Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[JSSkinz]

24 minutes ago, AlvinWaltonIsMyBoy said:

500 per month, 7200 deductible.  No subsidy.  In North Carolina.

 

I want healthcare access for all, but there's gotta be a better way.   

 

 

I have a close friend who was just laid off and he had United Healthcare at his former company and his Cobra was cheaper than the marketplace.

 

I'm in Florida and this person showed me a copy of the Cobra coverage which is $527 a month for a very good plan that has $2500 deductible, $2500 max out of pocket and pays 80% of hospitalization/major surgery.

 

The same plan on the marketplace is $723.00 monthly and he said that was with a subsidy of $132 a month which he got by lowballing what he thinks his income will be in 2017 by saying he would only make $30,000.  

 

It can't be good when Cobra is cheaper.

 

Edited January 5, 2017 by jschuck12001

[Ron78]

2 hours ago, Hersh said:

Do you have numbers to back this up? What do you think hospitals did all those years before Obamacare when people without insurance would show up to a hospital? 

 

First hand experience.  I work in the financial sector of the Health Care industry.  Obamacare is costing hospitals a good chunk of money because of the way it has changed reimbursement.

 

2 hours ago, Larry said:

 

Do you actually think that those words you've strung together form a coherent point?  

 

That was a substantive response.  :eyes roll:

Edited January 5, 2017 by Ron78

[Larry]

2 minutes ago, Ron78 said:

 

First hand experience.  I work in the financial sector of the Health Care industry.  Obamacare is costing hospitals a good chunk of money because of the way it has changed reimbursement.

 

In what way(s) has Obamacare changed reimbursement?  

[Ron78]

5 minutes ago, Larry said:

 

In what way(s) has Obamacare changed reimbursement?  

 

In a nutshell, it has significantly increased the percentage that patients owe of allowed reimbursement amounts.  For example, subscriber deductibles, copays, or coinsurances are often higher than what they were before Obamacare.  So, insurance companies are not paying as much of their allowed amounts as they were prior to Obamacare, and patients are not paying all of the high patient liabilities assessed by the insurance companies either.  This results in hospitals sending more of their patient liability to bad debt, which is often either negotiated down or simply goes unpaid.

Edited January 5, 2017 by Ron78

[TheGreatBuzz]

1 hour ago, TheGreatBuzz said:

Please quote the insults you refer to.  Or where I called you a liar or idiot.  I did say you didn't know what you were talking about and that you were wrong.  That does not make you an idiot, it just makes you wrong.  I believe the only insult used was by you which you went back and edited out.  I believe a mod even commended you for it.

@Larry  still waiting for you to show where I called you an idiot and a liar and the other insults.

[Larry]

Just now, Ron78 said:

 

In a nutshell, it has significantly increased the percentage that patients owe of allowed reimbursement amounts.  For example, subscriber deductibles, copays, or coinsurance are often higher than what they were before Obamacare.  So, insurance companies are not paying as much of their allowed amounts as they were prior to Obamacare, and patients are not paying all of the high patient liabilities assessed by the insurance companies either.  This results in hospitals sending more of their patient liability to bad debt, which is often either negotiated down or simply goes unpaid.

 

I'm pretty sure that deductibles and copays have existed for at least 40 years.  And have been going up for some time, well before Obamacare.  

 

I'm also pretty sure that there were a whole lot of non-payment before, too.  Including people who used to have no insurance at all (and now have deductibles and copays, instead.)  

 

I don't doubt your (completely unsupported) assertion that maybe those amounts are increasing.  If for no other reason that I bet they've been increasing before Obamacare, too.  

 

In short, without some good, whole-country, apples to apples numbers, it's really hard for folks out here in the audience to tell whether this is simply another one in the long list of people taking something that's been happening for decades, and claiming that now it's all Obamacare's fault.  

 

(Although, I also have to say that, even if all you've got to support your assertion is simply your own assertion?  It's possible that your position, itself, lends some credibility to the assertion.)  

