US politics 2016: I can see Russia from my White House

[felice]

7 minutes ago, IamMe90 said:

The ACA needs to be fixed, absolutely, but dismantled?

If it can be replaced by single-payer, certainly; the whole health insurance industry is just insane. But somehow I doubt that's going to happen under Trump.

[TerraPrime]

1 hour ago, Rhom said:

Every possible replacement plan I have seen allows for continuity of coverage.  Basically, as long as you don't have any lapses in coverage you are fine.

Which is how it always was before the ACA.

So, the only draw back here is that she won't have access to a doctor whom she trusts and who is known to be able to help her.

 

Is there any indication that no other doctors, ever, can do this for her?

[Rhom]

Just now, IamMe90 said:

It's not even a temporary option for me and others, really.

As far as your situation, that sounds shitty, although it's hard for me to know exactly what wrong with her previous health plan through the exchange from your vague description.I have a preexisting condition (type 1 diabetes) which necessitates a lot of costly regular prescriptions, and I've just gotten off my mother's plan, as I turned 26 this year. I've gotten on a plan through the exchange with a $314 monthly premium and a $1,200 deductible with no prescription drug deductible, and while believe me, it's not by any stretch an ideal situation, it's certainly more affordable than COBRA. On the other hand, there's a good chance I wouldn't be able to find insurance period if they ACA weren't passed, because of my diabetes; I make too much money between my two part time jobs to qualify for Medicaid.

The ACA needs to be fixed, absolutely, but dismantled? If I weren't pretty much guaranteed to be landing a full time position at the law firm for which I currently work in half a year, I'd be terrified. Thankfully, I'll be able to stay on this plan for at least the six months' down time.                                                                                      

The plans on the exchange were also readily available to individual customers off the exchange.  The only benefit to the exchange was to qualify for tax exemptions and to have one place to compare products.  Our household income pushed us out of any sort of assistance category.  The exchange began requesting income verifications almost non-stop.  As I say, I was not on the plan.  Kynect began requesting proof of MY income and wanted full tax documents from my office.  That was more information than we were prepared to give up.  When transitioning to the exact same plan off the exchange but dealing directly through Anthem, it was an even worse nightmare.  Kynect sent our payment to Anthem but provided an incorrect cancellation date.  So the payment sat in Anthem's account not being applied while her insurance was cancelled retroactively based on Kynect's mistake.  Could have been over a thousand dollars in unpaid medical bills if left unresolved. That became a huge problem in and of itself that required the intervention of our state representative to eventually correct.

As a comparison to your plan, I'm 38 and on the aforementioned plan that was grandfathered in.  This year I paid $140/mo with a $3,500 deductible.  Next year, the deductible stays the same but the plan jumps to $200.  As I say, cheap in the scheme of things for someone approaching middle age like myself.  The two of them will be paying just shy of $500/mo with a $3,500 deductible, but without access to multiple doctors she has seen for years.  The only one she considers to be irreplaceable is the rheumatologist. 

The Tier 4 drug she is on for the JRA is a whole other mess.  This plan will only pay 40% after the pharmacy deductible is met.  The drug costs near $1,000 per month.  Now here's where things in the private sector get sketchy though... the manufacturer offers a payment assistance program which we have been on.  It was never vitally necessary previously, so we didn't pay close attention to the particulars.  Turns out, the only two qualifications for the assistance program is 1) Be a US citizen and 2) Have a commercial insurance plan (ie Don't be on Medicaid or Medicare.)  The drug now will cost us nothing out of pocket.  Moral of that story is that the only people paying full price for the drug are recipients of government aid. 

[Rhom]

7 minutes ago, Mexal said:

The issues with the ACA are long because an imperfect law was passed to get people health insurance. But instead of fixing the issue, Congress tried to repeal the entire law 55 times with no plan to replace. So yea, I get your point and agree with you that the lack of choice is a massive issue with the ACA right now and lots of people are being screwed by the ACA, especially small businesses. I think the blame lies less with ACA itself and more with Congress for ignoring them.

I agree with this. 

I just don't see how anyone can say that any system that leads to a situation where one private company has a monopoly on the market is a good thing.

6 minutes ago, TerraPrime said:

So, the only draw back here is that she won't have access to a doctor whom she trusts and who is known to be able to help her.

 

Is there any indication that no other doctors, ever, can do this for her?

