Student Position on Employer Mandate – Story

I wanted to share my story since so many people were affected by what just happened to myself and my coworkers yesterday. I was hired in as a full-time non-career employee. This meant that I had the ability to work 40 hours a week while learning about working for the State Of Michigan while I finished my degree and eventually be converted to a with benefit employee by the time my degree is complete. I have worked 40 hours all year long, barely missing a day and always completing jobs assigned on a timely basis. I had received many comments of praise on my work.

Yesterday, we got an email from our boss that stated that all the non-career employees would get their hours cut. This meant that instead of being able to work 40 hours, I would have to work 30 hours or 130 hours a month. This meant that I would loose enough pay that paying out-of-pocket for my classes would be very difficult.

I am married with 2 kids and this situation is really bad. It is bad enough that I have been forced to live with my in-laws to be able to provide a good home and good schools to my children. This pay cut pushed the possibility of saving up and moving out, totally out the window.

I was for the healthcare reform, but not in this way. I felt that we should push the insurance companies aside and make a single-payer system like the rest of the country. Instead we got a horrible piece of legislation that really only benefits the insurance companies. I am highly disappointed that I am unable to work so many hours because a federal law says so and my employer cannot provide me the benefits that are deserved.

I hope this is fixed in the future. I don’t think this country is going in the right direction. We need to real reform that doesn’t line someone’s pockets.

Thank you.

ObamaCare June 2015 Overview

Everything you need to know about ObamaCare for June 2015 including Hawaii’s exchange, a subsidy lawsuit, Florida and Medicaid, and other healthcare news.

What you Need to Know About ObamaCare in June 2015

Hawaii will close their state health insurance exchange. Nearly 40,000 enrollees will be transitioned to the federal Obamacare marketplace, Healthcare.gov. After about $130 million invested into the Hawaii Health Connector the site is still not up to par with the Federal website and ACA regulations. Sen. Sam Slom (R) went as far as to describe the Connector as “a boondoggle from the very beginning”. Whoa, Sen. Slom, just whoa. Really though, this is perhaps another display of why it would have been smarter and more economical to simply have “one website to rule them all” (HealthCare.Gov) rather than expecting each state to reinvent the health insurance subsidy delivery wheel. Speaking of which…  – Read more  about the Hawaii health insurance website at the Huffington Post.

Boondoggle defined: “Work or activity that is wasteful or pointless but gives the appearance of having value.”

The President disagrees with the Supreme Courts decision to entertain the “subsidy lawsuit” (King V Burwell). The lawsuit ruling will be announced this month. Conservative backed groups started planning which lawsuits they would bring against the ACA before it was even passed (video evidence found here). Some of them stuck, some of them didn’t. The NFIB lawsuit in 2012 made expanding Medicaid optional and declared the mandate a tax validating the ACA as the law of the land. I don’t think anyone is specifically saying which specific Libertarian / Conservative groups are behind this, but if you let your imagination run wild you just may correctly guess which groups have orchestrated the lawsuits and cherry picked the plaintiffs to go after weak points in the law. That is the right of these groups, but President Obama and a few others found it surprising that SCOTUS actually entertained the King V. Burwell case as it is seemed clear to many that subsidies should be made equally available to all Americans, in all states, who meet the eligibility guidelines.

“This should be an easy case. Frankly, this boondoggle probably shouldn’t even have been taken up,” Paraphrasing President Obama. – Read more about the President’s opinions on King V. Burwell from Fox News.

Florida will continue to deny Medicaid expansion. Speaking of Supreme Court cases and States, Florida has continued to push back against expanding Medicaid to something like 800,000 Floridans despite 100% – 90% of funding from the Federal Government (they don’t trust the Federal Government to actually pick up the bill). Things were looking up until the Federal Government threatened(ish) not to give full funding for a program that reimburses hospitals for charity care unless Florida expanded Medicaid. Florida under governor Rick Scott (R and ex hospital executive) was like (paraphrasing / fabricating), “See Florida I told you we can’t trust the Federal Government to pay us. They won’t even reimburse us for tax-advantaged charity funds we use to pay for the unpaid hospital bills of people who should have been covered through Medicaid expansion in the first place. This has been a boondoggle from the start (referring to the Federal Government and not the lawsuit or the ironic part about charity funding).” Scott then moved forward with a lawsuit against the Federal Government.

Ps. The whole reason hospitals need charity funding is that they have unreimbursed care from… ya know like 800,000 Floridans without Medicaid.

“On May 21, the Obama administration told Florida in a letter that it would receive less than half of what it wanted for the charity pool for the 2015 fiscal year and even less the following year. At the same time, it suggested that Florida could do itself and its poor residents a favor by expanding Medicaid. It pointed out that by voluntarily expanding its Medicaid program, Florida would increase hospital revenues beyond the payments the hospitals would be getting from the charity pool.

Medicaid expansion would cover an estimated 800,000 uninsured Florida residents, and this is by far the best way for any state to go. The federal government pays 100 percent of the costs of covering newly eligible people through 2016, dropping down to 90 percent in 2020 and future years.

Charity pools simply reimburse hospitals and other providers after the fact for financial losses they have suffered for treating underinsured people. Medicaid enables patients to get care at little cost to themselves, reduces the number of uninsured people and strengthens the finances of hospitals with big charity loads. The 21 states that have not yet expanded Medicaid ought to rethink their positions.” – read more on the Florida Medicaid expansion battle at the NY times.

Also hospital growth and healthcare jobs are seeing their biggest boom in a long time, health insurance stocks (like Humana) are up crazy amounts, and ObamaCare is hurting Kentucky hospitals and insurers are jacking up rates because they are losing money.

Without dissecting this too much I think we can paraphrase this whole thing in one blurb, “There are a lot of good ideas in this big law, but there have been a few misfires too… misfires have been more common for those who aren’t embracing the Affordable Care Act, but frankly some misfires have just been due to the sheer size of the law and the breadth of what it tries to accomplish. Hopefully SCOTUS doesn’t rule that HealthCare.Gov is just a boondoggle, but rather finds that the lawsuit itself was the real boondoggle all along. In the meantime something like tens of millions of people still lack health insurance and public debt as a result of healthcare is still a major issue. The financial and physical wellbeing of Americans is perhaps the one thing happening in June that is NOT a boondoggle. Let us not lose focus on the real problem here and let us remember that the ACA is a solution… if not always the perfect one in practice.”

Obamacare Rate Hikes 2016

Insurers are planning rate hikes for 2016 under ObamaCare. ObamaCare being both the reason we know about it, and part of the reason it’s happening. Let’s take a look at some facts and opinions to help us shed light on the 2016 rate hikes of as much as 10%, 20%, or as much as 60%.

Under ObamaCare’s rate review provision insurers must post rate hikes of 10% or more. Here is the complete list of 2016 rate hikes.

Insurers Must Make a Profit

The ACA allowed America to retain a for-profit healthcare system and a for profit health insurance system, while still reforming healthcare. That means insurers need to make a profit (and to be fair, a good public system wouldn’t ideally operate at a loss either). Insurers can jack up rates if they feel they may not make a profit providing health insurance or if they didn’t make big enough profit margins last year. In some states the requirement for insurers to cover everyone who can afford coverage led to losses and less than expected profits. So a number of insurers in a number of states across the country have submitted rate hikes of 10% or more under ObamaCare’s rate review provision.