[Ron78]

Just now, Larry said:

 

I'm pretty sure that deductibles and copays have existed for at least 40 years.  And have been going up for some time, well before Obamacare.  

 

I'm also pretty sure that there were a whole lot of non-payment before, too.  Including people who used to have no insurance at all (and now have deductibles and copays, instead.)  

 

I don't doubt your (completely unsupported) assertion that maybe those amounts are increasing.  If for no other reason that I bet they've been increasing before Obamacare, too.  

 

In short, without some good, whole-country, apples to apples numbers, it's really hard for folks out here in the audience to tell whether this is simply another one in the long list of people taking something that's been happening for decades, and claiming that now it's all Obamacare's fault.  

 

(Although, I also have to say that, even if all you've got to support your assertion is simply your own assertion?  It's possible that your position, itself, lends some credibility to the assertion.)  

 

Yes.  Deductibles and copays have existed for a long time, and now they have spiked as a direct result of Obamacare. 

 

Yes.  Non-payment has existed for a very long time too, but now there is more patient liability, so there is even more not being paid.  Not everyone has coverage because many younger, healthier people are choosing to pay the tax penalty instead of for coverage.

 

I don't have data for you, but I believe people will ultimately fall where their political loyalties lie anyway.  Also, it's reality that the Trump administration is going to change health care regardless of what people hash out in this thread.

[Larry]

1 hour ago, TheGreatBuzz said:

Please quote the insults you refer to.  Or where I called you a liar or idiot.  I did say you didn't know what you were talking about and that you were wrong.  That does not make you an idiot, it just makes you wrong.  I believe the only insult used was by you which you went back and edited out.  I believe a mod even commended you for it.

 

I just saw this post.  

 

Seriously?  You want me to quote you?  

 

My bolding:  

 

5 hours ago, TheGreatBuzz said:

You haven't "had Obamacare".  No one has "had Obamacare" because it isn't an insurance.  Do you even know what you are talking about?  This kind of uninformed rambling is what gives the right a bad name.  Please stop, this hole is just getting deeper.

 

3 hours ago, TheGreatBuzz said:

Mr. Pink already hit on what you actually had above.  What bothers me is that you even posted this.  You either knew what you had and ignored it to make a snarky remark or you really have absolutely no clue whatsoever and aren't in a position to even discuss this.  I believe it's the former.

 

Look!  I can chastise people on both sides.  I'm bipartisan!

 

3 hours ago, TheGreatBuzz said:

My picky was defining Obamacare in the "Obamacare thread".  Seemed like a good place for that accurate info.  You posted knowingly false info and I corrected it.  I know, I know, facts shmacts.

Well considering my wife's entire job is ensuring large companies are compliant with Obamacare and everyday she likes to tell me about all the things people have wrong about it, I consider myself better informed than most.  

Now the market place was set up by Obamacare but it doesn't sell Obamacare.  Think of it like buying a redskins hat from Amazon.  When you do, you have a hat.  You don't have Amazon.

 

2 hours ago, TheGreatBuzz said:

 

Thanks for editing out the name calling.  It wasn't needed.

 

I went back and quoted again where you attempted to say you had Obamacare.  You either knew you actually had private insurance thanks to OC (which I think is the case) or you think Obamacare is actually an insurance plan which is 100% wrong.  If the former is correct than you were posting false info.

 

2 hours ago, TheGreatBuzz said:

Well then I was wrong in my previous assumption.  I thought you were posting false info.  I guess you actually just don't know what you are talking about.  I apologize for my incorrect assumption about you.

 

"All of the health insurance policies sold through health insuranceexchanges are policies sold by privateinsurance companies. ... However, they're technically not Obamacare insurance, they're Kaiser, Aetna, UnitedHealthCare, or whatever private health insurance company sold that particular health insurancepolicy."

