalling insurance company and PhARMA abuses, populist anger and political capital than they're likely to have in your lifetime.

And what did they administration do with it? Tar and feather every opponent of reform with them? Nope. They came out with statements that "they're not bad people" and proceeded to make backroom deals with them and allow their lobbyists to write much of the legislation. Brilliant.

At least brilliant for Republicans, who watched as Democratic approval plummeted and they took Kennedy's Senate seat.

[nightrain]

104. "Free" preventive care in my state is limited to a paltry $500/year. Recursion, you've just got

to start doing more homework. The bill is crap for regular people, and particularly for middle-aged, middle-income folks who haven't been able to purchase insurance, AND NOW STILL CAN'T!!!

And why continue to massively subsidize a failing corporate-based non-system.

Have you looked at Taiwan's success?

[LiberalFighter]

11. Those that complain about it... what did they do to provide a better HCR law?

Probably just complained to their family and friends. Probably didn't make a call or send a letter or email to their legislator.

Probably didn't educate themselves about the necessity. Probably had blinders on.

[depakid]

17. Unlike people who call themselves "fighters" -they actually fought

in front of Senate and Representatives offices (at least in Oregon) -and in front of the Whitehouse until they were (barely) let in the White House gate and given a seat at the back end of the table.

While the new president had the "real" "stakeholders" in the back room- making shady deals and selling out the public interest -just like any craven Republican would.

[dave29]

39. or, they bitched on DU

:shrug:

[Honeycombe8]

91. There's not much one person can do, beyond a certain point. Voting is the main thing.

The vote is the most important thing.

Beyond that...well, it doesn't make much difference. My Senators are far right Republicans. No number of calls or e-mails will have any effect; they vote the Republican way. Period.

Collectively, the lefters let it be known how they felt about the HCR. The WH knew it, Congress knew it. It made no difference. I'm not saying I don't see WHY the bill is the way it is. I do.

But once passed, I don't hear any Dems on the trail shouting out the bill's glories, do you? Once passed, it was almost never mentioned again...except by the Right.

I'm afraid that's because the HCR doesn't really do much, if anything, for most Americans. It doesn't affect me at all, benefit-wise. It only affects me in that it costs me. I don't begrudge having to pay for those who can't afford healthcare. But let's not try to pass the bill off as something that it's not. It really only affects the average American in that it costs us all. (They will start to tax my ins. coverage cost from my employer, I think, so I will have that added cost, above the other taxes.)

[unapatriciated]

62. I made numerous calls, sent letters, emails and attended protests.

My problem with this bill is there are no penalties for the industry for delaying and denying claims.
I spent over ten years fighting my Insurance Company. California enacted strong laws regarding pre-existing conditions and claim denials in the early 90's in part because of many like myself who demanded and fought for those laws. Unfortunately the insurance industry found ways around those laws because they helped (just like this legislation) to write the laws. There are problems in this bill that need to be addressed and fixed.

[Ozymanithrax]

9. No Irony at all... This bill was enormous progress over what we had...

It did not institute a perfect system.

[depakid]

60. Nope- the Bill was a big step backwards

Not only failing to solve the major problems that needed to be addressed- but further entrenching the parasites in the system and throwing tons of government money their way!

In short, the Democrats blew it. Again- and the electorate's about to make them pay.

[Honeycombe8]

92. I don't think so. It made a couple of improvements for a small segment.

Those are important improvements. But several other changes actually benefit the insurance companies, not the public so much.

And most of the bill doesn't affect MOST Americans at all...except for the cost. Most working Americans will pay extra for the bill.

I'm not saying it's terrible. But let's not make it out to be some progressive FDR-worthy bill. It was remarkable it got passed. Those two improvements that were made needed to be made (no rescission after someone gets sick; refusing to insurance pre-existing conditions on the open market (of course, they already couldn't do that for group policies...no "reform bill" was needed for that provision)).

[bkozumplik]

31. now, count the costs

what did we give up. do you know those things?

[Recursion]

36. White male voters over 40 is a big one NT

[Sentath]

4. Re: 2013

Holy $#!7 they popped the cap.

The aristocrat party must be shitting bricks and prepping to kill this part.