The Rate Hike Issue By CNN: In Florida, for instance, United Healthcare (UNH) wants to raise the rates of plans sold on the Obamacare exchange by an average of 18%. Individual policies available outside the exchange through United Healthcare or through a broker would go up by 31%, on average, with hikes as high as 60% for certain plans in certain locations.

In Texas, insurer Scott & White is looking for a 32% increase for exchange-based plans, while Humana (HUM) is asking for an average 30% boost for its exclusive provider organization policies, which generally cover only in-network services.

Insurers say they want to hike rates because enrollees are going to the doctor, getting lab work and filling prescriptions more than they had originally anticipated.

Under ObamaCare Insurers Must Disclose Rates of Over 10% For Review

Before the ACA insurers could have just dropped some sick people from their plans, raised prices on sick people, jacked up the price of coverage without anyone knowing, or cut benefits. A few people (those affected negatively) would know, but the chances of seeing an Associated Press article on it was probably slim.

Today, under the Affordable Care Act, all rate hikes of over 10% must be disclosed and reviewed by the state or federal government and posted online for public view (currently at HealthCare.gov). This doesn’t mean hikes can be denied, they just have to be justified.

So today, not only do more people have private insurance than ever, there is also a lot more transparency with rate hikes and plan changes being public knowledge.

Requirements to Cover Sick People Helped Cause the Rate Hikes

Rate hikes aren’t just about sick people digging into profits, there are a number of other factors in play of course (like the cost of healthcare in the first place).. but let’s be honest, having to cover people who actually need to receive more dollars in care than they pay in premiums doesn’t help.

This isn’t a subsidies issue (subsidies just mean tax payers are funding the difference in premiums and out-of-pocket costs) this is a people actually using their insurance issue.

As expensive as we all think insurance is, that price tag doesn’t even begin to cover the cost of healthcare. In the past the health insurance system operated by pushing the sick away and insuring those who were a safer bet. This allowed for affordable coverage, but at a very human cost.

Today everyone must be allowed to purchase insurance and sick people can’t be charged more for it (the other way for insurers to avoid rate hikes). All of these factors together has led to some insurers paying out (or projecting to pay out) more in claims then they made in premiums after operating costs.

The Underlying Costs of HealthCare are Killing Us (Metaphorically)

So insurers are jacking up rates for 2016 because they are losing money covering sick people, most middle income people without subsidies are struggling with the new insurance costs (although the 1 in 2 with a preexisting condition are doing so gratefully), the 2%-ish-ers (not the .0001%-ers, the literal 2%) are paying more taxes, those with subsidies are happy with their new coverage but struggle with out of pocket costs, people in non-expansion states struggle without healthcare options, Republicans struggle to repeal, Democrats struggle to support the law, the economy struggles with interest as federal healthcare spending continues to rise, hospitals struggle to meet new requirements and profit under the ACA, providers struggle with demand outpacing supply… literally we seem to have a system (before and after the ACA) where everyone struggles and costs rise at an unsustainable rate.

Meanwhile (we all remember that bitter pill article from TIME) the underlying cost of everything healthcare from drugs, to machines, to saline solution, to a hospital gown, is really unreasonably expensive. It doesn’t mean the problem starts and stops there, maybe the problem was with people (us, me and you, employers) being willing to pay those prices. Maybe it was private insurers  being willing to pay those prices under the old system. Maybe it was public insurance (Medicare, Medicaid, TRICARE) being willing to pay those prices. Maybe it’s a bloated billing, claims system. Oh wait wait, maybe it’s people taking a bunch of drugs for everything under the sun and phrama charing more than anyone would ever pay out-of-pocket for stuff no one even heard of 50 years ago. Maybe it’s litigation. Maybe it’s Wall Street. Maybe that $80 ibuprofen was really coated in gold and we aren’t being appreciative of it. Maybe it was a mix of all these things. Or maybe it’s something eluding us.

One thing is for sure though. Bernie Sanders and single payer 2016. (Kidding, sort of…)

Really though, if this is our country and our healthcare system, and everyone is struggling, then at the very least we need to look beyond using ObamaCare as a scapegoat and continue to look at what reforms need to be made. Like it or not we are all in this together and the $3 trillion dollar system succeeds or fails on our backs, so we will need to continue to address the issues until we can all figure out how to provide sustainable quality healthcare to the 99.99% of America.

Mailing Address Change Automatically Cancels Obamacare Subsidy – Story

March 1, 2015
A new health insurance policy with Blue Cross Blue Shield of NC (BCBSNC), subsidized by Healthcare.gov begins. The subsidized rate is $257.83. This replaces my policy with BCBSNC that, on Jan 1, increased from $295 to $405 due to me turning 50.

April 23, 2015
I called the Marketplace 800# (Healthcare.gov) to correct my mailing address. They did not have the suite#. However, the street name and number as well as the city, state and zip code were correct.

May 18, 2015
I receive a new health insurance card and info from BCBSNC in the mail. The subscriber number is the same, but the group id and the account number have changed. It says I have an increased rate of $495.83 a month (effective as of April 23, 2015). An additional amount of $132.22 was added (prorate from April 23 – 30). Invoice total was $628.05.

May 20, 2015
I call the Marketplace 800#. I was told that because correcting a mailing address is considered a ‘life change’ by Healthcare.gov my subsidy was automatically cancelled and I was given a new policy, without any subsidy, and with higher deductibles across the board. I am told by the first representative that she is aware of this ‘life change’ problem and internally the other reps are upset about it as it happens all the time.

My call is escalated to a supervisor who matter-of-factly says that I should have known that a mailing address correction would cancel my policy. She directs me to the ‘appeals form’ on the Healthcare.gov website and says it would likely take 3 months to be looked at. She said that if I don’t pay the current higher premium of $495.83/month from BCBSNC, I cannot reapply for insurance through Healthcare.gov until the following year.

• I was originally never told that correcting the mailing address over the phone would automatically cancel my subsidy.

• My new rate of $495.83/month is $90/month HIGHER than my old policy that was replaced by the Healthcare.gov policy on March 1st. And my deductibles are higher and my benefits worse.

May 21, 2015
I mail in the appeals form and all required paperwork to the address in London, KY. I subsequently was told to pay the $628.05 to keep my changed policy in effect.

May 23, 2015
I went online at BCBSNC.com to register the new policy but it would not accept it even though they already sent me a bill and the insurance cards with the updated subscriber number and group number. I went to the pharmacy to get prescriptions drugs refilled. They said the policy is in the system but not ‘activated’ by BCBSNC yet. They told me to call BCBSNC. It is the Memorial Weekend and nobody in that department of BCBSNC would answer the phone.

May 26, 2015 (Tuesday, day after Memorial Day)
I called BCBSNC and they said ‘registration’ of this newest policy – aka: getting it into the system – would take about 10 days and that I could not pay the premium due, $628.05, until it was complete. The rep said she would escalate it but it would likely take another 5 business day. I was told to pay the cash price for the drugs and I would be reimbursed later. So now the premium invoice states that the policy will be canceled if not paid by May 31st and the good people at BCBSNC of NC say I can’t pay the premium until it is completely ‘in the system’ which may not happen until AFTER May 31st.

May 27, 2015
Tried repeatedly to contact BCBSNC via phone. It kept saying they were having technical errors and it would auto end the call. This happened ALL day.