 

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.verywell.com/what-is-obamacare-1738505&ved=0ahUKEwiln6f1yqnRAhVojFQKHfDqCrgQFgg3MAE&usg=AFQjCNFq6CH_VbgdHD16_b1uP0IpZb7ckw&sig2=NjBCYSsnzLe0qb9lXU8SBg

 

2 hours ago, TheGreatBuzz said:

Private employer offered plans and the market place are the same in that they have the same requirements.  Think of it as employer plan is Target and the marketplace is the mall.  One has more options and you may or may not find a better deal.  It's just up to how much time do you want to spend shopping.

I have repeatadly.  You said you have Obamacare.  That isn't true.  I also posted a link to explain why that wasn't true.  Do you need me to go quote it again?

Yea I was wrong.  Apparently it is the latter.

 

1 hour ago, TheGreatBuzz said:

@Larry  I'm not going to keep beating this horse.  I will explain it one more time.  The. You can read back through what I have posted and if you can't understand it still, you are beyond help and I don't know what to do.  

 

No one can have Obamacare.  Obamacare is a law, not an insurance.  (Technically the marketplace isn't even Obamacare, just a thing set up that was required ny Obamacare.  But that is a nuance not worth debating).  You can have Etna for example that you may have gotten through the marketplace thanks to Obamacare.  

 

If you go to the mall and buy a tshirt, you have a tshirt.  You do not have "the mall".  Same thing.

 

this started because I was trying correct something disengenous that TWA said.  The you decided to tell me I was wrong.  I would have let it go after I corrected TWA but you wanted to tell me I was wrong so on down the rabbit hole we went.

 

Now I have explained my part, I have provided several quotes, and I have linked an article explaining why I am correct.  Either provide proof I am factually wrong or leave me alone.

 

If I'm not mistaken, I have, above, quoted every single post you've made in this thread in the last few hours, save one.  

[Larry]

4 minutes ago, Ron78 said:

 

Yes.  Deductibles and copays have existed for a long time, and now they have spiked as a direct result of Obamacare. 

 

Yes.  Non-payment has existed for a very long time too, but now there is more patient liability, so there is even more not being paid.  Not everyone has coverage because many younger, healthier people are choosing to pay the tax penalty instead of for coverage.

 

I don't have data for you, but I believe people will ultimately fall where their political loyalties lie anyway.  Also, it's reality that the Trump administration is going to change health care regardless of what people hash out in this thread.

 

Your support for the assertion that deductibles and copays "have spiked as a direct result of Obamacare" is?  

 

(To me, the only way to show that would be to post the numbers for the nation as a whole, for some time period, like 5-10 years prior to Obamacare, and then the same numbers after Obamacare.)  

 

(I really wish I had such numbers.  I wonder if maybe they don;t exist.  It's the only reason I can think of, to explain why neither side has trotted them out, in support of their side.)  

 

About the only "whole country, aggregate, before vs after" statistic I've seen is that since Obamacare, total health care spending, for the nation, has gone up, but at a slower rate than it was going up, before Obamacare.  (If we choose, we can then take that statistic and start arguing the distinction between correlation and causation, I suppose.)  

 

Quote

Not everyone has coverage because many younger, healthier people are choosing to pay the tax penalty instead of for coverage.

 

And such people represent people who "used to have coverage, but don't any more"?  Or are they people who didn't have coverage, and still don't?  (And, if the latter, how do we get from there to "Now, when uninsured people get treated, their non-payment is Obamacare's fault"?  

 

The statistic does seem clear that the aggregate number of people who are uninsured has gone down, under Obamacare.  (Granted, not by the huge numbers that were predicted.)  

 

[Ron78]

2 minutes ago, Larry said:

 

Your support for the assertion that deductibles and copays "have spiked as a direct result of Obamacare" is?  

 

(To me, the only way to show that would be to post the numbers for the nation as a whole, for some time period, like 5-10 years prior to Obamacare, and then the same numbers after Obamacare.)  

 

(I really wish I had such numbers.  I wonder if maybe they don;t exist.  It's the only reason I can think of, to explain why neither side has trotted them out, in support of their side.)  

 

About the only "whole country, aggregate, before vs after" statistic I've seen is that since Obamacare, total health care spending, for the nation, has gone up, but at a slower rate than it was going up, before Obamacare.  (If we choose, we can then take that statistic and start arguing the distinction between correlation and causation, I suppose.)  

