Obamacare "horror stories"
January 7, 2014 7:12 PM Subscribe
"Obamacare horror stories" where innocent citizens are losing their insurance and being forced to pay astronomical costs for new plans on the exchanges are being reported by some media outlets. The problem is that most of these stories don't survive further scrutiny.
There has also been some backlash against reporters fact checking other reporters.
There has also been some backlash against reporters fact checking other reporters.
Journalists have learned that you don't have to fact-check a person in the street. These stories are all framed around someone's claim, not an actual investigation.
posted by Ardiril at 7:23 PM on January 7, 2014 [6 favorites]
posted by Ardiril at 7:23 PM on January 7, 2014 [6 favorites]
Getting An Earful on Obamacare
Obamacare Makes "Takers" Of The Middle Class
The Rude Pundit: What Legalized Pot In colorado Teaches Us About Obamacare Implementation. It's the Rude Pundit, in the name
naked capitalism: America’s Shopper-in-Chief Has His Staff Sign Him Up for ObamaCare (But Not His Family) and Obamacare implementation as teachable moment
Obamacare Makes "Takers" Of The Middle Class
The cost of my Obamacare policy cannot be measured in dollars and cents but in dignity. It is transforming me from a contributing member of society into a welfare recipient; its corrosive system of subsidy incentives discourages me from working harder. My familiarity with the law has only bred contempt. Now that I see what’s in it, I don’t just hope but pray that it is overturned, replaced with reforms that actually improve the health care system.related: Keep Your Government Hands Off My Government Programs!: " many Americans who say they support cutting government programs don’t realize just how much they benefit from them."
The Rude Pundit: What Legalized Pot In colorado Teaches Us About Obamacare Implementation. It's the Rude Pundit, in the name
naked capitalism: America’s Shopper-in-Chief Has His Staff Sign Him Up for ObamaCare (But Not His Family) and Obamacare implementation as teachable moment
The administration bears some blame for that; the White House has done some conflating of its own. Most famously, the president assured us we would be able to keep our plans. That was never a promise he was in a position to keep. The new program still goes through the private insurance market, which means they decide what customers are restricted to.posted by the man of twists and turns at 7:23 PM on January 7, 2014 [6 favorites]
But that has always been the case. Insurers playing around with provider networks, policies etc. is a longstanding feature of the system. It’s not as though Obamacare introduced it. It was foolish, though, for the president to speak as though he was the one in charge of that. The only way to guarantee that is to prohibit insurers from altering their policies.
Had to hold my tongue at work today due to someone spouting off these stories.
posted by Twain Device at 7:24 PM on January 7, 2014
posted by Twain Device at 7:24 PM on January 7, 2014
stoke controversy
Replace that with reinforce a final consensus that Obamacare is a failure. "Stoking controversy" would imply they'd also write bad-guy-insurance-company stories too.
posted by Harvey Kilobit at 7:25 PM on January 7, 2014 [15 favorites]
Replace that with reinforce a final consensus that Obamacare is a failure. "Stoking controversy" would imply they'd also write bad-guy-insurance-company stories too.
posted by Harvey Kilobit at 7:25 PM on January 7, 2014 [15 favorites]
Funny all these similar stories just organically appearing at the same time in different parts of the country. You'd almost think that they were planted by the opposition but they'd never sink to that level.
posted by octothorpe at 7:29 PM on January 7, 2014 [19 favorites]
posted by octothorpe at 7:29 PM on January 7, 2014 [19 favorites]
It took me 3 months to (mostly) straighten out my NY state ACA insurance headaches, but I've continued to follow the goings-on on their facebook and it's still a fair bit of a logistical nightmare for many people--it certainly seems some people weren't able to get coverage by the deadlines and are facing gaps, even if it's not a majority. I managed to get coverage for myself and my husband but I had to call an absurd number of providers to find a new PCP who was actually taking new patients and who isn't refusing to take anyone with insurance coverage on the exchange (including medicaid plans, which is what I'm on now, as a pregnant woman). Had an appointment today to establish care at the one free local clinic that is taking my insurance and it went poorly enough that I came home and cried about it for awhile because at 36 weeks pregnant it was the last thing I wanted to deal with. Anyway, I look at the comments on their facebook account--as someone so liberal as to be essentially socialist, who really, really believes in socialized medicine and healthcare--and for every ten legitimate questions or concerns from citizens there's someone bragging about how easy it was for them and how these comments must all be left by republicans. And it's awful, you know, to really believe in something and to hope it will make your life better but to be told you must be some sort of political tool rather than a person who is trying to make the most of a bad situation. Or worse, who is simply trying to get questions answered (the NY state exchange facebook page has been consistently the ONLY place to get any immediate answers--their phone line averages a 2-3 hour wait time.)
There must be a way to let people talk about their difficulties, to address those difficulties reasonably, without declaring the whole thing a failure. Because if you don't listen to people's very real worries and difficulties, it seems to me that you are dooming something to be a failure from the start.
posted by PhoBWanKenobi at 7:31 PM on January 7, 2014 [68 favorites]
There must be a way to let people talk about their difficulties, to address those difficulties reasonably, without declaring the whole thing a failure. Because if you don't listen to people's very real worries and difficulties, it seems to me that you are dooming something to be a failure from the start.
posted by PhoBWanKenobi at 7:31 PM on January 7, 2014 [68 favorites]
ALEC is running an anti-Sen. Hagan ad like this in North Carolina right now
posted by thelonius at 7:32 PM on January 7, 2014
posted by thelonius at 7:32 PM on January 7, 2014
What's the opposite of astro turfing? Because that's what this is.
posted by emptythought at 7:39 PM on January 7, 2014
posted by emptythought at 7:39 PM on January 7, 2014
I called the Deathpanel on my elderly neighbor the other day. They took nearly three hours to show up and didn't even bother using the cattleprod on her. Thanks, Obama!
posted by dr_dank at 7:41 PM on January 7, 2014 [41 favorites]
posted by dr_dank at 7:41 PM on January 7, 2014 [41 favorites]
I fully admit to not having read the story linked here, but peoples' receptiveness to "Obamacare Horror Stories", real or not, is based substantially on personal experience. Case in point, my parents, whose premiums jumped 15% in September and who just received a notice that their plan deductible will almost double next month.
My parents have gone from die hard Obamafans to outright disgust.
My HSA deductible jumped $1500 last August and the premium increased 20% this month.
Want to get people to pay attention? Hit them in the pocket book.
posted by tgrundke at 7:48 PM on January 7, 2014 [2 favorites]
My parents have gone from die hard Obamafans to outright disgust.
My HSA deductible jumped $1500 last August and the premium increased 20% this month.
Want to get people to pay attention? Hit them in the pocket book.
posted by tgrundke at 7:48 PM on January 7, 2014 [2 favorites]
Legit question: Does HealthSherpa.com still reasonably approximate what plans are offered on the exchanges? Because last I checked my premiums would double or triple if I was forced to convert from my grandfathered catastrophic individual plan to a Bronze plan with a similar deductible.
But my anecdote is not any better than these anti-anecdotes and anti-anti-anecdotes. Where's the data?
posted by RobotVoodooPower at 7:49 PM on January 7, 2014 [2 favorites]
But my anecdote is not any better than these anti-anecdotes and anti-anti-anecdotes. Where's the data?
posted by RobotVoodooPower at 7:49 PM on January 7, 2014 [2 favorites]
I fully admit to not having read the story linked here
I fully admit to skipping the rest of your comment.
posted by The Hamms Bear at 7:58 PM on January 7, 2014 [46 favorites]
I fully admit to skipping the rest of your comment.
posted by The Hamms Bear at 7:58 PM on January 7, 2014 [46 favorites]
Robot voodoo power: trust me when I say this, your catastrophic plan is just that, catastrophic for you. Dig deep into the fine print, I will eat my hat if you ever would see a dollar or reimbursement from your catastrophic plan.
Anecdote: I can, for the first time in my adult life, buy real insurance for less than the price of my Brooklyn apartment's monthly rent. Substantially less.
posted by Freen at 8:05 PM on January 7, 2014 [6 favorites]
Anecdote: I can, for the first time in my adult life, buy real insurance for less than the price of my Brooklyn apartment's monthly rent. Substantially less.
posted by Freen at 8:05 PM on January 7, 2014 [6 favorites]
What's the opposite of astro turfing?
Astro turding.
posted by Behemoth at 8:07 PM on January 7, 2014 [9 favorites]
Astro turding.
posted by Behemoth at 8:07 PM on January 7, 2014 [9 favorites]
Obamacare Makes "Takers" Of The Middle Class
Remarkable that a regular columnist should have a personal experience that so precisely validates the beliefs he expresses in his other columns. I'm sold!
posted by George_Spiggott at 8:10 PM on January 7, 2014 [2 favorites]
Remarkable that a regular columnist should have a personal experience that so precisely validates the beliefs he expresses in his other columns. I'm sold!
posted by George_Spiggott at 8:10 PM on January 7, 2014 [2 favorites]
Conservatives lie, all the time, about everything, especially successful government programs and Democratic accomplishments.
News at 11. Brought to your local network by prepackaged reporting paid for by the Koch brothers and ALEC.
posted by T.D. Strange at 8:10 PM on January 7, 2014 [6 favorites]
News at 11. Brought to your local network by prepackaged reporting paid for by the Koch brothers and ALEC.
posted by T.D. Strange at 8:10 PM on January 7, 2014 [6 favorites]
It is still a mess, but it's a mess that could be fixed if Republicans hadn't made obstructionism the only thing they believe in. This is what you get when you have one party that has no plan but to drag their heels as hard as they can and oppose anything the other party does, no matter who it hurts. (well, unless it somehow hurts a billionaire).
Those of you in the exchanges are, unfortunately, the early adopters of a shitty system that will eventually be reformed (dear god let it be soon), but is being held back by a bunch of shitheads with lots of money and power.
I mean, the goddman county got shut down by these fuckers, damn the torpedos and fuck everyone, because they were so pisspants afraid of ACA.
Just today...just today! Mitch McConnell said he wouldn't let the unemployment benefits be extended unless Democrats delayed some parts of ACA yet again.
There is a place to pin the failure of ACA, and while I can't let Democrats off the hook, we all know which group of assholes is doing everything they can to make it fail. They went out of their way to make your experience shitty. Because if just enough people do use it and like it, they'll never be able to get rid of it, and they know it.
posted by emjaybee at 8:23 PM on January 7, 2014 [89 favorites]
Those of you in the exchanges are, unfortunately, the early adopters of a shitty system that will eventually be reformed (dear god let it be soon), but is being held back by a bunch of shitheads with lots of money and power.
I mean, the goddman county got shut down by these fuckers, damn the torpedos and fuck everyone, because they were so pisspants afraid of ACA.
Just today...just today! Mitch McConnell said he wouldn't let the unemployment benefits be extended unless Democrats delayed some parts of ACA yet again.
There is a place to pin the failure of ACA, and while I can't let Democrats off the hook, we all know which group of assholes is doing everything they can to make it fail. They went out of their way to make your experience shitty. Because if just enough people do use it and like it, they'll never be able to get rid of it, and they know it.
posted by emjaybee at 8:23 PM on January 7, 2014 [89 favorites]
The politico-media effort to undercut Obamacare has been impressive and deafening.
I basically stopped consuming "news" for the holidays and I still somehow keep hearing about how horrible Obamacare is.
I imagine when in a few years it is seen as a mostly successful centrist health-care fix-up all this will disappear down the memory hole.
posted by Ray Walston, Luck Dragon at 8:25 PM on January 7, 2014 [1 favorite]
I basically stopped consuming "news" for the holidays and I still somehow keep hearing about how horrible Obamacare is.
I imagine when in a few years it is seen as a mostly successful centrist health-care fix-up all this will disappear down the memory hole.
posted by Ray Walston, Luck Dragon at 8:25 PM on January 7, 2014 [1 favorite]
The price of Obamacare obstructionism
posted by T.D. Strange at 8:33 PM on January 7, 2014 [1 favorite]
posted by T.D. Strange at 8:33 PM on January 7, 2014 [1 favorite]
the NY state exchange facebook page has been consistently the ONLY place to get any immediate answers
Ugh, that is horrendous. Literally any forum software would be better than facebook.
posted by Steely-eyed Missile Man at 8:35 PM on January 7, 2014 [1 favorite]
Ugh, that is horrendous. Literally any forum software would be better than facebook.
posted by Steely-eyed Missile Man at 8:35 PM on January 7, 2014 [1 favorite]
What's the opposite of astro turfing? Because that's what this is.
This is absolutely astroturfing. It's fake grass rootsery.
posted by Pope Guilty at 8:35 PM on January 7, 2014 [2 favorites]
This is absolutely astroturfing. It's fake grass rootsery.
posted by Pope Guilty at 8:35 PM on January 7, 2014 [2 favorites]
Geez, guys, maybe we shouldn't dismiss the people in this discussion thread who are having issues with ACA?
I mean, it is possible to both support the law, blame right-wing obstructionism, and be sympathetic to the individuals who are having real issues trying to make this work. I agree with the above, that this will sort itself out with time and result in a better society, but there are certainly a good number of people suffering through the growing pangs (including on MeFi), and who are not shills.
posted by blahblahblah at 8:39 PM on January 7, 2014 [22 favorites]
I mean, it is possible to both support the law, blame right-wing obstructionism, and be sympathetic to the individuals who are having real issues trying to make this work. I agree with the above, that this will sort itself out with time and result in a better society, but there are certainly a good number of people suffering through the growing pangs (including on MeFi), and who are not shills.
posted by blahblahblah at 8:39 PM on January 7, 2014 [22 favorites]
Well, OK, out of a country of 360M or so, there are a few that are going to be negatively affected, no matter what.
Given the fact that those problems are all the media can focus on, can't we talk about how overblown those problems are in general, how badly Republicans have consistently tried to screw everybody and how they wrecked the enrollment process? Can't we talk about how well it has worked for the vast majority of people?
posted by KGMoney at 8:55 PM on January 7, 2014 [1 favorite]
Given the fact that those problems are all the media can focus on, can't we talk about how overblown those problems are in general, how badly Republicans have consistently tried to screw everybody and how they wrecked the enrollment process? Can't we talk about how well it has worked for the vast majority of people?
posted by KGMoney at 8:55 PM on January 7, 2014 [1 favorite]
Ugh, that is horrendous. Literally any forum software would be better than facebook.
Yep.