May 28, 2015
Called BCBSNC and waited 22 minutes for a rep. She said the “first” system was telling her that my new policy was terminated by HealthCare.gov and to call them. After additional questioning by me she asked her supervisor and they looked into a “second” system – which told them that the policy WASN’T canceled but was still not fully built into the system. She said that even though my issue was already ‘escalated’ it would actually take about 10 business days to fix. I was instructed to mail in a check for my premium payment and it would be applied when the policy was fully active in the system. I was also told to pay cash for my drug prescriptions, which now are a week into not being filled, and I would be reimbursed. Lastly, she said she would call me on June 4th to update me on the status.

Memorial Day Facts (HealthCare)

Memorial day is about remembering those who served our country, it’s also a day that has a high civilian death toll due to alcohol related events… and of course that means ER rooms across America working around the clock to save lives.

deaths-world-wide

The ACA (ObamaCare) does a lot to improve healthcare and that effects VA coverage, TRICARE, and improves coverage for those Americans who will depend upon the overworked staff at the local hospital today. Here are just a few quick facts to remind you to be grateful for the men and women who serve our country both in healthcare and the military:

 Holiday car crashes 2010 Data

Holiday Fatalities
Fourth of July
(3-day period)
392 deaths
(39 percent alcohol related)
Labor Day
(3-day period)
403 deaths
(36 percent alcohol related)
Memorial Day
(3-day period)
397 deaths
(40 percent alcohol related)
New Year’s
(3-day period)
297 deaths
(48 percent alcohol related)
Thanksgiving
(4-day period)
431 deaths
(40 percent alcohol related)
Christmas
(3-day period)
259 deaths
(37 percent alcohol related)
Source: National Highway Traffic Safety Administration, 2010 data. From insure.com
  • In 2012, 10,322 people were killed in alcohol-impaired-driving crashes. These alcohol- impaired-driving fatalities accounted for 31 percent of the total motor vehicle traffic fatalities in the United States.
  • According to NHTSA data, in 2012 there were 377 crash related fatalities during the Memorial Day holiday period. That is one of the highest death tolls due to alcohol of any day of the year.
  • About 12% of all  deaths in the month of May will happen on memorial day weekend.
  • According to the CDC economic costs of excessive alcohol consumption in 2006 were estimated at $223.5 billion, or $1.90 a drink.
  • Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions. These are most often the result of binge drinking.
  • Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems.
  • As of 2013 there were a total of 1,196,793 total war casualties, of which 300,000 are buried the the Arlington National Cemetery.
  • There are about 2,500,000 alcohol related deaths worldwide each year according to the WHO (World Health organization).
  • Read more facts on alcohol from nih.gov.

Unfortunately there is no end of facts related to federal spending, alcohol, healthcare, and death or injury. Celebrate the people who protect this country by respecting yourself and watching out for the people you love.

  • Don’t forget to give it up to the healthcare and military workers who will save hundreds of lives today as they do every day.
  • Don’t forget to give it up to the Affordable Care Act that has taken steps to ensure better healthcare for all Americans.

Ok that was heavy. Be safe and here is a fun fact to get back in the spirit of celebration and appreciation:

  • Memorial Day was officially proposed on May 5, 1868, by General John Logan and was first celebrated 25 days later at the Arlington National Cemetery, although at the time it was actually known as Decoration Day due to the practice of decorating graves with flowers, wreaths, and flags. Federal law declared “Memorial Day” the official name in 1967.

memorial-day-pa

Being Forced to Change Plans – Story

We could not afford this insurance but due to the law We were forced to get coverage. This year We are told it will double. We can’t make more income , I am disabled and My Wife makes less than than enough to keep us going I explained this to the representative and still were told either cancel or pay twice the amount. We paid last year. They say We will make so much in 2015. How do they know this? We are getting less than Last year and We have to pay twice as much this year.

I ask for help and We don’t qualify for exempt status We have been given a week to ten days to make a decision. This is coverage only for My wife one person. It not a fair law, We are told what to take I have lost My doctor and We can’t afford Doctor visits so UI can get. My pain Medication coast 125.00 per visit and coast of meds. We did not miss a payment and now were told don’t pay until we accept the new policy. What can we do? please Help. We don’t want this we are forced to take it. no freedom of choice no rights to pick what We can possibly afford what can We do ?

Kaiser Survey Says, “People like ObamaCare” (ish)

A recent survey from KFF.org shows that people like their non-group insurance under ObamaCare. This includes all ACA-compliant insurance purchased outside the Marketplace and insurance obtained through the Health Insurance Marketplace with or without cost assistance.

Highlights from the Study

The findings are pretty remarkable showing:

  • Republicans are more likely to dislike their insurance then independents or democrats.
  • More people are benefiting from plan costs under the ACA then not.
  • People tend to feel better about higher premium low deductible plans (although as a side-note the math can make the actual value of a high deductible plan better… but of course this is about perception not number crunching.)
  • The only thing people like less than ACA-compliant plans are plans that aren’t ACA compliant, but people with non-compliant plans are actually less apt to complain about cost sharing.

Our Conclusion

What we pull from this data is that although people are happy with premium costs and having coverage under the ACA, no one is thrilled about the high deductibles and lackluster cost sharing… and why would they be? One of the ways insurers are keeping premiums “affordable” is by covering very little before deductibles.

Before the ACA some people had affordable premiums and affordable cost sharing while others were dying in the street because they had hay fever when they were three. Today everyone has access to coverage and premiums are affordable (although about 20% of people are paying a little more). The big change under the ACA is that since insurers can’t cut corners anymore they have responded by covering very little in regards to cost sharing on most plans. The ACA limits maximums, but one can in many cases expect to pay for most care out of pocket under the ACA and it’s hard to say people expected this unless they understood how insurance worked.

The high deductible stuff is good in a way, it makes people shop around for care and makes people care about what they are paying (and that needs to happen)… but it’s bad in a way because most on high deductible plans simply pay into an insurance fund, but only ever benefit from the catastrophic coverage and free preventive services. This may make economic sense in the long term, but it’s hard to really feel good about those high deductibles and high costs and that is what this survey is looking at, feelings.

One thing is for sure though, despite all of this people are pretty darn happy to have access to coverage, well at least not-Republicans are.

Read the Survey

Of course there is a lot more than that, and instead of reprinting the whole piece why not give the Kaiser Family Foundation some love and go check out their findings here.

Dental Coverage for Children Not Covering Costs – Story

A few weeks ago my daughter’s dentist told us the enivitable had come about. Rachel’s wisdom teeth were erupting and beginning to crowd her teeth. They had to come out. They gave us a referral to an oral surgeon and told us to do it sooner than later.

I knew the procedure is not cheap, but I also knew that under the ACA, dental is covered for children. I checked our regular dental coverage and noted that we only get cleanings covered, so I checked my daughter’s healthcare to see what was covered for dental. Carefirst’s website showed that oral surgery is covered under her Healthy Blue plan.

I called to check on the exact coverage. The first guy didn’t know what he was talking about and said there was no dental. I knew that was not true. I called again a few days later and was told exactly what I thought, Rachel would be covered! The plan paid 80% after a $25 deductible. Meanwhile, however, the oral surgeon called and was told no coverage. We were told we would have to pay 2800 out of pocket.