[Recursion]

5. And they're levying investment income

What's really funny is that the GOP back in the Reagan days made a big point of saying a levy isn't a tax, so that Reagan wouldn't have officially signed the largest tax increase in history. But, the usage stuck, so none of this is a "tax increase". Suck it, Republicans...

[bornskeptic]

30. Actually all earned income has been subject to Medicare tax since 1993.

There is a cap on income subject to Social Security tax, but not Medicare tax. However,it is great news that unearned income will be taxed as well. I see no reason why any income should be excluded.

[lillypaddle]

6. Thanks for the reminder - K&R nt

[JTFrog]

7. K&R!

[golfguru]

12. $4000 max deductible does NOT include the cost of

rocketing premiums. The 14 to 29% rate increases just approved
in California will put a lot of people in the "can't afford insurance" bracket.

So big deal I have a limit of $4000 out of pocket if I am paying $1000 EVERY
MONTH OUT OF POCKET to keep the insurance.

This bill is a huge SCAM. The profits of private insurance corporations will
rocket up, affordability by the working folks takes a nose dive.

[Recursion]

13. The profit is capped at 15% of revenues

(That's if there are somehow 0 admin costs; all admin costs have to come out of that 15% too.) And premiums are capped at 9.5% of income -- if your premiums exceed that, you can join a state-run non-profit insurance program.

So, no, the profits can't keep on "rocketing up". That's the point.

[Cleobulus]

41. "And premiums are capped at 9.5% of income" and that is way too fucking high a cap...

I sure as hell can't afford to have damn near 10% of my income taken out of health insurance, I don't know anyone who can afford that in my income bracket.

[derby378]

42. Which means that premiums for ANY insurance company...

...will likely increase until it hits that 9.5% mark, just like it is with BCBS. Only thing is, this time it'll be illegal to dump your insurance company.

[Recursion]

43. No, they can't give you an individual rate

They can't simply look at your income and take 9.5% of that. They have to use a single formula (well, 4 formulas for the cartesian products of male, female and under 60, over 60).

[golfguru]

51. and all of that 9.5% of your income IS OUT OF POCKET

no matter how much lipstick you put on a sow,
it is still a pig.

[golfguru]

49. Are you really that naive?

The revenues just rocketed upto 29% for ONE YEAR in California.

There is no resstriction of ANY KIND on high the premiums can be
jacked up. And premiums translate directly into revenues.

[Recursion]

53. They announced this BEFORE HCR WAS PASSED

They jack up rates however they want as it is, the law phases in things to stop that, like letting you join a state-run non-profit insurance company if the premiums are higher than 9.5% of your income (that unfortunately only starts in 2014).

[golfguru]

55. The best HCR bill would have included the following:

Cap rate increases to actual inflation rate = CPI

If that is not acceptable to health insurers then cap
the maximum out of pocket at 7.5% of total family income.
That includes monthly premiums + deductibles.

So if a family has yearly income of $60,000, their max
out of pocket would be $4500 INCLUDING Health insurance.

Allow individuals to purchase health insurance from any other state.
IOW increase competition.

Establish a national review board to rule on what medical procedures would be
covered by the insurance company. That would have the effect of limiting
exotic and fruitless medical procedures.

None of above is present in the current HCR bill.

Oh well...may be president Hillary will get it done,
where president Obama has failed.

[derby378]

57. Hey, I didn't trust Hillary to get the job done right, either

Maybe Obama should have stuck to jobs, the environment, and prosecuting torturers like he was supposed to do in the first place.

[livetohike]

14. We received a notice from our health insurer regarding

1)The lifetime limit on benefits no longer applies as of Oct. 1, 2010

2)Young adults under the age of 26 may stay as dependents on the family policy effective Oct. 1, 2010

Good news!

[Recursion]

15. Bingo

I don't think they were required to lift that cap until January, but it looks like they're doing it anyways (makes sense since open season is almost upon us).

[golfguru]

65. My policy already covers students under age 26

before HCR.

[livetohike]

79. The difference is now they don't have to be students to

stay on the coverage :-).

[dflprincess]

105. Some states already have laws the keep

adult children on a policy whether they are students or not. In Minnesota the age cut off has been 25.