In case anyone is curious about the real problems people are facing with the ACA, here's the NY State of Health facebook. The major problems seem to be:
All that being said, I'm grateful. My husband and I are going to save over five hundred dollars a month on health insurance. But . . . the coverage is really crappy, we can't find providers, and I'm not sure we'll use it? Good to have for an emergency. I guess. And it is cheap. But they're all HMO options in our area and it seems pretty much impossible to find a decent PCP.
posted by PhoBWanKenobi at 8:57 PM on January 7, 2014 [9 favorites]
Yep.
In case anyone is curious about the real problems people are facing with the ACA, here's the NY State of Health facebook. The major problems seem to be:
- Unresolved issues confirming people's incomes and identity (and speaking from first-hand experience, the NY exchange application, at least, is needlessly complicated, particularly for freelancers--requiring that you estimate 2014 income and expenses even before we've filed 2013 taxes)
- Certain health plans, namely Empire, have yet to bill anyone who has applied--since October. They won't provide billing information over the phone and it's unclear whether individuals who selected these plans are considered covered.
- Inaccurate provider information on the website and difficulties finding providers who are actually taking insurance on the exchange. I know that several providers I called--listed as taking new patients on my plan's website--told me flatly (and fairly rudely!) that they aren't taking any exchange plans
- Useless support personnel on the website (the one time I used chat, the person on the other side seemed to be speaking English that was barely intelligible and gave me flat-out misinformation) or via phone. Their phone chat has long wait times and sometimes inexplicably disconnects after hours on hold.
- Nightly website outages. You just can't access the website on many weekends and evenings.
All that being said, I'm grateful. My husband and I are going to save over five hundred dollars a month on health insurance. But . . . the coverage is really crappy, we can't find providers, and I'm not sure we'll use it? Good to have for an emergency. I guess. And it is cheap. But they're all HMO options in our area and it seems pretty much impossible to find a decent PCP.
posted by PhoBWanKenobi at 8:57 PM on January 7, 2014 [9 favorites]
Is there any place that's collecting positive stories about ACA? Because it seems like some kind of balance must exist. Where are the "I finally have health care" or "I'm finally able to start my own business" stories?
posted by amtho at 9:07 PM on January 7, 2014 [1 favorite]
posted by amtho at 9:07 PM on January 7, 2014 [1 favorite]
Want to get people to pay attention? Hit them in the pocket book.
My anecdote is that my coverage and price is identical under Obamacare.
posted by readyfreddy at 9:09 PM on January 7, 2014 [4 favorites]
My anecdote is that my coverage and price is identical under Obamacare.
posted by readyfreddy at 9:09 PM on January 7, 2014 [4 favorites]
Is there any place that's collecting positive stories about ACA? Because it seems like some kind of balance must exist. Where are the "I finally have health care" or "I'm finally able to start my own business" stories?
I lied in my last post. My coverage and price are the same (and so are the crappy deductibles I can afford). But one big difference is that I get a nice tax break at year's end. I am self-employed. I've been taken to the cleaners on health insurance for years. Those of you who get insurance through large employers have no idea how bad it is for the lone dude out there. This is the first sign of relief I've ever seen in my adult professional life. I'm all for Obamacare (personally, I'm upset that it isn't single payer). It will help my family considerably, even though coverage is still awful, prices are still high, and whoever thinks America has the best medical system in the world hasn't left her borders.
posted by readyfreddy at 9:13 PM on January 7, 2014 [12 favorites]
I lied in my last post. My coverage and price are the same (and so are the crappy deductibles I can afford). But one big difference is that I get a nice tax break at year's end. I am self-employed. I've been taken to the cleaners on health insurance for years. Those of you who get insurance through large employers have no idea how bad it is for the lone dude out there. This is the first sign of relief I've ever seen in my adult professional life. I'm all for Obamacare (personally, I'm upset that it isn't single payer). It will help my family considerably, even though coverage is still awful, prices are still high, and whoever thinks America has the best medical system in the world hasn't left her borders.
posted by readyfreddy at 9:13 PM on January 7, 2014 [12 favorites]
What's the opposite of astro turfing? Because that's what this is.
Swiftboating.
posted by charlie don't surf at 9:26 PM on January 7, 2014 [4 favorites]
Swiftboating.
posted by charlie don't surf at 9:26 PM on January 7, 2014 [4 favorites]
My anecdote...
My insurance premium costs doubled. I went to the insurance commissioner site to complain about the rates when I got the notice from my insurance company that my policy was cancelled and they would move me to this new, twice as much money, no coverage at all plan. There were at least 16 other detailed complaints all identical to mine - cost doubled, coverage now more dismal than a catastrophic plan.
I found a different company to get insurance from and my cost is still double what it was but what it covers is much better that what the other company offered to those wanting individual plans.
I was amazed when Obama announced people could keep their plans - spoken like a person who has never had to deal with insurance companies who sell individual plans!
This law was a perfect opportunity to raise rates and lower coverage at the same time, and the companies got to send letters saying "Due to the ACA..."
I get the feeling someone thought, This is a great idea! And then did not actually find out, by asking other people (the ones making the plans and determining the premiums) how things would really work. Also, they did not think about people who live in the middle of nowhere, miles from any primary provider - those folks really get zero benefit for their premiums, since they can't access the care easily enough to actually use it.
posted by AllieTessKipp at 10:03 PM on January 7, 2014 [8 favorites]
My insurance premium costs doubled. I went to the insurance commissioner site to complain about the rates when I got the notice from my insurance company that my policy was cancelled and they would move me to this new, twice as much money, no coverage at all plan. There were at least 16 other detailed complaints all identical to mine - cost doubled, coverage now more dismal than a catastrophic plan.
I found a different company to get insurance from and my cost is still double what it was but what it covers is much better that what the other company offered to those wanting individual plans.
I was amazed when Obama announced people could keep their plans - spoken like a person who has never had to deal with insurance companies who sell individual plans!
This law was a perfect opportunity to raise rates and lower coverage at the same time, and the companies got to send letters saying "Due to the ACA..."
I get the feeling someone thought, This is a great idea! And then did not actually find out, by asking other people (the ones making the plans and determining the premiums) how things would really work. Also, they did not think about people who live in the middle of nowhere, miles from any primary provider - those folks really get zero benefit for their premiums, since they can't access the care easily enough to actually use it.
posted by AllieTessKipp at 10:03 PM on January 7, 2014 [8 favorites]
Is there any place that's collecting positive stories about ACA?
I don't want to downplay the experiences of the people who've had problems, but I think I've done well. Affordable individual health insurance that actually stands a good chance of paying for claims I make, for the first time ever. My state's exchange site had what seemed to me to be a lot of options to choose from, and I could have gotten insurance at rates lower and higher than what I ended up picking, but I think I'll be pretty happy with it.
I haven't quite gotten up the nerve to call and ask for my first appointments, though. They have a phone number just for new members for that, and I hope they're patient with my not having a clue what doctors I might want to see or how any of this "getting health care" stuff works. There's a website where I can look up all the doctors available but it's not like I have informed opinions about what medical schools they went to. I guess I could make small talk with the ones who went to school in places I've lived? The rating sites seem pretty useless.
Mostly it's all just a sigh of relief that I've now got a card in my wallet that will, I hope, ensure that I'm not going to have creditors hound me for years if I slip and fall on ice, or crash my bike, or fail to keep my appendix from bursting.
posted by asperity at 10:24 PM on January 7, 2014 [1 favorite]
I don't want to downplay the experiences of the people who've had problems, but I think I've done well. Affordable individual health insurance that actually stands a good chance of paying for claims I make, for the first time ever. My state's exchange site had what seemed to me to be a lot of options to choose from, and I could have gotten insurance at rates lower and higher than what I ended up picking, but I think I'll be pretty happy with it.
I haven't quite gotten up the nerve to call and ask for my first appointments, though. They have a phone number just for new members for that, and I hope they're patient with my not having a clue what doctors I might want to see or how any of this "getting health care" stuff works. There's a website where I can look up all the doctors available but it's not like I have informed opinions about what medical schools they went to. I guess I could make small talk with the ones who went to school in places I've lived? The rating sites seem pretty useless.
Mostly it's all just a sigh of relief that I've now got a card in my wallet that will, I hope, ensure that I'm not going to have creditors hound me for years if I slip and fall on ice, or crash my bike, or fail to keep my appendix from bursting.
posted by asperity at 10:24 PM on January 7, 2014 [1 favorite]
They're probably getting a lot of calls like that.
That's my other reason for dawdling -- I was sorta hoping to avoid the deluge and probable hold times! Doesn't really make sense to wait since I'll probably have to wait for an appointment anyway.
posted by asperity at 10:33 PM on January 7, 2014
That's my other reason for dawdling -- I was sorta hoping to avoid the deluge and probable hold times! Doesn't really make sense to wait since I'll probably have to wait for an appointment anyway.
posted by asperity at 10:33 PM on January 7, 2014
After the backpedaling of "oh, wait, you can keep your old plan if you want to", my insurance company sent me a letter letting me know that I could now keep my shitty, horrible insurance policy come January if I wanted to, all I had to do was call a phone number and let them know.
I called the phone number and made them assure me that, if I took no further option, my plan would be cancelled at the end of December and they wouldn't auto-deduct another month's premium. They told me that this was correct.
So imagine my surprise when I checked my bank account over the weekend and saw that they had deducted $39 (significantly less than my actual premium). I called them and was told that this was some "supplemental" plan that was still continuing. I completely lost it, and flipped out at the customer service rep. After I calmed down, she told me that they would send me a refund check in 2 weeks, and that my plan was For Reals cancelled this time. Fuck those guys.
My new plan through the exchange is a $20 increase in premium, but a $1000 lower deductible and just better all-around (Oregon's co-op health plan). I am stoked to not get screwed over with every claim anymore.
posted by hopeless romantique at 10:36 PM on January 7, 2014 [7 favorites]
I called the phone number and made them assure me that, if I took no further option, my plan would be cancelled at the end of December and they wouldn't auto-deduct another month's premium. They told me that this was correct.
So imagine my surprise when I checked my bank account over the weekend and saw that they had deducted $39 (significantly less than my actual premium). I called them and was told that this was some "supplemental" plan that was still continuing. I completely lost it, and flipped out at the customer service rep. After I calmed down, she told me that they would send me a refund check in 2 weeks, and that my plan was For Reals cancelled this time. Fuck those guys.
My new plan through the exchange is a $20 increase in premium, but a $1000 lower deductible and just better all-around (Oregon's co-op health plan). I am stoked to not get screwed over with every claim anymore.
posted by hopeless romantique at 10:36 PM on January 7, 2014 [7 favorites]
My anecdote . . .
Under our new ACA plan, my husband and I will:
- save $48/month in premiums
- go from a $3000 deductible EACH to a $2000 deductible COMBINED
- go from 80/20 coverage to 85/15
And it took me all of about 20 minutes to fill out the forms online, compared to the hours and hours of gathering forms and records, being denied due to previous back surgery, filling out forms to appeal, getting supporting letters, etc. that it took the last time we bought insurance.
My office mate is saving over $200/month. He did have problems online so did it over the phone and found it very easy. We all three of us had a long chat today about what a huge thing this is for us and how very happy we are.
posted by HotToddy at 10:38 PM on January 7, 2014 [11 favorites]
Under our new ACA plan, my husband and I will:
- save $48/month in premiums
- go from a $3000 deductible EACH to a $2000 deductible COMBINED
- go from 80/20 coverage to 85/15
And it took me all of about 20 minutes to fill out the forms online, compared to the hours and hours of gathering forms and records, being denied due to previous back surgery, filling out forms to appeal, getting supporting letters, etc. that it took the last time we bought insurance.
My office mate is saving over $200/month. He did have problems online so did it over the phone and found it very easy. We all three of us had a long chat today about what a huge thing this is for us and how very happy we are.
posted by HotToddy at 10:38 PM on January 7, 2014 [11 favorites]
As a Libertarian hack I'm totally opposed to the ACA and I'm still predicting that it will be the ruin of our country but on a personal level it's been working rather smoothly for me.
It took me about 30 minutes on the Friday before the deadline to purchase a policy on the Healthcare.gov exchange. I called my local multi-doctor family practice clinic on Monday and got a new patient intake appointment for Thursday. Now I'll be able to get back on much-needed antidepressants and finally afford to begin treatment for my psoriatic arthritis instead of letting my joints continue to degenerate. Life is looking up for me.
All this cognitive dissonance is really annoying (thanks, Obama!) so I'm still holding out hope for a clusterfuck when it comes time for my new insurance provider to actually pay my claims. ;)
posted by Jacqueline at 10:43 PM on January 7, 2014 [11 favorites]
It took me about 30 minutes on the Friday before the deadline to purchase a policy on the Healthcare.gov exchange. I called my local multi-doctor family practice clinic on Monday and got a new patient intake appointment for Thursday. Now I'll be able to get back on much-needed antidepressants and finally afford to begin treatment for my psoriatic arthritis instead of letting my joints continue to degenerate. Life is looking up for me.
All this cognitive dissonance is really annoying (thanks, Obama!) so I'm still holding out hope for a clusterfuck when it comes time for my new insurance provider to actually pay my claims. ;)
posted by Jacqueline at 10:43 PM on January 7, 2014 [11 favorites]
Anecdata: I have a crappy crappy craptacular catastrophic plan from a shitty company, Moda (was ODS). Its main benefit is that it's cheap. As Freen says, I never expect to get anything from it ... except! Three doctor visits a year at $25 co-pay, plus three woo sessions (seriously -- acupuncture, naturopathy, some other random shit, $25 each).
The plan they wanted to move me to was about 50% more per month, deductible reduced slightly ($7500 to $4000 or something) and doctor visits start at $150. I'm not impressed by ACA, and will keep my crappy plan for as long as I can.
posted by spacewrench at 10:51 PM on January 7, 2014
The plan they wanted to move me to was about 50% more per month, deductible reduced slightly ($7500 to $4000 or something) and doctor visits start at $150. I'm not impressed by ACA, and will keep my crappy plan for as long as I can.
posted by spacewrench at 10:51 PM on January 7, 2014
long story short, a lot of people are a little better off (especially people who now have medicaid), a few people got fucked by it and most people didn't have any change at all.
posted by empath at 11:32 PM on January 7, 2014 [6 favorites]
posted by empath at 11:32 PM on January 7, 2014 [6 favorites]
a lot of people are a little better off
From this thread alone, there seem to be some people who are substantially better off as well.
posted by maudlin at 11:59 PM on January 7, 2014 [1 favorite]
From this thread alone, there seem to be some people who are substantially better off as well.
posted by maudlin at 11:59 PM on January 7, 2014 [1 favorite]
My anecdote which I've stated before but which has gone from potential to actually-in-effect:
My coverage is a bunch better for the same price. The deductible is basically zero(!) and my max out of pocket is lower. My co-pays are almost nothing on both in-network office visits and on medication.