I knew this was not accurate and called carefirst a third time. They had not checked the box for coverage. I guess they forgot the law. Rachel has dental coverage on her healthcare plan until the end of the year when she turns 19. We will NOT be paying 2800 for her wisdom teeth.

ObamaCare Doesn’t Care – Story

This site is full of facts about ObamaCare. Facts based upon the theory of what ObamaCare would bring. I doubt that this will be published, but I am a REAL ObamaCare user. I received a significant benefit in subsidies by using the marketplace. Due to significant health problems and lack of income I pay a fraction of what I used to pay for healthcare. However, I support repeal of the law. Why?

As of April 30th, 2015 an untold number of marketplace users lost their subsidies without notice or explanation. I was one of them. I submitted the required documentation regarding my income. But according to the marketplace management, my documents were declined and then deleted from the website (leaving me no evidence of having submitted them). Without my knowledge, they contacted my healthcare insurance carrier and changed my policy. I now have a $7,000 deductible and out-of-pocket maximum. My premiums are over $800 per month. I’ve talked with numerous managers at the marketplace and received no explanation. I can only conclude that this is how the administration plans to make the law seem financially viable.

I am currently on an injectible medication monthly with a cost of over $2,500 per injection. I told the marketplace management that I could not afford to keep taking these injections without the subsidies. The manager admitted that “many consumers are in the same situation”. I asked her, what if this was chemotherapy? Her response was that she was sorry, but there was nothing else I could do and no one else I could speak with.

I’ve done nothing wrong. And without explanation or notification, my Federal Government has gone behind my back and cost me thousands of dollars in collaboration with my insurance carrier and force me to cancel my medical treatments. Affordable Care Act???? REPEAL OBAMACARE! OBAMA DOESN’T CARE.

May 2015 Studies on Enrollment Under ACA

A 2015 RAND corporation study shows us the most recent report of gross enrollment numbers under the ACA at 22.8 million, while Medicaid sees 12 million.

According to the “Trends in Health Insurance Enrollment, 2013-15” RAND corporation study:

“22.8 million got coverage and 5.9 million lost plans for a net total of 16.9 million newly insured. 9.6 million people enrolled in employer-sponsored health plans, followed by Medicaid (6.5 million), the individual marketplaces (4.1 million), nonmarketplace individual plans (1.2 million) and other insurance sources (1.5 million). To clarify that is 4.1 million newly enrolled in the Marketplace and 7.1 who transitioned to Marketplace coverage for a total of 11.2 million. Likewise about 12 million enrolled under Medicaid according to a recent CMS report, while the RAND study concludes that only 6.5 million are newly enrolled due to the ACA.”

Remember ACA expanded coverage by: requiring large employers to cover people, offering small employers tax credits for providing coverage, expanding Medicaid and CHIP, creating Marketplaces with cost assistance, and letting young people stay on their parents plan. The ACA also improved Medicare, although we are only looking at non-elderly uninsured here.
  • The 16.9 million number mirrors a March 2015 HHS report that showed 16.4 million enrolled. However the HHS report focuses on young adults, Medicaid, and the Marketplace while the RAND study includes all insurance types, but then accounts for those who dropped their plans. Both reports rely on survey data and should be compared and contrasted.
  • Note that while the RAND study shows 4.1 million Marketplace enrollments, this number subtracts 7.1 million who they estimated transitioned to Marketplace plans for a total of 11.2 million. HHS by comparison estimated a total of 11.7 million enrolled in the Marketplace.
  • This study is notable as it is one of the first reports to give an estimate of employer and non-marketplace plans and take into account plan drops.
  • According to the study the largest source of coverage was employer coverage under the employer mandate. Considering about 50% of Americans get their coverage though work, as opposed to only about 15% on individual plans these are interesting findings.
  • The report concludes the number of uninsured Americans fell from 42.7 million to 25.8 million since October 2013.
  • According to the US Census Bureau, before the ACA in 2009 about 48.6 million or 15.7% of the population was uninsured.
  • The current US population is about 320 million. So 1% is 3.2 million. 3.2 divided by 25.8 = about 8% uninsured rate. To contrast a first quarter Gallup-Healthways poll on the other hand puts the rate at about 12%.

The information below are highlights from the 2015 RAND corporation study. See link below to read the full study.

Key Findings

Since the Affordable Care Act’s major provisions took effect, there has been an estimated net increase of 16.9 million people with health insurance.

  • 22.8 million people became newly insured.
  • 5.9 million people lost coverage.
  • The number of uninsured Americans fell from 42.7 million to 25.8 million.

Among those gaining coverage, the largest share (9.6 million) enrolled in employer plans.

  • 6.5 million enrolled in Medicaid.
  • 4.1 million enrolled through the Marketplaces.
  • 1.2 million enrolled in other non-marketplace individual plans.
  • 1.5 million used other sources (Medicare, military insurance, state plans).

An estimated 24.6 million Americans who were already insured moved from one source of insurance to another during the study period.

The Guy From South Carolina Who Didn’t Get ObamaCare

Last week a story went viral about a guy in South Carolina who didn’t get ObamaCare and ended up needing it. Lots of people, mostly Liberals, stepped up to the plate and helped fund a crowd funding campaign for his medical expenses… but not without a little “ObamaCare shaming”.

ObamaCare Shaming: Helping a Republican who decided not to get health insurance under the Affordable Care Act for ideological reasons, but making snarky “I told you so” comments in the process.

Here a Summary of the Story

  • Guy (Luis Lang) doesn’t get ObamaCare (ie get health insurance with assistance due to income) because he is a Republican and doesn’t want help from the Government and wants to do it himself.
  • Guy has diabetes. Diabetes gets bad after a Stroke. He loses his ability to work because he starts to go blind.
  • Guy goes to get medical care and realizes that medical care without insurance is F’n unaffordable.
  • Guy would have got Medicaid, but South Carolina didn’t expand Medicaid. Thus he had no coverage options (although after he goes blind SC will step in at that point via Medicare, not economical but does stop those bottom feeders from mooching on state dollars.) NOTE: Yes, this author is “ObamaCare shaming” South Carolina for not expanding Medicaid.
  • Guy realizes oh… “affordable” “care” act… As in I pay what I can now so I don’t stick the state with giant medical bills later when I really, really, for real have no choice but to get care. Oh, I get it now. Wish they would have just called it that instead of ObamaCare.
  • Author says, ” yeah this is why politicizing the ACA and opting-out for freedom is sort of evil and the denial of Medicaid expansion makes no sense economically”.
  • Anyway, people are funding the campaign… but there is lots of “ObamaCare shaming” going on in the process. It’s tempting to be like “I told you so”. But the truth is, we are all in this together. It’s not cool that “guy” can’t get care when he needs it, it’s unfair that 30-ish million others can’t either. So by all means donate, but keep it classy… and if you are going to shame anyone lets start with the state leaders who are the ones blocking Medicaid expansion. At the end of the day, it is South Carolina’s refusal of Medicaid expansion which has got this guy in a bind.

