Affordable Care Act (AKA Obamacare)

[planet planet]

http://www.economist.com/blogs/democrac ... thenumbers

The ruckus belies a simple fact. Both Democrats and Republicans agree that Medicare spending must be contained. The budget proposed by congressional Republicans, written by Paul Ryan, would preserve all Obamacare’s cuts to Medicare, including those to Medicare Advantage. Just don’t expect Republicans to mention that on the campaign trail.

[Joe Shlabotnik]

But what's the alternative? Turn to a socialist system where insurance companies, drug companies and doctors don't make a fortune? Sounds downright Unamerican.

Exactly.

[AWvsCBsteeeerike3]

Right there were basically a handful of democrats that the insurance companies bought. I have given their names before, but they were led by Mike Ross, who surprise surprise, is now running for governor. I wonder where he's getting his money?

COntinuing this story, Mike Ross won the democratic primary for governor in Arkansas, almost unopposed, in a state that mainly has democratic governors.

http://www.oregonlive.com/politics/inde ... _mike.html

[AWvsCBsteeeerike3]

Here's an article about what is and isn't working from one guy's perspective. I think it's a pretty good one.

http://www.diabetesmine.com/2014/06/oba ... linic.html

Now that we finally have health insurance reform, my view from the diabetes clinic trenches is that one arm of Obamacare has fallen flat on its face, and the other arm has succeeded beyond anyone’s wildest expectations. The surprise: the part of Obamacare that everyone involved in providing healthcare thought would be great is a disaster, and the part we didn’t think much about is the part that’s working.

Of course, I’m talking about the exchange programs and the expansion of Medicaid.

[Socnorb11]

That's a pretty good read, AW. Thanks for sharing.

But that insurance, although finally available, can be breathtakingly expensive. The cost of premiums on an Exchange, after the various subsidies, ranges from a low of 4% of your income to a high of 9.5%, depending on how much you earn. That’s a percentage of your gross income, not your take-home pay, which for most Americans is about 25% less. The truth on the ground is that to purchase an Exchange plan costs between 6-12% of your take-home pay. Frankly, many people living paycheck-to-paycheck simply can’t afford the extra expense.

4% to 9.5% of gross income doesn't really sound that high to me. I mean, many people probably pay half of that for auto insurance.

[AWvsCBsteeeerike3]

That's a pretty good read, AW. Thanks for sharing.

But that insurance, although finally available, can be breathtakingly expensive. The cost of premiums on an Exchange, after the various subsidies, ranges from a low of 4% of your income to a high of 9.5%, depending on how much you earn. That’s a percentage of your gross income, not your take-home pay, which for most Americans is about 25% less. The truth on the ground is that to purchase an Exchange plan costs between 6-12% of your take-home pay. Frankly, many people living paycheck-to-paycheck simply can’t afford the extra expense.

4% to 9.5% of gross income doesn't really sound that high to me. I mean, many people probably pay half of that for auto insurance.

That was kind of what I was thinking, at first, like, huh if you're paying $2500/year for insurance and making $30K....that's probably okay. But, then I remembered, that insurance is horrible and it's not getting you much. As he goes on to say....

So not only are Exchange plans expensive to own, they are expensive to use. It’s sort of like being forced to buy a gas-sucking SUV that you have to leave in the garage because you can’t afford the gas to drive it anywhere.

Anyway, I found it odd that I fall squarely on the socialist side of this argument now. I fully believe what the guy is saying (the private options are horrible and the medicaid expansion is awesome). As time goes on, I hope we eventually get to a single payer system. It just seems silly to have these forced middle men when we could jsut have the government be the provider, subsidize it a little bit, lower the costs for people on both ends and call it a day. Also, the US is still ranked horribly among other developed nations that have socialized care.....

[Socnorb11]

I'm with you, AW.

I was wondering what they meant exactly when they said the coverage was poor. I wish they had gone into more detail on that (or maybe they did, and I just browsed through it too quickly to notice).

[cardsfantx]

not sure if you guys have bought ins through the ACA, but affordable is not the word i'd use...

the coverage isn't all that bad, but for my family of 4 (who does not qualify for any subsidy), pays 1412.00 per month for a "gold" plan (if you're middle aged with a family, you need to be at least at the gold level) via the ACA marketplace.

[Secret Weapon]

Even if you can afford the insurance, many people can't afford the deductibles. Hospitals are taking a huge hit because of this. Hospital systems that used to make a few hundred million per year profit, that they would invest in replacing old equipment and expanding their systems, now are just hoping to break even in just a couple years. It won't be long before smaller hospitals go under, and even the bigger ones think about merging to get through this.

[AWvsCBsteeeerike3]

Well, this guy is a diabetes educator, or something like that and this site is obviously geared towards diabetics, but the examples he gave were copays that were roughly half of out of pocket costs (plus deductibles, plus premiums), only poor quality gear/medicine being covered, stuff not being covered or being covered in a way that isn't really beneficial. Diabetes has a lot of options available and there are many different ways to treat it, and that's just for Type 1.

For instance, some people are on a straight two shots a day regimen. They're forced to eat at the same time and the same amount, roughly, every day. They use two different types of insulin, combine them, and take a shot in the morning and do the same thing at night. Then, there are people who use different types of insulin and take one in the morning and take the other one every time they eat. Then there are people who use a 'pump' that delivers a continuous (roughly speaking) supply of only one type of insulin. There are many different types of pumps and 'gear' like tubing, catheters, etc. Obviously, some are better than others. Pumps, unsurprisingly, are expensive. Maybe $5k or so.

Then, there are blood glucose meters. These use test strips. The going rate for some of these test strips, which cost a quarter of a penny to produce, can be up to $1/strip. Some are closer to $0.20/strip. You kind of get what you pay for. Apparently a lot of insurance plans will only pay for the cheaper strips. Further, there are continuous glucose monitors (CGM). These, like pumps, have gear that keep the meter constantly in touch with the patient and give a blood glucose reading all the time. Also, like pumps, they are expensive.

So.....sorry for the tangent. All that to say this and more to his point: Sure, you can get 'covered' via a plan on the exchange. But, if you're paying $2500/year in premiums, and the plan is going to force you to pay a $1k deductible, $100 copays, and then half if not more of stuff like pumps/CGMS, well, what good is it? The cost of treatment is more expensive than people can afford. At best, they receive marginal discounts on prescription refills but lose that margin when the premiums are factored in. So, they're better off just paying the penalty (about one months worth of premium) and staying uninsured.

I presume this is all in reference to the lower end plans, fwiw, since they can't afford the more expensive plans.