The catch (and there's always a catch): My network is crap. None of the closest hospitals or facilities are in-network. I live in close walking distance to an excellent hospital but it's not covered, nor are the next couple closest. Finding a good doctor in-network is a chore. The ones who take the insurance are often not taking new patients. And so forth.
I would be quite willing to pay more for a better network but that is apparently impossible at any price.
posted by Justinian at 12:12 AM on January 8, 2014 [1 favorite]
My coverage is a bunch better for the same price. The deductible is basically zero(!) and my max out of pocket is lower. My co-pays are almost nothing on both in-network office visits and on medication.
The catch (and there's always a catch): My network is crap. None of the closest hospitals or facilities are in-network. I live in close walking distance to an excellent hospital but it's not covered, nor are the next couple closest. Finding a good doctor in-network is a chore. The ones who take the insurance are often not taking new patients. And so forth.
I would be quite willing to pay more for a better network but that is apparently impossible at any price.
posted by Justinian at 12:12 AM on January 8, 2014 [1 favorite]
I live in Australia and the bastards in power want to make me pay $6 every time I see a doctor.(*) Plus, sometimes I can't see my favorite doctor without making an appointment a day in advance. Or more! So I share your pain, America.
(*) This will be unpopular with their electoral base, so I expect it will fail. But still.
posted by Joe in Australia at 3:02 AM on January 8, 2014 [10 favorites]
(*) This will be unpopular with their electoral base, so I expect it will fail. But still.
posted by Joe in Australia at 3:02 AM on January 8, 2014 [10 favorites]
> My husband and I are going to save over five hundred dollars a month on health insurance. But . . . the coverage is really crappy, we can't find providers, and I'm not sure we'll use it? Good to have for an emergency. I guess.
I may be missing something here, but isn't that generally the point of any insurance? You don't know whether you'll use it, but if you need to, it's good to have.
posted by Too-Ticky at 4:21 AM on January 8, 2014 [1 favorite]
I may be missing something here, but isn't that generally the point of any insurance? You don't know whether you'll use it, but if you need to, it's good to have.
posted by Too-Ticky at 4:21 AM on January 8, 2014 [1 favorite]
There has also been some backlash against reporters fact checking other reporters.
Did it annoy anyone else the amount of times this article said "it's not a journalist's job to..." and then blithely move on? Reporting is just half the job, not the whole damn thing, otherwise it's just a megaphone, which isn't what journalism is.
posted by zombieflanders at 4:27 AM on January 8, 2014 [1 favorite]
Did it annoy anyone else the amount of times this article said "it's not a journalist's job to..." and then blithely move on? Reporting is just half the job, not the whole damn thing, otherwise it's just a megaphone, which isn't what journalism is.
posted by zombieflanders at 4:27 AM on January 8, 2014 [1 favorite]
Anecdata from Indiana...
Our private policy (Anthem) was cancelled, too. We got the notice in August.
Indiana has been a solidly "fuck you, ACA" state. It refused the Medicaid expansion. So, no state exchange. And the legislature enacted draconian rules that made it impossible for Navigators to work in the state. So, it's strictly a DIY situation when it comes to the ACA.
We started trying to use the healthcare.gov site as soon as it was up for business, but we all know what that was like. We came back later when things were working better. We shopped for both my wife and I as a couple, as well as shopping for our son. What we found available to us was a bit discouraging.
Despite my being semi-unemployed, we discovered that my wife and I did not qualify for any assistance. So, while we could find policies that would cut our costs, those policies were also much more limited than our old policy. When we looked at policies that were as close to an apples-to-apples comparison (which wasn't all that easy), we discovered that our costs were going to be roughly the same. Some were actually more expensive. Many limited the number of times you could see your doctor in a year. The deductibles were much lower on the ACA policies, though.
This biggest issue came when we tried to determine if any of our current doctors were on the ACA policy networks. We kept running into situations where Doctor 1 was on a policy, but Doctor 2 was not, or vice versa. Mostly, though, we kept seeing that our doctors (whom we have been with for decades) were not in many of the ACA policy networks. And, on almost all of the ACA policies, we also found that the hospital in our county was not in the network at all, or, if it was, it was only certain departments. Mostly, we found we would have to use a hospital a county or two away, depending on the policy. But, then we'd run into a situation where our local doctor wouldn't have admitting rights at that other hospital. Trying to pick our way through all of this often brought my wife, literally, to tears of frustration.
Luckily, we now have been able to keep our previous private policy for now. Hopefully, by this time next year, things will have gotten better. I'll be crossing my fingers.
posted by Thorzdad at 4:38 AM on January 8, 2014 [1 favorite]
Our private policy (Anthem) was cancelled, too. We got the notice in August.
Indiana has been a solidly "fuck you, ACA" state. It refused the Medicaid expansion. So, no state exchange. And the legislature enacted draconian rules that made it impossible for Navigators to work in the state. So, it's strictly a DIY situation when it comes to the ACA.
We started trying to use the healthcare.gov site as soon as it was up for business, but we all know what that was like. We came back later when things were working better. We shopped for both my wife and I as a couple, as well as shopping for our son. What we found available to us was a bit discouraging.
Despite my being semi-unemployed, we discovered that my wife and I did not qualify for any assistance. So, while we could find policies that would cut our costs, those policies were also much more limited than our old policy. When we looked at policies that were as close to an apples-to-apples comparison (which wasn't all that easy), we discovered that our costs were going to be roughly the same. Some were actually more expensive. Many limited the number of times you could see your doctor in a year. The deductibles were much lower on the ACA policies, though.
This biggest issue came when we tried to determine if any of our current doctors were on the ACA policy networks. We kept running into situations where Doctor 1 was on a policy, but Doctor 2 was not, or vice versa. Mostly, though, we kept seeing that our doctors (whom we have been with for decades) were not in many of the ACA policy networks. And, on almost all of the ACA policies, we also found that the hospital in our county was not in the network at all, or, if it was, it was only certain departments. Mostly, we found we would have to use a hospital a county or two away, depending on the policy. But, then we'd run into a situation where our local doctor wouldn't have admitting rights at that other hospital. Trying to pick our way through all of this often brought my wife, literally, to tears of frustration.
Luckily, we now have been able to keep our previous private policy for now. Hopefully, by this time next year, things will have gotten better. I'll be crossing my fingers.
posted by Thorzdad at 4:38 AM on January 8, 2014 [1 favorite]
One huge benefit of the ACA is the elimination of the pre-existing condition fuck you. I'm not sure how to value that but I'd bet most people who were previously unable to buy insurance because they were unlucky enough to get sick while uninsured are very happy with the ACA.
posted by Mitheral at 5:18 AM on January 8, 2014 [12 favorites]
posted by Mitheral at 5:18 AM on January 8, 2014 [12 favorites]
Anecdata from PA...
I have a pretty decent policy through my employer, and also cover my opposite-sex domestic partner. We both have pre-existing conditions and could not have gotten individual coverage previously, and his prevents him from working steadily to get his own employer-covered health insurance, so my last job search was stressful based partly on the need to find a job that allowed for opposite-sex domestic-partner coverage. I'm a fan of the ACA for that reason alone - my partner's ability to get insurance at all is no longer dependent on my staying employed steadily and at a place that allows for opposite-sex domestic-partner coverage.
That said, I did look into the exchange for him, as the domestic-partner coverage tax impliciations are not fun, and I thought it was possible we could do better spinning him off into his own individual plan. When I looked, the site was still down a lot and running extremely slowly, and I gave up and never really came back to it because our situation works well enough for now and I wanted the limited resources available to help people through the exchange to go to people who really needed them.
I'm still planning to sit down and try to sort it all out at some point to see if the exchange offers us a better option. But I sleep better at night knowing that there is an option out there for both of us if I lost my job, where our pre-existing conditions won't be an issue. I fully expect that option would be significantly more expensive than my employer coverage, due to the nature of individual vs. employer coverage, but I'm glad it will be there for us at all.
Still wish we could scrap the whole thing and go single-payer, but I'll take this over what we had before.
posted by Stacey at 5:20 AM on January 8, 2014 [1 favorite]
I have a pretty decent policy through my employer, and also cover my opposite-sex domestic partner. We both have pre-existing conditions and could not have gotten individual coverage previously, and his prevents him from working steadily to get his own employer-covered health insurance, so my last job search was stressful based partly on the need to find a job that allowed for opposite-sex domestic-partner coverage. I'm a fan of the ACA for that reason alone - my partner's ability to get insurance at all is no longer dependent on my staying employed steadily and at a place that allows for opposite-sex domestic-partner coverage.
That said, I did look into the exchange for him, as the domestic-partner coverage tax impliciations are not fun, and I thought it was possible we could do better spinning him off into his own individual plan. When I looked, the site was still down a lot and running extremely slowly, and I gave up and never really came back to it because our situation works well enough for now and I wanted the limited resources available to help people through the exchange to go to people who really needed them.
I'm still planning to sit down and try to sort it all out at some point to see if the exchange offers us a better option. But I sleep better at night knowing that there is an option out there for both of us if I lost my job, where our pre-existing conditions won't be an issue. I fully expect that option would be significantly more expensive than my employer coverage, due to the nature of individual vs. employer coverage, but I'm glad it will be there for us at all.
Still wish we could scrap the whole thing and go single-payer, but I'll take this over what we had before.
posted by Stacey at 5:20 AM on January 8, 2014 [1 favorite]
There has also been some backlash against reporters fact checking other reporters.
Oureportos?
posted by Slackermagee at 5:24 AM on January 8, 2014 [2 favorites]
Oureportos?
posted by Slackermagee at 5:24 AM on January 8, 2014 [2 favorites]
We're self employed and Michigan has no exchange thanks to republicans determined to sabotage the ACA. Our catastrophic BCBS policy was canceled because it didn't meet the new standards. Took many, many, many hours on the phone to get new coverage sorted out but we ended up with a policy with slightly higher premiums, much lower deductible that covers far more so a win on the whole. One entertainment for us was figuring out what out of network means for our dependent college kids who go to school out of state. Turns out by staying with Blue Cross any Blue Cross participant in any state will be in network so that was a major factor for us.
The number of hours it took to get this all sorted out was unconscionable though and the process was pretty opaque.
posted by leslies at 6:39 AM on January 8, 2014
The number of hours it took to get this all sorted out was unconscionable though and the process was pretty opaque.
posted by leslies at 6:39 AM on January 8, 2014
My insurance premium costs doubled. I went to the insurance commissioner site to complain about the rates when I got the notice from my insurance company that my policy was cancelled and they would move me to this new, twice as much money, no coverage at all plan.
I am so incredibly skeptical of this. Have you checked health sherpa to see if there are less expensive plans available or did you just go with whatever your old insurance company offered you?
posted by empath at 7:08 AM on January 8, 2014
I am so incredibly skeptical of this. Have you checked health sherpa to see if there are less expensive plans available or did you just go with whatever your old insurance company offered you?
posted by empath at 7:08 AM on January 8, 2014
Anecdata from TX...
We were on COBRA from my previous employer. Monthly premiums were $1,960. We moved from Cigna to BC/BS and kept all our doctors with essentially the same coverage, co-pays, and deductibles. Our new premium is just over $800. Plus, I'm a cancer patient and the chance of getting insurance on our own prior to ACA was nonexistent.
posted by ElDiabloConQueso at 7:14 AM on January 8, 2014 [3 favorites]
We were on COBRA from my previous employer. Monthly premiums were $1,960. We moved from Cigna to BC/BS and kept all our doctors with essentially the same coverage, co-pays, and deductibles. Our new premium is just over $800. Plus, I'm a cancer patient and the chance of getting insurance on our own prior to ACA was nonexistent.
posted by ElDiabloConQueso at 7:14 AM on January 8, 2014 [3 favorites]
there are certainly a good number of people suffering through the growing pangs (including on MeFi), and who are not shills.
Some of them RTFA too!
I got the notice from my insurance company that my policy was cancelled and they would move me to this new, twice as much money, no coverage at all plan. There were at least 16 other detailed complaints all identical to mine - cost doubled, coverage now more dismal than a catastrophic plan.
This is now illegal, to have a 'no coverage at all plan'.
As a Libertarian hack I'm totally opposed to the ACA and I'm still predicting that it will be the ruin of our country but on a personal level it's been working rather smoothly for me.
This is a fantastic sentence.
My personal anecdote is that my fiancee can now get coverage for her medical issues.
posted by MisantropicPainforest at 7:31 AM on January 8, 2014 [2 favorites]
Some of them RTFA too!
I got the notice from my insurance company that my policy was cancelled and they would move me to this new, twice as much money, no coverage at all plan. There were at least 16 other detailed complaints all identical to mine - cost doubled, coverage now more dismal than a catastrophic plan.
This is now illegal, to have a 'no coverage at all plan'.
As a Libertarian hack I'm totally opposed to the ACA and I'm still predicting that it will be the ruin of our country but on a personal level it's been working rather smoothly for me.
This is a fantastic sentence.
My personal anecdote is that my fiancee can now get coverage for her medical issues.
posted by MisantropicPainforest at 7:31 AM on January 8, 2014 [2 favorites]
When I was visiting my Mom over Christmas, sometimes Fox News got put on the TV. I never watch it, and was horrified by what I saw. It was nothing but non-stop, fact-free, "Obamacare is evil" propaganda. Constantly. "Here's a small business owner who is TERRIFIED of Obamacare!" - Gee, reporter, how about you ask that business owner how many employees they have, to insure that the ACA applies to his business at all? Why don't you ask how much he's paying for his insurance plan now, and do the research to find out what will actually change? These are facts that can be known - but the reporters don't even try. They just parade fear, fear, fear and more fear.
The saddest thing was my Grandmother. After all her Fox News watching, I think she actually believes Obamacare literally is a socialized, national health insurance plan. When I told her that insurance companies have been caught deceiving their customers and trying to force them into more expensive plans than are necessary she just said "that's not happening."