[livetohike]

107. I didn't know that. I know that's not the case here in PA

My brother and s-i-l have two kids they were concerned about with the insurance who are no longer in college and don't have a job with good benefits (ages 25 and 22).

[dflprincess]

108. It is a state by state thing

My brother had 4 of his over 18, but not in school kids on his insurance until this past July. He has cancer and once he used up his PTO & FMLA his employer laid him off - fortunately he has disability insurance that pays about $1,000/month but he had to go on COBRA. I've been picking that up for him but I had to throw the kids overboard. I hated to do that, but the premiums just for my brother are $400/month, if I'd left the kids on it would have been $1,200/month (note that his family premium would be more than his disability pays).

I do not understand why we cannot have access to health care like people in civilized countries have.

[livetohike]

109. I'm sorry to hear about your brother

:hug: I agree - we are long overdue for decent health care here. I have cousins in Saskatchewan - and I envy their health care system.

[area51]

24. Really?

So 273 people will stop dying each day in this country? People will stop going bankrupt to pay for medical treatment? Private, for-profit insurance companies, beholden to their shareholders, will "get Jesus" and stop denying claims? What's the weather like on the planet you're on?

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, and bankrupts people. Republinazi '93 plan:

"Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."

"We will never have real reform until people's health stops being treated as a financial opportunity for corporations."

[Recursion]

26. Sigh

So 273 people will stop dying each day in this country?

Given that they will be able to get preventitive care for free with no copay, yes, their chances are probably better. Not to mention the tripled funding for FQHCs (that was what got Bernie Sanders on board with the bill, and unsurprisingly DU is completely ignoring it).

People will stop going bankrupt to pay for medical treatment?

For the most part, yes. Premiums will be capped at 9.5% of income and deductibles will be capped at $2000.

Private, for-profit insurance companies, beholden to their shareholders, will "get Jesus" and stop denying claims?

Just like medicare or a hypothetical public option, they can deny claims depending on their standard of care agreement with you (which has to meet standards set by the state). You do know that medicare denies claims too, don't you? Not everybody is going to be able to get every treatment. Furthermore, denying claims does lead them closer to the 15% profit threshhold they can't break.

[bornskeptic]

33. It's not a 15% profit threhhold.

No health insurance company has a profit margin anywhere near 15%. The industry average is under 5%. From a USNEWS article about a year ago:

mong the large, for-profit health insurers, profit margins line up with the industry as a whole. UnitedHealthGroup, the biggest health insurer, had a 4.1 percent profit margin over the past 12 months. WellPoint, the next biggest, had a 4 percent profit margin. Aetna, Cigna, and Humana came in below that.

Health insurers turn out to be underperformers compared with the other parts of the healthcare sector. Pharmaceutical companies have a profit margin of 16.4 percent—seventh highest of the 215 industries that Morningstar tracks. Others segments of healthcare with margins well above the median include healthcare information (9.4 percent), home healthcare firms (8.5 percent), medical labs (8.2 percent), and generic drugmakers (6.5 percent).
http://money.usnews.com/money/blogs/flowchart/2009/08/25/why-health-insurers-make-lousy-villains.html

The 15% limit is on total overhead, most of which goes into the salaries of claims processors, actuaries, and other ordinary working people, and on advertising and marketing.

Many DUers have the idea that skyrocketing healthcare costs can be controlled by attacking insurance companies, but that's not where the main problems lie, as the second paragraph quoted above should show.

Profits for the largest 5 health insurance companies combined were $12.2 billion.
http://articles.latimes.com/2010/feb/11/business/la-fi-health-profits12-2010feb12
That's a lot of money, but it's only about a half of a percent of US healthcare costs, which are estimated between $2.1 trillion and $2.5 trillion annually. In order to have per capita costs comparable to those of other industrialized companies, we would have to cut our costs by 50%. Attacking the health insurance companies won't come close to getting that done.

[Recursion]

47. Yeah, I was being loose with language

because people are convinced that's all "profits". So, yes, it's a 15% overhead limit.