Here is his story:

“My name is Luis Lang and I live in ft. mill sc and Several months ago I was told that I had suffered several mini strokes over a period of 3-5 days. Because of this a eye condition that I have has come back with a vengeance. I suffer from Diabetic retinopathy. Because of my condition I have not worked since December. I tried to sign up for the affordable healthcare act but I was refused. And since in SC tghey have not expanded the medicaid program I have fallen into the so called dounot hole. I was told about 1 1/2 years ago about my eyes and found a doctor that worked on a sliding scale for paitints like myself without insurance.My visit were $80.00 per treatment. And I had 3 treatment but when I went in for my next appointment the cost went from $80 to $610. I asked why and was told since the healthcare act was now in place that he could not give me the discount that he was giving me. So at that point I stop treatment but that was ok becouse my eyes were much better. But because of the strokes and stress it has come back with a vengeance like I said before. At this point I’m looking at $10,000 – $30,000 in treatment or I will go blind.  At the moment I am down to about 20% in my left eye and about 30% vision in my right eye. So I do need to apologize about my spelling because I can not see very well. I have tried every organization out there but I’m either to young ot to old for there program. I am to old because i am older then 10 and to young because i am not 65 yet I am only 49. As each day goes by my vision get worst. And if I do go blind it will take surgary to get my vision bac if they can.Thank you and god bless. This is why I started this go fund me page so that I can get the treatment that I need.”

You can read the original story from the Charlotteobserver.com here and you can check out his crowd funding campaign here.

Random “ObamaCare Shaming” from the GoFundMe page:

“Here’s another five bucks from a liberal, anti-racist. Please don’t use your repaired sight just to watch Fox News. Try PBS once in awhile.”

“Let’s re-cap shall we? You have diabetes, yet you continue to smoke. You let two open enrollment periods for the ACA go by without signing up for insurance. You were gainfully employed, yet chose to not purchase health insurance for yourself or your family. Now that you have reaped what you have sown, you expect other people to GIVE you to thousands of dollars you need for your medical procedures, preferably while you keep your $300k house. And on top of that, you want to blame Obama for your troubles. How’s that “personal responsibility” thing working out for you?”

“I want to donate enough to really help you out, but I can’t figure out how to get GoFundMe to accept bootstraps.”

“If only there was some type of program that would allow people to pay money into a pool even if they were healthy so that if the time ever came when they would need it, they would not have to worry about losing evetrything they worked for. Maybe they could even have a preexisting condition and not have to worry about it being covered. Oh, and if they couldn’t afford the premium, maybe the state they live in could expand medicaid so it it can help them afford it. A subsidy, if you will. If that was offered by the Federal Government to states it would be CRAZY for the states to deny that to their citizens. Yeah, if only.”

– Sincerely, Bordering on not classy, but admittedly funny, “ObamaCare shaming” people.

Author’s Conclusion

As long as we lack Universal coverage there will always be some American out there who suffers due to their income and/or ideology.

We don’t have a Medicare-for-all solution, but we do have the ACA and that can in theory be close to enough to achieve near universal coverage. If we all get covered under the current system and states expand Medicaid, and SCOTUS doesn’t make subsidies illegal, maybe sometime in the next decade-ish we can get pretty close to eliminating this sort of thing.

HHS Issues Guidance On Birth Control Mandate

HHS issued guidance to clarify the requirement that insurers cover at least one form of each of the 18 FDA approved contraception (birth control) methods. This comes on the back of recent studies that showed that insurers were not covering certain birth control types or charging cost sharing for birth control of a certain category.

The guidance also makes it clear that:

  • Grandfathered plans (plans that started before March 23rd, 2010) are exempt from the rule.
  • Insurers cannot limit preventive services for transgender people based on their sex assigned at birth.
  • Birth control methods include morning-after pills and IUDs despite their being looked down upon by some religious and conservative groups for being “abortifacients,” meaning they cause abortion.

“Today’s guidance seeks to eliminate any ambiguity,” HHS said. “Insurers must cover without cost-sharing at least one form of contraception in each of the methods (currently 18) that the FDA has identified for women in its current Birth Control Guide, including the ring, the patch and intrauterine devices.”

Under the Affordable Care Act non-grandfathered plans must cover specified recommended preventive care services without cost sharing, consistent with PHS Act section 2713.

The 18 types of contraception are:

• Sterilization surgery
• Surgical sterilization implant
• Implantable rod
• Copper intrauterine device
• IUDs with progestin (a hormone)
• Shot/injection
• Oral contraceptives (the pill), with estrogen and progestin
• Oral contraceptives with progestin only
• Oral contraceptives, known as extended or continuous use that delay menstruation
• The patch
• Vaginal contraceptive ring
• Diaphragm
• Sponge
• Cervical cap
• Female condom
• Spermicide
• Emergency contraception (Plan B/morning-after pill)
• Emergency contraception (a different pill called Ella)

Read the clarification from HHS issued on May 11th, 2015 here.

Learn more about the new rules from the Hill.

The Distant Future of June 5th 2015

Far in the distance, a long time from now, on June 5th 2015 the GOP will be expected to have a solution in place for the potential repeal of ACA subsidies.

What is that you say? “June 5th isn’t the distant future, it’s actually less than a month away?… And the GOP have no solid agreed upon plan for what to do?”

Hmm, that sounds like a disaster waiting to happen.

Can’t imagine that is going to go over well with the 7 million plus Americans in states like Florida and Ohio who may have their health insurance taken away, or the millions who may see premiums increase again (this time due to rights being taken away instead of given). At least the Presidential elections are in the distant… Oh, wait those are coming up too.

On June 5th King V Burwell comes to a head as the Supreme Court will rule on whether subsidies are legal in 36 states. If SCOTUS says they are illegal then congress will either have to present a simple fix to the ACA (rewriting one sentence in the 1000 plus page law), pass an alternate plan, or sit back and watch as millions suffer.

Considering the facts, the army of repealers the GOP worked so hard to mobilize, and the timeframe… the outcome of the King V Burwell might be the rewriting of a sentence, but not the one the GOP was hopping for. Something like:

Jeb Bush 45th President of the United States.” “Hillary Clinton 45th President of the United States”

Hillary_Clinton_2016_president_bid_confirmed

State subsidy graphic and more reading at Huffington Post.

 

Repaying Tax Credits After Getting a Job – Story

My story is simple. I was retired at 62, applied for healthcare, received a reduced premium and a waivered amount for coverage due to my income. I decided that social security was not enough income, so I planned to go back to work. I cancelled my coverage when I accepted a job. 30 days later, my healthcare benefits from my job started. There was no overlap in Obamacare coverage and my new coverage. I was shocked when I did my taxes to find out that I was penalized $600.00 for 3 months of coverage for Obamacare – which I NEVER USED! The end result is that 3 months of coverage ended up costing me $1500.00 because I opted to be covered by my job. I feel this was unfair, since I was covered during my period of retirement, but was penalized for getting a job, getting better coverage on my job, AFTER I cancelled my Obamacare coverage!

Is the Medicare Shared Savings Program Working?

The Medicare Shared Savings Program (MSSP) established by the ACA allows healthcare providers to group together under ACOs to get paid for quality over quantity. Initial reports show savings for Medicare and providers under the Accountable Care Organization (ACO) model established under the ACA. Not all the initial “Pioneer ACO” groups faired equally as well, but overall the model has seen success.

Findings of the initial study on MSSP and ACOs: 32 organizations, considered “Pioneer ACOs,” began using the ACO model back in 2012. An independent evaluation report has shown that between 2012 and 2013 the ACO model saved about $300 per Medicare beneficiary for a total of $384 million ($279.7 million in 2012; $104.5 million in 2013).