How are we supposed to fix the problems when we can't even acknowledge the same set of facts? Ugh.
posted by dnash at 7:58 AM on January 8, 2014 [18 favorites]
The saddest thing was my Grandmother. After all her Fox News watching, I think she actually believes Obamacare literally is a socialized, national health insurance plan. When I told her that insurance companies have been caught deceiving their customers and trying to force them into more expensive plans than are necessary she just said "that's not happening."
How are we supposed to fix the problems when we can't even acknowledge the same set of facts? Ugh.
posted by dnash at 7:58 AM on January 8, 2014 [18 favorites]
I may be missing something here, but isn't that generally the point of any insurance? You don't know whether you'll use it, but if you need to, it's good to have.
I like to be able to use my insurance. I've gone to my primary care physician a few times in the past few years--it's why we pay for it. Not only because my husband got into a motorcycle accident, but also because I got an ear infection and had a cat bite that needed to be checked out. With an HMO, you're supposed to go to a primary care physician for this stuff. With our current one, I'd have to go to someone I don't even want to converse with.
Not all of us want only insurance that is catastrophic or essentially catastrophic.
posted by PhoBWanKenobi at 8:27 AM on January 8, 2014 [1 favorite]
I like to be able to use my insurance. I've gone to my primary care physician a few times in the past few years--it's why we pay for it. Not only because my husband got into a motorcycle accident, but also because I got an ear infection and had a cat bite that needed to be checked out. With an HMO, you're supposed to go to a primary care physician for this stuff. With our current one, I'd have to go to someone I don't even want to converse with.
Not all of us want only insurance that is catastrophic or essentially catastrophic.
posted by PhoBWanKenobi at 8:27 AM on January 8, 2014 [1 favorite]
And keep in mind that my plan is a medicaid plan, for which I couldn't find doctors. I don't feel I'm substantially better off than I was--I'd honestly much rather pay the $166 a month that my husband is paying for his plan, but if you're medicaid eligible, you have to take medicaid or forgo all subsidies for your entire family. So.
posted by PhoBWanKenobi at 8:32 AM on January 8, 2014 [1 favorite]
posted by PhoBWanKenobi at 8:32 AM on January 8, 2014 [1 favorite]
emptythought: What's the opposite of astro turfing? Because that's what this is.
I'm over-thinking this, but here's my rough chart:
I'm over-thinking this, but here's my rough chart:
REAL FAKE
|
CORP- Lobbying | Culture
ORATE and PR | jamming
|
-------------------------------
|
PUBLIC Grass | Astro-
SUPPORT roots | turf
|posted by filthy light thief at 8:33 AM on January 8, 2014 [2 favorites] Not all of us want only insurance that is catastrophic or essentially catastrophic.
Furthermore, most forms of health care are cheaper if you have insurance than if you don't -- even if the insurer isn't paying for a share of your costs. The negotiated discounts can result in substantial price differences. Insurance is such a misnomer here -- what we're all really trying to get is access, and preferably on a more level playing field.
posted by asperity at 8:40 AM on January 8, 2014 [4 favorites]
Furthermore, most forms of health care are cheaper if you have insurance than if you don't -- even if the insurer isn't paying for a share of your costs. The negotiated discounts can result in substantial price differences. Insurance is such a misnomer here -- what we're all really trying to get is access, and preferably on a more level playing field.
posted by asperity at 8:40 AM on January 8, 2014 [4 favorites]
While reading the story at the "problem" link concerning the Fort Worth Star-Telegram, I couldn't help but think how much I miss the voice of Molly Ivins.
posted by TedW at 8:58 AM on January 8, 2014 [5 favorites]
posted by TedW at 8:58 AM on January 8, 2014 [5 favorites]
I looked up the plans on the ACA website and my workplace insurance is just barely less expensive, for the same coverage. By about $20 per month. That should tell you how crappy my work insurance is.
posted by Fleebnork at 8:59 AM on January 8, 2014 [1 favorite]
posted by Fleebnork at 8:59 AM on January 8, 2014 [1 favorite]
Here's my ACA story. We started getting benefit from the ACA years ago, when we could move from COBRA (at $1955 per month) to an individualized plan without filling out a health questionnaire. The real benefit to our family came after about eight months on that plan, when my husband was diagnosed with psoriatic arthritis, but thanks to the non-recision portion of the ACA, they couldn't withdraw his health insurance. (When the ACA went up for SCOTUS review, we got a letter pointing out that his condition was a disqualifying one for continued coverage, and to, you know, bear that in mind.) So at this point, we were 100% pro-ACA.
When the time came to actually choose a plan, things got a little uglier. Our family's primary care, my ENT, and my husband's rheumatologist are all through the University of Washington. My children both have some special health concerns (son has some neuromotor delays, daughter has a rare GI disorder) for which they are managed through Seattle Children's Hospital. Of all the plans on the exchange, both the UW and SCH were only in-network for one plan. . . and it wasn't the same plan. Looking further, many of the plans didn't cover most of the major hospitals in the area -- for Seattle area folks, virtually none of the plans covered Swedish, Overlake, UW, Evergreen. . . in some cases, the only hospital covered was Harborview. This was very upsetting to me; I've been with UW since I was 19, half my life, and my husband's rheumatologist is one of the best in the business.
But here's the important thing to realize: the failure in this case is that the law didn't go far ENOUGH to dictate to private insurance companies what they had to cover. I am angry at the WA state insurance commissioner's office for certifying these plans as offering comprehensive coverage, when they leave off nearly every major hospital and specialty network in the area. The decision to choose not to cover these hospitals lies with the insurance companies and the insurance companies alone; in fact, Seattle Children's Hospital is suing to get access to more exchange plans, pointing out that they provide services that nobody else in the area does. (And it's true. If your kid gets admitted to the peds ward in any of the other major hospitals in the area, the hospitalist who does the admitting and the attending who rounds on your child will almost certainly be from Children's, although that won't necessarily be obvious when you meet them. Imagine THAT sticker shock on your hospital bill!) The ACA didn't force anybody's hand -- the only failure there was a failure of imagination as to how shitty insurance companies could be.
We ended up moving to Group Health, an HMO, on one of their true Kaiser-style HMO plans. Our deductibles and out-of-pocket maximums are nearly half of what they used to be (and the premiums are more than $100 a month cheaper), the coverage is much more comprehensive, the clinic is closer to my house, and we have prescription drug coverage for the first time in three years. This means that my husband can start the expensive biologic drug treatment for his condition that will likely actually put him into remission, instead of just stopping him from getting worse. Our doctors, so far, appear to be amazing -- me and my husband's PCP was recommended by a friend, as was my kids' pediatrician, and our experience thus far has been really positive. (The pediatrician has not only heard of my daughter's condition, he may actually know more about it than I do!!) However, there was ONE plan that made that possible, and tellingly, it's a co-op, not a for-profit health insurance company.
I hope some of these kinks get ironed out. I hope the ACA gets strengthened and some of these crappy loopholes get tightened; I hope that people on Medicaid don't continue to get left out in the cold. But overall, the ACA has been really positive for our family.
posted by KathrynT at 9:05 AM on January 8, 2014 [14 favorites]
When the time came to actually choose a plan, things got a little uglier. Our family's primary care, my ENT, and my husband's rheumatologist are all through the University of Washington. My children both have some special health concerns (son has some neuromotor delays, daughter has a rare GI disorder) for which they are managed through Seattle Children's Hospital. Of all the plans on the exchange, both the UW and SCH were only in-network for one plan. . . and it wasn't the same plan. Looking further, many of the plans didn't cover most of the major hospitals in the area -- for Seattle area folks, virtually none of the plans covered Swedish, Overlake, UW, Evergreen. . . in some cases, the only hospital covered was Harborview. This was very upsetting to me; I've been with UW since I was 19, half my life, and my husband's rheumatologist is one of the best in the business.
But here's the important thing to realize: the failure in this case is that the law didn't go far ENOUGH to dictate to private insurance companies what they had to cover. I am angry at the WA state insurance commissioner's office for certifying these plans as offering comprehensive coverage, when they leave off nearly every major hospital and specialty network in the area. The decision to choose not to cover these hospitals lies with the insurance companies and the insurance companies alone; in fact, Seattle Children's Hospital is suing to get access to more exchange plans, pointing out that they provide services that nobody else in the area does. (And it's true. If your kid gets admitted to the peds ward in any of the other major hospitals in the area, the hospitalist who does the admitting and the attending who rounds on your child will almost certainly be from Children's, although that won't necessarily be obvious when you meet them. Imagine THAT sticker shock on your hospital bill!) The ACA didn't force anybody's hand -- the only failure there was a failure of imagination as to how shitty insurance companies could be.
We ended up moving to Group Health, an HMO, on one of their true Kaiser-style HMO plans. Our deductibles and out-of-pocket maximums are nearly half of what they used to be (and the premiums are more than $100 a month cheaper), the coverage is much more comprehensive, the clinic is closer to my house, and we have prescription drug coverage for the first time in three years. This means that my husband can start the expensive biologic drug treatment for his condition that will likely actually put him into remission, instead of just stopping him from getting worse. Our doctors, so far, appear to be amazing -- me and my husband's PCP was recommended by a friend, as was my kids' pediatrician, and our experience thus far has been really positive. (The pediatrician has not only heard of my daughter's condition, he may actually know more about it than I do!!) However, there was ONE plan that made that possible, and tellingly, it's a co-op, not a for-profit health insurance company.
I hope some of these kinks get ironed out. I hope the ACA gets strengthened and some of these crappy loopholes get tightened; I hope that people on Medicaid don't continue to get left out in the cold. But overall, the ACA has been really positive for our family.
posted by KathrynT at 9:05 AM on January 8, 2014 [14 favorites]
David Rhodes, president of CBS, was a vice president at Fox News. Our liberal media.
Having said that, my situation is: After creating a second account on healthcare.gov, and slogging through the enrollment process, I was hit with nearly double my current premium, and I lose dental (and I think the vision plan is worse). In fairness, the deductible is a little smaller, but what's the point of a slightly less unaffordable deductible if the premium is more unaffordable? Luckily I get to keep my current plan until the end of July. In other fairness, half the problem is my douche-drinking state government, but that's one of my big problems with ACA -- it leaves most of the enforcement up to the states (and that's doubly worse now that the Medicare expansion is unconstitutional).
The worst thing about Obamacare is how it forces me to be in agreement with my racist relatives, though for different reasons (them: communist healthcare plan that gives free healthcare to lazy black people. Me: nakedly fascist regulation that forces us to pay into a stunningly corrupt and evil industry just to be alive in this country).
posted by dirigibleman at 9:14 AM on January 8, 2014
Having said that, my situation is: After creating a second account on healthcare.gov, and slogging through the enrollment process, I was hit with nearly double my current premium, and I lose dental (and I think the vision plan is worse). In fairness, the deductible is a little smaller, but what's the point of a slightly less unaffordable deductible if the premium is more unaffordable? Luckily I get to keep my current plan until the end of July. In other fairness, half the problem is my douche-drinking state government, but that's one of my big problems with ACA -- it leaves most of the enforcement up to the states (and that's doubly worse now that the Medicare expansion is unconstitutional).
The worst thing about Obamacare is how it forces me to be in agreement with my racist relatives, though for different reasons (them: communist healthcare plan that gives free healthcare to lazy black people. Me: nakedly fascist regulation that forces us to pay into a stunningly corrupt and evil industry just to be alive in this country).
posted by dirigibleman at 9:14 AM on January 8, 2014
the NY exchange application, at least, is needlessly complicated, particularly for freelancers--requiring that you estimate 2014 income and expenses even before we've filed 2013 taxes
To follow up on this bit, they ask you to estimate your 2014 income so they can see if you qualify for tax credits or not. Yes, it's not ideal for freelancers whose income can change, but I'm not sure there's a better way to do it given that they pay the credits in advance directly to insurance companies, rather than at the end of the year when you file your taxes (you can elect to take the credit at the end of the year, but my understanding is you still need to estimate your 2014 income when you apply for insurance).
Another consequence of this is that at the end of the year, if they've given you a larger amount of the tax credit than you qualified for (for example, if you made more money than you thought you would), you will have to pay back the credit, up to a certain amount. Or if you got too little, they will owe you. If your circumstances change during the year, you should be able to go back on the exchange and update your information so that you aren't getting too much or too little of the tax credit, much like changing your income tax withholding at work.
posted by ultraviolet catastrophe at 9:27 AM on January 8, 2014 [1 favorite]
To follow up on this bit, they ask you to estimate your 2014 income so they can see if you qualify for tax credits or not. Yes, it's not ideal for freelancers whose income can change, but I'm not sure there's a better way to do it given that they pay the credits in advance directly to insurance companies, rather than at the end of the year when you file your taxes (you can elect to take the credit at the end of the year, but my understanding is you still need to estimate your 2014 income when you apply for insurance).
Another consequence of this is that at the end of the year, if they've given you a larger amount of the tax credit than you qualified for (for example, if you made more money than you thought you would), you will have to pay back the credit, up to a certain amount. Or if you got too little, they will owe you. If your circumstances change during the year, you should be able to go back on the exchange and update your information so that you aren't getting too much or too little of the tax credit, much like changing your income tax withholding at work.
posted by ultraviolet catastrophe at 9:27 AM on January 8, 2014 [1 favorite]
To follow up on this bit, they ask you to estimate your 2014 income so they can see if you qualify for tax credits or not. Yes, it's not ideal for freelancers whose income can change, but I'm not sure there's a better way to do it given that they pay the credits in advance directly to insurance companies, rather than at the end of the year when you file your taxes (you can elect to take the credit at the end of the year, but my understanding is you still need to estimate your 2014 income when you apply for insurance).
They were asking us to do this in October 2013, down to monthly estimates for both income and expenses for a three month period from January 2014 to March 2014. This is pretty much impossible for the vast majority of freelancers of my acquaintances, and from what I gathered from the facebook page, also caused significant difficulties for those who are unemployed because they are required to report unemployment income they have no idea if they'll be receiving or not.
Yes, it's a special snowflake situation--but freelancers and the unemployed are precisely the people who are likely to be quick to apply for federally subsidized health insurance. We're the ones who have been buying our insurance anyhow.
posted by PhoBWanKenobi at 9:35 AM on January 8, 2014 [3 favorites]
They were asking us to do this in October 2013, down to monthly estimates for both income and expenses for a three month period from January 2014 to March 2014. This is pretty much impossible for the vast majority of freelancers of my acquaintances, and from what I gathered from the facebook page, also caused significant difficulties for those who are unemployed because they are required to report unemployment income they have no idea if they'll be receiving or not.