[unapatriciated]

63. sigh

This bill is more or less the same as what California enacted (without mandates) in the early 90's. Those laws did not prevent my insurance company from doing routine "reviews" of claims which delayed care for my son. During the many many reviews, I was forced to use credit cards to provide medications and care, I finally had to sell my home. If there are no real penalties for wrongful denials and delays, it will be business as usual. Denials and reviews are standard procedure in regards to catastrophic illnesses. It is their way of keeping the monies in their coffers for as long as possible. Please rent and review Sicko for detailed instructions on how the insurance industry works and why they shouldn't be involved in our health care.


btw all the claims that they denied and reviewed were eventually found to be covered, after years of fighting. The credit cards I had to use during those years still wanted their interest. BCBS didn't have to pay that added expense I did.

[Mimosa]

69. What if a person gets sick (say, cancer) before 2014

And cannot afford deductibles, copays and Rxs? What about the people who aren't poor enough for Medicaid but have crummy policies they might have to drop when they are sick?

[Recursion]

72. I've said I think the phase-in is way too slow

And, unfortunately, what happens to them for the next 4 years is what's happened to them for the last 30 :(

[TheKentuckian]

25. No, this has been argued a million fucking times. I've said exactly why it is shit over and over

You are selling features not structure and the structure is the problem.

Enhancements on the current fiasco is not reform and make reform more difficult and further away.

Rolling out the list of enhancements every few weeks isn't changing any minds.

[Recursion]

27. Yes, I know you wanted the private health insurance industry to disappear

Too bad there aren't the votes for it. Kick the South out of the country and we could probably do it.

These complaints remind me of the people who complained about Mother Theresa because she "didn't change the structure" and "didn't address systemic problems".

[TheKentuckian]

29. That would be best but never was what I expected.

I wasn't even a hardcore public option guy so I don't know who you are talking to or about.

Maybe you should avoid talking out of your ass in a vain effort to wipe and dangle.

[Nicholas D Wolfwood]

32. You've got more than enough ass for all of us, thanks. (nt)

[TheKentuckian]

34. You wear a collar and have not even the low honor of a price.

[Recursion]

37. Cicero? Cato the Younger? NT

[abq e streeter]

28. "...definitely not making things worse". Yet another great slogan for Democrats to run on

[ZombieHorde]

35. Here is the problem, we were promised $1,000,000, but we received $1000.

$1000 is good, but next to the promised $1,000,000, the $1000 seems lame.

Note: the dollar amounts are merely a gimmick used to demonstrate a point and should not be taken as literal.

[Phx_Dem]

38. Thank you. So much that people don't know about hte bill they're constantly

bitching about.

[unapatriciated]

64. I do and have been involved in hcr since the early 90's.

I read the entire bill and could not find any significant penalties for wrongful denial of claims or delays in care. It will be business as usual for them.

on edit: there were penalties for filing "fraudulent" claims or "material misrepresentation". I repeat rent Sicko for details on what the Insurance Industry deems misrepresentation to mean

[Cleobulus]

40. Question, where do you get your information....

particularly about the deductible, and completely forgot to mention maximum out of pocket expenses for the year? If you have a plan with a 2000 dollar deduct and co-insurance of let's say 80%, with a maximum out of pocket of 5000 dollars, then you are going to pay 5000 dollars for anything major, regardless of the actual deductible. Even worse if you need a lower premium plan you could see a 5000 dollar deduct and 10,000 dollar max out of pocket.

In addition the 85% requirement is great, if loopholes aren't found, and they are. Same thing with covering kids till they are 26, some plans are dropping dependent coverage entirely, they aren't obligated by this law to cover kids at all, much less until they are 26.

[Recursion]

46. hhs.gov, medicare.gov, healthcare.gov, healthreform.gov

All this stuff is online.

[Vinca]

44. I just read an article at HuffPo that only 1200 people have signed on to the

pre-existing condition pool, primarily because it costs a small fortune (something I have first hand knowledge of, by the way). Another person responding to the article said her 20-something children were able to stay on the family policy . . . as long as they ponied up $400 a head per month for them. The bill was a disaster.

[Recursion]

45. $400 per person per month is less than the Medicare Part A premium

That's $450 per month if you've contributed less than 30 quarters (and the public option "medicare part E" would have to use that price if it was going to be solvent).