 

 

And such people represent people who "used to have coverage, but don't any more"?  Or are they people who didn't have coverage, and still don't?  (And, if the latter, how do we get from there to "Now, when uninsured people get treated, their non-payment is Obamacare's fault"?  

 

The statistic does seem clear that the aggregate number of people who are uninsured has gone down, under Obamacare.  (Granted, not by the huge numbers that were predicted.)  

 

 

Increased deductibles under Obamacare is not news.

 

 http://www.cbsnews.com/news/obamacare-deductibles-deliver-hefty-sticker-shock/

 

Sure, your Affordable Care Act is working famously.

 

 

[Major Harris]

 

2 hours ago, TheGreatBuzz said:

@Larry  I'm not going to keep beating this horse.  I will explain it one more time.  The. You can read back through what I have posted and if you can't understand it still, you are beyond help and I don't know what to do.  

 

No one can have Obamacare.  Obamacare is a law, not an insurance.  (Technically the marketplace isn't even Obamacare, just a thing set up that was required ny Obamacare.  But that is a nuance not worth debating).   

 

 

 

 

Weird,  you've been doing it for 2 pages now. 

[TheGreatBuzz]

20 minutes ago, Larry said:

 

I just saw this post.  

 

Seriously?  You want me to quote you?  

 

My bolding:  

 

 

 

 

 

 

 

 

If I'm not mistaken, I have, above, quoted every single post you've made in this thread in the last few hours, save one.  

Thanks.  Still don't see the one where I called you an idiot or a liar.  Notice only one of us resorted to name calling.  (Hint: it wasn't me)

 

 

apology accepted.

1 minute ago, Major Harris said:

 

 

 

Weird,  you've been doing it for 2 pages now. 

I was pointing out that Obama care wasn't insurance.  I hadn't been talking about what the market place was.  But again that's just a small nuance.  The market place being called Obamacare to me is on the level of a jar of petroleum jelly being called Vaseline.  Technically it isn't correct but I know what you mean.  Maybe I'm a stickler on the insurance part because I meet so many people that hate Obamacare but don't even realize it isn't insurance.  

[Major Harris]

5 minutes ago, TheGreatBuzz said:

Maybe I'm a stickler on the insurance part because I meet so many people that hate Obamacare but don't even realize it isn't insurance.  

 

 

Larry and i almost never agree.   But even i will say 100% Larry isn't one of those people. 

 

Obamacare is not insurance, but calling it obamacare is an easy way of saying you got your insurance through the marketplace. 

 

In all honesty,  this will be Obama's legacy.  His name should be attached to it.

[redskins59]

My wife had Insurance with United Health for slightly above a 100 bucks prior to Obamacare. The deductible was much higher, since the insurance was one of the cheap ones.  Now the cost is 300 something for me. That's a big increase.  You can't get a 100 dollar insurance anymore.  Obamacare made it so that Health Insurance needs to cover more stuff.  So it is more expensive.    Now, my daughter's insurance is cheaper at 200+ dollars (a 19 month old).  It covers her a lot more.  Insurance is cheaper for children I guess.

I pay 500 something for health insurance.  That is pretty expensive. The problem with Obamacare is that it does not cover the middle class.  I did not get any discount, because I make too much money.  However, the reality for me is that $500 is pretty steep. 

So I would think that instead of repealing it, it needs to be expanded, so that more people get a discount.  

 

[TheGreatBuzz]

7 minutes ago, Major Harris said:

 

 

Larry and i almost never agree.   But even i will say 100% Larry isn't one of those people. 

 

Obamacare is not insurance, but calling it obamacare is an easy way of saying you got your insurance through the marketplace. 

 

In all honesty,  this will be Obama's legacy.  His name should be attached to it.

But that's part of the problem.  Obama care isn't even the exchange.  So saying Obamacare as meaning you got it from the market place is wrong.  It could be that you have insurance through your employer when you previously you wouldn't have had that option.  Obamacare means so much more that just the exchange.  Using one to define the other doesn't give due credit to the program.