Yes, it's a special snowflake situation--but freelancers and the unemployed are precisely the people who are likely to be quick to apply for federally subsidized health insurance. We're the ones who have been buying our insurance anyhow.
posted by PhoBWanKenobi at 9:35 AM on January 8, 2014 [3 favorites]
I just can't thank the ACA enough for making our coverage last for me and my recently-post-cancer sibling after our college graduations. Those two years bought us doctor visits, biopsies, ob-gyn care and more, until we had jobs and our own coverage. I think that aspect, the 26 year limit,has been invaluable to many people in the post-college bracket.
posted by jetlagaddict at 9:40 AM on January 8, 2014 [2 favorites]
posted by jetlagaddict at 9:40 AM on January 8, 2014 [2 favorites]
Oh, and I should say that they estimate the yearly income based off of that three month period (which, if you're dealing with, say, advance checks during one of those months which pays your family for the entire year, could easily cause your income to be grossly overestimated). When I called to speak to a navigator, they told me that I should bring my 2012 taxes to estimate my 2014 income. I have a feeling quite a few people are going to end up with large gaps between their estimates and what they've actually earned come tax time.
posted by PhoBWanKenobi at 9:44 AM on January 8, 2014
posted by PhoBWanKenobi at 9:44 AM on January 8, 2014
I have a feeling quite a few people are going to end up with large gaps between their estimates and what they've actually earned come tax time.
Yeah, it's definitely going to be an issue for a lot of people, and one that most people don't know about, especially the part about having to pay it back at the end of the year if you get too much. People in this situation should try to stay on top of it and go back to the exchange throughout the year to update their information.
posted by ultraviolet catastrophe at 10:03 AM on January 8, 2014
Yeah, it's definitely going to be an issue for a lot of people, and one that most people don't know about, especially the part about having to pay it back at the end of the year if you get too much. People in this situation should try to stay on top of it and go back to the exchange throughout the year to update their information.
posted by ultraviolet catastrophe at 10:03 AM on January 8, 2014
they ask you to estimate your 2014 income so they can see if you qualify for tax credits or not.
I was playing around with the site and it seems to insist that if you make too little, regardless of assets, they shunt you to Medicaid; which for a whole variety of reason is not a great way to go. Am I missing something?
posted by IndigoJones at 10:28 AM on January 8, 2014
I was playing around with the site and it seems to insist that if you make too little, regardless of assets, they shunt you to Medicaid; which for a whole variety of reason is not a great way to go. Am I missing something?
posted by IndigoJones at 10:28 AM on January 8, 2014
Reading a lot of these stories has made it clear that some places are better than others when it comes to health care options.
One of the main components of the Wyden-Bennett health care bill was eliminating the local state health care restrictions and making everything compete in a single national exchange. It seems like something that could solve a lot of these types of issues though at the same time could be very bad in terms of creating monopolies.
posted by charred husk at 10:29 AM on January 8, 2014
One of the main components of the Wyden-Bennett health care bill was eliminating the local state health care restrictions and making everything compete in a single national exchange. It seems like something that could solve a lot of these types of issues though at the same time could be very bad in terms of creating monopolies.
posted by charred husk at 10:29 AM on January 8, 2014
I really hope that the next step in all of this is "wow, it's really hard for people to navigate all of this and people still have trouble accessing care. If we had one national plan that covered everyone..."
I appreciate the optimism, but I think you know that the opposite is what will happen.
Reading a lot of these stories has made it clear that some places are better than others when it comes to health care options.
Yep. Some places (every other developed nation) are better than others (the Unites States and the rest of the Third World).
posted by Steely-eyed Missile Man at 10:42 AM on January 8, 2014
I appreciate the optimism, but I think you know that the opposite is what will happen.
Reading a lot of these stories has made it clear that some places are better than others when it comes to health care options.
Yep. Some places (every other developed nation) are better than others (the Unites States and the rest of the Third World).
posted by Steely-eyed Missile Man at 10:42 AM on January 8, 2014
I was playing around with the site and it seems to insist that if you make too little, regardless of assets, they shunt you to Medicaid; which for a whole variety of reason is not a great way to go. Am I missing something?
No, that's precisely right and how the system is designed to work. Whether or not your doctors take medicaid or whether you'd actually prefer to buy a subsidized plan off the exchange seems to have not been figured into the whole equation.
(I mean, you CAN buy a plan off the exchange, but it's either take medicaid or pay full price for an exchange plan.)
posted by PhoBWanKenobi at 10:58 AM on January 8, 2014
No, that's precisely right and how the system is designed to work. Whether or not your doctors take medicaid or whether you'd actually prefer to buy a subsidized plan off the exchange seems to have not been figured into the whole equation.
(I mean, you CAN buy a plan off the exchange, but it's either take medicaid or pay full price for an exchange plan.)
posted by PhoBWanKenobi at 10:58 AM on January 8, 2014
I'm looking at this from North of the border. I've written before that the cost of healthcare in the US was a factor in us deciding to move to Canada, rather than back to the US. I'm hoping that this bumpy start is just a waypoint on the road to a proper single payer plan that allows improved coverage for all.
posted by arcticseal at 12:10 PM on January 8, 2014
posted by arcticseal at 12:10 PM on January 8, 2014
On the "Thank you, Obamacare" side, my daughters both have a rare genetic condition. Because their condition is so rare, the only way for the drug company to make money on the one drug that treats it is to charge a ridiculous amount, in the neighborhood of $100k per person per year for it. If we ever lose our current health insurance (ie, if I ever lose my job) then my daughters would have a pre-existing condition for the rest of their lives. If they were denied insurance on that basis, they would never again have access to this drug. I personally breathed a huge sigh of relief when this legislation passed, despite the fact that my coverage hasn't changed.
posted by OnceUponATime at 12:50 PM on January 8, 2014 [4 favorites]
posted by OnceUponATime at 12:50 PM on January 8, 2014 [4 favorites]
jamaro, any reason your son can't be on your or your SO's policy?
posted by schoolgirl report at 1:06 PM on January 8, 2014
posted by schoolgirl report at 1:06 PM on January 8, 2014
My anecdote: using the exchange site was difficult - for instance, when it said I need to download documents, they would be unopenable until I appended '.pdf' to the filename. It took me hours to figure everything out, and some of it had to be done over email since the site straight up would not accept uploads for documents it demanded I upload. While the people I emailed with never seemed to have access to any of my previous emails.
However, I *did* get insurance, and as of Jan 1, 2014, I am paying substantially less per month for a zero-deductible plan than I was for a $5000 deductible plan last year. Even without qualifying for a subsidy.
posted by solotoro at 1:39 PM on January 8, 2014 [2 favorites]
However, I *did* get insurance, and as of Jan 1, 2014, I am paying substantially less per month for a zero-deductible plan than I was for a $5000 deductible plan last year. Even without qualifying for a subsidy.
posted by solotoro at 1:39 PM on January 8, 2014 [2 favorites]
Jamaro, you're saying none of the CoveredCA plans offer dependent coverage? That sounds odd, but you're obviously more familiar with it than I am.
posted by schoolgirl report at 2:32 PM on January 8, 2014
posted by schoolgirl report at 2:32 PM on January 8, 2014
Paper apologies for story on ACA ‘victims’
Twain's quote about the lie traveling half way around the world while the truth is putting on its shoes seems relevant.
posted by tonycpsu at 3:13 PM on January 8, 2014 [1 favorite]
Twain's quote about the lie traveling half way around the world while the truth is putting on its shoes seems relevant.
posted by tonycpsu at 3:13 PM on January 8, 2014 [1 favorite]
Keep in mind that Obamacare had two rather modest goals. It was not a radical change to U.S. heathcare.
The first goal was help people excluded from health insurance because of pre-existing conditions and kicked out of health insurance by rescissions after they get sick. This goal was accomplished and life changing for people who insurance companies previously discriminated against.
The second goal was to provide health care for millions of low-income people through Medicaid. This is partially successful but due to the Roberts Supreme Court ruling, these benefits do not extend to many Republican controlled states.
The insurance exchanges are a bit of a mixed bag. They make shopping for insurance much easier because you can compare plans all in one place and they have standardized the means of comparing plans. The exchanges are also a mechanism for providing subsidies for some people who have incomes too high for Medicaid.
The reason for the complicated application process is that the subsidies are means tested. In order to determine your eligibility for a subsidy, you have to provide detailed income information. Folks complaining about this process might have a little more sympathy for the bureaucratic aggravation, frustration and humiliation that low-income people have to put up with every day in applying for food stamps, Medicaid, and unemployment. Welcome to the world of welfare in America.
Nobody is forced to use the exchanges or choose an exchange plan unless you want a subsidy. If you don't want or don't qualify for a subsidy, you can purchase any health insurance plan you want directly from an insurer.
However, it is still a private insurance program, just like before. Insurers will raise your premiums. Insurers will limit your network choices. Insurers will cancel your plan and offer new more limited and more expensive plans just like before. These problems aren't anything new that was created by Obamacare.
If you have complaints, it isn't because of Obamacare. Those problems were always there and will remain as long as we rely on a private insurance system.
But as modest as Obamacare's goals, it has been a life changing improvement for millions of people.
posted by JackFlash at 3:40 PM on January 8, 2014 [8 favorites]
The first goal was help people excluded from health insurance because of pre-existing conditions and kicked out of health insurance by rescissions after they get sick. This goal was accomplished and life changing for people who insurance companies previously discriminated against.
The second goal was to provide health care for millions of low-income people through Medicaid. This is partially successful but due to the Roberts Supreme Court ruling, these benefits do not extend to many Republican controlled states.
The insurance exchanges are a bit of a mixed bag. They make shopping for insurance much easier because you can compare plans all in one place and they have standardized the means of comparing plans. The exchanges are also a mechanism for providing subsidies for some people who have incomes too high for Medicaid.
The reason for the complicated application process is that the subsidies are means tested. In order to determine your eligibility for a subsidy, you have to provide detailed income information. Folks complaining about this process might have a little more sympathy for the bureaucratic aggravation, frustration and humiliation that low-income people have to put up with every day in applying for food stamps, Medicaid, and unemployment. Welcome to the world of welfare in America.
Nobody is forced to use the exchanges or choose an exchange plan unless you want a subsidy. If you don't want or don't qualify for a subsidy, you can purchase any health insurance plan you want directly from an insurer.
However, it is still a private insurance program, just like before. Insurers will raise your premiums. Insurers will limit your network choices. Insurers will cancel your plan and offer new more limited and more expensive plans just like before. These problems aren't anything new that was created by Obamacare.
If you have complaints, it isn't because of Obamacare. Those problems were always there and will remain as long as we rely on a private insurance system.
But as modest as Obamacare's goals, it has been a life changing improvement for millions of people.
posted by JackFlash at 3:40 PM on January 8, 2014 [8 favorites]
I am glad to have coverage but confused about why the California exchange website still has not fixed its password reset system.
posted by steinsaltz at 5:07 PM on January 8, 2014
posted by steinsaltz at 5:07 PM on January 8, 2014
I wish more people understood that the unavailability of doctors on these plans is either the fault of the doctor, who has opted out of the plan, or the fault of the insurance company, who is using only the physicians they managed to sell their plan to.
The unavailability of your doctor on these plans has nothing to do with Obama or with the way the ACA was intended to operate.
The fact that the Republicans managed to restructure the ACA to eliminate the original single-payer plan, leaving individual insurance companies in a competitive brawl over your premium is, again, not in any way part of Obama's original idea. The Republicans tried to snafu the ACA to the best of their ability, hoping that that would get the entire plan abolished. That didn't work, so what's actually happening now is the insurance companies are fighting over scraps - they have too many rules to follow, such as allowing pre-existing conditions, that just spoil all their fun - and they're doing everything they can - like cancelling plans and raising premiums - to try to squeeze every last dime out of everyone they can.
It's not the ACA, it's not Obama. It's the insurance companies - and, in many cases, physicians who refuse to take part because they can't make as much money as they want - or because they too have been scared to death about the future under the ACA through their own medical society information, which of course is all oriented to the right. My Internist simply quit practicing medicine, and my cousin's in Houston did the same. Oh, well - that's a loss, but it's not impossible to get around - there are other excellent physicians.
I'm in good shape because I'm old and have Medicare. But my granddaughter, a college student, signed up for ACA and now pays a very low premium and has good medical insurance for the first time in years; the copays are affordable and so is the deductible. She's thrilled, and so am I. After having an emergency appendectomy and then a readmission to the hospital for nearly a week with a massive inflammation of the small bowel last February, she's ecstatic that she'll now have coverage if something like that should happen again.
Follow the money - that's where the answer is, always. And the ACA itself isn't about money - but the insurance companies are.
posted by aryma at 5:32 PM on January 8, 2014 [4 favorites]
The unavailability of your doctor on these plans has nothing to do with Obama or with the way the ACA was intended to operate.
The fact that the Republicans managed to restructure the ACA to eliminate the original single-payer plan, leaving individual insurance companies in a competitive brawl over your premium is, again, not in any way part of Obama's original idea. The Republicans tried to snafu the ACA to the best of their ability, hoping that that would get the entire plan abolished. That didn't work, so what's actually happening now is the insurance companies are fighting over scraps - they have too many rules to follow, such as allowing pre-existing conditions, that just spoil all their fun - and they're doing everything they can - like cancelling plans and raising premiums - to try to squeeze every last dime out of everyone they can.
It's not the ACA, it's not Obama. It's the insurance companies - and, in many cases, physicians who refuse to take part because they can't make as much money as they want - or because they too have been scared to death about the future under the ACA through their own medical society information, which of course is all oriented to the right. My Internist simply quit practicing medicine, and my cousin's in Houston did the same. Oh, well - that's a loss, but it's not impossible to get around - there are other excellent physicians.
I'm in good shape because I'm old and have Medicare. But my granddaughter, a college student, signed up for ACA and now pays a very low premium and has good medical insurance for the first time in years; the copays are affordable and so is the deductible. She's thrilled, and so am I. After having an emergency appendectomy and then a readmission to the hospital for nearly a week with a massive inflammation of the small bowel last February, she's ecstatic that she'll now have coverage if something like that should happen again.