Even with 30+ quarters, Part A + Part B is $350, which isn't much less than $400

pre-existing condition pool, primarily because it costs a small fortune

http://www.hhs.gov/ociio/initiative/hi_risk_pool_facts.html

By law, the premiums cannot exceed the standard medicaid group rate.

[Vinca]

68. That must work out real well for the people getting by on $800 a month SS.

The premiums should be ZERO. Everyone should have a health access card, no questions asked, and it should be paid for out of the common funds (just like the money used for killing people in wars). How anyone can be a cheerleader for this horrible bill is beyond me. The only citizens who will benefit are the people who can afford whatever big insurance bills them and the people poor enough to eventually get onto Medicaid. It's a real incentive to throw in the towel and become dirt poor rather than semi-poor.

[Recursion]

76. If you're on $800 a month on SS you almost always paid in for 40 quarters or more

And in that case you don't pay that premium. The point of the "Medicare for everyone" people are pushing for (including me), is that you can buy in with premiums before you are fully "vested" with your levies (it's not really a vesting, but it acts like one). But these premiums are not very cheap, because as much as we don't like coming to terms with this fact on DU, a whole lot of the cost of insurance comes from how much medical care costs.

[Vinca]

81. Funny how Canada, Great Britain and scores of other countries manage to do it.

This is the only country where big insurance is given greater priority than the citizens.

[nightrain]

48. yeah, what a success it was--on July 15th my state boasted that 4 people had signed up

for the federal pre-existing pool.

FOUR.

Not four hundred or four thousand! 4.

It's unaffordable (between $386 and $480 per month), has high deductibles, high copays in the thousands separately for visits/procedures, and more deductibles and out of pocket for meds!

Guess who administers it? Who reaps the rewards?

Blue Cross.

Oh, and that 80 or 85% Medical Loss Ratio? How about insurance corporations' plan to put administrative costs in as "patient care", or exclude investment income? see

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x555929

Look deeper Recursion. It's not so pretty under the surface.

[Recursion]

54. $386 - $484? Sounds like the Medicare Part A premium

Are we even listening to ourselves here? If you want a public option or single payer, you're asking everybody (or those who opt to) to pay the less-than-30-quarters price of Medicare Part A, which is about $400 per month.

[nightrain]

66. your figures for Medicare Part A seem inflated. $386 to $480/month is a lot of

money when you don't have it sitting about. What ever happened to "affordable"? Affordable for a single middle income person who has to pay out of pocket would be about $100-200/month, and minimal copays, deductibles, etc. It's extortion by insurance corporations.

How come other countries can provide total care for 1/3 - 1/2 of what Americans pay?

Answer-- greed and profit in the US non-system. That seems okay with you.

That the premiums, copays, deductibles, and out of pockets costs are so high and have to be susbsidized for lesser-income folks is an admission that the costs are too high! Otherwise subsidies wouldn't be necessary.

[Recursion]

75. I got them from medicare.gov

https://questions.medicare.gov/app/answers/detail/a_id/2260/~/medicare-premiums-and-coinsurance-rates-for-2010

It's $254 / month if you've paid in for 30 quarters or more (ie, you've had the medicare deductions taken out of your paycheck for 8 years of work). If you're somebody who hasn't had 8 years of Medicare-deducted work, Medicare (aka single payer or a public option) is $461 per month. This is what everybody is clamoring for, and they don't seem to realize how much it actually costs the people using it.

[nightrain]

80. interesting.... you quote the figure most useful to make your point. I sensed

the figure was too high, and so it was. $200/month higher. Many, most?, of the folks I know have met the quarters quota and so are paying the lesser amount.

Single payer costs are less than what you claim, considering that about 31% of current insurance premiums, deductibles, and copays go toward "administrative costs" including profit, those enormous exec compensation packages, denial staff, excess paperwork, etc. So, even if the insurance corps don't get to shift their proposed costs into "patient care" and the 80-85% actually does pan out... that leaves another 11% unaccounted for-- (31 minus 20). There's plenty of citizen money in the non-system already to cover single payer costs, if only the PTB would do what's best for the country (but they probably won't for a while).

We could learn from Taiwan's experience, but we refuse to.

See pnhp.org for more accurate cost information.