[Larry]

2 minutes ago, redskins59 said:

Obamacare made it so that Health Insurance needs to cover more stuff.  So it is more expensive.

 

Now that's a claim that I have no trouble accepting, completely without support.  

 

To me, it's completely believable that the Obamacare law mandated all kinds of coverage.  After all, Congress was making a sausage, and it doesn't cost Congress anything to throw more mandates into the sausage.  

 

Nor do I have any trouble believing somebody when they say that "my old coverage went up a bunch because Obamacare made them cover lots of things that they didn't cover, before."  Same reasoning.  

 

Although, I have to say that, after what seems like 5 years of complaining about Obamacare, I really haven't seen anybody come forward with examples of "Obamacare said they had to cover so-and-so, and that made the premiums go up 200%".  Only thing I've seen people complain about being mandated, is birth control.  And there's no way you can convince me that covering birth control caused huge increases in health insurance costs, nation wide.  

 

My response to such people, though, is "yeah, your rates went up, but so did your coverage."  

 

To me, it's the only way to reconcile the claims of huge premium increases, with the fact that the law mandates that 80% of what they take in, has to be paid to the providers.  

[Major Harris]

6 minutes ago, TheGreatBuzz said:

But that's part of the problem.  Obama care isn't even the exchange.  So saying Obamacare as meaning you got it from the market place is wrong.  It could be that you have insurance through your employer when you previously you wouldn't have had that option.  Obamacare means so much more that just the exchange.  Using one to define the other doesn't give due credit to the program.

 

 

Fair enough.  I admittedly know less than most here about it, lucky enough to have always had pretty decent insurance.   I just didn't think Larry was saying what you think he's saying.  

[redskins59]

It is 100% true that coverage went up.  For one, you can't be denied healthcare due to preexisting condition.  One of the questions that United Health asked my wife (this was prior to Obamacare) was whether my wife had any preexisting conditions.  Preexisting conditions tend to always be expensive.  Trump has said that he will not repeal the "preexisting conditions" requirement of Obamacare.  So I am pretty sure that you will never be able to buy a really cheap $100 type health insurance anymore.  You know what else, one of the things that your Health Insurance is supposed to cover is pregnancy related stuff.  My wife was pregnant around that time, so I decided to get the best Health Insurance from the website.  

So the requirements that your Insurance needs to cover more stuff make it more expensive. 

It is also a fact that if you make less than a certain amount of salary, you qualify for a discount.  If I recall, the number was 50,000 for a family of 3?  I don't remember the exact number, but if you are not making a lot of money, you will get a discount.  
Unfortunately for me, I make more money than that salary limit.

 So what does it mean?  If you repeal Obamacare, people who aren't making a whole lot won't be able to afford insurance.  That is not a good idea.  At the same time, I think  more people should qualify for the discount.  The middle class I think is getting  screwed here.  It went up for me.  I would like a discount.  

Obamacare is good, but it needs to be expanded.  I think that if more people got a discount, you would see that people would be more satisfied with Obamacare.

 

[redskins59]

Let me also mention that my premium really jumped this year.  Last year, I was paying 400 something.  This year, it will be 500 something.  So an increase of $100 for me.

[twa]

mine jumped 400($1900 a month) this yr, so we downgraded to the peasant plan for 370

 

 

[TheGreatBuzz]

Defining Obamacare aside, there are many good parts and many bad parts.  Unfortunately it's the bad parts that pay for the good parts.  The basic premise of Obamacare (and I'm dumbing it down and using made up numbers for explanation) is sharing the pain.  A poor person who couldn't afford health care because they were sick would have to pay $20,000 a year for their treatment.  What the thought is that we will take the 20 grand and instead make 20,000 people pay an extra dollar.  Now most people are healthy so the extra dollar goes to pay for that other person.  And every person is required to pay for insurance so there is a lot of those extra dollars to go around.  A big problem is that the people who would have just gone without treatment now have insurance and seek treatment so costs go up.  So now you need more dollars.  There are many other details that go into it but the is some of the basic ideas and intents.  Great idea that everyone should have health care but the costs haven't worked out like one would hope.