The drawback is the lack of choice.  There are hundreds of insurance companies contracted to do business in the State of Kentucky.  And only one is offering a plan?  There's something wrong with that.

Can she find someone else?  Perhaps, but in her experience its never been an easy thing to do.

[aceluby]

Since we're discussing the ACA, let's not forget that it is mainly a list of guidelines states and insurers are supposed to follow.  Since the vast majority of states have some sort of major Republican representation, and Republicans have made it their priority that the ACA needs to fail because Obama passed it, it's not surprising to me that it's not working that well.

The ironic part is that despite this, Republicans are now tasked at fixing it, but have no idea how.....   It probably would have been easier to try and make it work from the get-go and make smaller course corrections along the way.  Now they've dug themselves a hole and I hope that they actually pay for it in the upcoming elections.  

[Dr. Pepper]

11 minutes ago, felice said:

If it can be replaced by single-payer, certainly; the whole health insurance industry is just insane. But somehow I doubt that's going to happen under Trump.

The wealthy poster seems he would still have a problem with it seeing as his only complaint is lack of choice.  

[Rhom]

4 minutes ago, Dr. Pepper said:

The wealthy poster seems he would still have a problem with it seeing as his only complaint is lack of choice.  

Wealthy poster.  Yeap.  That's me.

Look, I won't apologize for doing well.  But I'm firmly entrenched in the middle class.  Come sit at my desk and write a payroll check.  Watch yourself pay 50% in taxes.  Yes.  I'm not exaggerating.  My personal income this year will be just shy of $100K.  For me to take home a check for $5,000; my office sets aside $10,000.  Five goes to me, five to the government.

My "only" complaint being a lack of choice is a huge deal.  In an environment where it was economically feasible for Cigna, Aetna, Humana, or any number of other insurers to provide a policy option for us, do I think we could get a PPO option to keep her doctor?  Absolutely.  Do I also think the premiums would be less?  Probably.

[Swordfish]

Just now, Rhom said:

Wealthy poster.  Yeap.  That's me.

Look, I won't apologize for doing well.  But I'm firmly entrenched in the middle class.  Come sit at my desk and write a payroll check.  Watch yourself pay 50% in taxes.  Yes.  I'm not exaggerating.  My personal income this year will be just shy of $100K.  For me to take home a check for $5,000; my office sets aside $10,000.  Five goes to me, five to the government.

My "only" complaint being a lack of choice is a huge deal.  In an environment where it was economically feasible for Cigna, Aetna, Humana, or any number of other insurers to provide a policy option for us, do I think we could get a PPO option to keep her doctor?  Absolutely.  Do I also think the premiums would be less?  Probably.

You will never get some people to acknowledge that the ACA did not make life immediately better for everyone, or that if not for the fucking republicans, all the 'minor' issues would have been resolved by now.

It was a fundamentally flawed bill from the start, but a lot of members of this board are 100% committed to the idea that it has only passing minor flaws, and those only really apply to a statistically insignificant fraction rich people, so who cares.

It was the 'right' thing, and therefor you are not supposed to complain about it, even if it has significantly negatively impacted you.

Fear not though, because all that;s really needed to completely fix it is to move to an even larger government entitlement program.

I mean, it's obvious.

 

[Dr. Pepper]

11 minutes ago, Rhom said:

Wealthy poster.  Yeap.  That's me.

Look, I won't apologize for doing well.  But I'm firmly entrenched in the middle class.  Come sit at my desk and write a payroll check.  Watch yourself pay 50% in taxes.  Yes.  I'm not exaggerating.  My personal income this year will be just shy of $100K.  For me to take home a check for $5,000; my office sets aside $10,000.  Five goes to me, five to the government.

My "only" complaint being a lack of choice is a huge deal.  In an environment where it was economically feasible for Cigna, Aetna, Humana, or any number of other insurers to provide a policy option for us, do I think we could get a PPO option to keep her doctor?  Absolutely.  Do I also think the premiums would be less?  Probably.

I didn't ask you to apologize for being wealthy.  I simply have no shits to give that you are no longer getting everything you want.  Hypocritical?  Maybe.

The reasons all of those insurers could operate is because they could prevent millions of people from access.   People like your wife, except your wealth means you weren't prevented because you can pay whatever premium they give you.  I have no shits to give for someone complaining about lack of choice when the reality for millions has been no choice at all and no choice at all will soon be the reality for those millions.  

