obamacare missing something

[GlobeSpotter]

Originally Posted by rexdutchman

250 a month payment and a copay of 7500 and yes it was going to be a way to find low cost health care ?

Originally Posted by LexusLover

.. a "copay" of $7,500 ...

That sounds more like an annual deductible. If so here's my point:

"Self-insured":

Premiums $250 a month = $3,000 annually
Annual deductible = $7,500
Total annual cost = $10,7500
.......

So in 2015 for last plan year (2016) as the ACA plans made their first big attempt to keep from collapsing, they kept premiums about the same and some reduced them. (Texas I'm talking about)

But what they then did,...was RAISE the deductible AND the OOP cap. Of course bronze plans were higher and gold lower....but in any case, the trend was for the deductible to equal the cap.

So likely her deductible or "copay" is 7500 AND her cap is 7500. Funny misleading part is that she may have a benefit for something that pays at 80% (her copay 20%). But benefit doesn't kick in until she reaches her deductible...which happens to be her cap.

So for an 80/20 procedure, she either pays ALL of it...or NONE of it depending if she is under or over the deductible/cap.

What that means is that, basically, one has NO COVERAGE until the deductible is met and then basically 100% because the OOP limit was met at the same time.

"coverage" meaning something is actually "covered" under the plan

To me,...IMO this is basically catastrophic insurance. No coverage for little stuff (pay out of pocket 100%)....then bankruptcy protection against the big stuff...obviously only for one year at a time. So it would be better to get cancer or have your heart attack in January instead of December.

Now, for me,....a rich guy....this would be FINE AND DANDY.

IF,....the fucking cost of entry wasn't so expensive. In other words, I'd happily just pay my doc for a visit or even the plan fee for a stress ekg once a year. Then rely on insurance for a heart attack, cancer, or other detrimental financial hit.

The feds could probably work that out for me,....If my premium didn't need to cover the cost of four poor families.

I'll continue on.....

I have my 2016 spreadsheet on another computer. So later I might try to make a postable table of the numbers for 2015/16/17 for all's FYI.

But here is a brief summary of a few of THE FEW plans offered to me this year. Now,...remember,....I'm RICH and in that 2% the dems always attack for money. So the numbers have to be high enough for the feds to provide health care for 4 or 5 families out of what I pay.

Plan Monthly Annual DedFam Prem+DedFam OOP Fam Prem + OOP Fam
Bronze 1 920 11,052 10,000 21,052 14,300 25,352
Silver 1 1,120 13,445 3,000 16,445 14,300 27,745
Bronze 2 1,218 14,620 14,300 28,920 14,300 28,920
Silver 2 1,704 20,450 7,000 27,450 14,300 34,750

Note that IIRC the max OOP of 14,300 for the family total seemed to be across both plan brands. Me thincks that number came from the FEDS.

Scenario 1: everyone in my family NEVER gets healthcare. Min cost for me for the year = 11,052 Bronze / 20,450 BCBS silver

Scenario 2: enough of us in the family get enough healthcare to get us to the family cap, the max cost for me is 25,352 Bronze and 34,750 BCBS Silver

Now for both scenarios, don't forget the expenses that weren't covered...like say eye glasses, contact lenses, dental work including 3k wisdom teeth extraction and so on.

Finally, I haven't run the numbers for last year. But in the years past, if you add up what I paid in premium and subtract the benefit i received from the plan, there was a helluva lot of money left over for the four poor families I'm paying for through the back door.

Also note that the Silver 2 plan from BCBS Tx went up 70% from 2016...with REDUCED coverage.

It is unfucking believable.

[GlobeSpotter]

Originally Posted by instfixer

......
My insurance agent said that Gov Perry killed Medicaid for people between 18 and 65 when the ACA came into being. Waging war upon the backs of poor people I guess
....

Originally Posted by LexusLover

Gov Perry didn't kill anything! Your insurance agent is full of shit!
....

Yeah,...let's clarify what the communist insurance agent meant.

Back in the day, Texas maintained an insurance pool for those that couldn't get it through their employer. I don't remember the requirements to get in but I'm trying to find that for another argument. But, nevertheless, it was there and priced on a per person cost as a function of the person's age and sex....even in a family plan....per person.

The "coverage" wasn't quite that of a first class plan from a large employer,...but it was pretty good. Not all of my doctors were in it but several were. Almost all hospitals were in it IIRC.