[Bluenorthwest]

95. Almost all Medicare participants pay zero premiums for part A

Zero. The vast majority. Few pay these 'buy in rates'. A phantom figure indeed.

[nightrain]

100. thank you for that piece of information! Readers need to know the

distortions being promoted in this, and other, threads.

[bornskeptic]

111. That's because it's paid out of the trust fund, which was expected to be depleted by 2017 before HCR

Passage of the Patient Protection and Affordable Care Act moved the depletion date back to 2029.Whether the cost is paid by the enrollee or government, it's still cost. Somebody has to pay the doctors and hospitals. While most enrollees only pay a Part B premium of $96.40, that is highly subsidized from the trust fund. People in higher income brackets pay more, up to the full Part B premium, which is 353.60. So the actual cost of Medicare Part A and Part B is about $800 per month. Add prescription drug coverage, also subsidized from the trust fund, and you're looking at a total cost of some $900 per month. There's nothing phantom about that figure. If you still think there is, look at the annual budget appropriations to cover some 45 or 46 million people, and add in the $96.40 Part B premiums, and you'll come up with about the same number. It's nonsensical to talk about a "Medicare buy-in", and pretend that those costs will magically disappear.

[Mimosa]

70. It was obvious BC/BS devised these awful plans

Nightrain, the plans are exactly like what my partner and i are paying $900 a month for except we have $10,000 each annual deductible, 70/30 in network, and a $1,000 deductible for Rxs.

I looked up the plan for GA and it was about as bad as what we now have. We'd first have to drop coverage for 6 months. The fine print at the Gov plan websites even says they can't guarantee coverage because things could change. or they'd run out of money!

And BC/BS told me that if we dropped they don't have to accept us (or anybody) until 2014. Yes, what a great scheme. *roll eyes*

[nightrain]

101. horrendous transfer of your wealth. I am so sorry.... Thank you for posting!

[CTLawGuy]

56. K&R

NT

[denimgirly]

58. I find it sad that the some People are brainwashed to think this is a Great Bill...it has tweaks but

the US is still the embarassment in the world when it comes to healthcare. It has some small tweaks around the edges but most certainly is not a progressive bill...not even close.

However it appears america moves very slowly in the forward direction and so if i am hoping in about 50 years someone will propse a real progressive bill that will solve this basic right...somethign that the rest of the world has already done.

[Milo_Bloom]

59. What a bunch of nothing.

The BS trying to sell this piece of garbage is amazing.

The 85% thing is useless, since all they have to do is reclassify job titles to shift employees to "patient care consultants" and "quality control"... job titles are being shifted as we speak to prepare for this... so there actually is nothing to control "costs", just how they CALCULATE profits.

Premiums are skyrocketing right now in preparation for pre-existing conditions to hit the pool and there are loopholes allowing them to deny people for pre-existing conditions (we just rename why they are being denied).

Out of pocket costs will FAR EXCEED $4000, since this doens't count the cost of the premiums!


In return for this bunch of nothing, we are forced to contract with companies who offer an inferior product with no other option.

The one good thing that could come out of a republican takeover is the repeal of this garbage.. unfortunately, there is so much other crap that comes with the GOP that it isn't worth it.

[nightrain]

106. exactly. Anyone who believes the insurance corps or Big Pharma will be successfully regulated

is in a fantasy.

Giving up denial is very painful, hence the desperation seen in OPs like this.

[dflprincess]

67. "People with pre-existing conditions can now get health insurance "

If they can afford it. And, if they do buy a policy, hopefully it won't have deductibles that are so high they still can't afford to get care. I checked out the high risk pool avaible in Minnesota for my brother and found the cheapest coverage available (about $400/month) comes with a $10,000 deductible.

Insurance (aka "coverage") is not the same has having access to care.

[Mimosa]

71. Typical BC/BS ripoff, exactly like what we have now. n/t

[Honeycombe8]

94. That's not the HCR bill, I think. There are no "high risk" pools in the HCR...

is the way I recall it. That's because they thought the cost would still be too high, like it is now.

The govt is making the ins. cos. pool everyone in the open market in exchanges or something, and the premiums for those with high risks can't be a certain percentage higher than for others. But there is no longer a separate "high risk" group/exchange.