Follow the money - that's where the answer is, always. And the ACA itself isn't about money - but the insurance companies are.
posted by aryma at 5:32 PM on January 8, 2014 [4 favorites]
aryma: "The fact that the Republicans managed to restructure the ACA to eliminate the original single-payer plan, leaving individual insurance companies in a competitive brawl over your premium is, again, not in any way part of Obama's original idea."
I agree with most of the rest of your comment, but this is not an accurate portrayal of what happened. There was no "original single-payer plan" that was ever pushed for by the Obama administration. There was a single-payer bill introduced in the house, but it went nowhere, because everyone, including the President, knew there was no chance of getting "Medicare for All" or any other universal single-payer plan through a filibuster in the Senate.
I say this as a pretty consistent defender of the ACA as just about the best possible plan Obama could have gotten given opposition from all Republicans and many conservative Democrats, and someone who wished we could have gotten single-payer. It just wasn't in the cards given a need to appease the Joe Liebermans and Ben Nelsons of the Senate.
posted by tonycpsu at 5:45 PM on January 8, 2014
I agree with most of the rest of your comment, but this is not an accurate portrayal of what happened. There was no "original single-payer plan" that was ever pushed for by the Obama administration. There was a single-payer bill introduced in the house, but it went nowhere, because everyone, including the President, knew there was no chance of getting "Medicare for All" or any other universal single-payer plan through a filibuster in the Senate.
I say this as a pretty consistent defender of the ACA as just about the best possible plan Obama could have gotten given opposition from all Republicans and many conservative Democrats, and someone who wished we could have gotten single-payer. It just wasn't in the cards given a need to appease the Joe Liebermans and Ben Nelsons of the Senate.
posted by tonycpsu at 5:45 PM on January 8, 2014
Since I'm single, self-employed, and low-income, I've been on the "hope-and-pray-I-don't-get-sick" plan for years. The ACA and the fact that I live in Oregon have made a huge difference in my life already, just by making it possible for me to see a doctor when I need to.
Here's a post I made to my Facebook friends on Dec. 31, 2013:
Here's a post I made to my Facebook friends on Dec. 31, 2013:
As of tomorrow, Jan. 1, 2014, I will have health insurance.posted by velvet winter at 6:18 PM on January 8, 2014 [11 favorites]
I will have easy access to health care.
This means so much to me.
When I got the letter from the state telling me I qualified for the subsidized Oregon Health Plan and could even be enrolled via the fast-track plan because I’m on SNAP (food stamps), I cried tears of relief.
After years of being uninsured after I lost my health insurance and all my financial assets through an unwanted divorce in 2007, I am finally going to be insured again. After years of living in constant low-level fear that I was just one severe illness away from bankruptcy, I am finally going to be insured again. After years of worrying that I might not even be able to get treated at all if I got severely ill because I had no money and no insurance…I am finally going to be insured again. After years of hunting for jobs I didn’t even want just because they provided health insurance, I can finally leave all that behind and focus on doing what I really want to do with my life, secure in the knowledge that I can see a doctor or dentist when I need to.
This means I will have something I have dreamed of all my life: access to affordable health care that does not depend on me being married/domestically partnered or employed full-time.
This frees me up to focus on developing my house cleaning/home organizing business and writing my book manuscript.
Thank you, Obamacare. Thank you, Oregon.
Thankyouthankyouthankyouthankyou.
The unavailability of your doctor on these plans has nothing to do with Obama or with the way the ACA was intended to operate.
That's misleading. The unavailability of the doctors has nothing to do with Obamacare in the same way that insurance carriers dropping their plans despite those plans being grandfathered in has nothing to do with Obamacare. That is: Nothing in the law requires these things to happen but they are an obvious and inevitable results of the law as passed.
posted by Justinian at 8:02 PM on January 8, 2014
That's misleading. The unavailability of the doctors has nothing to do with Obamacare in the same way that insurance carriers dropping their plans despite those plans being grandfathered in has nothing to do with Obamacare. That is: Nothing in the law requires these things to happen but they are an obvious and inevitable results of the law as passed.
posted by Justinian at 8:02 PM on January 8, 2014
Want to get people to pay attention? Hit them in the pocket book.
If only. Then there would be more outrage about deregulation in the financial and other sectors that has resulted in a reduction of wages and services for the majority of people in the country.
posted by juiceCake at 9:16 PM on January 8, 2014 [1 favorite]
If only. Then there would be more outrage about deregulation in the financial and other sectors that has resulted in a reduction of wages and services for the majority of people in the country.
posted by juiceCake at 9:16 PM on January 8, 2014 [1 favorite]
It should be noted that a lot of the network problems are the result of the consolidation of providers over the last fifteen years.
Networks originated in the 80s as a way for insurance companies to negotiate lower rates from providers — insurance companies were fewer and had the advantage, by creating preferred provider networks they were able to negotiate lower rates from the providers in exchange for bringing those providers more patients (because the plans had those preferred providers). This helped keep costs lower, although it's debatable whether the insured ever saw any of those savings in their premiums or deductibles.
The negotiated rates were some percentage discount from the providers' standard rates.
In the 90s there was this big wave of consolidation in the health care industry, with big hospital chains forming that swallowed up independent hospitals and smaller chains and then also private practices. In some markets there are no more than two or three big corporate providers, almost all hospitals and physicians are owned or affiliated with these few providers.
And what's happened is that the advantage has switched from the insurance companies, who were previously few and very large against many and smaller health care providers, to the providers, who are now few and very large. Indeed, in many areas the providers and the insurance companies are one and the same.
The result of this is that these network preferred provider agreements with their negotiated rates have switched from being a means for the buyer to negotiate a lower rate to a means for the supplier to negotiate a higher rate.
This has happened in a very sneaky way, slowly as this whole landscape has changed. What the providers have done has been to largely keep the same kinds of contracts with about the same discounts included, but they've just over time inflated their supposed "standard" rates. So the "discounted" rates for in-network services have risen dramatically. The standard rates have risen even more dramatically ... absurdly, as a matter of fact. Anyone who's ever looked at their medical bills has seen this. The insurance companies have lost the leverage in this relationship; now they have no choice but to go along with this because the employers who shop for employer group plans look for plans that include the hospitals and doctors that their employees already see.
Enter the ACA. What's happened with the ACA is that it required a set of minimum coverages and the exchanges make it possible for consumers to transparently compare coverages and premiums/deductibles across insurers. The insurance companies had to come up with plans that would meet the requirements and be competitive with their competitors before the ACA exchanges opened. So what many of the insurers have done with the less expensive plans have been to not go with the big providers that have all the leverage, and thus are able to charge higher rates, and instead go with independent and/or smaller providers that charge lower rates, and therefore offer insurance plans that are less expensive. So a lot of these less expensive plans don't include the physicians and hospitals that are part of these big provider networks.
This isn't in any sense an apologetic for the insurance companies. They're as evil as always. But it's an example of how perverse the American health care system truly is. The reason why we get so little for so much more money than anyone else is that our entire system sort of works in ways that make it almost impossible to control costs.
This is also why it's so difficult to find providers who will take Medicaid patients. Medicare pays slightly less than private insurers, but it's huge and the elderly, who are its chief demographic, have a lot of political, cultural, and economic clout. Most providers will take Medicare patients, although there certainly are some who won't.
But this isn't the case with Medicaid. Medicaid chiefly insures children and the very poor. And for this reason, it's a poorly funded program that necessarily pays even lower rates than does Medicare, and it's a fully state administered program, which just worsens its poor stepchild status. So providers don't want to accept Medicaid and they can get away with not taking Medicaid patients.
This varies by state. Some states have grouped a bunch of different state administered health insurance programs, including Medicaid, into one big program that has more leverage and therefore is more difficult for providers to refuse. In other states, it's extremely difficult to find doctors who will accept Medicaid.
This is a big problem with the ACA expanding coverage via Medicaid. But then, as mentioned above, this is how all need-based government programs work: they work poorly and they deliberately make it difficult to apply and receive benefits (this truly is intentional; with limited funds, all this hoop-jumping is a way to ration without appearing to ration, but of course it's the most disadvantaged and vulnerable who bear the largest burden of this strategy). This isn't the ACA's fault, it what life is like for the poor, period.
posted by Ivan Fyodorovich at 1:06 AM on January 9, 2014 [8 favorites]
Networks originated in the 80s as a way for insurance companies to negotiate lower rates from providers — insurance companies were fewer and had the advantage, by creating preferred provider networks they were able to negotiate lower rates from the providers in exchange for bringing those providers more patients (because the plans had those preferred providers). This helped keep costs lower, although it's debatable whether the insured ever saw any of those savings in their premiums or deductibles.
The negotiated rates were some percentage discount from the providers' standard rates.
In the 90s there was this big wave of consolidation in the health care industry, with big hospital chains forming that swallowed up independent hospitals and smaller chains and then also private practices. In some markets there are no more than two or three big corporate providers, almost all hospitals and physicians are owned or affiliated with these few providers.
And what's happened is that the advantage has switched from the insurance companies, who were previously few and very large against many and smaller health care providers, to the providers, who are now few and very large. Indeed, in many areas the providers and the insurance companies are one and the same.
The result of this is that these network preferred provider agreements with their negotiated rates have switched from being a means for the buyer to negotiate a lower rate to a means for the supplier to negotiate a higher rate.
This has happened in a very sneaky way, slowly as this whole landscape has changed. What the providers have done has been to largely keep the same kinds of contracts with about the same discounts included, but they've just over time inflated their supposed "standard" rates. So the "discounted" rates for in-network services have risen dramatically. The standard rates have risen even more dramatically ... absurdly, as a matter of fact. Anyone who's ever looked at their medical bills has seen this. The insurance companies have lost the leverage in this relationship; now they have no choice but to go along with this because the employers who shop for employer group plans look for plans that include the hospitals and doctors that their employees already see.
Enter the ACA. What's happened with the ACA is that it required a set of minimum coverages and the exchanges make it possible for consumers to transparently compare coverages and premiums/deductibles across insurers. The insurance companies had to come up with plans that would meet the requirements and be competitive with their competitors before the ACA exchanges opened. So what many of the insurers have done with the less expensive plans have been to not go with the big providers that have all the leverage, and thus are able to charge higher rates, and instead go with independent and/or smaller providers that charge lower rates, and therefore offer insurance plans that are less expensive. So a lot of these less expensive plans don't include the physicians and hospitals that are part of these big provider networks.
This isn't in any sense an apologetic for the insurance companies. They're as evil as always. But it's an example of how perverse the American health care system truly is. The reason why we get so little for so much more money than anyone else is that our entire system sort of works in ways that make it almost impossible to control costs.
This is also why it's so difficult to find providers who will take Medicaid patients. Medicare pays slightly less than private insurers, but it's huge and the elderly, who are its chief demographic, have a lot of political, cultural, and economic clout. Most providers will take Medicare patients, although there certainly are some who won't.
But this isn't the case with Medicaid. Medicaid chiefly insures children and the very poor. And for this reason, it's a poorly funded program that necessarily pays even lower rates than does Medicare, and it's a fully state administered program, which just worsens its poor stepchild status. So providers don't want to accept Medicaid and they can get away with not taking Medicaid patients.
This varies by state. Some states have grouped a bunch of different state administered health insurance programs, including Medicaid, into one big program that has more leverage and therefore is more difficult for providers to refuse. In other states, it's extremely difficult to find doctors who will accept Medicaid.
This is a big problem with the ACA expanding coverage via Medicaid. But then, as mentioned above, this is how all need-based government programs work: they work poorly and they deliberately make it difficult to apply and receive benefits (this truly is intentional; with limited funds, all this hoop-jumping is a way to ration without appearing to ration, but of course it's the most disadvantaged and vulnerable who bear the largest burden of this strategy). This isn't the ACA's fault, it what life is like for the poor, period.
posted by Ivan Fyodorovich at 1:06 AM on January 9, 2014 [8 favorites]
The unavailability of the doctors has nothing to do with Obamacare in the same way that insurance carriers dropping their plans despite those plans being grandfathered in has nothing to do with Obamacare. That is: Nothing in the law requires these things to happen but they are an obvious and inevitable results of the law as passed.
What obvious and inevitable result? The exchanges are composed of competing insurance companies. Competitors have different strategies for getting customers. Some insurers are like Walmart and compete on low prices. These insurers will have the lowest premiums and smallest network of providers. Other insurers are like Macy's and compete on better quality. Their plans will have higher premiums and and a wider network of providers.
You as the customer have your choice of competing insurers -- low cost or wider networks. You don't get both. This is no different than before Obamacare.
If your exchange has poor choices, blame your state insurance commissioner, not Obamacare. State insurance commissioners were responsible for selecting and qualifying the plans offered on the exchange, not Obamacare. The state insurance commissioner is probably the most important and powerful state official that most citizens can't even name. In some states they are elected and in others they are appointed, but either way citizens should become more directly involved in their selection. They can be either consumer friendly or insurance company friendly and have control over 10% or more of your household spending.
posted by JackFlash at 8:32 AM on January 9, 2014 [1 favorite]
What obvious and inevitable result? The exchanges are composed of competing insurance companies. Competitors have different strategies for getting customers. Some insurers are like Walmart and compete on low prices. These insurers will have the lowest premiums and smallest network of providers. Other insurers are like Macy's and compete on better quality. Their plans will have higher premiums and and a wider network of providers.
You as the customer have your choice of competing insurers -- low cost or wider networks. You don't get both. This is no different than before Obamacare.
If your exchange has poor choices, blame your state insurance commissioner, not Obamacare. State insurance commissioners were responsible for selecting and qualifying the plans offered on the exchange, not Obamacare. The state insurance commissioner is probably the most important and powerful state official that most citizens can't even name. In some states they are elected and in others they are appointed, but either way citizens should become more directly involved in their selection. They can be either consumer friendly or insurance company friendly and have control over 10% or more of your household spending.
posted by JackFlash at 8:32 AM on January 9, 2014 [1 favorite]
My very limited Obamacare experience.
I don't currently need it because I am covered by my wife's insurance through her job but I delayed seeing a doctor before we immigrated because I was scared of being denied insurance for a pre-existing condition. So even though I was in a country with proper health care I avoided using it even when I needed it because I knew I was moving to the United States of crappy healthcare insurance.
Other immigrants won't have to make the same choice now.
posted by srboisvert at 9:19 AM on January 9, 2014
I don't currently need it because I am covered by my wife's insurance through her job but I delayed seeing a doctor before we immigrated because I was scared of being denied insurance for a pre-existing condition. So even though I was in a country with proper health care I avoided using it even when I needed it because I knew I was moving to the United States of crappy healthcare insurance.