Here are a few facts to help you understand Medicare Shared Savings and Accountable Care Organizations:

  • Accountable Care Organizations (ACOs) were established under the ACA as a way for doctors, hospitals, and other care providers to group together to deliver organized care to Medicare patients.
  • Providers who group together in an ACO can choose to be paid by the Medicare Shared Savings Program (MSSP) instead of being paid via a traditional fee-for-service (FSS) model. Several different ACO models are being tested, but they work in similar ways rewarding quality over quantity.
  • The MSSP model pays for quality over quantity. It pays out like a fee-for-service model, but by meeting certain benchmarks and keeping costs and re-admittance down ACOs can gain or lose extra payments from Medicare.
  • Today there are over 300 ACOs, but the first 32 are called Pioneer ACOs. They started in 2012. Their success was measured and studied. While not all 32 had success stories, overall the group showed that Medicare saved money while patients benefited and providers saw a profit.
  • This new model of quality over quantity, if embraced by more providers, could help to curb Medicare spending in the long term and decrease the deficit. In 2013 it was projected this model could save up $940 million over the next four years.

See the summary from CMS below or read more about ACOs and MSSP from our page on Accountable Care Organizations.

Read the full April 10, 2015, Report on ACOs from CMS

Feel Like I’ve Been Treated Poorly Due to ACA Insurance? – Story

Have had lump in right breast since 2012. Had real insurance then and a mammogram and ultrasound and was told some cells didn’t look right, come back in 6 months. In 6 mos my Cobra insurance had ended. I was uninsured for the next 2 1/2 years.

Scored Obama Care Ins. In March 2015. Was excited because the insurance co is the the same I had when married. My Neurologist still treats me the same. The drug coverage is a relief.

However, when going back to my old Gynecologist, who is on the list, I had been a patient there from 1994 to 2009. I wasn’t welcomed with open arms on Obama care.

I was asked to bring the records back to my Former Gyno office from the 2012 Abnormal Mammogram at the other facility. I took a day off to retrieve them and drive 35 miles to pick them up. I arrived at my appointment with them. Instead of seeing my Dr they set me up with his PA, who I had never seen before. They were pleasant enough, but things weren’t the same. The PA reviewed the CD and didn’t really examine my breast. She said she didn’t need to, she had seen it on the CD and it needed to be taken care of. Then she proceeded to talk to me about my insurance being Obama Care and that any Oncologist owned by Northside Hospital would treat me and that went for any Dr owned by Northside. I did appreciate that information. I was told they would scan the written info that came with my file and they kept the CDs. I was then sent down to the office that set up surgeries and procedures.

That lady made it sound urgent, but I couldn’t do it the next week because of my daughters appointment so I scheduled for 2 weeks out.

I arrived at the breast center at 12:50. I was supposed to be there at 1:00pm fir a 1:30 procedure. All was going smoothly. I got called back. The lady asked me if I wore deodorant, I told her I did but she didn’t give me a wipe. So I got my own. Others were brought back and were quickly taken back.

Waited…finally they came to get me, they had no record of the CD or any news of it from the Drs office. When the Dr office looked for it they claimed they couldnt find it. So, during this time I was made to sit in that wsiting room again. About 2:20 I decided at 3:00 I was getting dressed and keaving. Soin after that they came and got me. Still no CD.

They did a regular mammogram. Set me back in the same waiting room. I think this tech felt sorry for me , she gave me a warm blanket. Then a little later they cme back and did more mammo in my right breast, which I expected. Waited again. Then they came and got me for Ultrasound. Then the Dr came in to tell me there is nothing there, although, I still have a lump and my breast hurts worse than ever. I can’t help but wonder if I was somehow team railroaded here so as not get the care I need. I don’t know where to turn or who to trust. That was a Gyno that had done 7 surgeries in me and delivered my youngest infertility baby. I am bewildered by this Obama Care.

I had another horrible experience with an Urgent Care clinic in April.

Costs Went Up So We Choose a Health Sharing Ministry – Story

Two years prior to the start of the Affordable Care Act, my health insurance premiums were raised by 40% each year for no reason, 20% each year. I was told by the insurance representative that it had nothing to do with my personal policy but instead that the industry was readying itself for the approaching ACA. My deductible also increased from 1000 to 5000 and finally to 10,000 dollars. My husband, who works part-time and will be 60 this year, is unable to afford insurance. So the first year, he paid the penalty, which was much less than $6000.00 a year. This year, he has signed on with a Christian Co-op feeling he would rather give his money to people like himself who struggle to make ends meet and can’t afford insurance, knowing he is helping others this way than to the government. I feel this is a TAX burden added to the middle class. And it’s taxation without representation. When will we wake up and see this isn’t working. I’m guessing you won’t publish this because it doesn’t support your agenda but one can only hope that those of us whom this law has hurt will be heard.

Bankruptcy Over Unaffordable Coverage – Story

I am 50 years old and have never had health insurance, I always pay out of pocket in FULL for every doctors visit, every ER visit and have always had a reserve of $25,000 dollars saved up through small monthly contributions to draw on in case of emergencies. This is how I figured all American’s should be, responsible. It is NOBODY else’s job to provide you with anything…It took me over 20 years to get this little healthcare only nest egg setup. I have ALWAYS paid my medical bills off, never once have I not.

I make well over the federal poverty level, thus I qualify for NO government help at all. I am a self employed truck driver, running my own small business.

I pay a lot in taxes as it is, including things such as both sides of the social security tax. All the businesses expenses are a lot too, and depending on business needs my income can fluxuate. If the truck needs a lot of work one month it could lower my income for that year a lot while I’m not driving and its in the shop, sometimes it can happen multiple times a year. Add to the mix that its usually thousands of dollars for the work too each time. I’ve had years where I bring home a 100k and years where I bring home far more than that. It isn’t like a steady job where your income stays the same.

It also depends on the loads available at the time. Sometimes loads pay a lot and sometimes you barely break even and sometimes you even lose money on one. If you wait around for a good load you might be waiting for awhile making nothing. Anyone who knows the trucking business knows sometimes you have to move to another location to get a better load and you might not make anything getting there.

I looked into getting health insurance that I don’t really need and the cheapest plan I could get with a high deductible is $900 dollars a month. I signed up for it to avoid paying the increased taxes that the ACA includes.

Problem is now, it is draining my healthcare savings reserve. I’m using it faster than I was contributing to it before. I had hoped it would be cheaper. Even though I make a lot of money I am also heavily in debt from an ex wife, alimony. Divorce is an expensive business, also business expenses still being paid off. Basically lots and lots of loans, so while my income makes people unsympathetic because they think if I made that much I’d have no problems, do keep in mind my debts match my income as it is and I was able to keep a float hoping that in 5 years things would be better as debt got paid off. If you think 100,000+ per year is a lot of money imagine having a debt load quite a bit higher than that.

Lots of people have been in situations where adding even one my bill would break the camels back for a few years while things got paid off, but imagine being in that situation and now you have to add a whole new bill that the government REQUIRES. I could not have gotten a loan for another 900 a month but here I am basically having a forced loan/payment that I never would have been able to qualify for.

Being required to suddenly spend $900 dollars extra a month I do not have doesn’t miraculous make me suddenly have it. I have started the bankruptcy process because I can no longer pay all my debts after adding this new one.

