Will technology accomplish what the GOP could not?

[hobbsyoyo]

Hobbs - Awesome. Glad to hear it. I know you'd been concerned about the issue for months. With that said, I'll comment on a few of your experiences.

Yeah, the anticipated cost was really bugging me. It wound up being a bit less than I feared, with a bit better coverage than I feared, so it worked out.

I believe my way back first impression that you would receive subsidies in the form of a tax credit turned out to be incorrect. People will get subsidized in their actual bill.

Actually, they give you the option to either receive the subsidy monthly or get it as a tax credit. I chose to take the subsidy monthly because my wife has a contract that won't change and as a student, I'm not making any income, so our income should remain relatively stable. As I'm writing this though, I forgot to factor in her yearly raise. Oh well, I got a lot back in taxes this year so next year even if I have to pay back some of the subsidy, it won't really change much.

With that said, let me tell you why, IMO, that was a political ploy but not a good one. It was a political ploy because everyone's happier that way! Everyone would prefer a smaller upfront bill rather than a tax credit, right? But, but... how do we know what your income is going to be for the rest of the year?

If you wind up with a much higher paying job for the last 6 months of the year, you should probably get a lower subsidy, right? If someone with a high paying job right now gets laid off, they should get a bigger subsidy than what the website would calculate right now, yes?

So, the easiest (not saying better, just easiest) way is to true it up when you pay your taxes. Take your whole year into account. Not your fluctuating income. Then determine your subsidy. I'm actually glad it worked it out this way. It's just not the best way to calculate the subsidy, mathematically speaking. And us mathematicians are hard-assed by-the-numbers peoples. Not known for our empathy, us mathbots. But I'm glad that empathy won out in this case.

They do ask you to take your whole year into account if you opt for the subsidy up-front and they also warn you that if your income changes, you may have to pay back some of the subsidy. I'm guessing if your income went down, they'd give you a bigger tax refund as well. But I can imagine a lot of people will under/over estimate their income and have to make some sort of adjustment, which may be unpleasant. However, by that point, you're doing your taxes and should be prepared for a potential bill, so the pain of having to pay back some subsidy at tax time may be less stressful than the prospect of paying higher upfront monthly premiums to most people. That's just a guess based on how stupid I estimate most people to be.

That's good to hear, but honestly, I hate that you were surprised by this. Everyone's doctor is still in network from the plans they were shopping before all this. The same drugs are covered.

Well, I didn't have any coverage before and I didn't have a doctor either, so I had no idea which plans that are offered allow you to see which doctors. So I checked each plan I looked at just to be sure because I didn't want to be buy a plan that I can only ever use if I drove 2 hours or something to see the one doctor near me in their network. Just trying to be a good consumer and all that.

What are we, stupid? Of course we (the insurance companies) designed the plans that we chose to offer on The Exchange to reflect the same plans we are currently offering pre-Exchange. Same doctors as our current plans. Same drugs. We're businesses. Our competitors are also on The Exchange! What kind of idiots would we be to design an Exchange Plan that didn't have the same doctors as the plans you could sign up for right now, off The Exchange? This is a big artificial issue with a giant DUH sign on it.

Here's the thing though - having a single exchange and all of that information at your fingertips is such an amazing powerful tool for consumers. Regardless of what people thing the government's role in healthcare should be, I would hope even diehard libertards can see the enormous benefit that this level of transparency brings to individuals. You say that's it's a no-brainer to offer the same doctors/plans on the exchange as off the exchange, but without the exchange, consumers have no real easy way to check that. It's daunting (to say the least, and as a practical reality all but impossible) to go out and check every single plan offered by every single provider for things like coverage/doctor networks/RX benefits and so on. It just can't be done easily with all the options and confusing individual company websites out there. But with the exchange, *bam* it's right there in your face and you can select multiple plans can compare them against one another on the same page. Then you can dig deeper if you want and get all the nitty-gritty details from links on that page that take you to the info on the providers page. But it's not even necessary to do that, I just wanted to cover all my bases. Just about everything you really need is right there on the exchange.

It's freaking amazing. I know it's weird to be this hyped up about health insurance but it's a BIG DEAL.

Outside of HSA plans (which 1] I can go explain if anyone wants & 2] is what I have), most plans above Copper should have visits to your doctor & most prescriptions as a copay. The level varies, of course, but what you found *should* be the norm.

What is an HSA plan?