Other immigrants won't have to make the same choice now.
posted by srboisvert at 9:19 AM on January 9, 2014
What obvious and inevitable result?
That to provide the good coverage required by Obamacare plans with a wide (read:expensive) provider network would require the plans to be expensive? That's obvious and inevitable. Therefore the companies don't offer wide networks.
posted by Justinian at 10:11 AM on January 9, 2014
That to provide the good coverage required by Obamacare plans with a wide (read:expensive) provider network would require the plans to be expensive? That's obvious and inevitable. Therefore the companies don't offer wide networks.
posted by Justinian at 10:11 AM on January 9, 2014
That to provide the good coverage required by Obamacare plans with a wide (read:expensive) provider network would require the plans to be expensive? That's obvious and inevitable. Therefore the companies don't offer wide networks.
That makes no logical sense. Insurance companies are competing for customers. Size of network is one of the items they compete on. They must offer plans that customers want or else they won't buy them.
Have you ever purchased a plan on the individual market recently? Do you even know how it works? What it was like before Obamacare?
posted by JackFlash at 10:30 AM on January 9, 2014 [3 favorites]
That makes no logical sense. Insurance companies are competing for customers. Size of network is one of the items they compete on. They must offer plans that customers want or else they won't buy them.
Have you ever purchased a plan on the individual market recently? Do you even know how it works? What it was like before Obamacare?
posted by JackFlash at 10:30 AM on January 9, 2014 [3 favorites]
Have you ever purchased a plan on the individual market recently? Do you even know how it works? What it was like before Obamacare?
I have! We've been on individual insurance since 2011. We actually started after some of the ACA provisions had taken effect, thank god, or else my husband would have been uninsurable. Prior to this year, our policy covered virtually all providers and hospitals, with $2500, a $5K per-person out of pocket maximum, and a LOT of policy exclusions -- there was no maternity care coverage from day 1, and as the years went past, we lost mental health, rehab services (including OT/PT for my son), and prescription drug coverage. Our costs went up every year by double-digits per month.
Post-ACA, the exchange policy from the same insurance company excluded virtually all doctors and hospitals, including everyone my family had ever seen. It included maternity care, mental health, rehab services, and drug coverage, for a $2000 individual deductible, $4300 family, and and a $4000/$10,000 out of pocket maximum. The non-exchange policy included all the same doctors that had been covered before, with maternity, mental health, rehab, and drug coverage, for a $6350 personal deductible and a $15,500 out of pocket maximum, per-person. The costs were about the same as our final previous bill.
posted by KathrynT at 10:51 AM on January 9, 2014
I have! We've been on individual insurance since 2011. We actually started after some of the ACA provisions had taken effect, thank god, or else my husband would have been uninsurable. Prior to this year, our policy covered virtually all providers and hospitals, with $2500, a $5K per-person out of pocket maximum, and a LOT of policy exclusions -- there was no maternity care coverage from day 1, and as the years went past, we lost mental health, rehab services (including OT/PT for my son), and prescription drug coverage. Our costs went up every year by double-digits per month.
Post-ACA, the exchange policy from the same insurance company excluded virtually all doctors and hospitals, including everyone my family had ever seen. It included maternity care, mental health, rehab services, and drug coverage, for a $2000 individual deductible, $4300 family, and and a $4000/$10,000 out of pocket maximum. The non-exchange policy included all the same doctors that had been covered before, with maternity, mental health, rehab, and drug coverage, for a $6350 personal deductible and a $15,500 out of pocket maximum, per-person. The costs were about the same as our final previous bill.
posted by KathrynT at 10:51 AM on January 9, 2014
I first signed up via the website (took 20 minutes! not bad...) and my application was successful. Great right? Nope. I had made an major error on my application. So I called them and the nice lady told me that she had removed my application and to check back on the website in 24 hours. Well, after 48 hours my application was still showing up on the site. So I called again only to wait on hold 45 minutes until my call was answered by a robot voice wanting to rate my experience with my navigator. What navigator?! I didn't speak to anyone! I called again and waited an hour on hold and a nice lady answered and said that there must be a glitch on the website because she could see no existing application for me and would I like her to begin a new application? Sure! Long story short my application was successful. She said that there was no way the system would have accepted my application if I already had another one in the system. Welp, I now have 2 applications out there in the ether that NOBODY can delete, not even their escalation team. The escalation team said that it shouldn't be possible to have 2 applications out there and they have no clue how to fix it. I was told to wait until Jan. 1st and there would be a new "remove application" feature on the website. That feature was already there but grayed out with a message saying to check back January 1st. As of today that feature is not available but the message has changed to "check back next month. There is much more to this story than I feel like typing out right now. I am just really pissed off at this point. I had been counting down the days to be able to apply for the ACA only to have this happen. My life is on hold until this gets sorted out but no one can sort it out.
posted by futz at 11:04 AM on January 9, 2014 [1 favorite]
posted by futz at 11:04 AM on January 9, 2014 [1 favorite]
Hi, KathrynT. I looked up the insurers in the Seattle area. You could have chosen Community Health on the exchange. It covers every major hospital in the city and has a very wide provider network. But the Community Health premium is significantly higher than the other plans on the exchange. You can choose low cost or you can choose wide network. You can't get both at the same time. That has nothing to do with Obamacare. That's just business as usual.
It appears that Blue Cross and Blue Shield in your area chose to compete on low cost and therefore have narrow networks. Community Health chose to compete on larger network size and therefore has a higher cost. Obamacare didn't cause this. These companies simply made decisions on how to attract the most customers. Time will tell which strategy is most successful, but at least you have a choice.
posted by JackFlash at 11:08 AM on January 9, 2014
It appears that Blue Cross and Blue Shield in your area chose to compete on low cost and therefore have narrow networks. Community Health chose to compete on larger network size and therefore has a higher cost. Obamacare didn't cause this. These companies simply made decisions on how to attract the most customers. Time will tell which strategy is most successful, but at least you have a choice.
posted by JackFlash at 11:08 AM on January 9, 2014
Looks like KathrynT has choices, just not good ones for her.
posted by futz at 11:11 AM on January 9, 2014
posted by futz at 11:11 AM on January 9, 2014
You could have chosen Community Health on the exchange. It covers every major hospital in the city and has a very wide provider network.
It does not cover Seattle Children's Hospital. I have two children, each of whom have some weird health concerns, and that was my dealbreaker. We would have gladly paid higher premiums to be able to stay with everyone we were seeing, but at the time we made our decision, the only plan that covered Children's was Group Health.
I know this isn't the fault of Obamacare/ACA; it's the fault of the insurance companies and our insurance commissioner. I was just comparing the individual insurance market in Washington (which was much better for purchasers than it was in other states, for reasons I am happy to go into if you want) in 2013 vs. 2014. I prefer where we are now, by far.
posted by KathrynT at 11:17 AM on January 9, 2014
It does not cover Seattle Children's Hospital. I have two children, each of whom have some weird health concerns, and that was my dealbreaker. We would have gladly paid higher premiums to be able to stay with everyone we were seeing, but at the time we made our decision, the only plan that covered Children's was Group Health.
I know this isn't the fault of Obamacare/ACA; it's the fault of the insurance companies and our insurance commissioner. I was just comparing the individual insurance market in Washington (which was much better for purchasers than it was in other states, for reasons I am happy to go into if you want) in 2013 vs. 2014. I prefer where we are now, by far.
posted by KathrynT at 11:17 AM on January 9, 2014
Got it. Thanks.
posted by JackFlash at 11:19 AM on January 9, 2014 [1 favorite]
posted by JackFlash at 11:19 AM on January 9, 2014 [1 favorite]
My CURRENT frustration with the Washington exchange, btw, is that when you create or change your password, it sends you the new one in a clear-text unencrypted email. I have had remarkably little luck getting anyone to pay attention to this, even after I managed to get the issue in front of the website's ops team. They confirmed that that was what they did, that that was by design, and that it was fine, since "email is secure."
posted by KathrynT at 11:22 AM on January 9, 2014 [1 favorite]
posted by KathrynT at 11:22 AM on January 9, 2014 [1 favorite]
They confirmed that that was what they did, that that was by design, and that it was fine, since "email is secure."
Looks like they hired web designers when they needed sysadmins.
posted by one more dead town's last parade at 11:58 AM on January 9, 2014 [2 favorites]
Looks like they hired web designers when they needed sysadmins.
posted by one more dead town's last parade at 11:58 AM on January 9, 2014 [2 favorites]
Looks like they hired web designers when they needed sysadmins.
Most web-devs are not that stupid anymore. But then most smart web-devs do more fun things that work for the government. So you get what you get.
posted by srboisvert at 12:02 PM on January 9, 2014
Most web-devs are not that stupid anymore. But then most smart web-devs do more fun things that work for the government. So you get what you get.
posted by srboisvert at 12:02 PM on January 9, 2014
No significant changes for me. Our plan remains more or less the same. The premiums increased slightly. They've done that every year anyway. Bonus: my spouse saved some money on her lady-parts maintenance.
Also I'm not horrified of getting laid off/losing my job any longer. Anxiety-attack levels of horrified because my wife was pre-ACA "uninsurable" and has chronic--what will likely be terminal at some point--respiratory issues. I'd see the pre-adjusted bills we get from various providers and the next thing you know I'm spending the next several nights sleepless at trying to figure out how we'd pay for that without coverage.
So, definitely okay with the ACA. I'd prefer single-payer but I'm not holding my breath just yet.
posted by Fezboy! at 3:54 PM on January 9, 2014
Also I'm not horrified of getting laid off/losing my job any longer. Anxiety-attack levels of horrified because my wife was pre-ACA "uninsurable" and has chronic--what will likely be terminal at some point--respiratory issues. I'd see the pre-adjusted bills we get from various providers and the next thing you know I'm spending the next several nights sleepless at trying to figure out how we'd pay for that without coverage.
So, definitely okay with the ACA. I'd prefer single-payer but I'm not holding my breath just yet.
posted by Fezboy! at 3:54 PM on January 9, 2014
That makes no logical sense. Insurance companies are competing for customers. Size of network is one of the items they compete on. They must offer plans that customers want or else they won't buy them.
It makes perfect logical sense when you realize that the big majority of customers will only look at monthly premium and, secondarily, benefits. Hell, many of the plans hadn't even finalized their networks while people were buying the plans! You're arguing what and how it would work in a perfect world which is not what we've got.
Secondly, you're arguing as though the companies are offering tons of different plans. Some with low cost and small networks and some with high cost and big networks, so you can just look at the more expensive plans. But that's not how the exchanges work; the companies essentially offer ONE plan at each of the tiers (bronze, platinum ,etc). So you don't get to choose between, say, a cheaper platinum plan with a small network and a more expensive platinum plan with a larger network. You get the platinum plan.
Lastly, you can say that network size is one of the items the companies are competing on but the real world disagrees. None of the non-catastrophic California plans have wide networks. NONE. This isn't a theoretical exercise. You can check the provider networks yourself if you really care to. Why they are all narrow should be (but apparently isn't) obvious; wide networks are expensive and nobody will offer an expensive plan on the marketplaces because fewer people would sign up for them.
posted by Justinian at 4:03 PM on January 9, 2014 [1 favorite]
It makes perfect logical sense when you realize that the big majority of customers will only look at monthly premium and, secondarily, benefits. Hell, many of the plans hadn't even finalized their networks while people were buying the plans! You're arguing what and how it would work in a perfect world which is not what we've got.
Secondly, you're arguing as though the companies are offering tons of different plans. Some with low cost and small networks and some with high cost and big networks, so you can just look at the more expensive plans. But that's not how the exchanges work; the companies essentially offer ONE plan at each of the tiers (bronze, platinum ,etc). So you don't get to choose between, say, a cheaper platinum plan with a small network and a more expensive platinum plan with a larger network. You get the platinum plan.
Lastly, you can say that network size is one of the items the companies are competing on but the real world disagrees. None of the non-catastrophic California plans have wide networks. NONE. This isn't a theoretical exercise. You can check the provider networks yourself if you really care to. Why they are all narrow should be (but apparently isn't) obvious; wide networks are expensive and nobody will offer an expensive plan on the marketplaces because fewer people would sign up for them.
posted by Justinian at 4:03 PM on January 9, 2014 [1 favorite]
Obamacare didn't cause this. These companies simply made decisions on how to attract the most customers.
Obamacare doesn't force them to do it, no. But Obamacare sets up the situation such that in California (where I live) the marketplace is such that all the insurance cos are competing on price. To compete on price they need narrow networks. Is that the "fault" of Obamacare or the insurance companies? Both, really, if talking about "fault" is useful in such a situation. Which it probably isn't. But to say Obamacare has nothing to do with it is misleading. In the absence of Obamacare, I would be able to buy a plan with a wider network. With Obamacare, I cannot. That's incontrovertible.
That says nothing about whether Obamacare was a good thing or not. If you've read my comments in previous threads on the subject you know my answer to that. But there are both costs and benefits to it and acting like the benefits are all due to Obamacare but the costs are due to evil insurance companies is disingenuous. Nothing is free.
posted by Justinian at 4:11 PM on January 9, 2014 [2 favorites]
Obamacare doesn't force them to do it, no. But Obamacare sets up the situation such that in California (where I live) the marketplace is such that all the insurance cos are competing on price. To compete on price they need narrow networks. Is that the "fault" of Obamacare or the insurance companies? Both, really, if talking about "fault" is useful in such a situation. Which it probably isn't. But to say Obamacare has nothing to do with it is misleading. In the absence of Obamacare, I would be able to buy a plan with a wider network. With Obamacare, I cannot. That's incontrovertible.
That says nothing about whether Obamacare was a good thing or not. If you've read my comments in previous threads on the subject you know my answer to that. But there are both costs and benefits to it and acting like the benefits are all due to Obamacare but the costs are due to evil insurance companies is disingenuous. Nothing is free.
posted by Justinian at 4:11 PM on January 9, 2014 [2 favorites]
But Obamacare sets up the situation such that in California (where I live) the marketplace is such that all the insurance cos are competing on price.