Ironically I’ll likely lose my truck, my business and my income…within a year or two I’ll likely be a zero income person getting free healthcare. I have been self employed my whole life and wouldn’t know how to work for someone anyways. It is why I started my business in the first place. I do admit that I cannot work for anyone else, because soon as a boss says or does something stupid I tell them off. Although that really has nothing to do with the situation just explaining WHY I went off on my own to due my own thing. Now I do believe I’ve spent too many years self employed I’ll never be able to work for anyone again.

What am I to do? Bankrupcy just doesn’t let me file it on one loan/debt to reduce my debt load to offset the ACA. It has to go for all debts, all loans and all assets. I am currently looking at it to restructure things so I can keep going as is in life but I’ll tell you right now this is a direct result of the socialist program we call ACA. If the restructuring fails then I could lose it all. Not having that 900 dollar a month payment would have prevented all of this.

I can’t be the only one this is happening to, a lot of American’s max out their debt based on income. I was fine about 5 years ago, until this whole divorce thing messed me up. My ex took out a lot of loans, add attorney fees and it got me to where I am now. The ACA is the straw that broke this Camel’s back. Of course now my credit will be ruined and it won’t be back to good again until I’m close to 65.

What I don’t understand is how so many American’s can support corporate socialism. Insurance is just a corporate version of socialism when you break it down and look at it. It shouldn’t matter if the government is doing it or a business that benefits from a government requirement.

Definition of Socialism: a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.

Everyone pays into it and everyone benefits, the rich pay more and the poor get a cheaper ride on the backs of the rich. It would actually in my opinion be better to get rid of the ACA and just increase the Medicare/Medicaid tax rate and put everyone on it that doesn’t have it through their work.

The ACA really should be tackling the expenses Doctors and especially hospitals charge to keep those prices down. Maybe it should be changed to require hospitals to show here is the cost of something and here is what we charge with a max profit level set on each item. So a Tylenol cannot be charged 80 dollars a pill anymore if 1 pill costs a buck they can only charge a few bucks for it. At least in my opinion the costs should be regulated like a Utility company and a review board needs to approve all price increases. I believe in the free market but if we are required to buy a product it is no longer the free market. That works great for optional services.

Study Shows ER Visits Up Under ACA

A study shows that ER visits have increased as more people have gotten coverage under the Affordable Care Act. This expected short term outcome isn’t ideal, but speaks to habits of the previously uninsured, the fact that ER visits are covered under the ACA, and an increased doc shortage as demand outpaces supply in the short term.

In the long term the healthcare provider workforce would be expected to grow and as people got used to having insurance more insured Americans would rely on primary doctors, urgent care, and other non-emergency solutions.

According to the American College of Emergency Physicians (ACEP) based on a report commissioned by the Emergency Medicine Action Fund  (EMAF) 47% of healthcare workers polled reported emergency room usage has increased slightly and 28% it increased greatly. Comparatively on 5% said it decreased in any way.
obamacare-Ascension-hospitals-profit

Emergency room visits may be up, but today more people are using insurance to pay for visits rather than simply sticking hospitals with unpaid bills.

Facts on Medicaid, ER Usage, and the New Report

We look at some facts behind the May 4th, 2015 American College of Emergency Physicians report on ER usage and the corresponding new 2015 acep poll affordable care act research results poll on ER usage below.

But first, let’s discuss the ER issue broadly:

  • Before the ACA there was only one way for the uninsured to get healthcare, and that is the ER. This behavior hasn’t changed as more people get Medicaid coverage, despite efforts by HHS and other groups to spread awareness of how to use coverage.
  • Under the ACA both Medicaid and Marketplace coverage cover emergency room visits as part of Ten Essential Benefits. That means all plans cover ER visits.
  • The correct thing to do would be to make an appointment with a doctor in non-emergency situations, use urgent care in immediate but less drastic situations, and to only use the ER in true or perceived emergency situations like chest pain.
  • The ACA incentivizes new doctors and healthcare workers, but adding healthcare providers to the workforce is something that happens over time. With uncertainty about the law and a spike in newly insured, demand is outpacing supply. Doctor wait times, especially for Medicaid and lower-premium Marketplace plans can be weeks or even months currently.

Facts from the American College of Emergency Physicians report on ER:

2,099 polls were completed with a 2.1% margin of error. About 60% worked for an emergency services company. 24% of member physicians polled practice in an emergency department with patient volume between 50,001-75,000, and 32% practice in emergency departments with patient volumes above 75,000.

  • Most of the respondents to the poll report little or no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics and telephone triage lines.
  • About 90 percent of more than 2,000 respondents say the severity of illness or injury among emergency patients has either increased (44%) or remained the same (42%).
  • More than one-quarter (28%) report significant increases in all emergency patients since the requirement to have health insurance took effect.  In addition, more than half (56%) say the number of Medicaid patients is increasing.
  • Since the implementation of the ACA, the majority of member physicians have noticed an increase in the volume of emergency patients. Specifically, 47% of emergency physicians indicate slight increases in the number of patients, while 28% of respondents report significant increases in the number of emergency patients.
  • Over half of emergency physicians indicate that the volume of Medicaid patients increased greatly (24%) or slightly (32%).
  • 70% of member physicians believe their emergency department is not adequately prepared for potentially substantial increases in patient volume.
  • Approximately 4 in 10 respondents report the acuity of emergency patients’ injuries or illnesses has remained the same since January 1, 2014. 44% of current members have noticed significant (14%) or slight (30%) increases in the acuity of emergency patients’ injuries or illnesses in their emergency department.
  • Despite urgent care centers, 43% of member physicians report the volume of patients with less severe illness at their emergency department remains the same.
  • For the majority of current members (49%), retail clinics have not changed the volume of patients with less severe illness at their emergency department. About one-quarter (26%) of respondents are unsure of the impact retail clinics have had on patient volume.
  • 44% of respondents report that they are unsure how the volume of patients with less severe illness has changed. However, 39% of respondents indicate that the volume of patients with less severe illness remains the same.
  • Notwithstanding the availability of more primary care options, the volume of patients with less severe illness remains relatively unchanged for 49% of respondents. 23% of current members are unsure about the impact of more primary care options on the number of patients.
  • In spite of the reductions in reimbursement for emergency care, 66% of member physicians indicate that they have not considered leaving the practice of medicine, although 34% have considered leaving the profession.
  • When asked if efforts are being made in their community or state to reduce the number of emergency patient visits, 41% of respondents report that no efforts are being made. 38% of respondents report that efforts are being made to decrease the number of emergency patient visits.
  • Almost 6 in 10 current members’ communities or states are not actively involved in diverting Medicaid patients from the emergency department.
  • 83% of member physicians have concerns about efforts being made to reduce emergency visits. Most respondents are concerned that patients will delay medical care or go to a less skilled site (44%). Other concerns about current efforts include their minimal impact on decreasing the volume of patients (44%) or lessening health care spending (41%).
  • When asked how elimination of federal subsidies would affect emergency departments, 73% of respondents indicate that emergency visits will increase (42%) or remain the same (31%). Only 12% of current members report either that emergency visits will decrease (10%) or their emergency department will be at risk of closing (2%) if the government eliminated federal subsidies for health insurance.
  • The majority of current members (65%) indicate that reimbursement for emergency care will decrease if the federal government were to eliminate federal subsidies for health insurance coverage in their state.
  • 65% of respondents indicate that they have not stopped accepting payments from a health insurance plan or plans that are taking them out-of-network. Only 5% of current members have stopped accepting payment from a health insurance plan(s) that are taking them out-of-network.
  • 64% of current members say that the time spent organizing patient care following visits to the emergency department has increased since January 1, 2014.
  • 47% of member physicians believe demands for care coordination are increasing due to increased difficulty in finding/arranging timely follow-up with primary care physicians and/or specialists.