That's the way I remember it explained.

Of course, that doesn't affect most Americans. If you get ins. coverage through a group policy thru your employer...there are no "high risk" groups, and all pre-existing conditions are covered.

[dflprincess]

102. Until 2014 (at least) adults with preexisting conditions may be able

to get coverage through state run high risk pools. Until then, the insurance bill only requires that children with preexisting conditions not be denied - and they only get "coverage" if their parents can afford it.

[eridani]

73. My organization is already collecting horror stories from people who can't afford the high risk pool

Too bad that the only numbers about how much is spent on care vs other costs only comes from insurance companies. That's why the 15 states that have tried to control costs this way have totally failed.

[nightrain]

103. good for you. I hope you will continue to inform us about this attempted extortion.

[Recursion]

77. Correction about 2013

As someone pointed out to me, I was misreading 2013. All earned income is currently levied for Medicare. After 2013, income over $250,000 will be levied at a higher rate.

[Safetykitten]

82. Now all we need is an official mascot. "Crutchy the HCR happiness imp".

[Honeycombe8]

88. LOL LOL!

Wish we had a crutchy smilie to select.

[Honeycombe8]

83. I don't know where you get your info, but if you get Medicaid, you don't need insurance.

You said in your post:
"People with pre-existing conditions can now get health insurance through the high-risk pool with a premium that can only vary based on age and location and that premium is calculated as if the people were part of the normal medicaid pool."

If someone qualifies for Medicaid, then they don't need to buy insurance. In fact, in order to qualify for Medicaid, you HAVE TO BE SO POOR THAT YOU CANNOT POSSIBLY BUY INSURANCE, no matter what the cost.

You EITHER:
Have insurance, OR
Qualify for Medicaid.

So your sentence isn't correct.

[Recursion]

112. No

The premium for the high-risk pool is calculated as if the participants were Medicaid participants.

[Honeycombe8]

84. Carrying adult children on your policy? That's a gift to the ins. cos.

That's not so much a gift to the public. After all, parents could easily pay for the very inexpensive medical coverage the kids get through their college, or even in the open market. Ins. for healthy young adults is dirt cheap.

BUT...insurance companies have trouble convincing those kids to buy their product. SO.....in steps the government, and makes it advantageous in some way for PARENTS to buy their kids insurance by adding them on their policies for not much $$$$. Parents are more likely to pay for insurance and see its value.

Cha-ching.

[Safetykitten]

85. Yes, I would think that age group is a financial win on paper, what no claims relatively speaking.

[Honeycombe8]

86. Real Reason your W-2 will have amount your employer paid for your ins.

So....you think it's a good thing to have on your W-2 how much your employer paid for your insurance? Even the insurance that you didn't want? Ya think?

Think again. You already either know what your employer spends (mine gladly tells us every year! a couple of times and ways!), or you COULD know (just ask...it's not a secret).

The REAL REASON that amount is going on your W-2 is that (drum roll, please), it's going to be taxed as income. Your income.

I'm against this because the employee has no choice in whether to have the insurance (you can't participate through teh govt to get a cheap policy, if your employer buys a policy for you), and the employee certainly has no decision making power in who the company is or what the benefits are. The employer makes all the decisions, since they are the one paying for it. They also get a tax deduction for it.

I wonder if they'll also tax my life insurance policy. My employer provides life ins. on all employees. I don't want it or need it. And now that might be taxed as income? Something I have absolutely no say about? That's just wrong.

[Honeycombe8]

87. Face it: it sucks. There's nothing in that bill that really affects most Americans.

Yet it costs every American money.

It does some good for some segments. That's very important and worthwhile.

But face it: I don't see anything in it that does anything for most of our fellow citizens, but everyone can surely tell you that they are aware it's going to COST each and every one of us something.

That is the definition of a sucky bill, I think.

[Bluenorthwest]

93. This is raving. People who get Medicaid are not paying for it

and they do not shop from a 'pool'. So you are clearly making things up, or simply do not understand the basics enough to be making any point at all. Learn your terminology. This is nonsense.

[Recursion]

97. Umm.. were you responding to the wrong post? NT