So you are saying that insurance companies did not compete on price previously? Why? What changed? That's a rather strange claim to make.
posted by JackFlash at 4:29 PM on January 9, 2014
So you are saying that insurance companies did not compete on price previously? Why? What changed? That's a rather strange claim to make.
posted by JackFlash at 4:29 PM on January 9, 2014
I meant that the insurance companies are now competing only on price. Since the policy tiers more or less define the benefits of the policies at those tiers, the only way the insurers can keep the policy costs down is to restrict the network. Previously they could fiddle with the benefits in order to offer a wider network.
posted by Justinian at 4:32 PM on January 9, 2014
posted by Justinian at 4:32 PM on January 9, 2014
Do you see what I mean? I'll give an example just in case; Previously I could buy an individual plan which offered a wider network but had a higher deductible. To me, the tradeoff was worth it. Others might have disagreed and could choose the lower deductible policy with a narrower network. That's fine.
Now because the benefits at the various plan tiers are essentially fixed the companies do not offer that choice. You get a low deductible plan with a narrow network. No higher deductible/wider network plan is available.
posted by Justinian at 4:38 PM on January 9, 2014 [1 favorite]
Now because the benefits at the various plan tiers are essentially fixed the companies do not offer that choice. You get a low deductible plan with a narrow network. No higher deductible/wider network plan is available.
posted by Justinian at 4:38 PM on January 9, 2014 [1 favorite]
Plans have deductibles ranging from zero to $5000 for individuals and $10,000 for families. Are you saying you want a plan with even higher deductibles? If you want a extremely high deductible, why do you even care what is in or out of network? You will end up paying all of your expenses out of pocket anyway unless you have a catastrophic event. Just go to whatever doctor you want any time you want.
There is nothing preventing insurers from having wider networks in the exchanges. In other states insurers do offer plans with wide networks on the exchanges. That is a business decision made by each insurer. It is not driven by Obamacare. The premiums are much higher and apparently the insurers in your state decided that too few individuals would be interested in such a policy.
If you don't like the plans on the exchanges, go directly to a private insurer and buy what you want. Obamacare doesn't prevent that.
posted by JackFlash at 4:57 PM on January 9, 2014
There is nothing preventing insurers from having wider networks in the exchanges. In other states insurers do offer plans with wide networks on the exchanges. That is a business decision made by each insurer. It is not driven by Obamacare. The premiums are much higher and apparently the insurers in your state decided that too few individuals would be interested in such a policy.
If you don't like the plans on the exchanges, go directly to a private insurer and buy what you want. Obamacare doesn't prevent that.
posted by JackFlash at 4:57 PM on January 9, 2014
There is nothing preventing insurers from having wider networks in the exchanges. In other states insurers do offer plans with wide networks on the exchanges. That is a business decision made by each insurer. It is not driven by Obamacare. [...] If you don't like the plans on the exchanges, go directly to a private insurer and buy what you want. Obamacare doesn't prevent that.
You're not listening. The insurers have, because of the marketplace created by Obamacare, exited the individual insurance market save for those plans on the state exchange. You cannot buy a wider-network policy.
Saying "There is nothing preventing" insurers from having wider networks on the exchanges is disingenuous. There is also nothing preventing them from giving me free health insurance and a cupcake. But it makes no business sense. Obamacare set up the framework in which offering a wide network makes no business sense. In that respect it is an inevitable result of Obamacare in California.
posted by Justinian at 5:14 PM on January 9, 2014
You're not listening. The insurers have, because of the marketplace created by Obamacare, exited the individual insurance market save for those plans on the state exchange. You cannot buy a wider-network policy.
Saying "There is nothing preventing" insurers from having wider networks on the exchanges is disingenuous. There is also nothing preventing them from giving me free health insurance and a cupcake. But it makes no business sense. Obamacare set up the framework in which offering a wide network makes no business sense. In that respect it is an inevitable result of Obamacare in California.
posted by Justinian at 5:14 PM on January 9, 2014
Obamacare set up the framework in which offering a wide network makes no business sense. In that respect it is an inevitable result of Obamacare in California.
Well, you can only say that insurers in California have determined that there are too few people like you to make a business case. They have decided that your business isn't worth to them. That's business. That isn't Obamacare. Insurers in other states, under the same Obamacare, have made different decisions and offer wider networks. That's what you have to live with under a private insurance system, same as always.
posted by JackFlash at 5:21 PM on January 9, 2014
Well, you can only say that insurers in California have determined that there are too few people like you to make a business case. They have decided that your business isn't worth to them. That's business. That isn't Obamacare. Insurers in other states, under the same Obamacare, have made different decisions and offer wider networks. That's what you have to live with under a private insurance system, same as always.
posted by JackFlash at 5:21 PM on January 9, 2014
That's extremely fine hair splitting. If they offered the wide network plans last year but do not offer them this year as it no longer makes business sense to do so because of the changes from Obamacare, it can reasonably be said to be a result of Obamacare.
posted by Justinian at 5:24 PM on January 9, 2014
posted by Justinian at 5:24 PM on January 9, 2014
From your description of the very high deductible coverage you want, it isn't clear why you even care about the size of the network. With a high deductible plan you are essentially self-insuring for everything except a catastrophic event. Since you are paying out of your own pocket, you can go to any doctor you want.
posted by JackFlash at 5:36 PM on January 9, 2014 [1 favorite]
posted by JackFlash at 5:36 PM on January 9, 2014 [1 favorite]
Because what I care about is primarily the hospital and facility network, not the physician network. I'm actually doing exactly what you suggest and seeing whatever doctor I want, in network or out of network. But that doesn't work if I need surgery, or imaging, or to be admitted to a hospital. That's far too expensive to pay out of pocket. So the hospital and medical facilities network is very important and much more limited than the physician network. None of my local hospitals are covered.
posted by Justinian at 8:45 PM on January 9, 2014
posted by Justinian at 8:45 PM on January 9, 2014
You're a tough case. I guess you'll just have to wait until next year and hope for better. I expect both the insurance companies and providers to make a lot of adjustments in reaction to their experiences in how things shake out the first year. Both the insurers and the providers are going to have to give some on costs.
posted by JackFlash at 11:07 PM on January 9, 2014
posted by JackFlash at 11:07 PM on January 9, 2014
Jon Chait, NYMag: The Death of the Death of Obamacare
The arguments McArdle and Gottlieb made last night bore little resemblance to the sorts of failure predictions that were widely circulating last November. Many of their arguments simply took issue with the law’s goals; they argued that Medicaid does not make people healthier, that healthy people ought to be able to enjoy the financial benefits of being skimmed out of the insurance pool, and that politicians will reverse all the mechanisms needed to finance the law. In other words, they argued that the law was doomed for the reasons opponents had argued it was doomed in 2010, or for reasons a conservative could offer to suggest Medicare and Social Security are also doomed.TPM: Even Worse Than We Thought
Fascinating email from TPM Reader DW about the sheer level of attempted sabotage down at the ground level in GOP-run Obamacare rejectionist states.posted by the man of twists and turns at 12:33 PM on January 21, 2014
Hate Obama, Love Obamacare
The Recchis now know all that, and they're fully insured for 2014. But it took a while. When we spoke in October and Stephanie told me she didn't "think Obamacare will help us," I suggested that she might be mistaken and that if she was unable to get information from the then sputtering website she should consult an insurance broker. (Insurers pay the brokers' fees, not consumers.)posted by the man of twists and turns at 1:36 PM on January 23, 2014
"When they came to my office, Stephanie told me right up front, 'I don't want any part of Obamacare,' " recalls health-insurance agent Barry Cohen. "These were clearly people who don't like the President. So I kind of let that slide and just asked them for basic information and told them we would go on the Ohio exchange"--which is actually the Ohio section of the federal Obamacare exchange--"and show them what's available."
What Stephanie soon discovered, she told me in mid-November, "was a godsend." The business that she and her husband had launched--which sells a product that enables consumers to store their DNA or that of family members for future genetic testing--had recently received investor interest after being featured on an episode of the television series CSI. So she estimated to Cohen that their income would be about $90,000 in 2014. But even at that level, her family of four would qualify for a subsidy under Obamacare.
Millions Are Now Realizing They're Too Poor For Obamacare
posted by homunculus at 6:59 PM on January 31, 2014
posted by homunculus at 6:59 PM on January 31, 2014
Millions Are Now Realizing They're Too Poor For Obamacare
Yep.
For months, the Governor of Iowa (R) has been proclaiming he was expanding Medicaid, breaking with other Republicans as described in that article. But it turned out to be a way to cut back Medicaid. Typical Republican doublespeak.
Iowa offered Medicaid to anyone earning less than 133% of the Federal Poverty Level (FPL). For the "near poor," anyone from 134% to 200%, they offered IowaCare. Under about 150% of FPL the coverage was free, for higher incomes a nominal insurance premium was charged.
But Governor Brandstad (R) completely eliminated the IowaCare program, ending coverage for 75,000 Iowans in the 134-200% bracket. Those people that lost their insurance, now have to go to the Federal Marketplace. I am one of them.
Months ago, I received a letter informing me IowaCare would end on Jan 1. Then another letter saying they'd extend it to Jan 31 since they hadn't decided eligibility levels. I heard eligibility numbers from 133% up to 166% under Expanded Medicaid.
Nope, they kept the existing Medicaid coverage at 133%, just as it always was. No expansion whatsoever.
IN 2013, I earned 139% of the FPL. This makes me ineligible for Medicare. However, I am seasonally employed, for the last 2 months I earned about 60% of the FPL. I had to show the DHS my December pay stubs. There was only one, for $600. But that stub had my YTD of $16,000. Even though the decision is based on your last month's income, projected forward, they decided to use my annual income. Even though I am still now well below the poverty line, will stay under the line for months (even while I am employed) and have no real hope of earning as much this year as last, I am ineligible. I am appealing the decision.
Now I have to go out on the Federal Marketplace. Just to ad further insult to injury, in order to buy insurance on the marketplace starting Feb 1, when IowaCare ends, I had to sign up by Jan 15. They denied me on Jan 20. Now I have absolutely no way to get health insurance for February. I have about 2 weeks of prescription drugs and I will have to ration them until March, maybe long into March.
According to the State, I earned about $700 too much to get Medicare. Now on the Marketplace, I get a tax credit I can apply towards insurance premiums. But even a low end Bronze plan will cost me more than $700 annually, beyond the tax credit. I should not have worked those $800 worth of overtime hours in the 4Q 2013.
I am in the crack in the program. Not poor enough for Medicaid. Too poor for ACA insurance. The $700 extra money I earned to get above the poverty level, will be more than taken away by new insurance premiums. The new system makes the poor stay poor. The old IowaCare program was designed to help the poor get out of poverty, and stay healthy enough to work. It was created by a Democratic governor, Tom Vilsack, who is now Obama's Secretary of Agriculture.
This is petty Republican backstabbing. Back in the late 1990s, Brandstad (R) was defeated by Tom Vilsack (D) in the race for Governor. Vilsack implemented IowaCare and other broad social welfare programs. But after Vilsack moved on to Federal political office, Brandstad (R) ran for election and won. And he has been tearing down all the social welfare programs Vilsack started.
posted by charlie don't surf at 10:03 PM on January 31, 2014
Yep.
For months, the Governor of Iowa (R) has been proclaiming he was expanding Medicaid, breaking with other Republicans as described in that article. But it turned out to be a way to cut back Medicaid. Typical Republican doublespeak.
Iowa offered Medicaid to anyone earning less than 133% of the Federal Poverty Level (FPL). For the "near poor," anyone from 134% to 200%, they offered IowaCare. Under about 150% of FPL the coverage was free, for higher incomes a nominal insurance premium was charged.
But Governor Brandstad (R) completely eliminated the IowaCare program, ending coverage for 75,000 Iowans in the 134-200% bracket. Those people that lost their insurance, now have to go to the Federal Marketplace. I am one of them.
Months ago, I received a letter informing me IowaCare would end on Jan 1. Then another letter saying they'd extend it to Jan 31 since they hadn't decided eligibility levels. I heard eligibility numbers from 133% up to 166% under Expanded Medicaid.
Nope, they kept the existing Medicaid coverage at 133%, just as it always was. No expansion whatsoever.
IN 2013, I earned 139% of the FPL. This makes me ineligible for Medicare. However, I am seasonally employed, for the last 2 months I earned about 60% of the FPL. I had to show the DHS my December pay stubs. There was only one, for $600. But that stub had my YTD of $16,000. Even though the decision is based on your last month's income, projected forward, they decided to use my annual income. Even though I am still now well below the poverty line, will stay under the line for months (even while I am employed) and have no real hope of earning as much this year as last, I am ineligible. I am appealing the decision.
Now I have to go out on the Federal Marketplace. Just to ad further insult to injury, in order to buy insurance on the marketplace starting Feb 1, when IowaCare ends, I had to sign up by Jan 15. They denied me on Jan 20. Now I have absolutely no way to get health insurance for February. I have about 2 weeks of prescription drugs and I will have to ration them until March, maybe long into March.
According to the State, I earned about $700 too much to get Medicare. Now on the Marketplace, I get a tax credit I can apply towards insurance premiums. But even a low end Bronze plan will cost me more than $700 annually, beyond the tax credit. I should not have worked those $800 worth of overtime hours in the 4Q 2013.
I am in the crack in the program. Not poor enough for Medicaid. Too poor for ACA insurance. The $700 extra money I earned to get above the poverty level, will be more than taken away by new insurance premiums. The new system makes the poor stay poor. The old IowaCare program was designed to help the poor get out of poverty, and stay healthy enough to work. It was created by a Democratic governor, Tom Vilsack, who is now Obama's Secretary of Agriculture.
This is petty Republican backstabbing. Back in the late 1990s, Brandstad (R) was defeated by Tom Vilsack (D) in the race for Governor. Vilsack implemented IowaCare and other broad social welfare programs. But after Vilsack moved on to Federal political office, Brandstad (R) ran for election and won. And he has been tearing down all the social welfare programs Vilsack started.
posted by charlie don't surf at 10:03 PM on January 31, 2014
It's called the "wingnut hole". More here and here.
posted by zombieflanders at 6:17 AM on February 1, 2014
posted by zombieflanders at 6:17 AM on February 1, 2014
charlie don't surf, that's terrible. I hope your appeal works.
I posted that link in the new ACA thread, if you guys want to add your 2 cents there.
posted by homunculus at 12:05 AM on February 4, 2014
I posted that link in the new ACA thread, if you guys want to add your 2 cents there.
posted by homunculus at 12:05 AM on February 4, 2014
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But... not in America.... right guys?
posted by entropone at 7:18 PM on January 7, 2014 [6 favorites]