ObamaCare Ransom Demands – Subsidy Extension for the Mandates

Obamacare Subsidies

If the Supreme Court rules against ObamaCare’s subsides the GOP has offered to allow subsidies to continue until 2016, in exchange for gutting the mandates. This isn’t the only proposal we have seen from the GOP in this regard, but is instead it is the common theme behind a number of different GOP based ideas.

What are the Mandate?

The mandates are the employer requirement to insure full-time workers (employer shared responsibility) and the individual requirement to get health insurance (individual shared responsibility).

Why This is Silly

Since the mandates and subsidies are the most important parts of the Affordable Care Act in terms of keeping the whole thing together, this is a rather silly offer. If you remove the mandates, there is no money to pay for the subsidies. So you may as well just remove all subsidies in general. But this is just from a logistics POV, not a political one.

The Political Side

What makes it even more silly is that the GOP stands to have a lot of Americans pissed at them going into the 2016 elections due to them spurring on the events that have potentially jeopardized the subsidies of 7.5 million in 36 states (including some blue states, but mostly red states).

Given this Democrats should probably respond with the following counter offer. “No, a better solution for you to save face would probably just be setting up exchanges or fixing the sentence in the law that the whole fuss is over in the first place.”

The sentence: “An exchange established by the State“. Just so we are clear, aside from ideology the actual court battle is about the intentions of these words. 7.5 million lives held in jeopardy over one sentence.

Sen. John Barrasso (R-Wyo.), who is leading the Senate GOP’s response to King v. Burwell, said Republicans will be willing to strike a deal with Obama to ensure that the 7.5 million people who stand to lose their subsidies are protected, at least until the 2016 elections.

But in return, they would demand that Obama to do something he has long resisted: nix the employer and individual mandates for insurance coverage.

Learn more about this story from The Hill.

Learn more about the subsidy lawsuit King V. Burwell

Learn more about subsidies

Learn more about the individual mandate

Learn more about the employer mandate

I Am Happy With ObamaCare, But… – Story

I am very happy about the Obama Care Act. I was able to purchase health insurance through this plan, but my plan has a $5,000 deductible that has to be met before I can use it, so I feel like I am no further than I was before. This insurance plan has yet to send me my policy, and I’ve been paying on it for three months. After three calls I finally got my cards, but that is all. I want to get rid of this insurance company but I can’t until Oct. of this year. I did finally get a sheet from the company that I can use my email to get copies of the policy and coverage and cards. I don’t want a paper card, and I would like a copy of my policy from the company. I am very unhappy with this company, the service is not very good at all.

Last Chance For Coverage is April 30, 2015

Open enrollment ended February 15, 2015 but last minute shoppers have until April 30 to get covered and avoid the fee, if they don’t have a health plan yet.

Here is the deal:

  • To qualify for this “special enrollment period” you have to have owed the fee for not having health coverage this year. It doesn’t matter if you took an exemption using the 8965 form, or if you didn’t file taxes, it just matters that you would have owed it (not having coverage for at least a month last year). Just attest to owing the fee when you go to sign up.
  • You also have to not have coverage yet this year.
  • If the above two don’t apply, then look into other qualifying life events via special enrollment.
  • If you miss this last chance then you won’t have coverage options for the rest of the year, and you’ll owe the new higher 2015 fee.
  • Unfortunately for those who don’t use healthcare.gov, there are a few states that cut off the deadline early. For example Washington state allowed anyone to enroll, but only up until the 17th. All of this being said, if you don’t have coverage you really should just go and check HealthCare.Gov. They are going to point you in the right direction.

In 2015, the Individual Shared Responsibility fee for not having insurance is $325 per adult and $162.50 per child (up to $975 for a family) or 2% of your taxable income – whichever is greater. The monthly fee is 1/12 of the total fee for each month you don’t have coverage or an exemption. See Individual mandate for more details on the fee.

My Doctor Won’t Treat Me Because of ObamaCare – Story

Discrimination, humiliation and denial. Words that I shouldn’t have to use to describe my experience at the doctor’s office while seeking treatment for my arthritic knee. I was openly treated as if I were less than human by a local clinic because I am receiving “Obamacare”.

I have been poor all of my adult life. Through a series of bad luck and hardship I was also blessed with depression- a double whammy for anyone to deal with but something that you may never overcome. I accept my circumstances, my doctor and his clinic do not.

I was openly mocked by my doctor because I wanted him to speak to me as an adult because he tried to treat me like an illiterate 6 year old, he questioned my job history because I told him I knew whet he was explaining to me because I educated myself. Apparently there is a rumor out there that all poor people are stupid. He treated me as if I were dirty- no eye contact and the bare minimum of care not to mention some very important information in my chart was never written in my chart. I have arthritis and the last x-ray that he ordered was from a year and a half ago -the pain in my knee has increased ten-fold since my first visit.He ignored any request for further treatment telling me I should lose weight and I am too young for knee replacement, then he doubled my prescription for an antidepressant-very dangerous to double this pill when I had been off of it for a week because he refused the refill until I had a doctor consultation-I had it refilled many times in the past year with no problem. That alone set off bells in my head.

He then reluctantly referred me to the rheumatologist that gave me an injection in my knee, told me to lose weight, still no x-ray and now I am looking forward to “relief in a month” IF the shot works. Just keep taking 1600 milligrams of Motrin (per day) even though I had told both doctors that I had been taking NSAIDS e.g. Motrin for twenty years almost daily- it doesn’t work anymore.I also told him about my other knee beginning to hurt. The man actually said, “there are people in wheelchairs that just sit there all day and they are okay”- implying that it was okay with him if that happened to me. I was ignored again. The second doctor also talked to me like I had no clue so I left there with no way to get rid of the pain and I had already lost my job due to this issue. They hurried me out of their office and I cried in the parking lot.

When I called to complain to my insurance provider I was told that my clinic was openly trying to get rid of A.C.A. patients and they are desperate to get rid of all of us. I decided to leave the clinic because I need care- my condition is not going to improve and they are not going to ever care because they had already shown me what they are about. What can you do? There are no legal protections for the poor- legally they can reject all of us and there we are with coverage but no one to take it. I will never understand the elitist attitude of anyone that is expected to care for others, nor do I think that doctors should be forced to do anything they do not want to do, but where do we draw the line? I am supposed to suffer for the rest of my life because my primary care provider openly shows disdain for me?

I am afraid that I didn’t have it in me to stay in that clinic- maybe if I had been more vocal with my issues they could have addressed them, but now I feel that by being a whistle blower to their horrific treatment only provokes them to further exacerbate my pain. I no longer have any faith in them and I have switched providers – keeping my fingers crossed that the new doctor is a decent person.

ACA Coverage for Heart Surgery – Story

My 12/4/12 heart surgery was possible because of the ACA which funded high risk pool insurance in my state just prior to the introduction of the ACA. I am very pleased to be healthy now and pleased to have insurance today !!

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