 

[Frog Eater]

2 minutes ago, Swordfish said:

You will never get some people to acknowledge that the ACA did not make life immediately better for everyone, or that if not for the fucking republicans, all the 'minor' issues would have been resolved by now.

It was a fundamentally flawed bill from the start, but a lot of members of this board are 100% committed to the idea that it has only passing minor flaws, and those only really apply to a statistically insignificant fraction rich people, so who cares.

It was the 'right' thing, and therefor you are not supposed to complain about it, even if it has significantly negatively impacted you.

Fear not though, because all that;s really needed to completely fix it is to move to an even larger government entitlement program.

I mean, it's obvious.

 

I have a client with a few hundred employees. Before the ACA they provided a poor health plan to their employees at a cost to the employer of around $1,000,000. After the ACA, they could not afford to offer an ACA compliant policy to their employees, and so now accrue $1,000,000 in penalties every year and offer no health care policy to their employees. Sure, their employees are now eligible to go on the federal marketplace and purchase a policy, maybe even qualify for a subsidy, but I would argue they were better off before the ACA. Most of their employees have no health care policy at all now. 

[Rhom]

3 minutes ago, Swordfish said:

You will never get some people to acknowledge that the ACA did not make life immediately better for everyone, or that if not for the fucking republicans, all the 'minor' issues would have been resolved by now.

It was a fundamentally flawed bill from the start, but a lot of members of this board are 100% committed to the idea that it has only passing minor flaws, and those only really apply to a statistically insignificant fraction rich people, so who cares.

It was the 'right' thing, and therefor you are not supposed to complain about it, even if it has significantly negatively impacted you.

Fear not though, because all that;s really needed to completely fix it is to move to an even larger government entitlement program.

I mean, it's obvious.

 

Naturally. 

As a healthcare provider as well, I see it on the other side of the equation too.  Not just what my family pays out for coverage, but what my patients really see.  My income has remained mostly flat for the past five years despite seeing nearly 30% more patient volume.  I still take my deposits to the bank personally every Monday.  That deposit is mostly checks from insurance companies with a handful of personal checks from patients and a little bit of cash.  In the last half decade, the deposit every week that I take has declined by close to 40%.  The overall deposit for the week however has remained flat because of a huge spike in credit card payments.

What that equates to is that patients are increasingly paying more and more out of pocket.  The price of an average co-payment at my office is now roughly the same as a cash visit.  Does make it much easier to have conversations on continuing care after coverage has expired, but has been detrimental to my patients.

[Tywin et al.]

2 hours ago, Rhom said:

I know that this thread mainly bashes Republicans, but I will say that for me... the dismantling of the Affordable Care Act cannot come fast enough.

The ACA is flawed, but I don't know if you should be too giddy about dismantling it:

http://www.salon.com/2016/12/06/paul-ryans-repeal-promise-nobody-will-be-worse-off-during-obamacare-transition/

Either way, as someone who works on the financial side of a hospital, I think it's unavoidable that health care costs will continue to spike over the course of the next decade.

(p.s. If your wife wants good, affordable healthcare insurance, tell her to get a job at a hospital)

[Rhom]

7 minutes ago, Tywin et al. said:

The ACA is flawed, but I don't know if you should be too giddy about dismantling it:

http://www.salon.com/2016/12/06/paul-ryans-repeal-promise-nobody-will-be-worse-off-during-obamacare-transition/

Either way, as someone who works on the financial side of a hospital, I think it's unavoidable that health care costs will continue to spike over the course of the next decade.

(p.s. If your wife wants good, affordable healthcare insurance, tell her to get a job at a hospital)

Ironically, I do use her work experience as good advice on careers for the students I teach in my anatomy class in college.

She trains banking compliance.  Mostly its webinars and such where she can work from home, but she also travels the country and teaches banks what they need to do to stay in the good graces of the FDIC and such.

She got into that line of work seven years ago.  She was hired by a local community bank to take over the compliance officer position that had been vacant six months.  She was basically in her own department kind of under the audit department and shared one employee with audit.  In the ensuing five years, the compliance environment in this country grew to the point that she was a full vice president with five employees directly under her.  She left the bank about a year and a half ago to work for the consulting company she is with now.