Also, at least in my area, about half of the Bronze plans (the lowest cost ones) had no copays for anything - you pay 100% out of pocket until you hit the deductible limit. The other half did have copays, but they were absurdly high IIRC. The plan I found was the only Bronze level plan I found with anything reasonable. It costs as much as low-cost Silver plans, but had much better benefits as far as copays for doctor visits and RX's go. In fact, it wasn't until you go to the mid-level Silver plans ($350/mo and up) that the benefits really started to equal the plan I found, so I got lucky.*

*having said that I realize that those other plans may have offered other benefits that my plan doesn't (I didn't even look at their details because I can't afford them) but for the things I care about (doctor visits and RX's), my plan was at least as good as those other Silver plans

The rest of your post I'll let stand on its own. It's really a win-win*. Us insurance companies love it - more members! - but it's much better coverage for many people. Or even "good coverage for people who had none". And it doesn't affect the vast majority of people who already had coverage through their employer!

Speaking of which - are employer plans allowed to 'grandfather' their plans or anything? My wife's insurance at her old job gave her an RX that the ACA mandated be made free, but when she changed jobs, her new insurer started making her pay for it again. I don't know why because I know for a fact the law says it should be free.

So, the uninsured get health insurance. People with health insurance get better, cheaper coverage. Also, we drink all your milkshakes! More like *win-win-win IMO.

NO IT'S NOT WIN WIN IT'S MORE LIKE OBAMA DESTROYED AMERICA


One other question:

You said something like a total of 26 million people got insurance through Medicare expansions/Medicaid, the Exchange and so on. So are those 26 million who didn't have insurance at all before the law? Because I know the country had like 52 million without insurance, so if I'm reading you right, the law helped ~half of those people get insurance already?

 

[RobAnybody]

Actually, they give you the option to either receive the subsidy monthly or get it as a tax credit.

I did not know that. Just pointing that out.

They do ask you to take your whole year into account if you opt for the subsidy up-front and they also warn you that if your income changes, you may have to pay back some of the subsidy. I'm guessing if your income went down, they'd give you a bigger tax refund as well. But I can imagine a lot of people will under/over estimate their income and have to make some sort of adjustment, which may be unpleasant.

Eh, I guess that factors into my "mathematically best way" to calculate it. It's like if you tell your employer to withhold "too much" you get a refund, "too little" you wind up writing a check to the IRS, either way it winds up the same, more or less. Probably always better off writing a check, but people always seem to prefer getting a refund.

Well, I didn't have any coverage before and I didn't have a doctor either, so I had no idea which plans that are offered allow you to see which doctors. So I checked each plan I looked at just to be sure because I didn't want to be buy a plan that I can only ever use if I drove 2 hours or something to see the one doctor near me in their network. Just trying to be a good consumer and all that.

That's a good point I don't always take into account. I tend to look at it from the previously-insured point of view. Just a bias from my profession, no doubt, 'cause that's all the people we ever interact with, but it does ignore the people who have no insurance & who they'd been seeing before, if anyone at all.

Here's the thing though - having a single exchange and all of that information at your fingertips is such an amazing powerful tool for consumers. [cut the rest for brevity, not content]

That's something we (us insurance companies) never get. That's very well put. This:

It's freaking amazing. I know it's weird to be this hyped up about health insurance but it's a BIG DEAL.

That's something we only "get" in the abstract. Even when I explain what The Exchange is to people IRL or even on a website, I can't truly comprehend, because I (as you might imagine) get health insurance from my job. Anyway, that part is great to hear. People *should* be able to shop like that. If the ACA did literally nothing else, that's awesome.

What is an HSA plan?

First things first, there are HSA plans on The Exchange (at least here in North Carolina). A Health Savings Account (HSA) is a high-deductible-plan. As in, you guessed it, a policy with a high deductible. Generally speaking, it has no copays, for doctors visits, or prescriptions, or anything. Sounds bad, but...

It let's you put pre-tax dollars into an Account which can be used for medical expenses. Better yet, it lets your employer put money into that Account for you. My employer puts $1000/year into my account.

Now, back to the downsides, it means if I go to the doctor & the doctor charges me $157.48 for my checkup, I have to pay $157.48 instead of a $15 copay.

But, back to the good side, it comes out of my HSA (*ahem* - Health Savings Account). Which I may have been (pre-tax) funding &/or my employer may have been putting money into for years.

Down side: if I have to pay a $87.58 prescription, I pay $87.58 out of my HSA.

Back to the good side - my premium is probably $100 lower per month than a typical copay plan most people have. I don't have copays. I pay the FULL amount for my doctors visits of prescriptions. But every year I pay a lower amount in premium AND my employer gives me $1000 to put in my "when I get really sick" fund.

Ideally, I pay more to visit the doctor or fill a prescription, but I make it up in lower premiums & have this "fund" I've been accumulating for several years to pay for stuff. Particularly if I ever get hospitalized. I can use my fund to pay off my higher-than-normal deductible.