 

id rather see the government do more to get the cost of treatment under control.  The $100 box of nasal membrane collection device (Kleenex) that everyone hears about.  Those are the things that drive up insurance costs.  The costs of treatment has become a huge bubble that is being supported by the government.  But when the bubble bursts it won't just be the economy crashing and people losing their houses like the housing bubble.  People will loose their lives instead.

[LD0506]

I hear ya Buzz, but just pulling the plug, going from Obamacare to TrumpDontCare and "cutting costs" by just denying people access to medical services, that's an answer? Kinda sticks in my craw a tad

[LadySkinsFan]

You men might not know, but before the ACA, many insurance companies considered pregnancy a pre-existing condition. Which meant unless you were covered under an employer policy, you might not get a policy, or if you did it was very expensive.

 

The cost of being female.

[Riggo-toni]

I think Caitlyn Bruce Jenner proved having a vagina is not always a pre-existing condition....

[tshile]

14 hours ago, Larry said:

 

In what way(s) has Obamacare changed reimbursement?  

I have posted about this a few times, but here's what i can tell based a variety of sources of information (but recognizing I don't work in the industry myself):

 

One of the criticisms of ACA is that it didn't put a cost control mechanism into place. I contend that's false - they did put a cost control mechanism into place, they did it by adjusting reimbursements via medicare and medicaid. They lowered the reimbursement levels and they are tiered based on HCAHPS feedback. The HCAHPS surveys are sent randomly to people who receive services paid for by medicaid/medicare, and unless you score an 'ALWAYS' you get dinged. The more you get dinged, the further down the reimbursement scale you slide.

 

In theory it sounds great - force quality care by tying it to reimbursements. Medicare and Medicaid are a primary source of revenue for hospitals at least in my area. That's a huge group to bargain with.

 

The problem is you get people who are not mentally capable of honestly filling out the survey driving down scores. It's not surprising that scores in high acuity circumstances are lower - those people are in a miserable situation to begin with, they demand a high level of care, and many of them are not intellectually there (this patient population consists of very old people and drug seekers.)

 

Another change to reimbursements has to do with re-admission. If a hospital sees you for an issue, you get a procedure, you are discharged with instructions. If you do not follow those instructions, you wind up back in the hospital. You are now a re-admission and the hospital's reimbursement for the readmission falls severely (I'm not sure, but maybe to zero? I definitely recall being told zero, but I'm not sure if that was accurate information.)

Again - sounds good in theory. Don't discharge people early, make sure they are cared for, else you pay for the follow up. The problem is that people (especially in the poor and elderly communities, which is what medicare/medicaid serves) seem to not be inclined to follow these instructions. They don't go to their doctor for a follow up, they don't do the right exercises, etc and they wind up with complications.

 

My opinion is that these are the cost control mechanisms the Obama team viewed as being the best (or, just the easiest to pass through) and I think they've wound up being wrong. You place the burden on the hospital, so the hospital now has to renegotiate all of their costs with their providers, and this would push some cost control down the line. The issue is that it seems like majority of hospitals have opted for restructuring their organization - getting rid of middle management which increases employee-to-superviser ratios, increasing patient-to-nurse/tech workloads, just buying cheaper supplies (which can be a good thing but is not inherently a good thing, especially in an environment that requires quality products.)

 

There are absolutely hospitals that have managed this transition and are doing well. I believe Virginia Hospital Center was the one I was told is knocking it out of the park with the changes in ACA. But there are also hospitals that are really struggling with the changes.

 

Likewise, there are hospitals that have figured out they can provide their own insurance, and cut out the middle man that is the traditional insurance company, and make more money off private care (while also offering reasonably priced insurance for their employees, and their immediate community.) So it's not all doom and gloom for hospitals, but they have been hit hard with the reimbursement changes.

Edited January 5, 2017 by tshile