The deductible was reasonably low...visits were copay not subject to deductable (IIRC) and OOP reasonable also. The Rx coverage was crap for the good stuff. Generic was low or zero.

So,....Texas had a system in place that worked. No,....it didn't meet ACA in the sense that immunizations were covered, employees of nuns could get birth control, abortions and all the other ACA bullshit. But the system was there and it worked.

Then, ACA came along and set the new standard for what a healthcare plan should look like. Subsequent to that,...states were given a choice. The choice was to maintain a system like that of Texas but was in FULL compliance with ACA and all the other bullshit financial crap from the Feds...or....don't do it at all and let the Feds do it as part of "The Marketplace"

If I understood correctly, the FEDS really wanted the states to have their own systems. I think that is a crock of shit....but that is what was said. To me, it was bait and switch to "appear" like feds didn't want single payer....leave it to the states.

Sooooo,....back to Texas and many or all of the other Red states that had a system already in place. The response from Perry was something like, "Look...we already have a system...don't need ACA. But if you are insisting that the FEDS get involved in healthcare, Y'ALL CAN FUCKIN HAVE IT AND WE'LL STOP OUR SYSTEM."

So,....the now "illegal" Texas system was terminated at the onset of ACA implementation.

So no Dem fed should bitch at Texas or the other Red states for shutting down systems that worked but now illegal. The Dem feds that voted this shit in GOT EXACTLY WHAT THEY ASKED FOR in an attempt to take over one sixth of our economy and suck wealth from my pocket to redistribute it to mostly lazy fuckin libertards all over the nation.

So tell your insurance agent to STFU.

Yeah there was some politics involved....likely our Texas Senators and Reps came back and told Perry...no fucking way....close it.

But, again, it is EXACTLY what Nancy, Hillary, Barry,...and all the rest of the fucks wanted.

ijs

[pyramider]

Why not have a fucked up Obamacare? There is nothing more fucked up than Texas Worker's Compensation.

[royamcr]

In all this talk, I don't remember 1 out of over 60 pieces of legislation that tried to change for the better ACA in the last 4 years. Instead over 60 pieces of legislation and billions spent trying to tear it down.

And why isn't anyone talking about Marco Rubio's legislation that fucked the risk corridor's and made everyone's premiums and deductibles go up. The insurance companies had the task of insuring millions of people that never had insurance before, and had 0 history on. When Risk Corridors were removed the insurance companies had no choice but to raise rates way over what they were to make sure they had enough income to cover everyone.

[flghtr65]

Originally Posted by royamcr

In all this talk, I don't remember 1 out of over 60 pieces of legislation that tried to change for the better ACA in the last 4 years. Instead over 60 pieces of legislation and billions spent trying to tear it down.

And why isn't anyone talking about Marco Rubio's legislation that fucked the risk corridor's and made everyone's premiums and deductibles go up. The insurance companies had the task of insuring millions of people that never had insurance before, and had 0 history on. When Risk Corridors were removed the insurance companies had no choice but to raise rates way over what they were to make sure they had enough income to cover everyone.

+1

You nailed it with the Risk Corridors. Yes, states/counties where health insurance companies had the most claims submitted is where you would see a spike in premium price and deductibles. In addition to raising rates, companies like UHG and Aetna simply stopped selling health insurance on the government exchanges in states with the worst risk pools. Aetna went from offering health insurance on the exchanges in 15 states in 2016 to just 4 in 2017.

http://www.cnbc.com/2016/08/16/aetna...s-in-2017.html

[LexusLover]

Originally Posted by GlobeSpotter

Yeah there was some politics involved....likely our Texas Senators and Reps came back and told Perry...no fucking way....close it.

But, again, it is EXACTLY what Nancy, Hillary, Barry,...and all the rest of the fucks wanted.

ijs

The Texas legislature (not Gov Perry) passed the plan that amounts to "enhanced" Medicaid that in effect satisfies the Fed guidelines, which is basically all that was required to assure that there was insurance coverage for those persons allegedly unable to afford health care coverage .... so Texas opted out of the Government Portal to find coverage. (You didn't need the portal if you lived in Texas ...because Texas already had a "portal" through which one could find coverage .... Insurance Commission website ... where Chips coverage could also be found for children.)