It's good for people who have extremely low medical costs (like, maybe 1 checkup per year) or extremely high medical costs (so they're always gonna hit their deductible, so that extra $1000 plus lower premiums are a good idea). I'm a low cost person, so I've accumulated several thousand $ in my account for when I break all limbs skydiving, or get an especially virulent STD from that hooker in Vegas, for example.

(I'm kidding on both accounts) If you have further questions or I didn't explain it well, just ask for clarification.

Also, at least in my area, about half of the Bronze plans (the lowest cost ones) had no copays for anything - you pay 100% out of pocket until you hit the deductible limit.

Those sound like HSA plans. High deductibles, no copays. Cheap. You can put pre-tax $ into a fund. Not saying 100%, just that they sound like them.

The other half did have copays, but they were absurdly high IIRC. The plan I found was the only Bronze level plan I found with anything reasonable.

There should be a good mix, where you find what you want. Eventually. I can only realistically speak to plans in NC, so most of what I say about specific plans should be taken with a giant grain of salt.

Speaking of which - are employer plans allowed to 'grandfather' their plans or anything? My wife's insurance at her old job gave her an RX that the ACA mandated be made free, but when she changed jobs, her new insurer started making her pay for it again. I don't know why because I know for a fact the law says it should be free.

This is opening a can of worms that could be worth a whole 'nother wall-of-text post, but I'll take a stab at it.

Oh, who am I kidding? This is gonna be a wall-of-text. This is already a wall-of-text.

Officially, Grandfathered (GF for short) plans are ones that were in effect pre-ACA (passed 3/10). What Obama meant, & what we have been required to enforce, is that "any plan you were on pre-ACA passing, you can keep". Those are GF plans. We have a poop-ton of individuals & groups that are on GF plans. We have to keep allowing their same plans they were on pre-ACA.

Because of the whole "he lied!" debacle from people who didn't understand that (& granted it was phrased poorly), Obama declared this past fall that ANYONE could keep the plan they were on as of 12/31/13. That wasn't the original intent. That wasn't what we, who understood the original intent, planned for. But By God we had to adapt to it. That was a nightmare, let me tell you. It was a good political ploy, because it suddenly made us the bad guys if we said you can't keep your plan, when we'd just been planning for that all along (again, excepting anyone who kept their pre-3/10 plan - we planned for that).

With that all out of the way (see? I'm wall-of-texting again, sorry), there are parts of the ACA that say all our non-GF plans have to cover certain prescriptions for free, notably women's contraceptives. No doubt your wife's prescriptions were now free under the ACA, but not all prescriptions were (that's not a thing, for anyone). The whole chicks-gotta-pay-for-being-sluts thing is a big Republican turn-out-the-base issue. They don't really care that contraceptives are used for many reasons. I admit I'm assuming what prescription you're talking about, but that's literally the only prescription that the ACA makes insurance cover that they didn't have to before. If it's something else, I apologize for assuming that, but the ACA didn't mandate any other drugs be covered.

tl;dr on that: she's either gonna have to work for a different company or else get her friends to vote Dem so it's not an issue (sorry to trivialize it, & if my assumption was way off-base, I apologize, the rest of the above stands)

One other question:

You said something like a total of 26 million people got insurance through Medicare expansions/Medicaid, the Exchange and so on. So are those 26 million who didn't have insurance at all before the law? Because I know the country had like 52 million without insurance, so if I'm reading you right, the law helped ~half of those people get insurance already?

Those don't sound like statistics I've said. I'd put it more like 10 million, & with even that said, some of those had insurance before, just that they probably have cheaper &/or better insurance than they had. I don't think I've ever said 26 million, in either category. We'd love to have 26 million more people buying our product, but that's an inflated number of milkshakes we're drinking, I think.

 

[hobbsyoyo]

Thanks for the clarification. Yeah I was talking about birth control. So I guess her new employer had an old plan that didn't cover it, and that got granfathered in, eh? So that will never change so long as they don't change their plan? The law will never compel them to cover birth control, even though it kind of does?


Also, on the '26' million thing...my bad, it was something Antilogic wrote. Specifically:

According to Gaba's website, the final number of enrollments (accounting for the signups through the website, Medicaid, students on parents' plans, etc.) is between 14.6 and 22 million people. The CBO originally projected 7 million would enroll through the website, but reduced that to 6 million after the buggy launch. Turns out the original projection was met.

So am I reading this right that possibly 22 million people out of 52 or so million people that didn't have insurance now have it thanks to Obamacare?

 

[Commodore]

So am I reading this right that possibly 22 million people out of 52 or so million people that didn't have insurance now have it thanks to Obamacare?