What I tell my students that want to go into healthcare, but don't know what they want to do is to go into Healthcare Compliance.  I tell the story of my wife's professional growth and then I tell them "I don't know what healthcare will look like in ten years... but I can tell you with certainty that the government will not be less involved with your health than they are now.  If you are the person that can tell a hospital or a doctor's office how to stay out of trouble with the government, you will have a job."

She is actually somewhat concerned about the Trump administration from a banking regulatory standpoint.  In the short run, rolling back regs will be fine because she'll have to interpret those and explain them to her client banks... but in the long run it would mean less job security. 

[OldGimletEye]

Just now, Rhom said:

I know that this thread mainly bashes Republicans, but I will say that for me... the dismantling of the Affordable Care Act cannot come fast enough.

Your claims are what exactly?

1. Life was grand before the ACA if you had pre-existing condition?

2. The ACA has caused an increase in employer sponsored healthcare premiums over their historical averages before the ACA?

3. Cost sharing have gone up over their historical averages because of the ACA?

4. The premium raises on the invidual market are out of control?

As far as the situation in Kentucky, that wouldn't possibly have anything to do with Bevins would it? Who vowed to destroy it? And couldn't possibly have anything to do with Republicans taking out the risk corridor provision could it?

You really, even though, the law ain't perfect the basic idea behind the law, getting more people to sign up for insurance with the mandate, so you didn't have to deny people insurance with pre-existing conditions was sound. The use of risk corridors was sound until the Republican Party got rid of it.

What can't end fast enough here is the Republican nonsense over the ACA.

 

[Yukle]

Trump says "Tremendous" a lot.

[Dr. Pepper]

25 minutes ago, Yukle said:

Trump says "Tremendous" a lot.

He's started to substitute with "bigly" so his vocabulary is expanding.  It's a fake word, but in his world of fake news it probably counts.  

[LongRider]

28 minutes ago, Yukle said:

Trump says "Tremendous" a lot.

Trump sez he wants to cancel the contract for Boeing to build the new Air Force One.  That's tremendous. 

[Yukle]

8 minutes ago, Dr. Pepper said:

He's started to substitute with "bigly" so his vocabulary is expanding.  It's a fake word, but in his world of fake news it probably counts.  

That's bigly impressive.

4 minutes ago, LongRider said:

Trump sez he wants to cancel the contract for Boeing to build the new Air Force One.  That's tremendous. 

I find that weird. Who doesn't want a free plane?! (At least, free for him, obviously... I mean if somebody offered me a fleet of three planes to travel in, I'd think that was... tremendous.  )

[DMC]

8 hours ago, Ser Scot A Ellison said:

I think the filibuster for Judicial nominees is toast.  I'll be surprised if it remains standing after the new Congress and President are sworn into office.

Well, Reid and the Democratic Senate have already largely taken care of that.  Not without good reason, mind you - the GOP obstruction in filling Circuit Court vacancies was verging beyond ludicrous, but it does mean they lose the high ground on it.  The GOP could extend this to SCOTUS, but I don't think it's necessary as long as Trump sticks to the list he put out months ago (think it was even before the convention).  Pretty boilerplate Republican nominees, especially considering they'd be filling Scalia's seat.  Sure, what they did with Garland grinds my gears, but you gotta pick your battles, and going to war over NOT having SCOTUS revert to its ideological status quo does not seem like a wise allocation of resources.  Just gotta hope Ginsburg (and Breyer....and Kennedy) eat their greens and hang in there.

[Yukle]

3 minutes ago, dmc515 said:

Well, Reid and the Democratic Senate have already largely taken care of that.  Not without good reason, mind you - the GOP obstruction in filling Circuit Court vacancies was verging beyond ludicrous, but it does mean they lose the high ground on it.  The GOP could extend this to SCOTUS, but I don't think it's necessary as long as Trump sticks to the list he put out months ago (think it was even before the convention).  Pretty boilerplate Republican nominees, especially considering they'd be filling Scalia's seat.  Sure, what they did with Garland grinds my gears, but you gotta pick your battles, and going to war over NOT having SCOTUS revert to its ideological status quo does not seem like a wise allocation of resources.  Just gotta hope Ginsburg (and Breyer....and Kennedy) eat their greens and hang in there.

Out of curiousity, how come the SCOTUS is appointed on the advice of the President? Aren't most judiciaries in the United States elected?

I'm not criticising this, I think that's a working, logical and efficient system. I'm just wondering why.