I've had folks tell me they couldn't afford it (the Texas Family Code REQUIRES parents divorcing to provide coverage for their children and they can be held in contempt for not doing so), so once they looked at the Insurance Commission website (even before the ObaminableCare) they were able to find some insurance that fit their needs ... even if it were only major medical coverage with a high deductible along with Chips for the kids).

IMO the people in Texas who whined either didn't want to get coverage (cigarettes and beer were more imporant!) or wouldn't get off their asses to look for it .... and shop.

Like: "it took me 12 years to get coverage for my dependent"!!!

[rexdutchman]

My daughter / granddaughter is on the state waiting list for services after submitting the paper work the list is down to 7 years ( and they call 6 x a year to see if they can be dropped, to shorten the list WTF) They receive services now however ( this is big) if she works or marries ( LT boyfriend) they lose services and part of the ACA forces insurance coverage However 20 Gs a year ACA 11Gs a year for very poor coverage ( on top of student loans) is impossible.
I don't know the answer , ( not gov run dysfunction & the ACA forces ) but something needs to change.

[LexusLover]

Originally Posted by rexdutchman

.... part of the ACA forces insurance coverage ....

Not now.Trump just signed an EO.

[bigwill832]

I'm glad this came up in here. I can't get others to discuss. I had my insurance license and I read and still have a copy of the ACA on my laptop. In my opinion, it was designed to fail as a step towards government provided healthcare. No, I'm not going to call it single payer..because the single payer is the government using taxpayer dollars. I think the markets do need to be opened up to where they can sell across state lines. And yes, there needs to be something about preexisting conditions. But, how do you do all of this and manage costs.

My thinking is this: There should be universal healthcare, BUT only for basic services: check ups, vaccinations, testing, etc. Anything for your basic day to day health. Now, anything beyond that should be individually purchased insurance on an open market. People could purchase insurance based on the risks they take in their day to day life.

[LexusLover]

Originally Posted by bigwill832

...still have a copy of the ACA on my laptop. In my opinion, it was designed to fail as a step towards government provided healthcare.

.. SOCIALIZED MEDICINE ..

It wouldn't be so bad IF ...

100% of the people living in the U.S. could only use it and no be able to use any over coverage ... and that includes the POTUS, members of Congress, SCOTUS, and all government employees nation, state, and local wide..... AND

covered complete dental and vision .. and I mean COMPLETE!

[rexdutchman]

I agree if the government forces healthcare they should be forced to have it also, the government should get out of peoples lives , and let the free market work .

[LexusLover]

Originally Posted by rexdutchman

I agree if the government forces healthcare they should be forced to have it also, the government should get out of peoples lives , and let the free market work .

Liberals don't want a free market to work .... but their biggest problem is they don't have the balls (or the Constitution) to regulate the market to maintain costs and premiums ... and if they pass "National Healthcare" they will not be able to cover the "costs and premiums" with taxpayers' dollars without regulating them!

I'm reminded of what I heard a politician say YEARS AGO regarding a series of incidents involving citizens around in the area, and this is a paraphrase and vague to protect the guilty:

"If this shit continues there won't be a politician in this county who will get a campaign contribution!!!!"

The Liberals have to "regulate" the costs, products, and services of ...

members of the AMA
pharmaceutical companies
hospitals and clinics

They can't and won't even if the constitution allowed them.

[royamcr]

Always remember the ACA is largely republican design going back 3 decades. Now they got it, and call it a failure. Hypocracy at its worst. Health care costs what it costs. Aca doesn't make our government healthcare providers. It just serves a mechanism so everyone pays in something at least. GOP shot so many holes in the plan over last 4 years of course it is failing. Shoot enough holes in a boat and it will sink...

[LexusLover]

Originally Posted by royamcr

Always remember the ACA is largely republican design going back 3 decades. ....

You mean under Romney?

If so, you can hardly call it a "Republican" design for a couple of reasons, at least. Massachusetts implemented the "RomneyCare" legislation and what Romney later proposed was different than the Massachusetts Plan, which had problems!

Also, and probably more importantly, with regard to your characterization, the Massachusetts Legislature was Democratic, and Romney had vetoed several provisions some of which were overridden by the Democrats in the legislature. BTW: Gruber "influenced" the Democrats' decision making. Remember him?

But tossing out artificial labels was a hallmark of Obaminable!

[royamcr]

Nope this stuff goes back to the Nixon years.