No that is not what that means. It just means that 22 million people total signed up. It does not however, state how many of those 22 million were forced to give up their previous health plan because it was deemed "not good enough" by the ACA and had to sign up to get a different plan.

I remember seeing somewhere (I'll try to find the source again later today) that of the 7.1 million that signed up through the site, only about 900,000 of those never had insurance before. If true, that doesn't seem like much of a victory for the ACA.

 

[JollyRoger]

I remember seeing somewhere (I'll try to find the source again later today) that of the 7.1 million that signed up through the site, only about 900,000 of those never had insurance before. If true, that doesn't seem like much of a victory for the ACA.

You would want to consider some who had insurance before but lost it for various reasons (change in health condition, loss of job) and those that got freedom from their job (were able to quit) because they now had insurance to turn to when they left their job.

 

[peter grimes]

Thanks for the clarification. Yeah I was talking about birth control. So I guess her new employer had an old plan that didn't cover it, and that got granfathered in, eh? So that will never change so long as they don't change their plan? The law will never compel them to cover birth control, even though it kind of does??

And right here, ladies and gentlemen, is the essential problem. This non-radically conservative poster has completely adopted the moral majority's propaganda. He's calling it "birth control", which is astoundingly inaccurate. [ for an engineer!]

Those pills should more correctly be called Abortion Prevention Pills. That's really their effect after all. An APP by any other name...

Who's with me on this? Reframe the dialogue, the message is the medium, etc and so on.

 

[RobAnybody]

Thanks for the clarification. Yeah I was talking about birth control. So I guess her new employer had an old plan that didn't cover it, and that got granfathered in, eh? So that will never change so long as they don't change their plan? The law will never compel them to cover birth control, even though it kind of does?

That's correct. A group that is Grandfathered will... (probably, I ain't saying 100%) ...will always be Grandfathered. They can keep their plan forever. "You can keep your plan. You can keep your doctor." That's what it actually meant.

And new employees are only given that plan that their employer offers. That's exactly what that meant. OTOH, there's really not a lot of companies that have chosen to keep the exact same plan they had pre 3/10. But, obviously, there are some.

So am I reading this right that possibly 22 million people out of 52 or so million people that didn't have insurance now have it thanks to Obamacare?

Oh, gosh, no. That's not the right way to interpret it. That's way, way, waaaaay, overstating it. I'd be very curious as to where that number came from - can you link me to it? I'd like to see where they got their numbers. (I'll get to the "right" number in a few paragraphs, bear with me)

On the other hand...

I remember seeing somewhere (I'll try to find the source again later today) that of the 7.1 million that signed up through the site, only about 900,000 of those never had insurance before. If true, that doesn't seem like much of a victory for the ACA.

...this is entirely wrong. This is way, way, waaaay, understating it. I think Commodore may have been Manchurian Candidated. Anyway, bolding mine. Commie, you should probably try to find that source. Can you link me to it? I'd like to see where they got their numbers.


The real number of previously uninsured who now have coverage is 9.5 million. 9.5 million (page down a couple times to the Reality section). Give or take a hundred thousand, I'll wager. Granted that's counting expanded Medicaid people + Exchance people + kids that can now get coverage 'til 26 who weren't able to before*.

The ultra-high number is just as wrong as the ultra-low number. The ultra-low number is just the usual Fox lie, more or less. But the ultra-high number counts ALL kids who are covered 'til age 26* & all potential new Medicaid people. For example...

Some states expanded Medicaid. Many (Republican states) didn't. Here's a map of the states that did & didn't (about a week out of date, but I can't imagine it's changed a whole lot). If every state chose to expand Medicaid (**!!!! I'm gonna get to why this is a dumb decision not to), then 15.1 million people would get health insurance who don't have it, &, like, we (insurance companies) don't even get their premiums. So I got no skin in this game, even! Just the facts, ma'am.

*Also, that way up above inflated number takes ALL "kids covered 'til 26 thing into account" But our company, as an example, already had that provision. We already covered kids 19-26. No new kids were added to our count due of that rule, because we already did it. Many other companies did as well. Some didn't, sure. So you have to take into account ONLY the new ones. That 9.5 million number takes that into account. The inflated number takes ALL 19-26 kids on their parent's plan into account.

**!!! It's dumb for any state not to expand Medicaid because the Feds pick up 100% of the cost through (& including) 2016. The states have to pay a whopping 10% come 2017. Source. If all states expanded Medicaid, it'd provide... "health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some — and in a number of states, possibly all or more than all — of the modest increase in state Medicaid costs. Expanding Medicaid is thus a very favorable financial deal for states." (from my source)

But, as you can see from the map above, all states did not do this. Some shot themselves in the foot out of spite, including my state.